Our residents participate in medical and procedural simulations on a routine basis during our morning didactics and our Wednesday afternoon didactics. Our state-of-the-art simulation center opened on MAHEC’s campus in 2018 and provides real-life skills practice in a controlled environment to optimize learning in a high-stakes scenario. The 15,000-square-foot facility has high-fidelity manikins, standardized patients, task trainers, and laproscopic surgery, endoscopy/bronchoscopy, point-of-care ultrasound, and virtual reality simulators.
Residents typically work through scenarios led by our own family medicine faculty and guest faculty and are grouped by class to support 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 diagnostic and surgical procedures.
Residents on the Family Practice Service at Mission Hospital
- care for geriatric, adult, pediatric, newborn, postpartum, antepartum, and laboring patients all on one comprehensive and interdisciplinary service;
- work one-on-one with our family medicine and pharmacy faculty; and
- work with the patient’s primary care provider and specialists to provide continuity and comprehensive care.
Residents at the Family Health Center
- see their own panel of continuity patients;
- are supervised in person and via video by family medicine and behavioral health faculty;
- learn about coding, billing, and practice management models;
- access a variety of community resources for their patients;
- see patients in variety of specialty clinics such as diabetes, healthy living, osteoporosis, colposcopy, vasectomy, chronic pain, OMT, sports medicine, geriatrics, medication-assisted treatment, and skin conditions;
- see patients in innovative group visits such as Centering Parenting;
- receive professional timely feedback on their performance and progress; and
- gain procedural skills such as skin biopsies, toenail removal, vasectomy, joint injections, casting, laceration repair, and sphenopalatine ganglion blocks.
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 a full afternoon of simulation training, dynamic classroom instruction, and resident support at our new Simulation Center.
- Simulation training on adult, pediatric, newborn, and maternity care is woven throughout didactic sessions.
- Use of innovative and interactive "flipped classroom" model of teaching that includes problem-based learning, case presentations, procedure rodeos, role-play, and audience response systems.
- Daily morning teaching topics led by our faculty or local specialists.
- Other didactic activities include an innovative evidence-informed decision-making curriculum and wellness workshops focused on resident well-being.
Residents on the adult medicine service at Mission Hospital
- work closely with attending physicians in 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;
- work in teams of four interns, a senior resident, a pharmacist, medical students, and the attending physician;
- lead the code team in ACLS as the first responders to all adult codes in the hospital; and
- participate in inpatient procedures such as airway management, paracentesis, central line placement, and thoracentesis.
Coming Soon! The addition of an internal medicine residency in the next year will further enhance our resident’s inpatient medicine experience.
Residents on the inpatient pediatrics, newborn, and family practice rotations
- 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 including but not limited to circumcisions and lumbar punctures;
- attend weekly community-wide pediatric conferences, weekly neonatology seminars, and participate in online pediatric modules—topics include but are not limited to acute respiratory infection, diarrhea, murmurs, gastroenteritis, and meningitis; and
- participate in neonatal abstinence syndrome service for newborns.
Residents in the outpatient setting
- care for a high volume of pediatric patients—one-third of the visits in the residents’ continuity clinics at the Family Health Center are with children;
- work in pediatric practices in our community; and
- 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 Center for skills practice during some ob/gyn didactic sessions.
- Collaborate with the MAHEC ob/gyn residency program during high-volume rotations on the labor and delivery unit at Mission Hospital.
- Interested residents can pursue optional high-volume experiences at outside hospitals during elective time.
- 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 maternal-child health fellowship to accommodate those residents’ educational goals. Feel free to reach out if you want to learn more about this fellowship opportunity.
- 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 substance use disorders treatment clinics.
- Perform initial surgical consults in the Emergency Department.
- Assist with surgeries, intubation, and pre- and post-operative care.
- Perform office-based procedures in primary care and surgery clinics.
- Attend procedure rodeos to practice procedures in the Simulation Center.
ELECTIVES & SCHOLARLY ACTIVITY
- We value individualizing the curriculum to meet resident’s personal educational objectives. We provide both longitudinal and block elective time in the second and third years. Examples of resident elective activities include maternity care at the local birth center, procedures with interventional radiology, audition rotations with potential employers, international medical missions, mental health crisis team, point-of-care ultrasound, and addiction medicine.
- Residents are required to complete a community, quality improvement, and research project prior to graduation. Click here to learn more about the clinical research and scholarly activity of our residents and faculty.
- Continuous quality improvement 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 emergency medicine faculty in the third-busiest emergency department in North Carolina (and 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, and ATLS.
- Spend time in rural emergency department settings in McDowell County.
- Attend monthly collaborative morbidity and mortality (M&M) sessions with emergency medicine faculty.
- 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.
- Participate in our home visit curriculum.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 at Biltmore under the supervision of 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 including shoulder and knee injections, aspirations, splinting, and casting.
- Obtain high-yield ultrasound experience through direct patient care and in the MAHEC Simulation Center.
COMMUNITY & GLOBAL HEALTH
- Provide primary care for underserved and underinsured patients in our office, at Mission Hospital, and at a free medical clinic through Project Access, a volunteer physician community-based healthcare initiative.
- Collaborate with local schools under the School Healthy Lifestyle Collaborative.
- Visit multiple rural hospitals and clinics under a national Teaching Health Center grant.
- Participate, if interested, in a two-week trip to rural Honduras with the not-for-profit nongovernmental organization Shoulder-to-Shoulder
- Assist Hispanic and underserved populations with navigating the healthcare system
- Volunteer with local housing developments and equity organizations
- Rotate with area federally qualified healthcare centers
- The primary care curriculum is complemented by additional specialty rotations in cardiology, ENT, nephrology, ophthalmology, dermatology, rheumatology, neurology, and urology.