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General Practice Training / Clinical Rotations

Rotations

The following information is provided as a summary of clinical rotations for the General Practice Residency Program:

CMC Dentistry/Dental Clinic

Residents spend a total of seven months in the first year and ten months in the second year delivering comprehensive dental care in our outpatient facility. Our clinic provides services to a diverse outpatient population, the vast majority of who are medically compromised. Many of these patients are indigent and rely on Carolinas Medical Center for their primary medical and dental care. Residents have considerable opportunities to select from this population the patients they wish to include in their clinical practice. Treatment plans are discussed in a conference forum to allow all residents to achieve the maximal educational benefit. Specialty sessions including periodontics, oral surgery, endodontics, and pediatric dentistry occur on a regularly scheduled basis. Clinic sessions are staffed by full- and part-time attendings.

Implant Dentistry

During their time in the clinic, residents are introduced to implant dentistry.  Residents work closely with one of the program faculty to identify appropriate cases at the outset of the program. Throughout the year, special clinic sessions are held. These allow residents the opportunity to place and restore implants. The curriculum in implant dentistry is comprised of didactic and clinical components that provide a broad experience for the general practice resident. The didactic component provides a foundation of knowledge in the biological and scientific basis of implant dentistry and covers a number of clinical scenarios, including implant retained dentures and bridges, single tooth implants, and fixed-removable prostheses. Additional instruction is provided in diagnosis and treatment planning, abutment selection, surgical placement, prosthetic restoration, postoperative care, and maintenance procedures. Several hands-on sessions are held to familiarize residents with implant components involved in the various steps of these procedures.

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Anesthesia (First year)

Residents are assigned to work with a specific staff member of the Department of Anesthesia to learn the principles and techniques of general anesthesia, including preoperative evaluation, venipuncture and intubation techniques, maintenance of patients on anesthetic gases, and monitoring of vital signs. Emphasis is placed on airway management and the pharmacologic and physiologic basis for sedation and general anesthesia. Literature and teaching sessions are provided to residents for study prior to this rotation.

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Oral Medicine (First year)

Residents on this rotation have responsibility for all inpatient consult requests from other clinical services. This oral medicine consult service provides residents with a broad spectrum of challenging dental problems in patients with significant medical considerations. First-year residents are the first to see new consults, present them to a dental attending, and manage them under the supervision of the chief resident. Patients are discussed on walk rounds, and many are brought to the dental clinic for evaluation and treatment. First-year residents also participate in operating room cases generated by the consult service. Residents gain an in-depth experience in the dental management of inpatients and have significant contact with the teaching faculty and community practitioners on other medical and surgical services.

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Oral Medicine (Second year)

Second-year residents are responsible for managing the dental consult service during their chief residency. Here, they supervise the first-year residents' care of the many compromised inpatients seen at the request of other services. The other major responsibility of the second-year resident on oral medicine rotation is to evaluate and manage the medically compromised patients referred on an outpatient basis. Through this experience, they become proficient at medical risk assessment for dental patients and the interdisciplinary management of the medically compromised patient.

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Oral and Maxillofacial Surgery (First and Second years)

Residents spend two weeks with an oral surgeon faculty at their private practice and at a community hospital. Residents also receive extensive clinical experience both at the private practice and at our outpatient clinic observing and performing a wide variety of procedures to include routine and surgical extractions, removal of impacted teeth, alveoloplasty / pre-prosthetic surgery, and biopsies.

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Geriatrics/Carolinas Mobile Dentistry (First year)

Residents in the first year spend two weeks on the Carolinas Mobile Dentistry service, an innovative dental delivery system providing on-site dental care to nursing home residents. Residents apply knowledge of medical history, pharmacology, consent, and patient competency in providing treatment in the long-term care setting. Interaction with nursing home staff to develop interdisciplinary care plans and the team approach to patient care are emphasized.

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Internal Medicine (First year)

Residents have a two-week rotation with the Department of Internal Medicine. Using the training acquired in physical assessment, residents work up, admit, and follow selected inpatients under the supervision of a dedicated group of physician preceptors while on this service.

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Otolaryngology / Head and Neck Surgery (First and Second year)

First-year residents have a four-week rotation on otolaryngology / head and neck surgery. This unique exposure deals primarily with surgical management of benign and malignant disorders of the head and neck region. During this time residents develop and refine their skills in the clinical assessment of the head and neck region, as well as increase their knowledge of disease processes and current treatment modalities. Residents play a role in the admission and management of inpatients while on this service, with a significant amount of training in the operating room. Outpatient exposure is achieved in a community practice setting as well as by attending the Head and Neck Cancer Clinics.

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Emergency Medicine (First year)

Residents spend two weeks in the Emergency Department for formal exposure to nondental (medical) emergencies. Emphasis is placed on urgent and emergent medical problems that could occur in the dental office setting. Supervision is provided by residents and attendings in this department.

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Electives (First and Second year)

First-year residents receive one month, and second-year residents two months, to pursue areas of individual interest. Residents develop a proposal for the utilization of their elective time period and can choose from a variety of dental and medical rotations. Past residents have completed rotations in the following areas: oral and maxillofacial surgery, IV sedation, practice management, delivery of dental care to special patient populations, geriatric dentistry, public health/pediatric dentistry, implantology, and clinical research, to name a few.

Residents may also choose from a variety of medical services on which to spend their elective time. Past residents have completed formal rotations on the following services: internal medicine, otolaryngology, pediatrics, emergency medicine, pathology, psychiatry, anesthesia, radiology, nephrology, general surgery, and family medicine. Residents are totally integrated into these services and function under the supervision of the medical residents and attendings.

Second-year residents have expanded elective opportunities, which allows them to perform any of the above rotations or to spend time at other training sites. Past residents have participated in elective rotations at MD Anderson Cancer Center (Houston), Roanoke Memorial Hospital (Roanoke, Va.), Bowman Gray School of Medicine (Winston-Salem), University of North Carolina Hospitals (Chapel Hill), Massachusetts General Hospital in Boston, Royal Hospital (London, England), University of Virginia Hospital (Charlottesville, Va.), and Glasgow Dental Hospital (Edinburgh, Scotland).

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Clinical Research

Residents may choose to spend their elective month involved in one of the department's ongoing clinical research projects. Current departmental research involves issues concerning bacteremia caused by dental procedures and the relationship with distant site infections, the use of toluidine blue in the early diagnosis of recurrent oral malignancies, and the management of patients with coagulopathies, to name a few. Residents may choose to develop an original research project. During this time, they work closely with one or more faculty and learn the principles of study design, develop research skills, review current medical/dental literature, and pursue formal presentation and/or publication of their work.

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Emergency Dental Care

Carolinas Medical Center is a Level I trauma center and receives a high volume of maxillofacial injuries and other urgent dental care problems. The hospital owns and operates three helicopters, two fixed-wing aircraft, and a jet to transport patients and organs from around the country to our hospital. The emergency room staff manages over 275 patients per day, many of whom are referred from surrounding counties.

The hospital patient population provides a rich experience in a wide spectrum of emergent dental problems, particularly the management of infection, trauma, bleeding, and pain. The high volume, range of conditions, and the close working relationship with residents and faculty from the Department of Emergency Medicine gives residents a strong background in this area. Urgent dental problems are managed in the dental clinic during the day and in the Emergency Department while on call during off-hours. A resident is designated to provide urgent care in the dental clinic on a daily basis.

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Conscious Sedation / Pain and Anxiety Control

The goal of this aspect of the training program is to provide experience in a variety of modalities to allow graduates to competently manage pain and apprehension. The comprehensive didactic curriculum includes instruction in medical risk assessment, pain physiology, regional anesthesia techniques, nonpharmacological methods of controlling pain and anxiety, and the use of inhalation, oral, and intravenous sedation modalities. Additional experience, particularly in the areas of patient assessment, anesthesia pharmacology, airway management, and intravenous access, is obtained while assigned to the anesthesia rotation. Certification in basic life support and advanced cardiac life support is received. This program provides residents with the opportunity to satisfy the didactic and clinical requirements for a conscious sedation permit as outlined by the North Carolina State Board of Dental Examiners. Residents receive significant clinical experience in this area.

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