Welcome to Klamath Falls! Cascades East Family Medicine Residency has embraced the 4 C’s of primary care - first contact, comprehensiveness, coordination and continuity through a modified “Clinic First” model. Whether we are working in the clinic, hospital, emergency room, or L&D - we learn not only how to practice in these contexts, but how to set our patients and ourselves up for health and wellness no matter where we head to next. Our dedicated clinic days and 2-week mini-blocks emphasize the interplay between the roles of the family physician in the rural community while offering the necessary balance between depth, breadth and repitition.
Orientation
Our interns spend two weeks getting acquainted with one another, faculty members, hospital staff and community preceptors. A structured program is presented with emphasis on Family Medicine concepts and practical tools to succeed in residency. New residents are introduced to clinic teams, trained in the electronic health record, assessed for learning styles and learn pearls from fellow residents. Our paid two-week orientation period includes ACLS, ALSO, and NRP training.
Family Medicine Practice
Residents in the first year of training participate in longitudinal care of patients in our 5-star Patient-Centered Primary Care Home - Cascades East Family Medicine Clinic. First year residents care for their panel of patients of all ages in collaboration with their full team - clinical pharmacists, behavioral health specialists, care managers, APPs, MD/DO faculty and more contribute to the resident learning experience and patient care. Instruction by full and part-time family medicine faculty from the community help residents develop skills in the evaluation and management of a variety of health problems. Instruction in patient care emphasizes the quintuple aim - working toward equity and joy in work through patient-centered and high-value health maintenance, disease prevention and treatment. Informed and effective utilization of community resources, management of the emotional and behavioral aspects of care, and longitudinal panel management are just a few of the emphases throughout the year. During the first year, each resident will be responsible for the ongoing care of approximately 150 patients - and must have at least 150 patient encounters over the year. We spend between one and four half-days a week every week in continuity clinic.
Inpatient Adult Medicine
First year residents have seven 2-week blocks on what we call RMT (Resident Medical Team). This is our inpatient medicine service at Sky Lakes Medical Center in Klamath Falls. Our patients are admitted either from the emergency room or directly from clinic. We are responsible for Cascades East patients, several area primary care clinic patients and any patients without admitting physicians in the area. There are multiple admissions per day and this includes ICU admissions and care. Our experience is organized into two services - called A and B. A Team includes an intern, upper level and faculty member - care for patients is distributed across all members of the team. B Team includes a single resident of any level paired one-on-one with a faculty member.
Residents have responsibility for the in-hospital and longitudinal care of these patients under the supervision of family medicine and internal medicine faculty.
Maternal Child Health
First year residents spend four 2-week blocks in maternal-child health training with an emphasis on low risk obstetrics, but with significant high risk obstetrical involvement, as well. We manage patients with the supervision of faculty and community providers, including family physicians and OB-GYNs. We deliver between 60-70 babies each month, with residents leading almost every delivery.
Rural Pediatrics
On this rotation, our Cascades East residents experience the full breadth of rural pediatric primary care. While residents and their preceptors are in their clinics, we also carry a pediatric pager to see emergency room pediatric patients. Additionally, when necessary, we admit, round and discharge pediatric patients from their own service.
Our residents assess and manage children with a wide variety of problems including acute infections, chronic debilitating diseases, disorders of growth and development, nutritional disorders, intellectual disability, and congenital malformations. Additionally, considerable experience in well-child care is gained.
Longitudinal Experiences
Broadly, longitudinal experiences are distributed throughout the year within Family Medicine Practice blocks. Some are grouped more tightly together, while others are evenly distributed throughout the academic year.
Behavioral Health: This longitudinal rotation occurs during all three years and provides education in the integration of behavioral health and primary care. Included in the series is experience with our behavioral health providers in warm hand-offs, health and behavioral interventions, specialty mental health care with a psychiatrist in the community, and time with other mental health and behavioral health providers in the community. Home visits, video precepting, and aspects of community health are also integrated into this experience. Our behavioral health faculty also facilitates a focus on provider wellness, recognizing that this is integral to our role as healers. In the PGY 1 experience you will be introduced to clinic teams with Behavioral Health integration.
Emergency Medicine: Sky Lakes Medical Center in Klamath Falls has a busy emergency department, with over 26,000 outpatient visits per year. Experienced emergency room physicians boarded in emergency medicine staff the emergency department. This rotation focuses on learning to assess emergency department patients and basic skills such as suturing, care of fractures, management of major and minor trauma and psychiatric emergencies.
Gynecology: This rotation occurs under the supervision of obstetrician/gynecologists in Klamath Falls and also working with family physicians in setting emphasizing gynecological and reproductive health care. Residents participate in the evaluation of outpatients and performance of procedures such as endometrial biopsy and colposcopy. Reproductive health procedures and work in a public health clinic is also included.
Health Systems Management: Four to eight residents and faculty spend a half-day together as a cohort of peers, near-peers and mentors - listening, sharing and helping each other to gain the skill necessary to care for our patients and ourselves within the healthcare system. A sampling of our HSM curriculum includes half-days dedicated to bystander training, equity and inequity in Oregon; and quality improvement.
Musculoskeletal Care: Our structured exposure to musculoskeletal care includes distributed days with our local orthopedic group, ultrasound clinic with an emphasis on US-guided injections, and integrated care within continuity practice.
Surgery: The surgery rotation takes place at Sky Lakes Medical Center in Klamath Falls. The emphasis is on learning minor outpatient surgical procedures, establishing airways, first assisting at major surgery and perioperative care. Our experienced general surgeons and anesthesiologists from the community supervise residents, on a one-to-one basis.
Subspecialties: Training in otolaryngology, urology, dermatology, ophthalmology and more occur in Klamath Falls in order to further residents' skills in recognizing, managing and coordinating primary care issues related to each of these fields.
Away Rotations:
Inpatient Pediatrics: Cascades East interns spend 4-weeks at Doernbecher Children's Hospital at OHSU in Portland, Oregon. The emphasis is on the assessment and management of primary care pediatric problems that will be encountered in a hospital setting. The strong teaching environment of Doernbecher provides an excellent learning experience and the program provides housing for residents in Portland during this block. Housing is provided.
Neonatal ICU: Cascades East interns spend three-weeks working alongside board-certified neonatologists at the Neonatal Intensive Care in Medford, Oregon. This experience prepares residents to stabilize and prepare infants for transport in isolated communities upon graduation. Housing is provided.