Rotations are scheduled as blocks. Each block is 28 days. There is a total of three blocks of elective time, which may be used to gain an in-depth knowledge of a particular area of practice, gain more experience with procedures, practice in a remote or rural setting, or pursue clinical research.
The first year of residency contains no electives and provides a broad base upon which to build a future practice in family medicine. In-house call is approximately one night in four for nine of the twelve months.
The second year continues to develop the fund of experience that is required of a practicing family physician. The clinical experience centers less on in-patient care and begins to focus on ambulatory care.
During their third year, residents are given more leeway in scheduling their rotations, with more elective time being available. Each resident acts as chief of the teaching service for six to eight weeks, and throughout the rest of the year is on-call to provide backup for the in-house resident.
Family Practice Teaching Service
The Family Practice Teaching Service provides inpatient care. It is made up of one or two first-year residents, one or two second-year residents and one third-year resident acting as chief. Each morning, the team meets with an attending physician for teaching rounds. Here, the management of each patient is discussed and bedside teaching is emphasized. Selected topics are reviewed several times per week and a member of the radiology staff attends for part of a morning each week to discuss interpretation of x-rays.
The second and first-year residents provide 24-hour in-house coverage of the service, and admit patients from the emergency room, from the clinic or as transfers from outlying hospitals. With the assistance of an attending physician, each resident is responsible for the medical care of the patients he or she admits, including specialist consultation. Residents are on the Family Practice Teaching Service for seven-eight blocks. In-house call for the teaching service is every four nights. Residents rotating through pediatrics and dermatology share the call schedule.
Residents spend two blocks on inpatient pediatrics in their first year. During this time, they are responsible for the inpatient care of pediatric patients, with the assistance of an attending pediatrician. Call is shared with residents on the Family Practice Teaching Service, and is one in four. During the second and third years, residents obtain additional training in outpatient pediatrics and neonatal intensive care.
Education in internal medicine and its subspecialties constitutes a part of each year’s rotation schedule. Required rotations include general internal medicine, cardiology, respiratory medicine, critical care and neurology. Additional elective rotations are available in gastroenterology, endocrinology, allergy and immunology.
Residents spend one block on the surgical residency teaching service. This is a service run by surgical residents and allows the family practice residents to gain competence in the inpatient care of surgical patients. While on the surgical service, residents gain operating room experience, exposure to common surgical procedures and learn to manage the critically ill patients in the surgical critical care unit. Call is one in four.
The obstetrical rotation takes place as two blocks in the first year and as two separate rotations during the second year and one block in their third year. Family practice residents are the only residents on the obstetric ward and therefore participate in the management of all labor and delivery patients. Residents also first assist on all cesarean sections and provide initial evaluation of all obstetrical patients that present to the hospital.
The center of the residents’ activities is at the Altru Family Medicine Residency facility. While working in the clinic, each resident will have faculty available to precept cases and other healthcare professionals are available to provide assistance. During the first year of residency, each resident spends one or two half days in the clinic each week. Initially, residents are scheduled to see patients every thirty minutes. The number of patients seen per half day gradually increases with resident competency.
By the end of the first year, most residents are scheduling patients at 15-30 minute intervals, depending on the complexity of patient problems.
Second-year residents continue to see patients at 15 to 30-minute intervals, with most residents seeing six to eight patients in a half day. The amount of time in clinic increases to three to four half days in a week.
Third-year residents are allotted four to five half-days each week at the clinic. They are encouraged to see eight to twelve patients each half day so that they can become comfortable with the level of productivity that is expected of a practicing family physician. Faculty continues to be available to precept questions throughout the three years at the center. Third-year residents are also encouraged to assist first and second-year medical students that rotate through the clinic.
All residents meet, and usually significantly exceed, minimum patient care encounters specified by the Residency Review Committee for family medicine.
The numerous opportunities include participation with many of the University of North Dakota athletic teams. Residents serve as team physicians for hockey, basketball, football, volleyball, swimming, soccer and track. Most of the program directors, and many of the hospital staff, are interested in teaching sports medicine and the residency program directs the sports medicine service of the University.
Conferences are held at noon each day to provide didactic learning experiences in the broad range of family practice. Lectures are presented by faculty, community physicians and the residents in order to update and enhance the educational experience. One afternoon each month is devoted to resident education, providing an opportunity to devote more time to in-depth study of various topics and procedures. Often this includes workshops covering casting and splinting, colposcopy or methods of musculoskeletal assessment.
Medical Student Rotations
Medical students interested in the Altru Family Medicine Residency Program are encouraged to consider an elective. Medical students assume patient care responsibilities with the Family Medicine Teaching Service as sub-interns as well as participate in office visits at the ambulatory center. Rotations are also available in Obstetrics and Sports Medicine
4th-year students - The student will serve as sub-intern on the inpatient obstetrical service with three family practice residents. This service delivers about 1,100 patients per annum and is popular because of the practical experience.
4th-year students - The student will be under the supervision of the Division of Sports Medicine which includes Family Medicine, Athletic Training, and Physical Therapy faculty. Time will be spent in the Training Room and on team service with football, basketball, or ice hockey. Academic requirements include development of, and presentations to, the athletic training students in the Medical School's Bachelor of Science in Athletic Training degree program.
4th-year students - The Family Medicine Teaching Service offers practice and management autonomy commensurate with the student's abilities and experience. It is staffed by a Chief Resident, who retains ultimate responsibility for all care rendered on the Service, and two or three junior residents.
For further information call 701.780.6810 or contact: A. Marc Nielsen, M.D.
Point-of-care ultrasound (PoCUS) is a diagnostic or procedural guidance ultrasound that is performed by a clinician during a patient encounter to help guide the evaluation and management of the patient. PoCUS is not meant to replace comprehensive ultrasound imaging, which is a consultative test that focuses on traditional ultrasound methods for fully evaluating anatomy and physiology. Rather, it is a complementary diagnostic tool that can help make the clinician more efficient, more independent, and more confident in their medical decision making.
Nationally, there is an increasing penetration of PoCUS into various clinical specialties that have not traditionally used clinician performed ultrasound at the bedside. Family medicine residencies (amongst many other specialties) and medical schools use PoCUS to teach future physicians anatomy and pathology. In fact, the philosophy of medical schools instruction of anatomy is transitioning from traditional dissection of cadavers to understanding anatomy through ultrasound. The popularity of PoCUS has been influenced by a newer generation of tailored ultrasound systems: reduction in cost and relative size improved portability and quality, and ease of use.
Altru FMR requires that all residents achieve a minimum skill set in PoCUS to successfully complete the residency. The ultrasound curriculum is composed of the following: basics of ultrasound, OB ultrasound, musculoskeletal ultrasound, and focused assessment with sonography for trauma (FAST). All residents will be required to complete the basics of ultrasound and OB ultrasound portion of the curriculum. Individual residents may seek further training in the musculoskeletal ultrasound and FAST portions of the ultrasound curriculum if there is perceived use for these skills in their future practice location.
Basic Ultrasound presentation