Internal Medicine Residency Rotation

Alaska Native Medical Center

The Alaska Native Medical Center (ANMC) is a 140 bed tertiary referral center dedicated to the care of Native Alaskans. In the department of medicine our staff of hospitalists provide 24hr/7 days inpatient coverage. A variety of subspecialty services are included within the Department of Internal Medicine, including Pulmonary and Critical Care, Cardiology, Nephrology, Dermatology, Rheumatology, Neurology, and Hematology and Oncology. Gastroenterology is split between the general internists (EGD’s) and the general surgeons (colonoscopies and ERCP’s). There are also two Hepatologists on staff.

Residency Rotation

We have had a variety of internal medicine residents rotating through our facility from Yale University and the University of Washington in the recent past. On occasion we have also had international medical students join us from England, Germany and Australia. We are currently working with the University of Washington and the Oregon Health and Sciences University to establish a more regular stream of residents working here, and are also open to residents applying for rotations from other medical schools.

Our service provides ample opportunity for residents to enrich their knowledge and gain experience in ICU skills, gastrointestinal endoscopy and other procedures. Residents are autonomous in assessing patients and devising diagnostic and treatment plans but are supervised by attending physicians with whom they discuss daily patient care. They admit daily and on average will be seeing 5 to 10 patients per day. Depending on individual interests, we can try to accommodate time spent on our service to be geared towards future fellowships (i.e. more ICU time, endoscopy experience, cardiology exposure etc).

The broad range of conditions in our patient population is overall representative of a typical general medical population, but with some conditions unique to the Alaska Native population such as cases of paralytic shellfish poisoning and botulism related to dietary factors. In addition, we see a large number of patients with liver diseases including alcohol related disease that may be coupled with underlying liver conditions (such as HCV, HBV and NASH) leading to end stage liver disease in relatively young patients.

Various infectious diseases including HIV and tuberculosis, botulism and infective endocarditis are frequently seen on our inpatient service. MRSA is endemic among villages in rural Alaska. Hence, we have encountered cases of serious MRSA disease, even in healthy young people.

Two other areas where we see an increase in morbidity and mortality in Alaska Natives are oncology and cardiovascular diseases. There have been many changes in culture of Alaska Natives as they opened themselves to western life style.

Many or our patients present in the later stages of diseases with clinical manifestations not frequently encountered in other settings. We have an abundance of interesting cases which makes for an exciting medical experience but also an opportunity to work at improving the health of a population.

Alaska Native peoples are culturally unique and interesting and gratifying to work with. Some of our patients do not speak English and come from remote villages where access to medical care can be problematic. Working at our facility affords an opportunity to work with a unique culture, and enhance skills on how to respect and embrace what is different, and develop tools for bridging cultural divides.

Our facility is dedicated to providing first rate tertiary medical care to people residing in rural conditions unique to Alaska. We are fortunate to have state of the art radiology systems and we are in the process of transitioning completely to an electronic medical record. We are a level 2 trauma facility with full surgical/neurosurgical staffing.

Our staff is committed to teaching and enjoys sharing knowledge with other colleagues. Some of our staff are former chief medical residents and many are relatively young, recently trained and eager to teach. We include residents whenever there is an interesting case or a procedure that a resident in training might benefit from. Teaching is usually provided by the attending physician and is linked to patient care. W have a weekly Grand Rounds program with speakers from the community as well as from outside Alaska.

Expectations from residents working with us include the following:

• Daily rounds on patients and discussion with the attending physician regarding the plan of care for patients. We expect the resident to take “ownership” of patient care and to do so in a culturally sensitive way. We encourage continuity of care and residents will follow their own patient from admission to discharge, even if attending physicians must change due to scheduling.
• Participation on daily interdisciplinary ICU rounds with the ICU team (if resident wishes to gain more ICU experience). Performing all needed procedures with supervision as needed.
• No weekend or night schedule, is expected, however many interesting cases arrive from remote villages in the evening hours. Therefore, if residents are interested we can accommodate working flexible/late hours. Otherwise, they will be expected to work from 8am-6pm Monday-Friday. We will adhere to resident work hour restrictions.
• Every evening before leaving the hospital, the resident is expected to check out with the on-call physician to sign off on his/hers patients.
• Journal club (discussing an article from a leading medical journal) or a case presentation for 30-45 min at the end of his//her rotation.

We encourage feedback in the middle and at the end of the rotation, in order to ensure satisfaction with the rotation. Our goal is to make this rotation the best possible experience for residents with emphasis on exposure to clinically challenging cases in a culturally unique environment.