Family Medicine Residency Curriculum

Our Family Medicine Resident Inpatient Medicine Service was started in July 2021 in order to provide comprehensive care to the patients of our Family Medicine Practice, and to provide residents with a special opportunity to develop cohesive teamwork and leadership training. Residents are trained to identify the conditions for which patients require hospitalization and provide high level care to those patients while supervised by senior residents and generalist faculty members. Bringing a generalist approach to the care of inpatient adults allows us to support our patients at their most vulnerable time and ensure their goals of care are maintained as they transition to life after hospital discharge. Through the inpatient medicine residency team experience, graduating family medicine residents are capable of recognizing which patients require admission and can provide in-hospital care for those patients if they choose. Alternatively, for outpatient focused graduates, they remain equipped to care for ill patients who can be safely managed in the community, helping to reduce cost of care while staying patient-centered.

Our inpatient medicine residency service team is made up of two interns (who provide the majority of direct patient care) as well as one PGY-2 and one PGY-3 senior who oversee the interns during the day. We also have a senior resident on night float. Faculty attendings are board certified in either Family Medicine, Internal Medicine or Medicine-Pediatrics and are passionate about teaching residents in the inpatient setting. Each intern carries 5-8 patients and is responsible for providing all care with the support of their senior, attending and team. The PGY-3 senior resident organizes patient care and daily education, supports the juniors in their duties and ensures quality care delivery. Admitted patients represent a diversity of medical conditions. Residents work six 12-hour days per week over four months during intern year. PGY-2 and PGY-3 residents complete a total of two months of inpatient medicine days, and 2 two-week night float shifts. All day-time residents attend FMP continuity clinic one afternoon per week, inpatient lecture on Monday, Tuesday and Wednesday at 1:30pm, and Thursday afternoon education didactics weekly. Residents interested in including inpatient medicine in their future practice will also receive support in completing additional elective rotations in the hospital prior to graduation.

Residents spend a total of three months focused on the care of children during their residency at Meritus. They spend two months rotating within a community pediatrics practice providing care for patients in the office setting, along with rounding in the newborn nursery. Residents spend one month providing care for hospitalized pediatric and NICU patients. These experiences occur during PGY-1 and PGY-2 years, with residents also caring for pediatric patients in the residency outpatient clinic throughout all three years of residency. Residents rotate through Meritus OR to care for children and adults suffering from medical emergencies. Opportunities for experiences in pediatric urgent care are also available. Some residents opted to pursue high volume inpatient pediatrics experience during elective time at a regional pediatric hospital.

Meritus Family Medicine residents spend two months in the PGY-1 year, and three months in the PGY-3 year with our dedicated OB-GYNs, Midwives and Family Physician. The first month introduces the resident to office-based prenatal and postpartum care, continuity deliveries and 24-hour L&D calls. The later obstetrics months are focused on the labor and delivery floor where PGY-1s work with midwifes and our faculty FP to manage labor, delivery and the immediate post-partum period. Residents interested in practicing family medicine plus non-operative obstetrics after graduation will need to have participated in at least 80 deliveries prior to graduation and allocate two additional elective months towards that goal. Approximately 2,000 babies are born at Meritus every year.

Residents spend one month in the PGY-1 year with OB-GYN faculty caring for women’s health issues. The resident is responsible for rounding on any (usually 1-3) admitted Gyn patients in the morning, meeting patients scheduled for surgery in pre-op, and attending scheduled surgeries for that day. The focus is on developing a deeper understanding of patient presentations, stories and exams, and a basic understanding of common Gyn procedures. Three days per week, the resident attends afternoons in the OB-GYN office seeing a handful of patients and generating assessments and plans under the supervision of their attending. These days the resident also is available for Gyn consults from the ER in the early evening. Family practice continuity clinic and Thursday didactics make up the remainder of the week. Gyn procedures are also performed longitudinally in the resident’s family medicine practice.

Our Family Medicine residents begin their dedicated time in geriatrics training with a month-long rotation during their intern year, followed by longitudinal geriatrics experience in their PGY2 and PGY3 years. Interns work closely with Dr. Stephen Metzner, the medical director at Homewood Retirement Center, a local nursing home renowned for its high quality of care. During this rotation, interns admit new patients, conduct daily rounds, and participate in the full range of services, including collaboration with physical, occupational, and speech therapists.

This experience also includes discharge planning and monthly interdepartmental Quality Assurance Meetings. Interns gain hands-on experience managing the full spectrum of geriatric care, including multisystem disease, polypharmacy, de-prescribing, palliative care, hospice care, and post-operative care. They also work with a geriatric psychiatrist to diagnose and manage dementia. Additionally, residents perform comprehensive geriatric assessments in their continuity clinics, focusing on screening, preventative care, and advanced care planning. Interns rotate with the hospital’s palliative care team, further developing their skills in advanced care planning and goals of care discussions.

Through the longitudinal geriatrics experience, residents continue to take responsibility for the care of their nursing home patients, managing routine and acute care, conducting family conferences, and navigating end-of-life decision-making. These experiences provide a well-rounded foundation in geriatric and nursing home care, preparing residents to manage the complexities of caring for older adults.​

Residents complete two 4-week rotations encompassing the breadth of musculoskeletal medicine over the course of their residency. Experiences include outpatient and operative orthopedics, sports medicine, physiatry, rheumatology, physical and occupational therapy, podiatry and osteopathic manipulative medicine. The goal of this rotation is to ensure that the resident develops a good understanding and clinical proficiency in the scope of musculoskeletal medicine that will equip them to deliver high quality care for patients, pertinent to the practice of family medicine. Residents are trained to perform common injections, manage simple fractures in the office and get a good understanding of indications for surgery and other procedures. Residents also provide clinical care to adolescents at a local boarding school where many sports medicine complaints are assessed. Faculty and residents continue to develop creative ways to engage with the Washington County athletic community, such as staffing games as the team physician.

Residents complete a general surgery rotation during residency. During this rotation, they have the opportunity to work with Surgeons who provide an excellent introduction into the surgical management of common medical emergencies, and good surgical technique. The resident’s surgical experience involves both office-based care as well as completing hospital rounds, surgical consultations and working with their attending in the operating room. Residents manage patients in the pre-operative, intraoperative and post-operative periods. Longitudinal outpatient procedural experience is provided through the resident’s Family Medicine Practice, as precepted by family medicine faculty. Additional dermatology opportunities through the FMP rotations serve to expand the resident’s tool kit in each PGY year.

During the PGY-2 year, residents complete a 4-week Critical Care experience at Meritus Medical Center. Working with dedicated attendings, the resident is an integral member of the care team and also has space and time to focus on development of skills and knowledge to ascertain signs, symptoms, and laboratory abnormalities of the critically ill, to maximize high quality care. Days begin at 6:45am with pre-rounding and multidisciplinary rounds and continue throughout the day with coverage of assigned patients. There is ongoing teaching during the rounds and shifts. Residents have the opportunity to join their attending during codes, and evaluate potential CCU patients, which they will then follow. Procedures are an integral part of this rotation.

Residents complete a blended psychiatry and neurology rotation in the PGY-2 year. The rotation is designed to prepare the resident to assess and manage common psychiatric conditions in primary care, and to work effectively with mental health providers to provide collaborative care to patients. During this rotation, time is split between neurology clinic and providing psychiatric care in both the inpatient and outpatient settings. Residents serve as integral members of our inpatient psychiatry and addictions consultation team, operating under the supervision of an attending psychiatrist. Residents attend Thursday afternoon didactics and FMP continuity clinic time weekly. 

Senior residents spend a total of four weeks learning about the basic science behind the three macronutrients, vitamins and minerals, their interaction with the neuroendocrine and immune systems, and food’s impact on health and chronic disease. Registered dieticians, family physicians and a dedicated endocrinologist serve as attendings. Three half days per week are spent in family medicine continuity practice in addition to Thursday didactics. Flexible time allows for reading at home, meal preparation and community engagement. Residents emerge with a core understanding of nutrition and its contribution to diabetes and other chronic diseases, and the ability to properly counsel patients towards achieving their goals and returning to health.

Residents are encouraged to identify individual interests early in the course of their residency and invited to craft their elective experience. A total of six electives are scheduled; one of these can be designed as an away elective free of any clinic or call obligations. Examples include: Substance Abuse and MAT, Gastroenterology, Endocrinology, Pain Management, Pulmonology, Infectious Disease, Hospitalist Medicine, Rheumatology, Nephrology, Urgent Care, Inpatient Pediatrics, Public Health, Ultrasound/POCUS, Integrative Medicine + OMM, Obstetrics and Women’s Health, Rural Medicine, International Medicine, Palliative Care, etc.