Our residents participate in medical and procedural simulation on a routine basis, during our morning didactics and during our Wednesday afternoon didactics. Our new Simulation Center opened on MAHEC’s campus in 2018; these facilities offer high-fidelity manikins and task trainers in a controlled environment to optimize learning in a high-stakes scenario. Residents typically work through scenarios led by our own FM faculty or guest faculty. Residents are grouped by class for these teaching sessions to achieve optimal learning based on experience. Scenarios are typically grouped by teaching topic to hone specific skills and learning points. Each session highlights unique and powerful learning opportunities in key competencies, including communication, teamwork, emergent conditions, and tasks that require well-practiced manual skills such as diagnostics and surgical procedures.
On the Family Practice Service at Mission Hospital, residents:
- Work one-on-one with our family medicine faculty and pharmacotherapists
- Work with the patient’s assigned doctor or specialist to provide comprehensive care and continuity
- Gain procedural skills (Ex: placement of central lines, intubations, thoracentesis, paracentesis, lumbar puncture, and circumcisions)
At the Family Health Center, residents:
- See their own patients and work-ins
- Are precepted in person and via video by faculty or their peers
- Learn about coding and billing, practice management models
- Access a variety of community resources
- See patients in variety of specialty-clinics such as diabetes, metabolic, osteoporosis, colposcopy, pharmacotherapy, pain, OMT, sports medicine, geriatric assessment, suboxone, and dermatology
- See patients in innovative group visits. Find out more about MAHEC Centering Parenting here.
- Receive professional, timely feedback on their performance and progress
- Gain procedural skills (Ex: skin biopsies, toe nail removal, vasectomy, joint injections, casting, laceration repair, and sphenopalatine blocks)
- Attend weekly didactics. Topics include gout, bronchitis, diabetes, URI, hypertension, step throat, incontinence, obesity, dementia, chronic pain, hematuria , jaundice, GI bleeding, kidney stones, and more
The payer mix for the Division of Family Medicine includes:
Private/Commericial – 15.61%
Medicaid – 28.33%
Medicare – 34.46%
Other Gov’t – 1.67%
Self – 19.93%
Age distribution of FHC Patients for 2017-18:
Age 0-2 13%
Age 2-9 11%
Age 10-19 10%
Age 20-29 17%
Age 30-39 16%
Age 40-49 9%
Age 50-59 8%
Age 60-69 8%
Age 70+ 7%
- Weekly protected time for dynamic classroom instruction and resident support at our new Simulation Center
- Use of innovative and interactive "flipped classroom model” of teaching which includes problem-based learning, case presentations, procedure rodeos, role-play, and audience response.
- Supplementary DAILY morning teaching by our faculty or local specialists
- Other didactics activities include OSCEs, M&M, monthly simulations, evidence-informed decision making curriculum, wellness workshops, lifestyle medicine, master clinician presentations, practice management lectures, and dedicated all-pediatrics didactics sessions
On the adult medicine service at Mission Hospital, residents:
- Work closely with attending physicians of the Asheville Hospitalist Group
- Manage “unassigned” patients on the Adult Medicine Unit, cardiac and pulmonary step-down units, Med-Surg ICU, Cardiac ICU, and Neurotrauma ICU.
- Teams include three to four interns, a senior resident, a pharmacist, medical students, and the attending physician
- Opportunities for procedural skills (Ex: airway management, skin biopsy, wound care, anoscopy, vaginal laceration repair, suturing, simulation lab, introduction to colonoscopy) and adult code response
- Attend daily teaching rounds and Internal Medicine conferences. Topics include: ACS, CHF, COPD, Pnuemonia, DKA, sepsis, Afib, DM, meningitis, chest pain, GIB, cirrhosis, and more.
On the Pediatrics service at Mission Hospital, residents:
- Manage normal growth and development, anticipatory guidance, and ambulatory or hospitalized children
- Experience daily case-based instruction and supervision by the "Mission Kids" hospitalist group
- Gain procedural skills (circumcisions, lumbar punctures, and more)
- Attend weekly community-wide pediatric conferences, weekly neonatology seminars, and participate in online pediatric modules. Topics include: acute respiratory infection, diarrhea, murmurs, gastroenteritis, meningitis, and more
- Participate in neonatal abstinence service for newborns
In the outpatient setting:
- Work in pediatric practices in our community and at the Family Health Center
- Explore Pediatric specialties in cardiology, orthopedics, obesity, hypertension, asthma, sleep, oncology, dermatology, endocrinology, neurology, allergy and asthma, developmental issues, and genetic disorders
OBSTETRICS & GYNECOLOGY
- Participate in outpatient OB/GYN care including: family planning clinics and STD clinics at the health department and Planned Parenthood, GYN clinics with local specialists, and dedicated Prenatal Clinic at the Family Health Center.
- Gain procedural skills, including colposcopy, IUD and contraceptive implant insertion, endometrial biopsies, miscarriage management, ultrasound, obstetrical laceration repair, pessary fittings, induction of labor and intrapartum procedures, and vasectomy. These skills are reviewed frequently in morning teaching sessions as well.
- Weekly didactics cover preconception care, breast and cervical cancer screening, contraception, vulvar disease, abnormal uterine bleeding, sexual dysfunction, menopause, natural childbirth, and management of pregnancy complications and chronic disease in pregnant patients. We also utilize the Simulation Lab for skills practice during some OB/GYN didactic sessions.
- Collaborate with the MAHEC OB/GYN residency program during high-volume rotations on Labor & Delivery at Mission Hospital
- Interested residents can pursue optional high-volume experiences at outside hospitals during elective time.
- You will follow pregnant patients longitudinally through their prenatal care in the Family Health Center and through their deliveries on the Family Practice Service at Mission Hospital. We do everything possible to facilitate residents attending the births of their continuity prenatal patients.
NOTE: Our maternity care curriculum is designed to accommodate the needs of those who are committed to practicing obstetrics and those who are sure they will not provide maternity care after graduation. The 3 year curriculum will prepare you to practice obstetrics after graduation if you wish. Some residents choose to pursue more intensive maternity care training. We have designed a 4th year fellowship to accommodate those residents’ educational goals. Feel free to reach out if you want to hear more about that!
- Practice within a national model of Integrated Care, collaborating with psychologists and psychiatrists.
- Learn fundamental skills in anticipatory guidance, supportive counseling, and caring for patients throughout individual and family life cycles.
- Spend time in mental health clinics and addictions clinics.
- Attend Support Group, and weekly didactics lectures. Topics include ADHD, substance abuse, parenting, Anxiety, Myers-Briggs, Genogram, Depression, Bipolar Disorder, Finding Meaning in Medicine, Ethics and Motivational Interviewing.
- The psychiatry residency located on our campus provides enhanced behavioral health learning opportunities.
- Spend time with general surgeons, both in the hospital and the outpatient setting
- Assist with surgeries, referrals, pre- and post-operative management
- Gain procedural skills (Ex: Intubations, skin biopsy, colonospcopy, anoscopy, Vaginal Repair, Suturing, Simulation Lab)
- Attend quarterly Procedure Rodeos in Didactics and practice procedures in Simulation lab setting
Coming Soon! The addition of a surgery residency in 2018 will further enhance our resident’s surgery experience.
ELECTIVES & SCHOLARLY ACTIVITY
- Examples of resident elective time include: additional experience in medical or surgical subspecialities, seeing patients in a practice they might consider working for in the future, going on an international medical mission, or assisting in community-based care
- All electives must be approved by the resident’s faculty advisor and program director as well as GME Office, Risk Management, and Fiscal Departments
- Residents are required to complete a community, QI, or research project prior to graduation. Click here to learn more about the Clinical Research and Scholarly Activity of our residents and faculty!
- CQI is the fabric of how we practice medicine. All residents will participate in team-based quality improvement projects and initiatives in collaboration with nurses and other clinical staff
- Supervision by ER-trained physicians in the 3rd busiest ED in North Carolina (one of the busiest in the nation)
- Improve procedural skills with the “Fast-track team” including EKG interpretation, incision and drainage, laceration repair, fracture reduction and splinting, point of care ultrasound, ATLS
- Spend time in rural ED settings of McDowell County
- Attend monthly collaborative EM/FM/M&M sessions. Topics include chest pain, trauma, overdose, syncope, fever/sepsis, wound management, asthma/COPD and more
- Longitudinal care for older adults at the Family Health Center, at two skilled nursing facilities, and through home visits.
- Acute care for geriatric patients in the hospital.
- Attend didactics lectures on medications in the elderly, failure to thrive, wound care, delirium/dementia, advanced directives, palliative medicine, physiology of aging, and movement disorders.
- Focus on Core Geriatric Competencies throughout training
- Opportunities for elective time for further geriatric experiences in the Continuing Care Retirement Communities we serve as well as with local palliative care and hospice services.
ORTHOPEDICS & SPORTS MEDICINE
- Attend primary care sports medicine clinic and provide continuity orthopedic care based at the MAHEC Family Health Center, precepted by Sports Medicine Faculty.
- Work with community-based general orthopedists, hand surgeons, spine specialists, physical therapists, chiropractors and podiatrists
- Administer sports physicals and provide side-line care at local sporting events and races.
- Diagnose and stabilize common musculoskeletal trauma and sports injuries, and inject soft tissues and joints.
- Gain procedural skills (shoulder and knee injections, aspirations, splinting, casting)
- Obtain high yield ultrasound exposure during direct patient care as well as through the MAHEC Simulation Center
- Attend Didactics lectures. Topics include Sciatica, Sprain, osteoarthritis, plantar fasciitis, carpal tunnel syndrome, Knee Injuries, Geriatric Trauma and Fractures, Shoulder Pain, Hip/Back Pain and more.
COMMUNITY & GLOBAL HEALTH
- Provide primary care for Project Access (volunteer based health care for the underserved and underinsured) patients in our office, at Mission Hospital, and at the ABCCM free medical clinic
- Collaborate with local schools under the School Healthy Lifestyle Collaborative
- Visit at least 5 rural hospitals and clinics under a national Teaching Health Center grant.
- Option to attend a medical Spanish course followed by a two week trip to rural Honduras with the not-for-profit, NGO called Shoulder to Shoulder
- Assist Hispanic and underserved populations with navigating the medical system
- Attend lectures on Biostatistics, Tuberculosis, Maternal Health in the Developing World, the Burden of Poverty, Infectious Diseases of the Developing World, and Skin Disorders of the Tropics
- Volunteer opportunities in the local housing developments and equity organizations
- Rotations with FQHCs in the area
- The primary care curriculum is accentuated by additional specialty rotations in cardiology, pharmacotherapy, ENT, nephrology, ophthalmology, dermatology, rheumatology, neurology, and urology.