Highlighted Curricular Strengths

Patient transport on backboard

Injured skier being transported on a backboard

Inpatient Medicine

We feel strongly about preparing you for inpatient medicine. We give you two blocks of experience on a VA internal medicine team in the intern year.  But the core of our experience is on a busy inpatient family medicine service at St. Alphonsus. You will do 2 blocks here in your R1 year, 3 in the R2 year and 2 in your R3 year.  Our senior residents run this service.  We take care of a good mix of acuity and you will be in and out of the open ICU through all 3 years. We do give you an additional two weeks of ICU time in your R2 year to build your skill set working 1:1 with our critical care docs.  Our patient population is underserved and you will see a great mix of pathology.  Our consultants (pulm-critical care, cardiology, GI, nephrologists, and a variety of surgeons)  are dedicated teachers.  Megan McInerney  (critical care) was elected the consultant of the year in 2016-2017.

Obstetrics

We provide a rich obstetrical training environment for our residents.  We provide  full-time or part-time L&D coverage at four local hospitals – St. Luke’s Boise, St. Luke’s Meridian, St. Alphonsus Boise and St. Alphonsus Nampa.  Our core maternal child health team is based out of St. Luke’s Boise and you will take advantage of relationships with local obstetricians here around labor management and delivery.  Additionally, our senior residents partner with the OB hospitalists and MFM consultant group to manage the high risk service.  C-section experience is gained here with all three groups of obstetricians and interested residents will get foundational experience in primary c-sections.  Our FQHC clinic system generates an average of 18-22 continuity deliveries per resident and you will manage these patients at one of the Boise / Meridian hospitals with a family medicine faculty doctor or a midwife.  We partner with Terry Reilly family medicine doctors for vaginal deliveries and c-section experience in Nampa in the R1 year and on inpatient selectives in the R2 or R3 year.  Two of our grads are doing c-sections at this hospital providing a model of FM with surgical OB here in the Treasure Valley.

Women’s Health

We are a RHEDI-funded resident training site. Residents have the opportunity to engage in full-spectrum women’s health care training throughout their 3 years of residency. A one month gynecology rotation includes time spent with board-certified gynecologists who provide colposcopies, LEEPs, and other procedures at our Fort Street Clinic. The RHEDI grant also allows us to provide free IUDs (Mirena, Paragard, and Liletta) and Nexplanons to patients. Those who qualify for our sliding fee scale pay a nominal insertion fee.

Integrative Medicine/Acupuncture

In 2018 we will be adding an acupuncture clinic to our largest training site, where residents will have the opportunity to rotate through and learn indications for/theories behind acupuncture. In addition, we provide an Integrative Medicine half day, where topics such as nutrition, herbs/supplements, naturopathic/functional medicine, and mind-body medicine are discussed. Additional lectures and exposure will be available to anyone who has a specific interest in this area. FMRI is excited for the anticipated growth in this area over the 2018-2019 academic year as a full time faculty member with integrative medicine interests will be joining the staff.

Procedures

FMRI provides training to perform all office-based and inpatient procedures needed to feel comfortable in a broad-spectrum practice. In 2018, we will be focusing on expanding our bedside ultrasound curriculum. See the list below for examples of the procedures we are performing at all training sites.
SkinSimple lesion destruction, removal of epidermal inclusion cysts, lipoma, warts, simple and complex repairs anywhere (yes anywhere), foreign body removal, piercing removal, simple and complex biopsy, mucous membrane biopsy, plastics and flaps, fungal biopsy, nail plate and nail bed biopsy, BCC, SCC, melanoma, traumatic repair
Sports MedJoint injections and aspirations small and large (fingers to hips), ultrasound guided injections (hips/knees/ankles, etc), carpel tunnel injections, dislocated joints, nursemaid elbows, casting, fracture management
MSKTrigger point injection, osteopathic manipulation, fascial distortion model treatment, ganglion cysts drainage and tx
HospitalParacentesis, thoracentesis, lumbar Puncture, central lines, arterial lines, ultrasound guided +/-, airway management and intubations
Womens HealthIUD, nexplanon, sedated pap smears, vulvar biopsy, periurethral biopsies, colposcopy, leep, Bartholins abscess treatment, OB ultrasound 1,2,3 dating (not anatomy scan), STD screening,  rectal biopsy, vaginal and anal condyloma removal, miscarriage management, pessary placement, EMB, GYN ultrasound
Mens HealthVasectomy (can track for training), genital/ anal condyloma removal
NeuroMigraine treatment- posterior occipital nerve injections, c6 para cervical blocks, sphenopalentine ganglion blocks, sciatica, meralgia parasthetica
CVExercise treadmills, US guided IV/ central line placement, bedside US
PedsCircumcision, frenotomy, umbilical artery, vein cath, NRP
ENTFlexible nasalpharengoscopy, anterior epistaxis cauterization, piercing removal and placement, hordeolum/chalazion tx simple and advanced, auricular hematoma drainage, peritonsilar access drainage, foreign body removal, mucocel, bite trauma
AnesthesiaConscious sedation, local nerve blocks (oral, peripheral), hematoma blocks
Wound CareUnna boots, wound debridement, long term management
GIColonoscopy, EGD (can track for scope training), pilonidal cyst management, anal skin tags, hemorrhoids internal and external, celiac biopsy, eosinophilic esophagitis biopsy, IBD r/o, anal fissure
POCUSPoint of Care Ultrasound is a growing curriculum.  Bedside based heart, lung, AAA screening, DVT exams, liver, gallbladder, skin mass/lipoma, access evaluation/cellulitis evaluation. IVC, kidney/bladder. FAST exams. Handheld ultrasound available for use on inpatient and bedside ultrasound available at all training sites.


Wilderness Medicine

View pictures from the 2018 Wilderness Retreat.

Here at FMRI, we acknowledge that many of our medical students, residents, faculty and graduates recreate throughout the state and seasons, so we feel it is important to develop proficiency in managing out of hospital emergencies. To achieve this goal we are incorporating Wilderness Medicine training into our curriculum. Currently, we have developed a 3 day course that is protected time during the R2 year at the remote and stunningly beautiful Burgdorf Hot Springs, near McCall, Idaho. This site is unique in that it is only accessible by snowmobile during the winter, is rustic yet comfortable with wood stove heated cabins and a large geothermal hot spring which we utilize both for water based training and relaxation. Our plan is to develop this course into a nationally recognized certification course such as AWLS (Advanced Wilderness Life Support) and to expand the curriculum to include a summer course as well.


Global Health Opportunities

FMRI offers two away electives to interested residents – one in the R2 year and one in the R3 year. This allows time for a global health focused resident to explore two different sites. Although residents are free to set up their own electives, we also have a variety of sites in Central America, the Caribbean, and Africa that former residents have utilized and at which we can help facilitate rotations. We offer a $500 stipend per resident to support one such trip.  In addition, we have extra funding for residents who are seeking to improve their Spanish language skills locally or internationally.  FMRI grads tend to apply their skills broadly and internationally; we currently have four graduates working in Africa in government jobs or for faith based organizations.

In addition to away electives, we have ample opportunities for residents to gain global health skills and knowledge right here at home.  Boise has traditionally been one of the top five cities in the US for refugee resettlement per capita, and so we are fortunate to take care of patients with refugee status from Africa, Asia, and the Middle East. Our Emerald clinic does the bulk of this care, providing initial screening exams for all individuals with refugee status who are resettled to Boise, and then ongoing primary care for the majority of those individuals.  Our Emerald clinic also houses our HIV, TB, and viral hepatitis subspecialty clinics.

Interested residents can choose Emerald as their continuity clinic site, and can participate in our Global Medicine Training Track, led by Abby Davids and Margaret Mortimer. Through a longitudinal curriculum as well as electives and online modules, residents gain experience in the spectrum of infectious disease, chronic disease, cultural issues, and behavioral health care needs that are essential to provide comprehensive care for our global populations.


Infectious Disease

Tied closely to our Global Medicine opportunities, residents at FMRI gain extra experience in infectious disease management. The Family Medicine Health Center Emerald Clinic houses the Wellness Center, a Ryan White funded HIV subspecialty clinic serving over 600 patients. All residents have basic exposure to the Wellness Center, and can do additional training either via elective rotations or by participating in our longitudinal curriculum and choosing Emerald as their continuity clinic site. Along with our HIV specialist faculty, our HIV & Viral Hepatitis Fellows are heavily involved in resident education. We provide all inpatient care for patients living with HIV on our family medicine service at St. Alphonsus, as well. We also train all residents in evaluating and providing patients with pre-exposure prophylaxis (PrEP) for HIV.

The Emerald Clinic also houses our TB clinic, via a partnership we have with the Central District Health Department. Providing care for individuals with both active and latent TB, the TB clinic is another great experience for residents wishing to gain skills applicable at both home and abroad.
Finally, as hepatitis C becomes an increasingly primary-care focused disease, we are working towards having all FMRI residents trained and comfortable in the management of chronic hepatitis C. Our hepatitis C clinic serves patients from both within the FMRI system and on a referral basis from other community providers. We are currently providing viral hepatitis care for prisoners via a partnership with the Idaho Department of Corrections, as well. All residents rotate through the hepatitis C clinic, and can gain extra experience via elective rotations.


Addiction Medicine

FMRI has an active curriculum in addiction medicine. All  residents get training and certification in  Buprenorphine/Suboxone prescribing and receive a waiver from the DEA. One of our family medicine faculty also has board certification in addiction medicine and our head of behavioral health has many years of experience working in addiction medicine. We have a well organized, multidisciplinary, best practice, screening clinic for all patients being considered for controlled substance prescriptions. Between this and a well organized Buprenorphine/Suboxone protocol, we believe that we provide a good model in the care of patients with chronic pain, anxiety,  or substance use disorders that serves our patients well and leaves our graduates with a good framework that they can use in their practices.

Osteopathic Manipulative Therapy

Osteopathic Physicians are rapidly becoming a major part of the physician workforce. The Family Medicine Residency of Idaho recognizes the growing number of Osteopathic Physicians who desire Osteopathic training during residency. FMRI offers longitudinal training in Osteopathic Manipulative Medicine to Osteopathic Physicians interested in continuing to improve their pre-doctoral skills. This includes integrating osteopathic manipulative therapy (OMT) into a resident’s own continuity clinic, as well as an OMT-focused clinic. Further opportunities include Fascial Distortion Model, trigger point injections, quarterly osteopathic journal clubs, and OMT didactics during residency-wide conference days.

Osteopathic Curriculum


Transgender Health Clinic

The Transgender Health Clinic at FMRI is housed at the Emerald Clinic and run by faculty physician Dr. Marvin Alviso. Dr. Alviso and nursing staff create an accepting atmosphere in offering health services for patients 8 years old and up. Services include gender affirming hormones, puberty blocker options and assistance in navigating transition needs. Currently an integrated part of Dr. Alviso’s regular clinic schedule, the Transgender Health Clinic will become a dedicated 3rd Tuesday session beginning in January 2018. This scheduling will allow residents and students to spend time in a focused transgender clinic to gain subspecialty experience.