Residents in our program complete rotations with various organizations, including HSHS St. Elizabeth's Hospital, SIHF Healthcare, Scott Air Force Base, Saint Louis University Hospital, and SSM Health Cardinal Glennon Children's Hospital. Rotations are divided into blocks of equal length for the year and the order of each rotation varies with each resident.
Program Year 1
|Geriatrics||Faculty, Volunteer Faculty, or Saint Louis University|
|Pediatrics-Outpatient||Scott AFB or Volunteer Faculty|
|Sports Medicine 1||Faculty|
Program Year 2
|OB Float (2 weeks) / Research+EBM (2 weeks)||St. Elizabeth's / Faculty or Volunteer Faculty|
|Research+EBM (2 weeks) / OB Float (2 weeks)||Faculty or Volunteer Faculty / St. Elizabeth's|
|Dermatology||Scott AFB, Saint Louis University, or Volunteer Faculty|
|Behavioral Medicine||Faculty or Volunteer Faculty|
|Family Medicine Clinic|
|Orthopedics||Faculty or Volunteer Faculty|
Program Year 3
|ER||Saint Louis University|
|Medicine or Surgical Elective||Volunteer Faculty|
|Pediatrics-Outpatient||Scott AFB or Volunteer Faculty|
|Community and Industrial Medicine||Various Agencies|
|Sports Medicine 2||Faculty|
|Family Medicine Clinic|
The sequence of rotations varies depending on each resident's individual call schedule.
Residents attend clinic one to two half days per week at the O’Fallon Family Health Center regardless of their current rotation. As a first-year resident, you will start with four patients per half day of clinic for the first half of the year and have six patients per half day for the second half of the year.
New interns are given a one-month orientation period at the beginning of the year. During this month, new residents spend time bonding and building core skills that ease the transition from student to doctor. Orientation to the inpatient and obstetrical services will occur during short shifts alongside current second and third-year residents. Interns will complete training in ACLS, ALSO, BLS, NRP, and PALS.
Family Medicine Inpatient Service
Four months are spent on the Family Medicine Inpatient Service at HSHS St. Elizabeth's Hospital. The residents work as a team of four, with two interns and two seniors (one PGY2 and one PGY3) caring for patients admitted to the Family Medicine Inpatient Service.
There are two teams on service at all times; with teams alternating taking call every other day. These months provide experience with a wide range of medical patients from the surrounding community, interaction with a variety of specialists and inpatient management of medical and social concerns. It is also an excellent opportunity for each civilian resident to begin building a panel of patients to follow for the full three years of residency.
An intern's call is broken up between one week of night float and three weeks of day shifts during which the intern takes approximately seven “short call” shifts which are from 7 a.m. to 8:30 p.m. Night shifts start at 6 p.m. and end at 7 a.m. Interns care for patients admitted to the rehabilitation, general medicine, and telemetry medicine floors. Interns typically carry an average of five to seven patients. Interns are assigned four articles to read per inpatient block, and required to complete an end of rotation quiz covering the articles.
Two months are spent working in Labor and Delivery at HSHS St. Elizabeth's Hospital. This is an unopposed setting where residents can participate in the triage, labor management, delivery and postpartum care of obstetrical patients (and their infants!).
Residents assume increasing responsibility for the care of OB patients in all aspects of peripartum care as well as the care of the newborn from bedside to the nursery. Residents average 10 to 20 vaginal deliveries in a month’s time as well as five to 10 C-sections. Two weeks are spent on night float, shifts lasting from 8 p.m. to 7 a.m., and two weeks of day shifts with hours from 7 a.m. to 8 p.m. A senior is also on OB-dedicated in-house call from 5 p.m. to 7 a.m. every weeknight, and around the clock on weekends.
Residents spend one month working in the Nursery at HSHS St. Elizabeth’s Hospital. They work closely with Cardinal Glennon pediatricians and assist in the care of all delivered newborns. During their rotation, residents develop experience in performing circumcisions, utilizing NRP and studying various newborn pathologies as they arise. Residents are responsible for admission of the newborn, inpatient care as well as discharge.
Outpatient Procedure Skills
One month is dedicated to outpatient procedures. The "procedure resident" is in clinic five days a week performing various procedures including colonoscopy, toenail removal, shave, punch, and excisional biopsies, colposcopy, vasectomy, IUD, and subcutaneous implantable progesterone rods.
One month of pediatrics experience is conducted at SSM Health Cardinal Glennon Children's Hospital. Family medicine residents are assigned to a team consisting of a pediatric intern and senior pediatric resident, supervised by a faculty member from SLU's Department of Pediatrics. Residents are responsible for the admission, inpatient care, follow-up planning and discharge of assigned patients. Call varies depending on the team to which the intern is assigned.
One month is spent in the general pediatric clinic at Scott Air Force Base or in the local community, including well child visits, acute illnesses, hospital follow-up or long-term treatment. Residents work one-on-one with pediatric attending physicians, learning about the clinic management of a variety of pediatric issues and routine health maintenance concerns.
Residents spend one month learning physical diagnosis and injection techniques as well as splinting procedures. Residents work with current sports medicine faculty (currently Dr. McLeod and Dr. Sylvester), community sports medicine physicians, and orthopedic physicians. Residents also work with local high school teams during sporting events, as well as at events like local marathons.
Recently overhauled, we aim to provide a holistic view of caring for geriatric patients. One month is spent working with HSHS Home Hospice and SLU Geriatrics department. Residents are responsible for performing initial assessments and managing complex chronic diseases in inpatient, outpatient, and home environments. Additional attention is given to managing polypharmacy and working with interdisciplinary teams with weekly time reserved for each.
Residents spend one month in the emergency departments at HSHS St. Elizabeth's Hospital and Touchette Regional Hospital under direct supervision of the emergency medicine staff. This month provides exposure to emergency medicine and enhances the residents' skills dealing with trauma, life support, procedures and general medicine.
The sequence of rotations will vary with each resident.
PGY-2 residents attend clinic two to three half days per week at the O’Fallon Family Health Center. Starting in the second year, residents take care of nursing home residents at a STL nursing home alongside SLU Geriatricians. PGY-2 residents also take an average of one weekend in-house obstetrics call per month during outpatient rotations
Residents spend two months on the Family Medicine Inpatient Service at HSHS St. Elizabeth's Hospital. The residents work as a team of fours, with two interns and two seniors (one PGY-2 and one PGY-3). As part of a team, PGY-2 residents alternate between two weeks of acting as the senior resident on night float and two weeks managing general medicine and telemetry medicine patients. While on days, PGY-2 residents will take short call every 4 days.
Intensive Care Unit (ICU)
Recently overhauled to provide our PGY-2’s with a hands-on learning experience. On this rotation residents spend one month caring for severely ill patients at HSHS St. Elizabeth's Hospital, working with intensivists learning the basics of ventilator management and other critical care issues. Continuity clinic will be held twice weekly. No call is taken.
Residents serve as the OB night float senior 5 p.m. to 7 a.m. Monday through Friday night for four weeks split between two blocks. The float resident is responsible for the care of laboring and postpartum mothers and newborns at HSHS St. Elizabeth’s Hospital overnight as well as taking the after-hours exchange call for the residency.
Four weeks split between two blocks are spent on scholarly work as determined by the resident and his or her advisor. During these two separate two-week blocks, the PGY-2 resident also serves as the backup senior for the Family Medicine Inpatient Service should they exceed their admission cap. The backup senior assumes a hospitalist type role for care of the patients they admit (progress notes the following day and discharge if needed) unless the inpatient team determines they can carry the patient.
Residents spend one month in the outpatient gynecology clinics at Scott Air Force Base. They learn a variety of diagnostic and therapeutic skills related to gynecology and long acting reversible contraception management: colposcopy, endometrial biopsy, IUD placement, and subcutaneous implantable progesterone rods placement. A portion of this experience includes participation in gynecologic surgery if the resident desires.
Pediatrics Emergency Medicine
One month is spent in the Emergency Department at SSM Health Cardinal Glennon Children's Hospital in St. Louis under direct supervision of the pediatric emergency medicine staff. This month provides exceptional exposure to pediatrics and emergency medicine and enhances the residents' skills in dealing with trauma and minor procedures.
One month is spent working with dermatologists at Scott AFB, SLU Dermatology, or a community group in a clinic setting and becoming familiar with diagnosis and treatment of common dermatologic conditions. You will also get the opportunity to participate in minor dermatologic surgical procedures.
One month is spent with the Prairie Cardiovascular group at their ambulatory care clinic (now just downstairs from us). This month provides an outstanding opportunity for residents to learn the acute and chronic care of the cardiac patient as well as observe cardiac procedures such as catheterization and pacemaker/ICD placement and management.
One month is spent working with a community surgery group working out of HSHS St. Elizabeth’s Hospital and their outpatient clinics. Residents will have the opportunity to first assist on procedures in the hospital as well as office procedures if applicable, depending on the specific surgeon with whom they are rotating. One element frequently highlighted by our residents is working with a breast surgeon to learn the management of our breast cancer patient from the initial mammogram to completion of therapy.
Residents spend one month rotating to various outpatient mental health facilities at the O’Fallon residency clinic, Scott Air Force Base, and Touchette Regional Hospital. This is an excellent opportunity to learn about mental health, including pain management, and the numerous resources available in the community. As part of this four-week rotation, each resident designs a 15-minute presentation on a behavioral health topic of interest to them.
Sports Medicine 2
Residents build on their musculoskeletal knowledge and foundation that has been established during their intern year. They work in our sports medicine clinic as well as a local preceptor’s office. Emphasis is placed on reviewing imaging associated with musculoskeletal pathologies and tying that into pathologies seen in clinic. Residents will have online assessments and readings through their rotation, as well as leading an informal discussion on a sports medicine topic of their choosing.
Four weeks are set aside for residents to complete an elective or research project of their choice. During this elective month, residents continue to see clinics three half days per week in the Family Medicine Clinic.
In order to prepare our second years for the rush of outpatient clinics they will be holding as a third year, we have assigned a clinic month with an emphasis on seeing a higher volume of patients and becoming more efficient with time management during a clinic day.
The sequence of rotations will vary with each resident.
PGY-3 residents have clinic three to four half days per week at the O’Fallon Family Health Center. Continuing into the third year, residents continue to manage nursing home patients. Call is only on the two family medicine inpatient service rotations; there will also be approximately three night shifts they will cover for the inpatient team over the course of the year.
In addition, third-year residents are expected to be available to attend the delivery of their OB continuity patients and follow mother and newborn for their hospital stay. Residents will present a 15-minute lecture discussing a current clinical guideline and a brief chart review of some of their patients.
Family Medicine Inpatient Service (FMIS) Senior
Residents spend two four-week blocks as the senior resident supervising the actions of the second-year resident overseeing the service's ICU patients and the two interns seeing the team's general medical patients. There is increased emphasis on providing education to more junior residents. In addition, seniors will give one or two 10 to 15 minute morning report lectures covering common inpatient topics to the teams before rounds. Short call (7am – 9pm) is taken every 2nd to 4th day.
One month is spent in a general pediatric clinic including well child visits, acute illnesses, hospital follow-up, and long-term treatment. Residents will work one-on-one with pediatric attending physicians.
Residents spend one month working in various sports-related areas. Four times a week is spent in our sports medicine clinic or in a local preceptor's office, one time a week in OMT (osteopathic manipulative treatment), and two times per week in a local orthopedic physician's office.. During the rotation, residents may elect to spend time in a physical therapy office learning the rehab skills necessary after sports injuries. Residents work with local high school teams during sporting events as well as at events like local marathons. Residents will have an end-rotation quiz as well.
Community and Industrial Medicine
One month is spent working with community agencies learning about the types of social services that are available to patients and their families. Residents will focus on their preventive medicine skills. They will also design and implement a community needs assessment that plans a simple intervention to be made to improve the health of their community of choice.
Electives and Medical/Surgical Electives
Residents have one block of medical "selective"- subspecialty rotations including, but not limited to, pulmonology, nephrology, gastroenterology, or cardiology- and two blocks of free electives to be used as the resident desires. Some residents have used the time for additional clinics, others to gain more procedures, still others to do more specialized rotations like wound care, sleep medicine or allergy/immunology.
Residents spend a block learning the components of private practice including billing and coding, quality-improvement projects and contract negotiations. Residents maintain their continuity clinic during this block.
Given that the vast majority of family medicine residency graduates go into primarily outpatient-based practice, third-year residents have a block of primarily outpatient clinics, including their continuity panel, acute appointments and procedures. Emphasis is on seeing a higher volume of patients and becoming more efficient with time management during a clinic day.