Our Curriculum

Family Practice Service

Residents spend two rotations during their intern year and three rotations in their second and third year covering the inpatient service. The service admits all patients from Hendersonville Family Health Center, Blue Ridge Community Health Center, the Health Department and three local rural practices: Etowah, Bat Cave and Flat Rock. Unassigned patients are admitted if the census is low. While on the service, residents provide care for newborns and ICU patients, as well as gain experience in pediatrics, adult medicine and obstetrics. Residents manage their own patients in the ICU with the assistance of critical-care physicians. The service is usually managed by two residents and two attending physicians, one for medicine and one for obstetrics. The patient’s primary care provider is notified and assists in making decisions if needed. Medical students perform two-week rotations on the service. Three iPads are available for residents to use while in the hospital. Weekly discussions are held by faculty, as well as scheduled conferences that cover hospital, obstetric and cancer cases.

Internal Medicine
During intern year, residents work four weeks of inpatient medicine with a hospitalist group at Mission Hospital in Asheville, as well as eight weeks on the inpatient family practice service in Hendersonville. During second and third year, residents work 12 weeks of inpatient medicine, described above, as well as core rotations in cardiology and critical care. All residents complete the ACLS course.  Residents also see patients in a local nursing home and make home visits.

Ob/Gyn

During first year, interns spend four weeks of training on the Labor and Delivery floor at the Women’s Hospital in Greensboro, NC, a 134-bed facility at which approximately 6,000 babies are delivered a year. Another four weeks are spent focusing on outpatient antenatal care and Labor and Delivery in Hendersonville, where 300 babies are born a year. During the second and third years, residents work four weeks of gynecology at the Health Department and a local OB/GYN clinic.

Residents acquire extensive experience managing labor and delivery as the inpatient service covers obstetrics. There is approximately one birth per call during the three years. Deliveries are performed alongside midwives, family physicians, and obstetricians. Residents participate in vaginal deliveries, vacuums, forceps and C-sections. Continuity prenatal care is provided at both clinics and at the Health Department beginning the second half of intern year. In addition to caring for their own patients, resident hold a combined OB/Continuity Clinic once a week at which patients have a chance to meet more than one resident. Half of all deliveries will be to Spanish-speaking patients.

Additional opportunities exist to rotate through the high-risk clinic and to learn how to perform ultrasounds. All residents complete the ALSO course.

Pediatrics
During the first year, residents spend three months in inpatient pediatrics at Mission Hospital in Asheville and are taught by pediatric hospitalists, intensivists and sub-specialists. They admit pediatric patients from all over Western North Carolina and are the only inpatient pediatricians to admit, which allows for a wide range of cases. Residents become comfortable caring for newborns and coordinating care with specialists, as well as managing common and complex illnesses.

Residents acquire ongoing inpatient pediatrics experience on the inpatient service in Hendersonville. Because of the thriving OB practice, many children are recruited by residents into clinic after participating in deliveries. Residents enjoy additional outpatient experiences at the local Health Department and a month-long rotation at a private pediatrics practice. Opportunities exist to learn neonatal resuscitation and attend C-section deliveries. All residents complete the PALS and NRP course.

Behavioral Medicine
Three behavioral health faculty currently see patients at HFHC. Two psychiatrists and other behavioral health faculty work at BRCHC. They are available for consults on clinic patients. Residents often schedule joint visits with behavioral health faculty for complicated patients. Residents also lead group visits for behavioral health issues. Rotations during second year on community medicine and behavioral health provides experiences in counseling patients and teaches residents about available community resources.

Emergency Medicine

For one month during intern year and another during second year, residents train in the second busiest emergency room in Western North Carolina, where they actively manage the routine of critically ill patients, as well as gain procedural experience. Residents often perform additional procedures in the ER while on call for the inpatient service.

Surgery
One month during intern year and one month during second year are spent with two local surgical practices. Time is divided between the outpatient clinic and in the hospital and operating room. Time is spent learning colonoscopy and endoscopy, as well as learning inpatient and outpatient management of surgical problems. Residents participate in surgery and have the opportunity to learn basic anesthesia and intubation in the OR. During third year, residents complete core rotations in urology, ophthalmology and otolaryngology.

Orthopedics
One month during intern year and one during second year are spent with two local orthopedic practices. Residents learn outpatient management of orthopedic problems and participate in surgery. They rotate through sports medicine clinics and physical therapy.

Practice Management
Residents learn about how to run a practice that adheres to a low-overhead patient centered model. They become adept at coding, billing, personnel management, patient flow and satisfaction. Considering Hendersonville’s history as part of the P4 initiative, residents have a strong advantage when integrating electronic medical records and low-overhead models in local rural practices. A one-month rotation during the third year focuses on skills necessary to run a practice.

International Medicine
Residents can travel to rural Honduras through Shoulder to Shoulder as early as the intern year. Didactics include lectures on international medicine topics. Most of the Hendersonville faculty have experience practicing abroad. Western North Carolina is home to a large population of native Spanish speakers, providing residents with ample opportunity to learn and practice Spanish. Roughly 40% of BRCHC patients speak Spanish. Two away electives, one during second year and one during third year, may be spent abroad doing international medicine.

Wilderness Medicine

Residents participate in didactics as well as periodic workshops and outings. They are given the opportunity to teach lectures for a wilderness EMT course. The residency is within close proximity to Dupont State Forest, Pisgah National Forest and multiple wilderness areas. As part of orientation, new interns go with the Hendersonville residency on a rafting trip on the Nantahala river and practice rescue techniques.
 




CALL/DIDACTICS

Didactics
Residents participate in the Wednesday afternoon didactic sessions in Hendersonville twice a month. These conferences cover a broad range of primary care topics including: patient management, behavioral medicine, OB/GYN, community medicine and practice management. All learning sessions are interactive. Residents attend grand rounds in pediatrics on a weekly basis via a teleconference center in the Family Health Center. Residents also are encouraged to participate in hospital activities, including four Cancer Conferences a month, and to be active members of various committees. Regular monthly conferences within the residency include lunch discussions of hospital cases, obstetrics cases, difficult outpatient cases, a Balint group and resident meetings.

Call Schedule
In the first year, during the Asheville inpatient rotations only, call is taken from the hospital, including two weeks of night float in the fall and two weeks of night float in the spring. Throughout the second and third year of residency, call is scheduled approximately one night a week and one weekend a month, and can be taken from home. A family medicine attending physician serves as backup and makes rounds with the resident on a daily basis.

PGY1 Curriculum

First Year
Pediatrics-Asheville       Six Weeks
Pediatrics-Asheville Six Weeks
Medicine-Hendersonville Four Weeks
Medicine-Hendersonville Four Weeks
Medicine-Asheville Four Weeks
Rural -Various Locations Two Weeks
Neuro-Asheville Two Weeks
Surgery-Hendersonville Four Weeks
Ortho-Hendersonville Four Weeks
ER-Hendersonville Four Weeks
Obstetrics-Greensboro Four Weeks
Obstetrics-Hendersonville Four Weeks
(One to two half days of patient care per week)

PGY2 Curriculum

Second Year
ER       Four Weeks
ICU Four Weeks
FP Service Four Weeks
Cardiology Four Weeks
Orthopedics Four Weeks
Surgery Four Weeks
FP Service Four Weeks
Gynecology Four Weeks
Community Medicine Four Weeks
Behavioral Medicine Four Weeks
Elective Away Four Weeks
FP Service Four Weeks
(Two to three half days of patient care per week.)

PGY3 Curriculum

Third Year
FP Service       Four Weeks
Dermatology Four Weeks
ENT/Optho/Urology Four Weeks
Infectious Disease Two Weeks
Nephrology Two Weeks
FP Service Four Weeks
Pediatric Outpatient Four Weeks
Practice Management Four Weeks
Elective Away Four Weeks
Elective Four Weeks
Elective Four Weeks
Elective Four Weeks
FP Service Four Weeks
(Three to four half days of patient care per week.)