Family Medicine Residency Spokane Curriculum
Spokane Training Track
Our commitment to our residents is to provide a comprehensive educational experience. We remain committed to this mission and have adapted our curriculum to prepare our graduates for not only the cognitive, but also the procedural demands of the well-trained contemporary family physician.
- Intro to Family Medicine (4 weeks)
- Outpatient Pediatrics and Specialty clinics (4 weeks)
- Emergency Medicine (2 weeks Adult and 2 weeks Pediatric)
- Family Medicine Hospital Service (8 weeks)
- Health Systems Management (4 weeks)
- Inpatient Pediatrics (8 weeks)
- Gynecology + Clinic (4 weeks)
- Obstetrics (8 weeks)
- ICU (4 weeks)
- Surgery (4 weeks)
- Outpatient Cardiology (4 weeks)
- Elective (4 – 8 weeks)
- Family Medicine Outpatient (8 weeks)
- Family Medicine Hospital Services (12 weeks)
- Inpatient Pediatrics (4 weeks)
- Obstetrics (4-8 weeks)
- Orthopedics/Sports Medicines (4 weeks)
- Rural Clerkship (4 weeks)
- VA Procedures/Surgery (4 weeks)
- Outpatient Pediatrics (4 weeks)
- Electives (12-16 weeks)
- Family Medicine Outpatient (8 weeks)
- Family Medicine Hospital Services (8 weeks)
- Obstetrics (4-8 weeks)
- Orthopedics/Sports Medicine (4 weeks)
- Geriatrics (4 weeks)
- Gynecology + Clinic (4 weeks)
Spokane Teaching Health Center
624 E Front Ave
Spokane, WA 99202, USA
For more information:
Email: Diane Borgwardt
Introduction To Family Medicine
(Only for First-Year Residents)
This occurs in the first month of residency for all interns. These first-year residents will spend the first 4 weeks rotating in the clinic, Family Medicine inpatient service, and OB service. The goal is to familiarize each intern with the services our program runs and the EMR system (Epic). The residents will learn the logistics of doing hospital admissions, discharges, and transfers to long-term care facilities. In the OB service, they will learn the flow of the labor and delivery department. In the clinic, they will learn the logistics of outpatient management.
Introduction to Family Medicine, a four-week block rotation in year one, focuses on introducing faculty, staff and clinic logistics; practice management policies and procedures; review of basic clinical policies and procedures; and the opportunity to build a patient base. During year 2 and 3, there are two, four-week block rotations each year focusing on the ambulatory care setting. Residents concentrate on continuity of care and the resident will gain experience in neurology with physicians at the VA; procedures such as vasectomy, colposcopy, LEEP, circumcision and lesion removal; specialty clinics such as geriatrics, nutrition, psychiatry, gynecology, podiatry, orthopedics, pediatrics and adolescent care; and practice management. Home visits and nursing home visits are also scheduled during this rotation.
Four weeks are spent working with local cardiologists in their outpatient clinic. Residents evaluate new consults and follow-up on prior consults. They have opportunities to observe and learn basic interpretation of exercise and nuclear stress tests as well as echocardiograms. This is also a valuable opportunity for our residents to improve on their EKG interpretations. Through this rotation, residents gain a better understanding of acute and chronic cardiac conditions including arrhythmias, valvular disease, hypertension, coronary artery disease and many other conditions. There is no scheduled call in this rotation.
This time may be used to pursue medical/surgical interests, research, experience and gain skill in an outpatient specialty, or experience an additional rural clerkship. Subject to faculty approval, electives have ranged from an international rotation, to a procedural rotation, to a subspecialty rotation. For each elective, the resident spends half-time in continuity clinic at STHC and half at the elective.
The R1 is supervised by board certified emergency physicians at Providence Sacred Heart Medical Center, the Level 2 Trauma Center for the Inland Northwest. The resident completes 18 shifts, divided between Pediatric ER and Adult Acute Care ER areas; one day of continuity patient care in the STHC. Second-year residents rotate at Deaconess Hospital in Spokane. The resident completes 15 ER shifts, one full day at the STHC each week seeing their own continuity patients, and has six days off.
On this block rotation (four weeks as R1 and four weeks as R2), residents work with general surgeons. Emphasis includes inpatient management, OR assisting, postoperative care and time spent in the attending surgeon’s office. There is no call during the R2 year procedure rotation.
Gynecology and women’s health is taught as a combination of rotation time, longitudinal care, and online learning materials. The gynecology rotation occurs in two 2 week blocks, one in the first year and one in the third year of residency, and is spent with local gynecologists and subspecialists. Residents also see gynecology patients in the continuity clinic and rural rotations, and have ample opportunity to learn office Gyn procedures including IUD’s, Nexplanon, endometrial biopsy, colposcopy and LEEP surgery.
Intensive Care Unit
During this four-week rotation, the R1 manages acutely and severely ill patients as part of ICU team. The rounding team is led by staff intensivists and pulmonologists. The team also includes the family medicine R1, an internal medicine or transitional intern, an internal medicine senior resident, and usually a medical and/or pharmacy student. Residents learn to manage vents, vasopressors, and other ICU care. They have opportunities to perform central lines, arterial lines, and other invasive procedures depending on the patients’ ailments. In addition, teaching includes x-ray rounds and the internal medicine noon lectures. Typically interns will carry four or five ICU patients at a time. The intern covers two weekend nights during the month. Although the experience is intense, residents generally consider it one of the best and most concentrated learning experiences.
Family Medicine Hospital Service
Each intern spends eight weeks on our family medicine inpatient service. The R1 is responsible for admitting and caring for acutely ill pediatric and adult patients under the supervision of a senior resident and faculty attending. R1 shifts are from 6:30 AM to 5:30 PM during weekdays plus two weekends of call over each four-week rotation. Evening call is covered by “night float” seniors (R2s and R3s). Interns typically carry 5-7 patients each. R2s spend twelve weeks on service each year and R3s spend eight weeks on service. This service provides a vast exposure to common and uncommon illnesses.
Residents rotate in obstetrics in all three years with an increasing level of responsibility. Interns are required 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.
Supervised by primary care sports medicine physicians and orthopedic physicians, residents will gain experience in evaluation and management of common musculoskeletal conditions, fracture care, pediatric musculoskeletal issues, as well as exposure to physical therapy. Residents will participate in the FMRS Musculoskeletal Clinic as well as training room experience working with athletic trainers at Gonzaga University. Opportunities for pre-participation exams and high school side-line sports medicine exist as well.
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.