Methodist Curriculum and Call

Rotations

First Year

CARDIOLOGY 1
Setting: One month inpatient rotation at Methodist Hospital with cardiology staff

Learning: Inpatient cardiology consults, EKG reading, echocardiography, stress tests, cardiac MRI, angiography


EMERGENCY MEDICINE

Setting: One month inpatient rotation in the Methodist Hospital emergency department with emergency physicians

Learning: Triage of acutely ill patients, evaluation and management of typical emergency room visits, suturing


FAMILY MEDICINE INPATIENT

Setting: A total of three months of inpatient family medicine at Methodist Hospital

Learning: Admission, management, and discharge of typical hospital patients, daily sit-down rounds, presentation required by the team at a noon conference based on a case seen during the month


HEMOTOLOGY / ONCOLOGY / PALLIATIVE CARE / HOSPICE

Setting: One month mixed inpatient/outpatient rotation at Methodist Hospital and community clinics with hemotology/oncology, palliative care, and hospice care staff

Learning: Inpatient management of complications of oncologic disease, management of pain and suffering, end-of- life care discussions, family conferences, fundamentals of hospice care


NEUROLOGY

Setting: One month mixed inpatient/outpatient rotation at Methodist Hospital and at general and specialty neurology clinics

Learning: Inpatient consults for acute stroke/TIA, intractable headache, neuromuscular disease, EMG clinic, outpatient management of Parkinson’s and other movement disorders, evaluation of seizures


OBSTETRICS 1 

Setting: One month inpatient rotation at Methodist Hospital labor and delivery with ob/gyn staff

Learning: Triage of antenatal patients and management of antenatal complications, active management of labor, delivery, management of labor complications, obstetrical procedures (such as artificially rupturing membranes, placing internal monitors, repairing lacerations), lactation rounds, perinatology clinic learning about management of high risk OB patients, performing OB ultrasound


OBSTETRICS 2

Setting: One month inpatient rotation at Methodist Hospital labor and delivery with ob/gyn staff

Learning: Continuation of developing mastery of the same topics from Obstetrics 1


PEDIATRICS 1

Setting: One month outpatient clinic rotation with pediatricians at Park Nicollet Clinic. Residents also spend time with developmental pediatric specialists at Park Nicollet Child and Family Behavioral Health Clinic.

Learning: Acute and well-child care, effective communication with families, health promotion, care for chronic childhood disease, clinic ADHD management


 

PEDIATRICS 2
Setting: Two weeks of pediatric emergency medicine at Children’s Hospitals and Clinics of Minnesota in Minneapolis, and two weeks of mixed experiences inpatient at Methodist Hospital (Level II nursery care, hospital rounds).

Learning: Pediatric emergency care, management of at risk neonates in the Level II nursery, management of pediatric patients in a non-specialty hospital, and on rounds with the rounding pediatrician at Methodist Hospital, management of children with neurobiological disorders


PEDIATRICS 2

Setting: Two weeks of pediatric emergency medicine at Children’s Hospitals and Clinics of Minnesota in Minneapolis, and two weeks of mixed experiences inpatient at Methodist Hospital (Level II nursery care, hospital rounds).

Learning: Pediatric emergency care, management of at risk neonates in the Level II nursery, management of pediatric patients in a non-specialty hospital, and on rounds with the rounding pediatrician at Methodist Hospital, management of children with neurobiological disorders

Second and third year

CARDIOLOGY 2 (THIRD YEAR)
Setting: One month rotation multiple clinic locations

Learning: Ongoing review of management of cardiac conditions with focus on specialty outpatient conditions such as outpatient management of CHF, management of warfarin dosing, management of dyslipidemia, EKGs, echocardiograms, cardiac imaging


COMMUNITY HEALTH (THIRD YEAR)

Setting: One month rotation, location to be determined by resident's interest

Learning: Residents typically choose one of the following three tracks:

A practice search track in which residents examine a community where they are interested in practicing after residency
An adventure or global track where residents travel to a community of interest somewhere in the world to study determinants of that community’s health
A Creekside track where residents select a local population of interest (e.g. GLBT, adolescents, urban underserved, etc.) and study that community while continuing to see patients at Creekside


CRITICAL CARE (SECOND YEAR)

Setting: One month rotation at Methodist Hospital with critical care staff

Learning: Management of common critical care conditions such as acute respiratory failure and fundamentals of ventilator management, acute renal failure and determining need for dialysis, sepsis and shock, acute GI hemorrhage, diabetic ketoacidosis, and others


ELECTIVE (SECOND/THIRD YEAR)

Setting: Dependent on elective

Learning: Dependent on elective


FAMILY MEDICINE CLINIC (THIRD YEAR)

Setting: One month

Learning: Through the provision of continuity care for patients in a model clinic, residents will gain an understanding of the full spectrum of diseases and conditions that are present in general family medicine, and will understand essential practice management tools which will enable them to graduate from residency ready to practice as effective clinicians.


FAMILY MEDICINE INPATIENT (SECOND YEAR/THIRD YEAR)

Setting: One month (second year) and two months (third year) rotation at Creekside

Learning: Ongoing integrative care in the outpatient clinic setting, developing mastery of the breadth of topics required by a family medicine physician, care of everyone for everything


GYNECOLOGY (SECOND/THIRD YEAR)

Setting: One month outpatient rotation at various clinic sites throughout Park Nicollet with ob/gyn and urogynecology staff

Learning: Common topics include contraceptive management and counseling, management of abnormal Pap smears/HPV tests, common office gyn procedures, urinary incontinence, sexual health topics, management of meno/metrorrhagia, evaluation of abnormal vaginal bleeding, management of cystocele/rectocele


INFECTIOUS DISEASE (SECOND YEAR)

Setting: One month

Learning: Residents will gain an understanding of hospital infectious disease that are frequently present in patients on a family medicine service and may be referred to an infectious disease consultant.


OBSTETRICS 3 (SECOND YEAR)

Setting: One month

Learning: Residents will gain an in-depth understanding of maternity care, labor and delivery, postpartum care, and of the roles of the family physician and obstetrician as partners in the care of pregnant women.


ORTHOPEDICS 1 (SECOND YEAR)

Setting: One month outpatient rotation at the TRIA acute orthopedic injury clinic in with orthopedic staff (includes CAQ sports medicine family physicians)

Learning: Evaluation and management of acute orthopedic injuries, joint injections, casting, splinting


ORTHOPEDICS 2 (THIRD YEAR)

Setting: One month rotation at the orthopedic clinic with orthopedic surgery staff

Learning: Clinic evaluation and management of common orthopedic concerns, casting, splinting


PEDIATRICS 3 (SECOND YEAR)

Setting: One month inpatient rotation at Children’s Hospitals and Clinics of Minnesota with attendings, pediatricians, and medicine and pediatrics senior residents

Learning: Hospital management of acutely ill pediatric patients, RSV bronchiolitis, rotovirus infections, neonatal febrile illness, asthma exacerbations, post-streptococcal glomerulonephritis, seizure disorders, and other common presenting concerns


PEDIATRICS 4 (THIRD YEAR)

Setting: One month outpatient rotation at Park Nicollet Clinic - Shakopee with pediatricians

Learning: Continuing developing mastery of outpatient pediatric care, option for spending time in pediatric subspecialty clinics


PSYCHIATRY (SECOND/THIRD YEAR)

Setting: Two month longitudinal rotation in the G2 or G3 years at Creekside

Learning: Evaluation and management of presenting psychiatric concerns, including depression, anxiety, OCD, panic disorder, schizophrenia, ADHD, personality disorders, and others


PULMONARY (SECOND YEAR)

Setting: One month mixed inpatient/outpatient experience with pulmonary staff

Learning: Hospital management of pulmonary disease, clinic management of chronic pulmonary disease, asthma, COPD, BOOP, IPF


SUBSPECIALTY ROTATION (SECOND/THIRD YEAR)

Setting: Two months for both second and third year at various locations with Park Nicollet subspecialists

Learning: Dependent on rotation, but generally learning details of medicine specialties as they pertain to primary care


SURGERY 2 (SECOND YEAR)

Setting: Ridgeview Medical Center, Waconia, Minnesota, with a surgeon

Learning: Seeing patients in surgery clinic, evaluating patients for surgery, first assisting during surgical cases, doing office-based procedures

Elective opportunities

  • Clinical teaching elective
  • Colposcopy
  • Eating disorders
  • Emergency medicine
  • Endocrinology
  • Gastroenterology
  • Global health
  • Infectious disease
  • Obstetrics
  • Oncology/hematology
  • Palliative care
  • Parental
  • Procedures
  • Physical medicine and rehabilitation
  • Rheumatology
  • Sports medicine
  • Surgery (outpatient)
  • Urgent care

Methodist Longitudinal Experiences

Our longitudinal experiences include the following:

  • Daily noon conferences
  • Continuity of patient care
  • Curriculum includes: 
    • Behavioral medicine
    • Community health
    • Developmental pediatrics and adolescent medicine
    • Geriatrics
    • Practice management

Methodist Behavioral Medicine Curriculum

Behavioral medicine is integrated longitudinally into the resident experience, including:

  • Diagnosing and treating mental illness
  • Honing communication skills and interviewing techniques
  • Developing self-awareness and mutual support among residents and faculty

Faculty

Behavioralist

  • Provides psychotherapy for patients
  • Supervises social work students
  • Coordinates and leads resident video reviews
  • Presents noon conferences
  • Shadows first-year residents in the clinic and hospital
  • Spends time in the preceptor room, helping with psychosocial concerns

Psychiatrist

  • Residents participate in his practice on their psychiatry rotation
  • Presents noon conferences
  • Available to precept psychiatric care in clinic and arranges for "co-visits"
  • Second- and third-year residents have co-visits with the psychiatrist evaluating continuity patients in clinic

 

Communication skills

  • Resident-patient interactions are directly observed by faculty and reflected on through video recording
  • Noon didactic presentations cover interviewing techniques, end-of-life issues, adolescent health, and family life cycles
  • Faculty observe history and physical exams on patients admitted to the hospital
  • Reflection groups provide an opportunity to discuss difficult patients

 

Support and reflection groups

  • First-year residents meet twice monthly with behaviorist and family physicians to discuss stress management and professional formation
  • Residents participate in three reflection meetings per year to address issues of meaning and offer opportunities to discuss difficult patients (facilitated by faculty)
  • Annual retreats provide guidance for the upcoming year
  • Faculty advisors meet quarterly with residents to review academic progress and assess well-being
  • The hospital offers Schwartz Center Rounds, a multidisciplinary forum to discuss social and emotional issues that arise caring for patients

Methodist Community Health Curriculum

  • Independently assess community, environmental, and family influences on the health of patients
  • Be responsive to the larger context and system of health care
  • Call effectively on other resources in the system to provide optimal health care.

Longitudinal curriculum

  • Factors adding richness to the community health experience:
  • Our socioeconomically and culturally diverse clinic population, which includes immigrants and families from around the country and world
  • Third-year residents practice at a free walk-in clinic
  • Two days at the Minnesota Department of Health, learning about epidemiology and health department services
  • Online virtual community-oriented primary care project

Block rotation

Third-year residents participate in a month-long, self-designed community health rotation. Residents define a community, identify the components of community health in that setting and how they are integrated into a family medicine practice. At the conclusion of the month, residents present findings at a noon conference.


Community health course

Each resident attends the Community Health course with other UMN family medicine residents, sponsored by UMN Family Medicine and Community Health. The course focuses on current and historical systems and their sequela that impact the health and wellness of communities. Residents engage in skill building to address these challenges and develop tools for career-long engagement to work with and alongside all the communities we serve. 

Methodist Developmental Pediatrics and Adolescent Medicine

Caring for children and youth is an integral part of our mission, taught both longitudinally and in block rotations.

Screening

  • Standardized to evaluate infants and children for developmental concerns, autism, and mental health issues
  • Teen screens identify psychosocial issues
  • Referral sources available
  • Active participant in Health Partners' Children's Health Initiative

 

Patient care


 

Community

  • Service required and fulfilled in a variety of ways, including providing school-based sports physicals and screening exams; talking to school groups about health topics; staffing athletic training rooms; tutoring children; and working diabetes or asthma camps
  • Committed since 1993 to putting Children First, which encourages the community to work toward increasing the developmental assets of youth
  • St. Louis Park routinely listed in the “100 Best Communities for Young People”, thanks in part to the contributions of residents at Central Clinic

Faculty

Patient care

Clinic

Park Nicollet Clinic – Creekside serves as a medical home to a large population of independent, older adults.

Residents manage the following:

  • Home care
  • Rehabilitation services
  • Specialty referral
  • Interpreting the health care system to maturing patients

Inpatient hospital service

Our inpatient family medicine hospital service usually includes a substantial geriatric population.

  • Counsel patients and families about end-of-life issues and work with the care integration team to plan appropriate patient disposition
  • Receive training as Physicians Orders for Life Sustaining Treatment (POLST) facilitators to help clarify treatment plans and orders
  • Learn a multidisciplinary approach to delirium prevention and treatment, including utilizing the Hospital Elder Life Program to reduce incidence in at-risk patients

Home care, long-term care, and TCU

  • Care for panels of four to six nursing home patients during second and third years, and care for TCU patients
  • Round monthly with attending and nurse practitioner; topics include behavioral challenges, life cycles, and practice management
  • Use innovative Geriatric Tool Kit—the award-winning, resident-designed backpack—to expand services offered in the nursing home
  • Call includes taking telephone calls from nursing homes regarding acute changes in patients
  • Learn how to manage nursing home patients as part of family medicine practice

Assisted living

  • Learn to care for patients in independent senior apartments and an assisted living environment
  • Learn how to help promote health and well-being with patients and their families in a home setting

Home visits

Residents assess the homes of older patients as well as health needs in the context of the living environment.

Chief and Assistant Chief Resident

The Methodist chief resident is a one-year elected, salaried position, occupied by a third-year resident. It includes a variety of academic and administrative responsibilities.

The chief is assisted by an assistant chief. Each third-year resident rotates as assistant chief for a two- or three-month period.

Chief resident duties


Training

The elected chief attends the AAFP Chief Resident Leadership Development Program, a three-day workshop in Kansas City, and a follow-up workshop at the AAFP Assembly. Expenses are paid by the program.

Administrative responsibilities

  • Make call schedule and facilitate coverage in emergencies, illness, or conflicts
  • Attend faculty meetings and retreats when appropriate and serve as spokesperson for residents
  • Coordinate and run the monthly open resident meeting and closed resident meeting when assistant chief is not available
  • Attend monthly nursing meetings or coordinate coverage with assistant chief
  • Assist residency coordinator with recruitment activities
  • Provide input on policy development
  • Orient the newly elected chief in preparation for the coming year
  • Foster team building and cooperation among residents through occasional organized social activities or other events as needed

Other expectations

Maintain full academic responsibilities and remain in good academic standing
Adapt to the changing needs of the residency

Assistant chief duties

The assistant chief works closely with the clinic medical director and manager as well as the residency coordinator and director regarding resident concerns, residency requirements, and practice management issues. The assistant chief works in conjunction with the elected third-year chief resident. The assistant chief role coincides with the third-year psychiatry rotation.

Evaluation

  • Continuous feedback throughout training
  • Quarterly meetings with faculty advisor to review progress and academic/career goals, milestone-based evaluations on rotations, and feedback from clinic staff, patients, peers, and faculty
  • Semi-annual evaluation by clinical competency committee
  • Video review of patient encounters
  • "On the fly" feedback while precepting

Methodist Call

Call

First year

First-year residents gain experience in evaluating and managing a range of acute medical problems.

OB call is 24 hours averaging every 4th night while on rotation.

House call averages every fifth night until 10:00 pm.

Responsibilities:

  • Rapid initial evaluation of hospitalized patients who have an acute status change
  • Leading the code team for both pediatric and adult codes, and providing rapid initial assessment for possible stroke patients

Prerequisites:

  • Certification in Advanced Cardiovascular Life Support (ACLS) and Neonatal Resuscitation Program (NRP) will be required during orientation
  • Ability to manage critically ill patients (with support from second-/third-year resident on-call)

Second and third year

Second- and third-year residents take overnight call three/four times per month. In addition to house coverage for the hospital, they admit patients to the family medicine service while on call.

Room

  • Used exclusively by Methodist residents
  • Includes private bathroom and shower, lockers, a Sleep Number bed, a small library, TV, a small refrigerator, and computer access