Family Medicine Outpatient
The residents spend their first month in "intern orientation". This month provides our incoming residents with important skills to maximize their success during their internship year. The month is a combination of didactic lectures, certifications including ACLS, and NALS, hands-on procedure training, and outpatient medicine. The month is carefully constructed to cover a wide range of topics including the most common outpatient clinical presentations, preventive medicine, practice management, and inpatient medicine. Residents begin seeing patients, learn about billing and coding, and are introduced to the clinical team that they'll work with for the next three years. This month allows our new interns to become familiar with each other and with their outpatient clinical home, Fort Lincoln Family Medicine Center, providing a strong foundation for the inpatient rotations that follow.
Family Medicine Inpatient
Two months of the PGY-1 year are spent working on the Family Medicine Inpatient Service. This team can include a third year student, an acting intern, one PGY-1, one PGY-2, one PGY-3, and an attending. The team's primary responsibility is to take care of patients admitted to the hospital from the Family Medicine practice. In addition, the team also takes care of patients from Unity Health Care, Carroll Manor Nursing Home, babies from a local mother and infant home, and delivers OB patients seen at the Family Medicine Center. This makes for a busy service with a wide variety of patients. The setting for the rotation is Providence Hospital, a well-equipped community hospital in Northeast, D.C.
The PGY-1 is responsible for collecting data on new and previously admitted patients and presenting to the team. The PGY-1 is also deeply involved in day-to-day management of inpatients, OB patients, newborns, discharge planning, and evaluation of possible admissions in the emergency department. Interns work independently and with the support of the team. This creates the confidence and experience for strong inpatient skills. Procedures learned include lumbar puncture, thoracentesis, paracentesis, vaginal delivery, intrauterine pressure catheter and fetal scalp electrode placement, and circumcision. Morning report occurs daily with the Family Medicine attending and team, a PharmD, and includes reviewing relevant films and studies firsthand. Radiologists are always available for film reading and discussion.
Each resident spends one month on the Cardiac Care Unit (CCU) during the intern year. The CCU team consists of the intern, a senior internal medicine resident, and a cardiology teaching attending. Rounds are made daily with the teaching attending to discuss all the patients on the service and to do didactic teaching. Additional teaching is provided periodically throughout the month by Dr. Pinder, a cardiologist who is regularly recognized by the residents for his commitment to their education. During the CCU month, the residents become confident managing seriously ill patients, reading EKGs, placing central lines, interpreting invasive cardiac monitoring, and running a "Code Blue".
The interns all spend two months on the busy obstetrics service at Providence Hospital. Two half-days per week are spent seeing patients in The Center For Life which is the Obstetrics and Gynecology clinic at Providence Hospital. The majority of these patients are presenting for prenatal care, but the interns also see women for their postpartum exams and gynecologic complaints. The remainder of the week is spent on Labor and Delivery managing laboring patients and complications of pregnancy. The interns work one-on-one with the obstetrics attendings, but are given a significant amount of autonomy based on their experience. The interns also have the opportunity to interact with nurse midwives to learn the midwifery approach to maternity care. By the end of the first year, each resident will have a minimum of 40–50 deliveries and be comfortable with episiotomy, 1st and 2nd degree laceration repair, first-assisting at Cesarean section and circumcision. In addition to the hands-on experience during the OB rotation, all the interns have the opportunity to take the "Advance Life Support in Obstetrics" (ALSO) course.
Longitudinal experience in obstetrics begins following the first month of the obstetric rotation and continues for the remainder of the residency. This involves the management of prenatal patients at the Family Medicine Center as part of each resident's patient panel. The labor and delivery of these patients will occur at Providence Hospital by the patient's primary provider under the supervision of Family Medicine faculty. The Family Medicine residents are also given the opportunity to co-manage the labor and delivery of patients from private Family Medicine physicians in the community including those at Unity Health Care. Second and third year residents, in conjunction with Family Medicine faculty and a family nurse practitioner, manage the prenatal clinic at Community of Hope, a community health clinic in Washington, D.C.
Pediatrics at MedStar Georgetown
During the intern year, residents spend two months on the pediatric wards at MedStar Georgetown University Hospital. Residents are assigned to a pediatric medical team for the month and take team call on average every fourth night. An upper level resident and the pediatric ward attending supervise interns throughout the month. Morning rounds are conducted daily with the team. There are also daily noon lectures and weekly radiology rounds conducted by a highly respected pediatric radiologist routinely recognized for outstanding teaching. Residents enjoy the opportunity to evaluate and treat the broad spectrum of medical illnesses seen in a university setting, ranging from asthma to rare childhood illnesses.
Each intern spends two months working with Washington, D.C. surgeon, Dr. Pedro Ceppa. Dr. Ceppa's diverse, general surgical practice offers the residents a rich environment to hone their surgical skills as well as to learn pre- and post-operative management. The resident scrubs with Dr. Ceppa on all his cases, large and small, from simple excisions to cancer surgery. The resident's responsibilities in the OR progress throughout the rotation as their skills improve. By the end of the first month, the interns are independent with suturing and some small cases. Between and after the surgical cases, Dr. Ceppa rounds on all the inpatients with the resident and provides extensive didactic teaching. Two-half days per week are spent seeing outpatients with Dr. Ceppa: one at his Providence Hospital office and one seeing surgical patients at the Family Medicine Center
Internal Medicine – Wards
Interns work as part of a team caring for inpatients at Providence Hospital. The diverse patients on the service are patients of a Providence Hospital Internal Medicine Attending or patients without a regular doctor. Residents report that they have a lot of autonomy to care for them. Residents round daily with their team of upper year residents and their attending. In addition, there are many venues for structured teaching include morning report, teaching rounds, and daily lunchtime talks.
Residents spend 6 weeks in the intensive care unit at Providence Hospital. Residents manage up to 6 patients under the close supervision of a team of intensivist physicians dedicated to resident education. Residents do many procedures during this rotation including becoming comfortable with line placement and ventilator management. Residents round twice a day with the intensivist physicians and always rate the teaching in this setting as outstanding.
Residents spend two weeks working one-on-one with a neonatologist at Virginia Hospital Center in Northern Virginia. Residents enjoy this experience because they get to focus and polish their skills in caring for newborns. Residents emerge confident in their newborn care skills as well as in their ability to recognize and manage symptoms of sick newborns and to resuscitate neonates. The second half of the month is spent working an additional two weeks in the Adult ICU at Providence.