General Surgery/Endoscopy
There are two four week surgery rotations, teaching residents to identify and manage surgical pathology. Surgical assistant skills and trauma stabilization are emphasized. The first rotation occurs in the R1 year, where residents work alongside Arizona surgical residents on the Alaska Native Medical Center’s surgical service. There they have opportunity to gain experience developing colonoscopic and EGD skills since 90% of all endoscopy is performed by the surgical service. The surgical residents rarely participate in endoscopy thus leaving ample opportunities for the R1. Interested residents can also work with Family Medicine faculty to further develop EGD and colonoscopy skills. As an R3 another rotation is spent with private surgery attendings at Providence. The experience ranges from general to colorectal surgery, to managing trauma and acute exposure injury. A research paper is required that has resulted in publications for multiple previous residents.

Internal Medicine
The Internal Medicine Service at Providence Alaska Medical Center provides a comprehensive general internal medicine and procedural experience throughout the resident’s three years. The Internal Medicine Service generally consists of a team of four interns, an inpatient chief resident, and a supervising faculty member. On average call occurs every fourth night. Residents work closely with the Internal Medicine hospitalist service, Family Medicine faculty, and community attendings. Residents manage inpatients throughout their hospital stay both in and out of the intensive care unit. Teaching rounds occur daily with Family Medicine faculty and community attendings. During the third year, each resident serves as team leader/teacher on the inpatient service for a five-week period and shares supervisory night call. This helps develop a broader and more sophisticated understanding of patient care. Second year residents manage critically ill patients during a six-week ICU/CCU rotation. There are also many options available for subspecialty rotations at Providence and the Alaska Native Medical Center.

Obstetrics-Gynecology
Obstetrical experience is gained primarily at Providence Alaska Medical Center. The Maternity Center averages 230 deliveries per month and “on-deck” residents are involved in all aspects of low and high-risk obstetrical care including surgical obstetrics. OB call is shared among all residents on OB and gynecology rotations. R1’s have one eight-week OB rotation, and an additional four-week rotation occurs in the second year. R3’s spend four weeks on the antepartum service and in clinic with the only perinatalogy group in the state. Residents interested in cesarean delivery competency have arranged for additional experiences through other institutions in the Pacific Northwest. The gynecology curriculum is taught longitudinally in the Family Medicine Clinic and through rural and ER rotations. In addition, a four-week gynecology rotation occurs during the second year. This rotation is completed at the Municipal Health Clinic, Planned Parenthood, and Alaska Native Medical Center. Colposcopy, IUD insertion, and contraceptive training are emphasized at these sites. Two specific gynecologic procedure workshops are also offered each year.

Orthopedics/Sports Medicine
Orthopedics and Sports Medicine are integral parts of residency training due to the Alaskan population’s young average age and active lifestyle. Two four-week orthopedic rotations occur, one in each of the second and third years at local orthopedic offices. Residents learn casting techniques, X-ray interpretation, surgical management, and emergency stabilization and transport. A variety of sports medicine experiences are included throughout all three years. Residents are required to participate as on-site medical personnel at various sporting events in the Anchorage community, as well as perform pre-participation sports physicals at local high schools.

Pediatrics
A strength of the curriculum, pediatrics is taught longitudinally through multiple venues: on rural rotations, on OB through continuity neonatal care, and 10 percent of the patient population at the Family Medicine Center is pediatric. R1’s spend eight weeks on the pediatric wards and PICU at Providence as part of the Pediatric Service, working with local pediatricians, pediatric intensivists, and pediatric surgeons. R1’s also have a four-week rotation in a neonatal intensive care unit, performing many procedures and neonatal resuscitations. R2's gain more outpatient experience through two four-week rotations at the Alaska Native Primary Care Center Pediatrics Clinic. They are also exposed to adolescent medicine through clinics at the Anchorage juvenile detention center. R2’s share call coverage of the inpatient pediatric service while on pediatric rotations. Third year residents serve as pediatric in-patient chief for one month, working with the interns and 3rd year medical students to manage the care of almost all of the pediatric patients admitted to Providence.

Rural Experience
There is no substitute for direct rural experience. The residency encourages as much rural experience as is allowed by the Graduate Medical Education guidelines. A six-week block in the R2 year is spent in either Bethel at the Yukon-Kuskokwim Delta Regional Hospital, or in Dillingham at Kanakanak Hospital. The experience includes heavy patient volumes, pathology rarely seen elsewhere, frequent patient transport (often in adverse weather conditions), obstetrics, village site visits and the challenging task of evaluating patients by phone through discussions with community health aides. R3’s spend eight weeks in rural rotations elsewhere in Alaska, often being one of only a few physicians, hours from the nearest major medical facility. These rotations help residents to understand the uniqueness of delivering health care in bush and rural Alaska.

Specialty Clinics
Unique, integrated four-week rotations during the second and third years allow each resident to participate in a variety of specialties over a prolonged period. ENT, ophthalmology, dermatology, and urology are all represented on a weekly schedule. The design allows residents to follow individuals seen in specialty clinics over time so that responses to therapy, complications, and outcomes are experienced with continuity. Training occurs in both private offices and public clinic settings providing residents with multiple perspectives on the delivery of health care.

Trans-Cultural Medicine
Trans-cultural medicine is a curriculum unique to the Alaska Family Medicine Residency held during December/January for all R1 and R3’s. It integrates Alaskan geographic, ethnic, environmental and political issues into components of cultural competency, wilderness and survival medicine, rural and remote medical skills, and complimentary/alternative medicine practices. The faculty tailors each course to the needs of the individual year. During this time, R2’s take all in-patient hospital call so as to promote teambuilding and protect R1 and R3’s from burnout. Wilderness Medicine Training with snow-cave building and winter camping occurs during this rotation as do Talking Circles and Native Sweats.

Electives
AKFMR elective policy states that a resident may do any medical elective they desire in the state of Alaska with an MD/DO overseeing them, as long as it fits within RRC guidelines. This flexibility in establishing rotations allows residents to personalize and tailor their training to fit personal interests or particular needs. If a resident desires to receive training in a field or subject that is not adequately taught in the state of Alaska, they may go “outside” (the lower 48) after special consideration.

Behavioral Sciences
The Behavioral Science curriculum is integrated throughout the 3-year residency. It includes didactic sessions on common behavioral issues, Balint process groups, outpatient shadowing with the behavioral science faculty, and one-on-one case management and consultation at the Family Medicine Center. A four-week Psychiatry rotation occurs during the third year. This rotation takes place at Providence Alaska Medical Center with a consulting psychiatrist for patients on the medicine, pediatric, and obstetric services. In addition, first and third year residents participate in a four-week Transcultural Medicine rotation.

Emergency Medicine
Emergency medicine training consists of 4-week rotations in each of the first and third years. First year residents work in Soldotna, the Matanuska Valley, or at the Alaska Native Medical Center. Soldotna and the Valley are small towns with catchment populations of approximately 20,000. Medivac transport via fixed wing plane and helicopter are regular activities in Soldotna. Training in airway management is a focus in the first year, with time dedicated to learning and practicing intubation skills. Third years work at Providence Alaska Medical Center, the main referral center for most of the state of Alaska. Emergency medical skills and experience are also gained through the wilderness and survival medicine portion of he TCM rotation, as well as on many rural rotations. Each resident will become certified in ACLS, ATLS, PALS, ALSO and NRP.