R1 Rotations

R1 Rotation: Duration:
Pediatrics 1 ½ months
Night Float 1 ½ months (in 2 blocks)
Family Medicine 2 months
Internal Medicine/ ICU 2 ½ months
OB 1 ½ months
Ortho/ Sports Medicine 3 weeks
Surgery 1 ½ months
ER 3 weeks


PEDIATRICS

Pediatrics

Pediatrics is an integral component of our training here at Natividad. A total of 3 months are spent during the R1 and R2 years in a variety of settings including the general and specialty pediatric clinic, in-patient pediatric ward, nursery, and Level III NICU. This provides residents with a full spectrum of childhood presentations from the well child to an acute trauma in the ER. Residents are trained in neonatal resuscitation, lumbar puncture, circumcisions and bladder aspiration. Educational sessions are provided during the rotation by ward attendings, as well as by visiting UCSF faculty, including pediatric specialists such as neurologists, endocrinologists, and gastroenterologists. The R3 rotation is exclusively ambulatory, with experience in the general and specialty clinics.

Duration: 1 ½ months

 

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Night Float

During this rotation, residents “run the hospital” from 8 pm to the following morning, Sunday through Thursday nights. The first year resident runs the labor deck, as well as doing medicine, pediatric and surgery admissions. The second year resident runs the ICU and the Neonatal ICU, as well as attending any complicated deliveries. The third year resident supervises the junior residents, including on the labor deck, assists in surgeries and assigns and supervises all admissions. The Family Medicine attending and the OB-Gyn attending stay in-house, other attendings are available by phone, or to come in when needed. At 7:30 AM, during Morning Report, the patients are presented. During this time, the second or third year residents will also do short teaching presentations as well as having discussions with the attending physicians about patient management issues. Night Float is an intense rotation, but is rewarding and helpful in developing decision-making, teaching and organizational skills. Residents on this rotation have between one and three short continuity clinics in the mornings. Despite the hard work, Night Float is considered a better way of doing call, as other calls (transition call) during the weekdays last only from 5 to 8 pm.

Duration: 1 ½ months (in 2 blocks)

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Family Medicine

The Family Medicine Inpatient Service is comprised of an R1, R2,  and FM Attending who work together to care for adult and pediatric, patients from the FM Clinic, the Alisal and Marina Health Department Clinics, and the CSVS network of community/migrant health clinics. In addition to caring for and learning about a broad spectrum of medical conditions, residents develop skill in working with multiple consultants, communicating with patients’ families and primary care physicians, and coordinating discharge needs.

Duration: 2 months

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Internal Medicine / ICU

Our inpatient internal medicine and ICU rotations take place in the R1 and R2 years. Working with a cadre of internal medicine and critical care specialists, residents admit and assume primary medical management for adult patients with a wide array of medical problems. A group of dedicated subspecialists are available for consultation, discussion and teaching. During your rotations in general internal medicine and ICU, you acquire necessary skills in many areas, including lumbar puncture; EKG interpretation; ventilator management; cardiopulmonary resuscitation; intubation; paracentesis and thoracentesis.

Duration: 2 ½ months

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OBSTETRICS

Obstetrics

Our OB-GYN inpatient rotations take place during the R1 and R2 years and an outpatient GYN rotation occurs in the R3 year. On Labor and Delivery, residents assume responsibility for an average of 200 deliveries per month. They also see patients in High Risk OB clinic, where they manage many medically complex pregnancies with perinatology and obstetric back up.

In addition to their time on the OB-Gyn rotations, residents provide prenatal care in their continuity clinic and are expected to attend to the mother and baby on Labor and Delivery and the Maternal-Infant Unit. During the OB- GYN rotations, residents gain experience in:
  • Spontaneous vaginal delivery
  • Vacuum assisted vaginal delivery
  • Caesarean section
  • Postpartum tubal ligation
  • Limited obstetric ultrasound
  • Colposcopy
  • Ambulatory Gyn evaluations

Duration: 1 ½ months

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Ortho / Sports Medicine

The sports medicine experience during residency is partly incorporated into the first year orthopedics rotation. The R1 works one session per week with the athletic trainer at the local junior college - at the training room, by performing pre-participation physical examinations or by attending sporting events. The residents learn rehabilitation techniques, physical examination skills, and acute injury assessment. During the R2 and R3 years, residents perform one group of pre-participation physicals for local athletes each year and attend one sporting event with an approved preceptor each year. Residents may also work at mass participation events with an approved preceptor. Physical examination skills and event coverage are covered at year group meetings during the early portion of the second year.

Duration: 3 weeks

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SURGERY

Surgery

Our Surgery curriculum has two distinct components: an R1 general surgery inpatient rotation, in which residents assist our general surgeons in all areas of pre-op, OR, and post-op patient care;  and R3 outpatient surgery rotations, in which residents spend time with both our general surgeons and local surgical sub-specialists, acquiring skills including excision of “lumps and bumps”, punch biopsies, suturing techniques, vasectomies, circumcisions, and slit lamp eye exams. The emphasis is on developing solid surgical skills that are useful for FMs in the care of their patients.

Duration: 1 ½ months

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Emergency Medicine

Residents learn to evaluate and manage a variety of problems in the Emergency Department for a total of 200 hours which are split between the R1 and R2 years. The knowledge base includes trauma and emergencies such as injuries, poisoning, and life support, as well as the acute care of a spectrum of medical, psychiatric, and surgical conditions. The ED is also an important milieu to learn about the interaction of physicians and patients with law enforcement, public health agencies, and the inpatient services. The emergency medicine attending physicians instruct and supervise the resident in diagnostic and therapeutic procedures. Throughout the residency, residents with a special interest in learning procedures or interventions are invited to participate in cases in the ED.

The ER rotation in the R2 year is 6 weeks, which allows time to complete the required ER hours, and take up to 2 weeks of vacation and/or a planned away elective. Rotations at the emergency departments of other hospitals in the US and abroad can be arranged during the elective rotations.

Duration: 3 weeks

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Natividad Medical Center • 1441 Constitution Blvd. • Salinas, CA 93906 • (831) 755-4111