San Juan Regional Health

Rotations:

Rotation Structure: Residents are scheduled on monthly rotations with designations to either days or nights without overnight call.

Rotation Locations: Residents will complete most of their rotations within the San Juan Regional Health system. However, residents will have out-of-network rotation opportunities with neighboring Northern Navajo Medical Center in Shiprock, New Mexico, Common Spirit Mercy in Durango, Colorado, and other nearby Indian Health Service clinics.

Continuity Clinic: Residents will have one full day of continuity clinic at San Juan Health Partners Internal Medicine and Specialty Clinic each week except when on certain high-intensity rotations where they will establish and manage a dedicated panel of patients. Residents will complete a Neighborhood Assessment Project in a location where a majority of their patient panel resides to inform how Social Determinants of Health might impact health and inform care of their patients.  Residents will be a part of a team with a designated clinic mentor to build and nurture an environment of support and collaboration over the three years of residency. Residents will have alternating designated afternoons for panel management.

Immersion Block: During the first month of residency, residents will complete an immersion block to orient to the multidisciplinary team, population, services, and land in San Juan County and our catchment area including tribal lands. In person visits to the various relevant organizations including the Sobering Center, the local shelter among many more will create context for care throughout their training. Residents will have the opportunity to join the AirCare team to pick-up helicopter transfers from our catchment area to appreciate the vast landscape we serve.

Additionally, residents will receive intensive procedural Simulation-Based Training in a psychologically safe environment followed by afternoons with interventional radiology and other specialty services to develop early exposure to set the foundation for procedural training. Residents can then tailor their procedural skills to career aspirations over the course of residency.

Critical Care Rotations: Residents will complete yearly critical care rotations within our 23-bed intensive care unit where they will be exposed to significant procedural opportunity, critical care specific didactics and undergo a rigorous POCUS training.

Subspecialty Rotations: Subspecialty rotations will offer a mix of both inpatient and outpatient care.

Research:  Residents will be provided a concrete framework on the discrete steps of a research project including Institutional Review Board approval when indicated, how to conduct and carry out different research projects (i.e. case presentations, cohort studies, randomized control trials, etc.). At least one research block on a topic of interest will be required during resident and residents will generate an oral presentation, poster presentation or submit for publication. Residents will additionally have longitudinal time (designated time during other rotations) to move their project forward. Residents will be paired with a mentor.

Quality Improvement: Residents will be paired with one of our four quality department sections: Patient Safety, Infection Control, Quality Management (including Patient Experience Spiritual Care) and Organizational Excellence. During PGY-1, each resident will attend their respective section’s monthly meeting to understand the roles and responsibility of the department and identify an area of personal interest. They will then design and implement the project over PGY-2 and follow-up outcomes and impact during PGY-3 year.

Electives: Residents will be offered six months of individualized educational experiences through electives, quality improvement and research. Elective rotations can be arranged and tailored based on interests and career aspirations.

New Zealand Rotation: You will be offered (not required) a unique opportunity to travel to Whakatane, New Zealand to rotate at a 90-bed hospital serving an approximately 40% Native Māori demographic during your third year where you will be exposed to the contrasting universal, publicly funded health system which provides free or low-cost healthcare to all.

Street Medicine Rotation and Track: Residents will be exposed to Street Medicine through the Sih Hasin Street Medicine Clinic founded and operating out of Northern Navajo Medical Center. Street medicine was pioneered in the 1990s and aims to provide healthcare and social services to the unsheltered homeless to address their unique needs directly within their environment to overcome barriers to care and follow through by meeting the individuals on their own terms in their own environment with efforts focused on harm reduction and improvement in health and wellbeing. The location of the visit may be in alleyways, urban encampments, under bridges, or the homeless shelter. Resident will attend street medicine clinic in Farmington and Shiprock two days a week during their first year of residency during their addiction medicine rotation. They will then have the opportunity of participating in the street medicine track which will include once weekly Street Medicine clinic in Farmington for nine months of their second or third year of training. The street medicine track will additionally include required research and quality improvement projects focused on street medicine and attendance of the annual International Street Medicine Symposium.