Swedish Rural Training Track

Program Overview

The Swedish Cherry Hill Rural Program is a 1+2 Rural Training Track (RTT), where residents have the unique opportunity to train in Seattle, WA with the core Swedish Cherry Hill FMR program for their first year, before relocating to Port Angeles, Washington, on the Olympic Peninsula for the following two years to train with a rural focus. The Swedish Cherry Hill RTT attracts residents from diverse backgrounds who are passionate about providing full-spectrum primary care to underserved rural communities and who are called to improve the health and well-being of vulnerable populations in rural areas.

Training Sites

The Swedish Cherry Hill Rural Training Track (RTT) welcomed its first class of two residents in 2017 and has now grown to three residents per year. Residents spend their first year practicing in an urban, community-based clinic with their Cherry Hill colleagues, spending most of their year on inpatient and obstetrics rotations at the Swedish First Hill campus, as well as inpatient pediatrics and pediatric emergency medicine at Seattle Children's Hospital.

RTT residents relocate to Port Angeles, Washington, for their remaining two years where they train with full-spectrum family physicians who also practice high-risk obstetrics. Port Angeles is a small community of about 20,000 people located at the base of the Olympic Mountains on the shores of the Straight de Juan de Fuca, whose healthcare systems serve a rural catchment area for the entire county of about 77,000 people. Outpatient training takes place at North Olympic Healthcare Network (NOHN), a HRSA-funded, Federally Qualified Health Center, while inpatient and obstetrics care are provided at Olympic Medical Center (OMC), a 67-bed acute-care safety net hospital, with a level III trauma center, birth center and busy emergency room with approximately 30,000 ER visits annually.

Residents also rotate with community preceptors in various specialties, and have opted to take elective rotations at a nearby tribal health center, the Clallam County Jail as well as away rotations at Indian Health Service sites and international sites through the Swedish-sponsored Malawi Global Health program. Family physicians have been providing full-spectrum care in this community since the 1950s and continue to attract new graduates who want to practice in small rural communities.

NOHN also serves as a clinical clerkship site for the University of Washington School of Medicine Targeted Rural Underserved Track (TRUST) scholars and often hosts sub-interns from the Washington State University College of Medicine providing senior residents the opportunity to develop clinical teaching skills.

Patients at a Glance: NOHN

Racial and Ethnic Identity, 2023

Language, 2023

1.21% of patients are best served in a language other than English.

Age, 2023

16% under 18 y/o, 25% over 65 y/o

Learning Opportunities

The Swedish Cherry Hill RTT has a unique focus of integrating outpatient and inpatient family medicine practice. Similar to the core program, the curriculum is divided into 4-week blocks, however RTT residents have distinctly different schedules, where they take integrated inpatient and OB call weekly, with more frequent call shifts during inpatient months. This longitudinal call structure allows the resident to practice in the way many rural family physicians do in this community, which is full-spectrum continuity with a consistent presence in the hospital. This prepares them to practice in similar rural settings after graduation. It also allows RTT residents to transition seamlessly between the clinic, emergency room and hospital, caring for pediatric, obstetric and ICU patients, with options to hone in on particular areas of interest to meet the goals of each resident.

Residents become proficient in a wide range of inpatient and outpatient procedures, provide prenatal and obstetric care, provide medication assisted treatment (MAT) for substance use disorders and regularly take part in community assessments and advocacy. They receive robust procedural training from family medicine preceptors, as well as hospitalist, emergency, interventionalist and surgical colleagues. Other unique opportunities include training to perform endoscopies and colonoscopies, learning point of care ultrasound, assisting with C-section deliveries, managing vents and drips in the ICU, providing adult and neonatal resuscitation, as well as integrated behavioral, addiction and procedural medicine.

In a small community like this, residents learn what resources are available, and when patients need to be transferred or referred out of the area. RTT residents participate in quality improvement projects, community-based activism and advocacy initiatives and continue to interface with the core program on a regular basis with dedicated retreats throughout the year. They also continue to have weekly afternoon didactics with the Swedish Cherry Hill FMR, present on various topics including evidence-based medicine and obstetric cases and give a final grand rounds presentation at the end of their third year. They are also able to participate in any of the Swedish Cherry Hill FMR Areas of Concentration (AOCs) if they are on track to complete graduation requirements.

Read about our rotations:

Faculty & Residents

The RTT core faculty consist of three physicians: Rob Epstein, MD (Program Director), Linsey Monaghan, MD (Assistant Director) and Ned Hammar, MD (Assistant Director), with a multitude of other physicians on inpatient and obstetric teams, as well as specialty community preceptors. Two of our most recent graduates are remaining at NOHN for family practice. You can read more about some of their paths in medicine here and exploring the links below.

• Training rural physicians is racial justice

• As newly insured seek care, rural doctor shortage worsens

• US senator tells Peninsula health officials of opioid efforts

• Suboxone treatment: Port Angeles clinic to triple capacity

Swedish Cherry Hill FMR and RTT are resident-driven programs, with ongoing collaboration between faculty, staff and residents to develop an iterative curriculum to meet the many different needs of all residents. A common phrase used amongst RTT faculty and residents is that we are “building a boat in rising waters” and that we train residents to practice "rural generalism." This means we learn to understand the needs of a community, adapt our training to meet those needs, and collaborate and evolve with the needs of individual learners. In a small community, health extends far beyond the four walls of the clinic, and RTT residents experience this reality as they conduct home visits and extend their care across multiple generations of families. This is why it is imperative that we continue to train physician leaders to think critically about the barriers and social determinants of health, highlight the intersectionality of systemic oppression and medicine and work towards instigating change in order to improve overall health outcomes.

Thank you so much for taking the time to explore the Swedish Cherry Hill Rural Training Track. Please feel free to reach out to Residency Coordinator Jaima Hardman with any questions.

The NRMP Match number 1755120C9 must be used when ranking RTT.

Virtual Tour

Visit our Rural Training Track residents up in Port Angeles, Washington! Let the residents and faculty show you their community and talk about their unique curriculum and 1+2 experience: one year of training in the heart of Seattle before moving to Port Angeles for years 2 and 3 of residency.

Hear from the residents

Hear from the faculty