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.
You will spend eight weeks on pediatrics in your R1 year. This will be split between newborn nursery and pediatric hospitalist rotations with supervision from pediatric and FM faculty. In your R2 year, you will do 2 weeks of NICU and 2 weeks of pediatric hospitalist. In your R3 year, you will do 2-4 weeks of pediatric hospitalist as well as 2 weeks of pediatric ER experience. In addition, throughout your MCH (OB) rotations you will do nighttime peds admissions. Consistent exposure to peds inpt care throughout residency will help prepare you for rural practice. Our outpatient curriculum is built around our own pediatric focused clinics in Boise, Meridian and Nampa as well as pediatric subspecialty clinic time in Boise. This is also spread across all three years.
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.
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.
You will spend one month in the St. Luke’s ER as an R2 and one month in the Saint Alphonsus ER as an R3. The R2 rotation builds a foundation of ER medicine. The Saint Alphonsus R3 rotation is a Level 2 trauma center providing great preparation for rural practice. Most residents also spend significant time in the ER at rural sites throughout residency training.
You will spend two weeks in the R1 year and four weeks in both the R2 and R3 year at rural sites in Idaho. You will work with our rural focused faculty and coordinator to select sites that fit your training goals. Sites offer a variety of combinations of clinic, ER and hospital experiences that will help you understand the breadth of rural medicine. Rural family physicians from 30 communities participate in our rural training so the offerings are extensive. Housing is provided at sites distant from Boise. Sites close to Boise allow residents with families to balance rural experience and the need to be home at night.
Our largest clinic and training site now offers an Integrative Medicine Clinic, where a full time faculty member offers IM consults and treatments. Residents will have the opportunity to rotate through to learn about a variety of subjects including acupuncture, gua-sha (scraping), herbs/supplements, and mind-body medicine. In addition, we provide an annual Integrative Medicine half day, which is protected time for all residents to be exposed to the above subjects. Additional lectures and exposure available on request. We anticipate continued growth over the next few years in our Integrative Medicine curriculum and offerings for residents.
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.
|Skin||Simple 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 Med||Joint 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
|MSK||Trigger point injection, osteopathic manipulation, fascial distortion model treatment, ganglion cysts drainage and tx
|Hospital||Paracentesis, thoracentesis, lumbar Puncture, central lines, arterial lines, ultrasound guided +/-, airway management and intubations
|Womens Health||IUD, 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 Health||Vasectomy (can track for training), genital/ anal condyloma removal
|Neuro||Migraine treatment- posterior occipital nerve injections, c6 para cervical blocks, sphenopalentine ganglion blocks, sciatica, meralgia parasthetica
|CV||Exercise treadmills, US guided IV/ central line placement, bedside US
|Peds||Circumcision, frenotomy, umbilical artery, vein cath, NRP
|ENT||Flexible 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
|Anesthesia||Conscious sedation, local nerve blocks (oral, peripheral), hematoma blocks
|Wound Care||Unna boots, wound debridement, long term management
|GI||Colonoscopy, 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
|POCUS||Point 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.
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.
Behavioral Health training is at the core of our residency training program. We have integrated behavioral health faculty and LCSWs into our clinic system. This allows for warm handoffs around behavioral issues (mental health, substance abuse, motivational interviewing, etc). Our two behavioral health faculty spend time on rotation with all of our R1s and R2s to build foundational knowledge and clinical care skill sets. We additionally have psychiatry residents who do primary care based continuity clinics at our Raymond site with psychiatry faculty oversight. Formal psychiatry consult clinic occurs on Mondays.
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.
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.
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. The Family Medicine Health Center follows the Centers for Disease Control Guideline for Prescribing Opioids. We try to use alternatives to opioid medications and, if opioids are needed, prescribe the lowest effective dosage. We do not prescribe chronic high dose opioid therapy for patients other than cancer and hospice patients.
Osteopathic Manipulative Therapy
FMRI is now recognized by the ACGME for Osteopathic Training; residents will now be able to choose to enter an osteopathic track after meeting certain criteria which will provide opportunities to expand their osteopathic knowledge in a longitudinal curriculum. Longitudinal training in Osteopathic Manipulative Medicine is offered to Resident Physicians who are 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. Three osteopathic faculty (Shepherdson / Colson / McCormick) provide oversight and mentoring. Additionally, we work hard to teach osteopathic principles and practical skills to our allopathic residents.
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 sub-specialty experience.
You will have 3.5 blocks (or 14 weeks) of time during residency on elective training to further your specific learning goals. You can do electives away from Boise (internationally or in other US locations), as well as locally. You will have control over your elective experiences with guidance available on how to schedule and create experiences that will suit your needs. We also have several longitudinal elective opportunities that you can participate in over the course of residency. In addition to this, the three rural rotations give you the opportunity to select sites / preceptors that fit your interests.