Adult Medicine
The adult medicine teaching service provides residents with a variety of experiences
that enable graduates to comfortably manage acutely ill, hospitalized patients.
Supervision is provided by Asheville Hospitalist Group, comprised of certified internal
medicine and med-peds physicians. Residents work closely with attending physicians to
manage patients on the Adult Medicine Unit, cardiac and pulmonary step-down units,
Med-Surg ICU, Cardiac ICU, and Neurotrauma ICU.
The adult medicine team consists of three interns, a senior resident, a pharmacist,
and the attending physician. Service cap is 18 (thus 6 patients per intern) and is
usually full. The population cared for by the medicine team consists of "unassigned" patients,
including indigent patients, folks who have no physician, visitors to the Asheville community,
and patients with whom their primary physician does not practice inpatient medicine.
Daily teaching rounds are the core of education on the Medicine rotation. Weekly
Cardiology and Internal Medicine conferences supplement learning, as do Wednesday
conferences, M&M talks, and PBL (Problem-based Learning) modules.
Residents have the opportunity to participate in any procedure that arises, including
paracentesis, thoracentesis, central line placement, and lumbar puncture.
Other adult medicine experiences include 6 weeks of Cardiology, 2 weeks of ICU,
2 weeks of Neurology, 1 week of Rheumatology, and time on the inpatient Family Practice Service.
Maternity Care/Women's Health
Maternity Care - Family Medicine residents often begin their training with a mix of
professional and personal feelings about including obstetrics in their future practices.
The maternity care curriculum is designed to accommodate the needs of those who are
committed to practicing obstetrics, those who are sure they do not wish to practice
obstetrics, and to stimulate those who are undecided. Whether or not the resident plans
to practice obstetrics, we feel that the care of the pregnant woman--from the physical,
emotional, and family dynamics perspectives--is an important part of the family medicine
experience.
The first year OB experience is composed of two six-week blocks with our sister MAHEC
OB/GYN residency program that provide extensive experience in high and low risk obstetrics
leading to approximately 50 or more deliveries. Additional experience is gained through
the longitudinal care of ten or more private prenatal patients in the Family Health Center,
supervised by the family medicine faculty.
Those residents who wish to go on to an “OB emphasis” track have the opportunity to
follow additional patients at the Family Health Center as well as participate in an
additional one to two months of higher risk, higher volume obstetric experience.
Women's Health - The gynecology rotation is a four-week block in the third year of
training that includes an introduction to colposcopy, family planning clinics, STD
clinics at the health department, and weekly conferences in general gynecology and
reproductive endocrinology. Colposcopy training is also available in the Family
Health Center under the supervision of family medicine faculty.
Pediatrics
Normal growth and development, anticipatory guidance, and management of ambulatory or
hospitalized children are emphasized in the pediatrics curriculum. The large size of
Mission Health System and its role as a regional referral center result in a particularly
strong pediatrics experience for residents.
Interns complete two six-week rotations on the busy inpatient service with a variety
of patients from private pediatricians and the county health department. Ambulatory
pediatric experience is obtained in local pediatric office practices and at the Family
Health Center.
The second year rotation is a mix of activities on the hospital-based pediatric teaching
service, in specialty offices, and in the outpatient setting. For three weeks,
second year residents supervise the inpatient service, coordinate patient care,
and present didactics for the team. Pediatric specialties that receive special attention
are cardiology, orthopedics, endocrinology, neurology, allergy and asthma, and preventive
medicine. Another three weeks are dedicated to obtaining outpatient experience in
pediatric practices in our community.
During the third year pediatrics rotation, residents focus on more advanced topics,
including developmental issues, genetic disorders, and non-accidental injury.
Didactic instruction includes weekly community-wide pediatric conferences, weekly
neonatology seminars, online pediatric modules, and daily case-based instruction by the
hospitalist group called "Mission Kids" which supervises the pediatric teaching service.
Surgery
Eight weeks of the first year curriculum are devoted to general surgery training. Residents
spend two four-week rotations with two general surgeons in the community. Opportunities for
surgical first-assisting and one-on-one teaching are excellent. Pre- and post-operative
management, office- and hospital-based procedures, and general management of patients with
surgical problems, including appropriate referral patterns, are emphasized. The balance of
hospital-based and office-based surgical education is a highlight of this experience.
Residents also have the opportunity to work with anesthesiologist before their cases to
practice intubations.
Family Medicine (Outpatient and Inpatient)
We strive to offer excellent training in our specialty in both ambulatory and hospital settings.
During the first year, interns spend four weeks in the MAHEC Family Health Center.
Residents see their own patients and work-ins, precept family practice faculty, learn
lab procedures, and begin to understand the process of coding and billing. During this
rotation, interns also acquaint themselves with community resources and spend time with
our radiologist reviewing xrays taken in our office. They also spend 1-2 half days in
clinic during the inpatient rotations.
During the second and third years, residents spend a few blocks in clinic and have
2-4 half days of clinic each week while on specialty rotations.
As part of our comprehensive care, our Family Health Center offers dedicated days/times
for office procedures, including colposcopy, vasectomy, and flex sigmoidoscopy. We also
have specialized clinics, such as osteoporosis, CHF, and Coumadin. Residents participate
in all of these specialty clinics throughout the three years.
Two six-week blocks during the third year are dedicated to our inpatient family medicine
service. Third year residents work one-on-one with our family medicine faculty managing
our practice’s hospitalized patients. The patient’s assigned doctor is also encouraged to
assist the family medicine hospital team to provide comprehensive patient care and continuity.
Community medicine electives in maternal and child health, communicable diseases,
occupational medicine, and community health are also available.
Behavioral Medicine
Behavioral medicine skills are incorporated into all aspects of patient care, with
longitudinal training throughout the residency. Taught by family therapists, psychologists,
social workers, and psychiatrists, residents learn fundamental skills in anticipatory
guidance, supportive counseling, and caring for patients throughout individual and family
life cycles. Teaching is accomplished during video precepting, hospital rounds, seminars,
support group sessions, and periodic consultations and co-counseling sessions with patients.
A six-week rotation during the second year is committed to behavioral medicine training.
During this block, residents spend time in mental health clinics, addictions clinics,
and in the Family Health Center with a designated behavioral medicine preceptor. Residents
also have the unique opportunity of working with a psychiatrist for psychopharmacology
consultations at our clinic. Lessons are reinforced by one-on-one instruction.
Our practice is a national model for Integrated Care, in which family physicians,
psychologists, and psychiatrists collaborate to serve our population.
Geriatrics
Throughout all three years, residents care for elderly patients both at the Family Health
Center and in the hospital. Our training in the care of older patients is enhanced by the
presence of a Geriatrics fellowship, which currently staffs two Geriatricians and two fellows.
Starting in the second year, residents see nursing home patients at Givens Estate
Retirement Center monthly. These visits are accompanied by structured lectures on topics
such as medication dosing, failure to thrive, wounds, levels of care, delirium/dementia,
and advanced directives. In addition, some didactic sessions on Wednesday afternoons are
dedicated to geriatric topics. A few times throughout the year, the Geriatrics attendings
supervise the inpatient Family Medicine service, offering their perspective and experience
on acutely-ill patients.
Emergency Medicine and Urgent Care
Six weeks of the second year curriculum are based in the Emergency Department at
Mission Hospital, which serves as a regional referral center for all of western North
Carolina and averages over 95,000 patient visits per year. In fact, Mission Hospital
is the busiest ER in North Carolina. Supervised by ER-trained physicians, residents
can see any patient that walks through the door, from stroke and heart attack victims,
to trauma, fractures, and lacerations. The Fast-track section of the ER is a great
place to fine-tune suturing skills and other minor procedures like I&D. Additionally,
residents spend a few days in one of the urgent care centers in the area.
Orthopedics/Sports Medicine
The eight-week orthopedics rotation is composed of a variety of experiences with the goal
of enabling our graduates to diagnose and stabilize common musculoskeletal trauma and
sports injuries, to splint or cast uncomplicated fractures, and to inject soft tissues
and joints. Second year residents work in the offices of general orthopedists, hand surgeons,
spine specialists, and orthopedists at the Asheville VA Medical Center. Additional time
is spent in a physical therapy practice, a chiropractic office, and a podiatry clinic.
Some time is spent working with a recent MAHEC graduate who specializes in Sports Medicine
and works at the Mission Hospital Rehab and Sports Clinic. Opportunities to attend local
sporting events and races are available. Elective sports medicine experiences at
UNC-Asheville are also available.
Subspecialty Rotations
Curricular time is also devoted to rotations in cardiology, ENT, ophthalmology,
dermatology, rheumatology, neurology, and urology. Six weeks during the second year
are spent working one-on-one with the cardiologists. This hospital-based rotation
includes patient management in the CCU environment. Six weeks during the third year
are spent on ENT/ophthalmology. Three weeks during the third year urology rotation
are spent in the office of a urologist. The urology experience is supplemented by a
high-volume clinic at the Asheville VAMC. Three weeks during the third year
dermatology/pediatrics rotation are spent with a private dermatologist. Two weeks
are dedicated to neurology, in the office and hospital settings, and one week is spent
with a rheumatology group.
Practice Management
Practice management education occurs throughout the residents' three years. Residents receive
extensive training on coding and are expected to appropriately code all outpatient encounters.
An ongoing series of conferences and seminars, utilizing the expertise of MAHEC administration
and community consultants, complements practical experience gained at the Family Health Center.
Recent graduates are frequently invited back to share their business models and lessons learned
about running a practice. Program resources are extended to our graduates who remain in this
region to provide them with ongoing support and education in this important area.
Procedures
There is a wide variety of procedures available to residents throughout their three years
of training. Intern year, residents are scheduled in procedure clinic while on the surgery
rotation. In this clinic, residents perform shave/punch/excisional biopsies, IUD placement,
Implanon placement, endometrial biopsies, toe nail removal, and cryotherapy, to name a few.
First year residents also spend time in splinting and casting clinics. Second and third year
residents also do procedure clinics, working directly with faculty or supervising interns.
There are also several specialty procedure clinics, such as colposcopy, vasectomy, and flex
sigmoidoscopy clinics. Inpatient procedures including placement of central lines, intubations,
thoracentesis, paracentesis, lumbar puncture, and circumcisions are available to residents.
Electives
Electives are available in Asheville in nearly all medical and surgical subspecialties.
Residents choose to use elective time in a variety of ways. Some have rotated in a practice
they might consider working for in the future. A few have gone to Guatemala, Africa, and
Malaysia on medical missions. Others have served as the physician at a camp they used to
attend as a child. All electives must be approved by the resident’s faculty mentor and
program director.
Four weeks in the second year and four weeks in the third year are available for approved
elective rotations away from Asheville. Six weeks of additional Asheville-based elective time
brings the total to 14 weeks.