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.
As Cascades East residents enter our third year, we have increasing clarity about what full-scope family medicine means to us. Full-scope family medicine is found in community and interdependence. Whether our post-residency life begins as a physician on the frontier - doing c-sections, staffing the emergency room, and doing scopes; in academic medicine - teaching, leading and researching; and/or in a low resource setting practicing rigorous full scope outpatient and/or inpatient medicine - we are able to aim with more precision toward our goal in our third year.
It is no accident that our graduates excel in rural full-spectrum care – it is through the rigorous and effective learning environment. Along with improving the health of our community here in the Klamath Basin – our twin program mission is just this - the graduation of 9 master adaptive learners every single year.
Highlighted below are experiences that are new to third year residents. For full introductory details, please review the Year 1 and 2 pages.
Elective
Our electives have many shapes and sizes, but broadly can be described as here or away; block or longitudinal; and are measured in size by how many half-days it consumes of your resident time. Our elective experiences are selected rather than compulsory. Please see the other pages on the curriculum tab for additional details. There are no core away curricular experiences during the third year. This opens the opportunity for up to 8 away elective weeks during this PGY3 year.
Family Medicine Practice
Third year residents spend one to seven half-days each week in the Cascades East Family Medicine clinic. Each resident provides health care for his or her panel of patients. Patients also are treated for episodic illnesses as in a family physician's office. Third year residents have greater clinical judgment to know when they need assistance; however, faculty supervision is available in the center at all times. Chart auditing and patient safety conferences stimulate residents to review their own performance more closely. Patients in the Family Medicine Center who require admission into the hospital are admitted directly to the inpatient service. Third year residents share after hours and weekend call for Family Medicine Center patients. During the third year, each resident's patient panel is approximately 450 individuals and the resident is responsible for reaching a total of 1650 outpatient encounters at the Cascades East
Inpatient Adult Medicine
Third 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
This rotation is for Maternal Child Health elective residents-only as third years have the ability to tailor their education based on whether they intend to provide maternity care after graduation.
As third-year residents on MCH, we have greater independence and involvement triaging and managing patients at the Family Birthing Center. Residents gain skills in both low and high risk obstetrics and assist on C-sections. Options for primary C-section training exist through our C-section pager program, through which recent residents have primaried more than 65 C-sections. See the dedicated page for additional details.
Pediatric ER
Another innovative rotation, we have residents stationed in our Sky Lakes ER with the goal of evaluating every pediatric patient in the ER and, between such cases, they are free to roam the ER, doing procedures or scanning one and all for practice in the Point of Care Ultrasound field.
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 third 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.