Four weeks are spent working with local cardiologists in their outpatient clinics. Residents evaluate new patients and follow-up on prior consults. They have opportunities to observe and learn the interpretation of exercise and nuclear stress tests as well as echocardiograms. This serves a valuable opportunity for residents to hone their EKG interpretation skills. Through this rotation, residents gain a better understanding of acute and chronic cardiac conditions. The schedule is Monday-Friday with standard business hours and no call.

Residents in their R1 year spend one month at Providence Sacred Heart Medical Center, a Level 2 Trauma Center that serves a large portion of the Inland Northwest. Residents complete 18 shifts divided between the pediatric and adult ERs, with one day per week of continuity patient care in the clinic. Second-year residents rotate at the nearby Deaconess Hospital. There, residents complete 15 shifts in the adult ER with one day per week in clinic. During these rotations, residents learn how to stabilize the acutely ill patient while gaining hands-on experience in procedures such as suturing, reducing fractures and dislocations, and intubations. The schedule is variable with the resident working several different shifts for varied experiences.

For four weeks during their R1 year, residents work with general surgeons in the community and at Sacred Heart Medical Center. The focus is on inpatient management of postsurgical patients, assisting in the OR, postoperative care, and outpatient surgical management. The schedule is variable but is generally Monday-Friday with standard business hours and no call.

Interns spend four weeks rotating through community clinics, learning about different models of care. Clinics include House of Charity and Street Medicine, Native Project, Unify, the Spokane Regional Health District, and Maternity Clinic — these care for homeless, Native American, English as a second language, addiction recovery, and underserved pregnant patients respectively. Residents choose a community clinic to continue visiting in their second and third years. This rotation also provides focused training in motivational interviewing in collaboration with our psychiatry team. The schedule is Monday-Friday with standard business hours and no call.

Residents rotate in obstetrics in all three years with an increasing level of responsibility. Interns are expected to complete two months of obstetrics. As seniors, they may choose to pursue an OB track, consisting of four months split between the R2 and R3 years. The minimum total OB requirement is four months. In addition to their own continuity patients, residents care for patients of community obstetricians and family physicians. Additionally, residents assist in caring for high risk patients of the OB hospitalists and perinatologists. Our OB fellowship serves to further support the experience. Call is shared either day or night on 12-hour shifts. All residents gain a robust experience in operative and non-operative obstetrics. Each resident is involved with approximately 60 to 80 deliveries per year.

Inpatient Pediatrics training takes place at Sacred Heart Children’s Hospital, which serves as the pediatric referral center for the Inland Northwest. Residents work directly with pediatric hospitalists for 8 weeks during their intern year and 4 weeks during their R2 year. The pediatrics’ team is composed primarily of family medicine residents. Transitional and psychiatry interns may also participate on the team. In addition to daily teaching rounds, didactics are provided during the rotation. Family medicine residents typically have one full day of continuity clinic each week. Each resident on the team will typically provide night coverage for 5-6 nights during each rotation. Outpatient pediatric experience is provided through pediatric clinic visits during the resident’s continuity clinic as well as 8 weeks of dedicated outpatient pediatric experience, 4 weeks each during the intern and R3 year. Time is dedicated to general outpatient pediatrics, with an emphasis on newborn rounding, developmental assessment, adolescent medicine, eating disorders, ADHD and learning disabilities.

To stimulate interest and acquaint residents with the needs of rural communities, R2s complete a rotation at the Rural Training Track site in Colville, Washington. Residents gain experience in rural hospital medicine, emergency medicine, obstetrics, and outpatient clinical medicine in the rural setting.