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Family Medicine Residency Coordinator

Diane Borgwardt
624 E. Front Ave.
Spokane, WA 99202
P (509) 626-9951
F (509) 626-9920

Family Medicine 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.

First Year

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)

Internal Medicine inpatient
(4 weeks)

Inpatient Pediatrics (8 weeks)

Gynecology + Clinic (4 weeks)

Obstetrics (8 weeks)

ICU (4 weeks)

Surgery (4 weeks)

 

Second Year

Outpatient Cardiology (4 weeks)

Elective (4 - 8 weeks)

Family Medicine Outpatient (8 weeks)

Family Medicine Swing (4 weeks)

Family Medicine Hospital Services (8 weeks)

Inpatient Pediatrics (4 weeks)

Obstetrics (4-8 weeks)

Orthopedics/Sports Medicines
(4 weeks)

Rural Clerkship (4 weeks)

VA Procedures/Surgery (4 weeks)

Third Year

Outpatient Pediatrics (4 weeks)

Electives (20 weeks)

Family Medicine Outpatient
(8 weeks)

Family Medicine Swing (4 weeks)

Family Medicine Hospital Services (6 weeks)

Obstetrics (4-8 weeks)

Orthopedics/Sports Medicine
(4 weeks)

Gynecology + Clinic (4 weeks)

 

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.

Family Medicine

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.

Cardiology

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.

Electives

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.

Emergency Medicine

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.

General Surgery

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. During R1 year call is from home—two nights each week and one weekend per four weeks. There is no call during the R2 year procedure rotation.

Gynecology

This aspect of the curriculum is taught longitudinally in the family practice center, with focused training in a private ambulatory care setting. This includes some surgery and inpatient experience. Residents spend time working with local gynecologists and urogynecologists. Additional experience is gained during the Rural Clerkship, GYN clinic and some electives. The rotational training includes two weeks in the intern year and two weeks in the third year.

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 lead 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 adult patients under the supervision of a senior resident and faculty attending. Any of our pediatric clinic patients admitted to the hospital are also managed by this service. 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 eight weeks on service each year and R3s spend 6 weeks on service. Two weeks are spent supervising and teaching interns during the day and two weeks are night float where we admit “unattended patients” as well as our own. R3s have 4 weeks of day shifts and 2 weeks of night float. This service provides a vast exposure to common and uncommon illnesses.

Internal Medicine Hospital Service

In addition to eight weeks of Family Medicine inpatient hospital service and four weeks of ICU, each intern spends an additional four weeks on the internal medicine residency hospital service. Similar to the family medicine service above, the interns admit and care for acutely ill adult patients. However, these four weeks provide exposure to Internal Medicine attendings and senior residents. It allows residents to learn from their style of care. Each R1 typically carries 5-8 patients. There is no night call, but interns do cover one day of each weekend. During both the family medicine and internal medicine hospital services residents attend noontime internal medicine lectures.

Obstetrics

Residents will rotate in obstetrics in all three years with an increasing level of responsibility. In the first year, interns are required to complete 8 weeks of obstetrics. After the intern year residents may choose to pursue an OB track consisting of four months split between the R2 and R3 year. The minimum OB requirement is four months. In addition to their own patients, residents care for the patients of community obstetricians and family physicians and assist in caring for the high risk patients of the perinatologists and OB hospitalists. Each resident is involved with approximately 60 to 80 deliveries per year. Our OB fellowship serves to further support the experience of our residents. Fellows and senior residents rotate night call, allowing both groups a robust experience in operative and non-operative obstetrics.

Orthopedics/Sports Medicine

Supervised by primary care sports medicine and orthopedic physicians, residents gain experience in fracture care, pediatric musculoskeletal issues, evaluations, sprains, strains, sports medicine and physical therapy. Residents have the opportunity to rotate through the FMRS Musculoskeletal Clinic. Sports Medicine experience is gained at U-District Physical Therapy, working with the athletic trainers and physicians at Gonzaga and Whitworth Universities and Rogers High School, and the team physicians for the Spokane Indians baseball team. Additionally, residents are required to participate in pre-participation physical exams with Whitworth University, Spokane Indians baseball and other local schools. There is no required call for this rotation but residents are asked to attend one sporting event during the rotation to experience side-line medicine.

Pediatrics

Inpatient Pediatrics training takes place at Sacred Heart Children’s Hospital, which serves as the pediatric referral center for the Inland Northwest. The pediatrics’ team is composed of 2-3 Family Medicine Residents, 1-2 Transition Year Residents, and 1-2 medical students. There are two pediatric hospitalist teams that the residents work with. Rounds are teaching and guidance in managing critically ill children. Didactics are provided daily by the pediatric hospitalists and guest speakers. Night shifts are typically 5 days long and are run by a single resident. Once this resident is done with nights they will then move back to the day shift. The Outpatient Pediatric experience utilizes outpatient pediatric offices for acute and scheduled visits. Additional time is spent in a developmental assessment and hospital-based specialty clinics. Call consists of rotating through the coverage of the FMS Hospital Service, which is home call.

Rural Clerkship

To stimulate interest and acquaint residents with the medical needs of rural communities, R2s complete a rotation at the Rural Training Track site in Colville or in rural Goldendale, Washington. Call depends on the individual site, but averages every fourth night. This rotation may be used by R3s to gain further rural experience, and is often used to preview a future practice site. Rural location of this rotation is dependent on faculty approval.