Providence St. Vincent Medical Center: Curriculum and Rotation
Balance in Education
The curriculum at Providence St. Vincent Medical Center provides residents with a broad exposure to all aspects of internal medicine, from outpatient, to consultative, to inpatient and intensive care work. Compared to other programs, we place a greater emphasis on ownership of patients in the ambulatory setting. While acting as "quarterback" of the primary care team for their own panel of patients in the ambulatory setting, residents develop leadership and communication skills that serve them well whether they choose to remain in primary care or enter a medical subspecialty.
Ward teams consist of one medical student, one intern and one upper-level resident. Teaching attendings are drawn from the full-time Department of Medicine faculty, Providence St. Vincent Medical Center’s hospitalists, and infectious disease specialists with a special interest in resident education. These attendings hold teaching rounds three times a week. This is time dedicated for case discussion, review of radiology and implementation of evidence-based medicine.
We believe that the educational experience is best when the number of admissions and service size is steady but not excessive. Service size is limited and managed to create an optimal learning environment. The teams are covered by the night float system five nights per week, which allows for much-needed rest and recuperation to maximize learning opportunities.
Interns and residents are on call every fourth day and have two overnight calls per four-week rotation. They average one day off per week. Interns spend five months of the first year on the general medical ward service, developing essential patient care skills.
Upper-level residents spend an average of eight months total over their second and third years leading the inpatient ward teams. As ward team leaders, upper-level residents develop their diagnostic acumen, interpersonal skills and teaching abilities.
The ICU team is comprised of a full-time intensivist along with three interns, one second- or third-year resident and usually a fourth-year medical student. Multidisciplinary rounds are held daily and include the director or the intensivist, house staff, nursing, social services, pastoral services, nutrition services, pharmacy, respiratory therapy and others. Teaching is focused on those patients on the house staff teams; however, all patients in the ICU can, and do, provide excellent learning opportunities. Care is provided in a state-of-the-art facility with multiple electronic teaching resources.
Interns spend three months in the ICU. Interns are on call every third day and have one day off each week. Hours are kept in accordance with ACGME requirements. The absence of fellows in the ICU allows interns to be much more involved with the management of their patients and have more opportunities to perform procedures. The extensive ICU experience helps promote confidence in managing complex, critically ill patients.
Second- and third-year residents spend about one month each year supervising interns in the ICU. The senior resident's primary responsibility is teaching the interns and medical student. There is no overnight call for upper-level residents in the ICU.
The night float team consists of an intern and a second- or third-year resident. This team handles admissions and cross-coverage issues from 8 p.m. to 7 a.m., Sunday through Thursday nights.
Interns spend one to one-and-a-half months on night float. Intern responsibilities include admissions and cross coverage. This rotation helps develop essential communication skills among physician colleagues. It also provides an opportunity to improve efficiency during the admission process.
Second- and third-year residents spend one month a year as the senior medical resident overnight in the hospital on the night float rotation. The resident supervises the night float intern and the on-call ICU intern. It is a demanding role, but one our residents value highly because of the autonomy it fosters.
For the preliminary interns, this one-month rotation combines a multitude of experiences not easily obtained in other areas of the curriculum. These include ambulatory orthopedics, ophthalmology, HIV care, ENT, travel medicine, etc.
For the categorical interns, the one-month rotation is dedicated to geriatrics. Interns participate in global geriatric assessment, neuro-cognitive assessment, in-home visits, hospice and nursing home care.
Second Year
During their second year, residents have a one-month Principles of Quality Improvement (PQI) rotation, which is designed to help them learn about medicine as a system. Residents prepare for their PQI block by identifying an area for quality improvement with a faculty mentor during their first year. During the PQI month, residents plan a strategy, implement that strategy and collect data to document the results of their intervention. Past projects have led to regional poster presentations and others have had the potential for publication.
Third Year
Third-year residents spend six weeks in a variety of ambulatory care settings. The curriculum is flexible so that areas of interest can be addressed including medical orthopedics, HIV care, exercise treadmill testing, nutrition, etc. Residents attend Virginia Garcia Memorial Clinic for migrant farm workers and the underprivileged one-half day per week.
Second- and third-year residents each spend one month in the emergency room at Providence St. Vincent Medical Center. Residents work one-on-one with board-certified emergency medicine physicians, perform procedures and interact with the Providence Stroke Team and Providence Heart Call Teams. They see a broad range of cases, in part because Providence St. Vincent is a referral center for coastal Oregon and southern Washington, with over 73,000 emergency room visits a year.
Second- and third-year residents spend one month each year on the Primary Care/Consultation rotation. Mornings are devoted to office-based primary care in the Department of Medicine Faculty Practice. In the afternoons, residents learn the skills of medical consultation by performing consultations for medical and surgical patients in the hospital. One afternoon a week is spent at the Virginia Garcia Memorial Health Center, a clinic for migrant farm workers and the underprivileged.
Interns have two to three months of electives during which any clinical rotation may be chosen. One rotation may even be done away from Portland if the intern wishes and if the rotation is applicable to the intern’s goals. Assistance and guidance are provided to ensure the most valuable learning experience for the intern.
Second and Third Year
Over the second and third years, approximately nine months are devoted to electives. They are offered in all the medical subspecialties. The rotations in cardiology, pulmonary, hematology/oncology, renal and gastroenterology are strongly encouraged as core electives. Residents have the opportunity to choose among the large part-time and volunteer subspecialty faculty to coordinate their elective experience. Most electives will include an office and hospital-based experience. There is significant flexibility within the curriculum, and residents tailor their experiences to their own needs and interests.
Categorical interns have one-half day of continuity clinic each week in the Department of Medicine Faculty Practice. Each intern is paired with a faculty mentor. This pairing will persist for the entire residency and allows close, mentoring relationships to develop. Each intern will receive a personal panel of patients from a graduating third-year resident to follow throughout their residency, adding patients from the ward experiences as the residency progresses.
Second and Third Year
The Continuity Clinic continues in the second and third year. Residents spend two half-days a week in the clinic establishing a relationship with a second faculty mentor for the duration of the residency. Learn more
Interns have three weeks of vacation, which can occur during any off-ward rotation. In addition, all categorical interns have a week off at the end of the year before starting their second year.
Second and Third Year
Second- and third-year residents have four weeks of vacation, which can be taken during the elective or ambulatory blocks.
Wards
First Year
