R2 Rotations

R2 Rotation: Duration:
Pediatrics 1 ½ months
Night Float 1 ½ months (in 2 blocks)
Family Medicine 3 weeks
Internal Medicine/ ICU 2 months
OB 1 ½ months
Community Medicine 1 ½ months
ER / Vacation/ Away Elective 1 ½ months
OPMS 1 ½ months


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: 3 weeks

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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 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
  • Intrathecal analgesia
  • Ambulatory Gyn evaluations

Duration: 1 ½ months

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Community Medicine

This rotation mixes independent work and scheduled modules to help Residents learn how their career as a physician fits into the general health of the community.  The first module involves multiple health promotion activities in various community and agricultural settings.  Residents get out of the hospital and work with community health leaders doing hands on work in free clinics at the homeless shelter, health presentations in the lettuce fields, and visits to migrant labor camps.  Residents also educate “Promotores” grassroots leaders in health promotion in Monterey County communities.

The second self directed module leads residents through a Community Oriented Primary Care (COPC) process in a public health issue of the resident’s choice.  Here residents conduct patient health surveys, meet with local leaders, explore partnerships, coalitions and develop promotion and control strategies that impact our community health.  Recent projects include Residents collaborating together to develop a woman’s free clinic, diabetes prevention outreach and education, developing a program for building disabled people access ramps in low income apartments.  Frequent one on one meetings with the Community Medicine attendings provide support and guidance.

UCSF-Natividad Family Medicine Residency has won a national grant from Center for Substance Abuse Treatment (CSAT) and has become a model in training Residents in Substance Abuse: Screening, Brief Intervention, and Referral for Treatment (SBIRT).  Residents receive intensive training in recognizing substance abuse and in counseling techniques as well as participation in the recovery process at multiple addiction centers for men, women and teens. 

Duration: 1 ½ months

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Emergency Medicine / Vacation / Away Elective

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: 1 ½ months

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OPMS

This rotation occurs during the R2 year working primarily with internal medicine specialty physicians in the surrounding community. On the first half of the rotation, residents spend a half day per week each the following clinics: Internal Medicine clinic at NMC, a private office for Allergy and Immunology, Nephrology, and Endocrinology. Two half days per week are spent working with the infectious disease experts in the Natividad Immunology Division Outpatient (NIDO) clinic primarily caring for HIV positive patients. During the second half of the rotation, residents spend one half day a week in each of the following specialties: Oncology/Hematology, Allergy & Immunology, Pulmonology, Internal Medicine, Gastroenterology and Rheumatology. The remainder of the time is spent in the residents’ own Family Medicine continuity clinic. Depending on the clinic and the provider the resident may see patients independently or in conjunction with the specialist provider with subsequent review of the differential diagnosis and treatment plan. The providers will also often provide educational articles for the resident to read and appropriate discussions regarding important primary care topics encompassing their specialty. Residents have found these rotations to be very useful and helpful in filling in gaps in their own knowledge base.

Duration: 1 ½ months

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