Critical
Care Medicine - ICU/CCU
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Assessment and
management of the critically ill patient admitted to the intensive care unit
and the acute cardiac patient requiring admission to the coronary care unit
is taught under the supervision of GLFHC faculty as well as the specialists
and other private physicians in the hospital. Respiratory support,
management of fluid and electrolyte imbalance, standards of hemodynamic
monitoring and resuscitation, as well as nutritional support are integrated
into the multidisciplinary approach to the care of the critically ill
patient. Residents will develop procedural skills, such as intubation and
central line placement. Residents receive training in advanced cardiac life
support, the fundamentals of critical care and the direct resuscitation of
patients. Emergency Medicine
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Residents receive
3 weeks of emergency medicine training in each of the first and second
years. The emergency medicine rotation is under the direction of a
Board-Certified emergency medicine physician. Residents are paired with
emergency department staff physicians so they benefit from both one-on-one
teaching and high-volume, hands-on experience. Residents learn to perform
common emergency room procedures such as suturing, splinting and casting,
joint aspiration, intubation and slit-lamp examination.
Geriatrics
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Care of
the elderly patient is taught longitudinally through care of ambulatory,
home-bound, hospitalized and nursing home patients and during a two-week
Geriatrics rotation. Residents develop the knowledge, attitudes and skills
required for the appropriate care of older people. Residents not only learn
to perform geriatric assessments but also to diagnose and treat common
geriatric syndromes and diseases. With the variety of clinical experiences,
residents are exposed to ethical issues, palliative care and health care
financing. Residents learn to function as part of a health care team and to
assess the emotional and mental health as well as the family support systems
of geriatric patients.
Surgery
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Residents spend one
month on surgery in each of the first and second years. Working one-on-one
with general surgeons, family physicians and surgical sub-specialists,
residents learn to be capable first assistants, to perform minor office
surgery and to master pre- and post-operative evaluation. The initial
work-up of patients with common conditions such as hemorrhoids, hernia or
malignancy of the breast or bowel, are taught. Residents on call can follow
the attending surgeon on surgical emergencies presenting through the
emergency room. However, this is predominately an outpatient rotation with
emphasis on outpatient procedural skills, many of which are performed in our
own GLFHC Procedures clinic which is staffed by family physician faculty.
Urology
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Residents work directly with private urologists in their offices and in the
hospital. Residents learn to diagnose, manage, and, when appropriate, refer
a variety of pediatric and adult urologic conditions. In addition,
residents learn to evaluate, initiate therapy and refer patients with
impotence or infertility.
Orthopedics/Sports Medicine
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The
resident learns to evaluate and manage orthopedic conditions commonly
encountered by family physicians. Mastery of the musculoskeletal exam,
pediatric orthopedics, procedures such as splinting, casting and joint
aspiration, and interpretation of X-rays to diagnose fracture or dislocation
are among the skills stressed. In addition, we cover sports medicine,
particularly in regard to training regimens to prevent and recuperate from
injury. Residents have the opportunity to participate at the orthopedic
clinic at the base of the Sugarbush Ski mountain in Vermont (see Sugarbush).
ENT
and Ophthalmology
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On the ENT
rotation, residents learn to perform a complete ENT exam and become familiar
with the diagnosis and management of common problems including epistaxis,
foreign body removal, acute and chronic infections, benign and malignant
neoplasms, and hearing loss. On ophthalmology, residents learn to diagnose
and treat commonly encountered eye conditions and become familiar with the
management of cataracts, glaucoma and retinopathy.
Practice
Management
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The Practice
Management curriculum allows residents significant flexibility to develop
skills applicable to the type of practice that they are choosing to pursue
after residency. Career development/job search, practice improvement
skills, malpractice and risk management, office practice management, and
personal finance are also covered. Residents have longitudinal sessions
scheduled across their three years which are mainly self-directed. The
hours in these sessions are supplemented by some Practice Management group
time early in their internship, as well as bi-monthly conferences they
attend, and the reading/research/project work they do on their own time
Language
Instruction & Annual Trip to the Dominican Republic
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As many of our
patients speak Spanish, an intensive, two-week language course is provided
to residents as part of their initial orientation with ongoing instruction 3
times each month throughout the first year. Because most of the health
center staff are bilingual, interpretive services are always readily
available. While it is neither expected nor required that new residents
speak Spanish, we are confident that they will develop Spanish communication
skills by the end of their first year. In addition, there is an annual trip
to the Dominican Republic which functions as an opportunity to see and
experience the country of origin of half our patient population, as well as
to have a break in the middle of winter in a tropical setting. The
residents use vacation time to attend, and half of the expenses are covered
by the residency, while the balance is paid by the resident (many choose to
use their CME to cover the balance). Specialty
Clinics
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In order to promote better care to our patients and hands-on experience for
the residents, we have incorporated more and more in-house specialty clinics
so that the residents have the opportunity to take care of the patients
while a precepting physician supervises. Presently, we have the following
specialty clinics, which all residents are scheduled to participate in
during their three years: Colposcopy, Procedures, Gynecology, Dermatology,
General Surgery, Pediatric Acute Care, Pediatric Cardiology, Growth and
Nutrition, Rheumatology, Diabetic Foot Care Clinic, wound care, “Mass Cares”
Clinic, and the Disabled Children’s Clinic. Sugarbush
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During the Sports Medicine or Orthopedic rotations, all residents will get
at least one and often two opportunities to go to the medical clinic at the
foot of the Sugarbush Ski Resort in Vermont where they will have a
tremendous opportunity to work with orthopedists in caring for injured
skiers. This experience has proven to be one of our best (ie, most
concentrated) learning experiences…and the skiing in the “down” time is
great, too! |