Welcome back to Klamath Falls! Cascades East Family Medicine Residency continues to embrace the 4 C’s of primary care - first contact, comprehensiveness, coordination and continuity through a modified “Clinic First” model. Whether we are working in the clinic, hospital, emergency room, or L&D - we learn not only how to practice in these contexts, but how to set our patients and ourselves up for health and wellbeing no matter where we head to next. Our dedicated clinic days and 2-week mini-blocks emphasize the interplay between the roles of the family physician in the rural community while offering the necessary balance between depth, breadth and repitition. PGY2s transition to increased independence and autonomy in their practice - see below for more!
Highlighted below are experiences that are new to second year residents. For full introductory details, please review the Year 1 page.
Family Medicine Practice
Second year residents spend one to five half days each week in the Family Medicine Center. Residents at this level provide continuing care to a larger number of families than first year residents and have a greater degree of responsibility. Residents are encouraged to coordinate all of the health needs of their patients with the assistance of our primary care home and under the supervision of family medicine faculty members. During the second year, each resident is assigned approximately 300 patients for continuing care and aim to experience at least 700 outpatient encounters. Second year residents share with third years the after hours and weekend call for Cascades East patients.
Inpatient Adult Medicine
The second year residents can fill one of two roles on the inpatient team - upper level or B-team. As the upper level, we supervise and assist the first year residents on the medicine service in delivering inpatient care. Residents develop their proficiency and efficiency in managing complex patients and become leaders of the inpatient team, running teaching rounds and prioritizing admissions. As previously, our ICU is open, so we care for all levels of care while on this rotation.
Maternal Child Health
See the PGY1 page for details, but as PGY2s we continue to practice full-scope family medicine. Eight weeks of year 2 are spent on our L&D service. By the end of our PGY2 year we have typically met or are approaching the ACGME requirement to become an independent obstetrical provider upon graduation.
Elective
Second year residents have access to 4 weeks of elective time that can be used in block or longitudinal format. The purpose of the elective blocks is to allow a resident to pursue an area of passion in healthcare that augments their education. Electives in the second year must take place in Klamath Falls but can include a wide variety of experiences. Examples of common electives chosen by second year residents include POCUS-intensive, OIT Student Health Center, Tulelake Clinic (a Spanish-English bilingual experience), Tribal Health Clinic.
Geriatrics
The geriatrics rotation occupies four weeks in the second year curriculum. Residents work in a Post-Acute Care/Skilled Nursing Facility in Klamath Falls under the supervision of family medicine faculty. The rotation emphasizes management of geriatric issues in post-acute care, wound care, and principles of ambulatory care of older adults. It includes time with our outpatient palliative team, local hospice, and inpatient palliative service.
Inpatient Swing
Our inpatient swing resident has a unique role on the team. It affords unique learning opportunities while also protecting outpatient learning opportunities for colleagues by serving as back-up inpatient provider. The inpatient swing provider is first call for inpatient jeopardy needs. This is a great opportunity to explore teaching; coordinate complex patient care needs; pursue procedures of interest and practice POCUS skills in ED/wards.
Outpatient Swing
We want to offer residents the opportunity to just be in clinic - without a full schedule of patients. This allows us to pick our heads up, listen and see what everyone else is doing in a different way. Through this rotation, our residents become integrated into the clinic community and flow in a new way. The outpatient swing resident is affectionately known as the Doc of the Day by our clinic as we also serve as the first call for clinic physician needs - whether for triage, procedures or more.
Rural Pediatrics
The rural pediatric rotation recurs during the second year. It provides experience in both inpatient and outpatient pediatrics, including the assessment and management of children with a wide variety of pediatric problems, supervised by community pediatricians. See the discussion in Year 1 for additional details.
Longitudinal Experiences
Broadly, our longitudinal experiences begin during intern year and continue steadily throughout the three years of residency. Effective adult learning requires spaced repetition. We keep this in mind throughout our time in residency.
Away Rotations:
ICU: The critical care rotation is four weeks in length and takes place in either Grants Pass, Bend, or in Klamath Falls, Oregon. The rotation includes procedural training and supplements the learning we already receive while caring for ICU patients on the inpatient medicine team. The emphasis is on cardiology and pulmonary medicine. This is a busy rotation for trauma and critical care, as the Bend hospital performs cardiothoracic surgery and neurosurgery. Residents are supervised by a team of pulmonologist/intensivists. Housing is provided.
Frontier Medicine: This five-week rotation takes place in one of three small communities in Oregon—Enterprise, Lakeview, or John Day. Residents work in a practice with family physicians and experience not just rural, but frontier primary care first hand. The program provides housing and travel expenses. Residents have the opportunity to staff the ER, provide surgical maternity care, and work in the clinic as well. Rural primary care and scope of practice is a continuum and on this highly-rated rotations residents get to ask themselves, “How rural do I want to practice?”