Residencies & Fellowships

The Family Medicine residency is a three-year program that is ACGME-accredited. Eight (8) categorical positions and one (1) Rural Track position are recruited each year.

• Tracks for Global Health, Obstetrics and Rural Training and collaboration with other specialties in various inpatient, outpatient and elective rotations ensure our graduates are well prepared to work in the setting of their choice or attend any fellowship they wish.
• Our program’s diverse group of faculty and residents come from various backgrounds to improve our innovation, creativity and strategic thinking.
• The Educational Fund supports presentations and travel to local, regional and national conferences. The Scholarly Activity Committee is comprised of faculty and resident representatives to improve the health of the community and strengthen the residency. 

The General Surgery residency is a five-year program that is ACGME-accredited. Eight (8) positions are recruited each year.

• Our program’s goal is to provide a comprehensive surgical education incorporating diverse operative experiences, structured didactic sessions and mentoring by internationally acclaimed faculty. Clinical experiences add immeasurably to a resident’s medical knowledge, diagnostic ability and surgical confidence.
• Residents also benefit from Creighton’s Professional Engagement and Resident Leadership Skills (PEARLS) program, which provides the tools to become an excellent leader in the operating room.
• Through diversity in training sites and exposure to broad patient populations, our residents are ensured progressive growth in skills and empathy.

The Internal Medicine residency is a three-year program that is ACGME-accredited. Twenty-six (26) positions are recruited each year. 

• Residents will be exposed to a diverse population through Bergan Mercy hospital, the VA hospital, and our Rural Track program in Kearney. Allowing for a wide variety of clinical problems and stages of disease experiences.
• Inspired by Jesuit values, we take pride in developing, not just our professional skills, but also the whole person.

The Neurology residency is a four-year program that is ACGME-accredited. Two (2) positions are recruited each year. 

• The residency program has highly approachable faculty who specialize in general neurology and major subspecialties and ensure personalized mentorship and support for every resident’s interests.
• Our weekly didactic and educational seminars bring in speakers from all around the country to help further diversify our residents’ interests and skills.
• A balanced workload with ample time for personal study, project development and research exploration supports resident well-being and fosters autonomy and academic excellence.
• Students are also given the opportunity to further their education with multiple training site locations and reimbursement for educational conferences.

The Obstetrics and Gynecology residency is a four-year program that is ACGME-accredited. Four (4) positions are recruited each year. 

The program aims to:

• Train competent specialists in comprehensive obstetrics and gynecology, by offering opportunities for improving surgical skills, utilizing multi-site training opportunities and current guidelines and literature to guide patient care.
• Act on Jesuit values to focus on the patient as a whole person.
• Train culturally competent physicians who focus on the underserved, encouraging residents to recognize different cultures through their clinical experiences and identify barriers to access for care for these patients, helping to overcome some of these social determinants of health.
• Generate lifelong learners who utilize and participate in scholarly activity, including increasing education and awareness of quality and safety issues, increasing didactic time specifically utilized for this purpose.
• Encourage residents to educate other learners and to act as mentors, fostering a robust educational involvement with medical students, participating in daily rounds, on labor and delivery and in the operating room.
• Foster an attitude of physician wellness and well-being, while balancing clinical responsibilities, learning efficiency and remaining resilient.

The Anatomic and Clinical Pathology residency is a four-year program that is ACGME-accredited. Two (2) positions are recruited each year.

• Our mission is to inspire our students, trainees and colleagues through our passion for our specialty and our dedication to the Jesuit traditions of ethical behavior, compassion, social justice and academic distinction.
• As pathologists and clinical scientists, we are committed to discover, understand and teach the pathophysiology of human disease and utilize this knowledge to provide high quality diagnostic information and consultations as an integral part of the patient care team.
• Rotations are at CHI Health Creighton University Medical Center – Bergan Mercy for surg path, cytology, blood bank, chemistry, microbiology, hematopathology, molecular. Other rations are at Immanuel Hospital, American Red Cross and Children’s Hospital.

The Psychiatry residency is a four-year program that is ACGME-accredited. Eight (8) positions are recruited each year.

• Our mission is to train ethical, compassionate, skillful and competent psychiatrists and to successfully prepare our residents for careers of their choosing in clinical practice, academia, research and/or administration.
• Our residents are not only trained to excel in the psychiatric care of patients, but also to provide service rooted in the Jesuit ideal of cura personalis (care of the whole person), which is founded on respecting each person as a part of the creation of God. Cura personalis also applies to our residents education through striving for health equity and eliminating health disparities.
• Our residents will become physicians who are equipped to serve underserved communities, including rural, high poverty and socially disadvantaged areas. They will develop exceptional skill in evidence-based integrated care models, telepsychiatry, community psychiatry and rural psychiatry.

The Radiology residency is a four-year program that is ACGME-accredited. Three (3) positions are recruited each year.

• The Department of Radiology aims to provide an excellent education that prepares our radiology residents for a successful career in the field.
• The small program size and absence of fellows contribute to full access to all Imaging.
• Located in Omaha, NE, a medium-sized, affordable city with many amenities.
• Graduates go on to top-notch fellowships and first-rate job opportunities.
• Additional aims include:
  • Educate radiology residents and medical students in medical imaging including interpretation, therapeutic and interventional procedures.
  • Develop interdepartmental and interdisciplinary relationships to enhance patient care and access.
  • Foster an attitude of leadership and service to others at the local, regional and global levels.
  • Offer a diverse educational experience with academic and community-based exposure.
  • Develop lifelong educational learning practices through scholarly and teaching endeavors.
  • Produce board-certified versatile and collegial radiologists able to practice in all medical environments with a strong focus on quality and safety.

The Urology residency is a five-year program that is ACGME-accredited. Two (2) positions are recruited each year. The program includes six months of general surgery training, and the remaining time is spent on urologic surgery training.  

• The residency will provide graduates with the ability to provide exemplary compassionate clinical and surgical care to patients while respecting the ethics, rules and laws which guide modern medicine. This will be done by the Jesuit-guided principles of excellence in education, research and quality compassionate medical care.
• The program aims to:
  • Produce clinical urologists well-versed in evidence-based medicine. Strong emphasis on using national evidence-based guidelines such as those from the NCCN and AUA in clinical decision making.
  • Train competent surgeons capable of safely and effectively treating the breadth of urological pathology. Continue to train in robotic surgery in adult and pediatric populations. Recent addition of fellowship trained faculty in Urological Oncology, and Minimally Invasive and Surgical Urology.
  • Provide care for a diverse group of patients across the spectrum of socioeconomic status.
  • Emphasize caring for our nation’s veterans and their urological needs.

The Emergency Medicine residency is a three-year program with ACGME accreditation. Sixteen (16) positions are recruited each year.

• Our core purpose is to develop competent and compassionate board-certified emergency physicians with the skills to be leaders in emergency medicine, lifelong learners and ability to practice in any clinical environment.
• Our residents rotate through three adult Level 1 trauma center emergency departments and three trauma center pediatric emergency departments in the valley. These sites offer residents distinct experiences and attending supervision in academic and community settings.

   

The Family Medicine residency is a three-year program with ACGME accreditation. Eight (8) positions are recruited each year.

• Our program aims to:
  • Provide high quality healthcare for our patients and their families, with personal attention to their physical and emotional needs.
  • Create a center of academic excellence that promotes patient care and physician learning in a supportive, collaborative environment.
  • Train a diverse physician workforce to serve our community.
• The Valleywise South Central Health Center is the heart of our program. As a Federally Qualified Health Center, we care for a diverse population of patients.

The Internal Medicine residency is a three-year program with ACGME accreditation. Twenty-six (26) categorial and seven (7) preliminary positions are recruited each year.

• The mission of the Internal Medicine Residency Program is to train compassionate and clinically outstanding physicians who:
  • Provide the highest quality, evidence-based, patient-centered care;
  • Advance the practice of medicine through excellence in patient care, education, research, and quality improvement;
  • Lead the nation in changing healthcare to meet the needs of the population, with special attention to the underserved.
• Residents treat a wide variety of pathology and provide care to a diverse population of patients both at St. Joseph’s Hospital and Medical Center and at Valleywise Health Medical Center.
• Our residency program is known for its collegial, collaborative environment, where residents, students, faculty and interprofessional team members work together to optimize patient care.

The Obstetrics and Gynecology residency is a four-year program with ACGME accreditation. Nine (9) positions are recruited each year.

• Our mission is to train excellent obstetrician gynecologists to be capable of independent practice in our specialty, eligible for competitive fellowship programs, and to function as leaders within the community.
• The structure of our program allows our residents to gain experience by caring for a diverse patient population.
• The Obstetric Services at both hospitals (Valleywise Health Medical Center and Dignity Health St. Joseph’s Hospital and Medical Center) combined have over 5,500 deliveries per year (35% high risk) and both are tertiary care centers that receive maternal-transport patients.

   

The Podiatry residency is a three-year program approved by the Council on Podiatric Medical Education (CPME). Two (2) positions are recruited each year. 

• The Podiatric Medicine and Surgery Residency Program with Rearfoot/Reconstructive Ankle functions primarily at Valleywise Health Medical Center, a 325-bed, county-owned acute care hospital.
• We aim to develop board certified podiatric physicians with the skills to become leaders in podiatric medicine and surgery.
• We are a small and close-knit, supportive residency that ensures each resident excels in the pursuit of personal and professional goals, while fostering a culture of academic excellence and service to the community.

The Psychiatry residency is a three-year program with ACGME accreditation. Seven (7) positions are recruited each year.

• Our program combines Valleywise Health Center’s historical commitment to our community with the academic rigor of Creighton University School of Medicine.
• Residents and faculty work closely together as part of a treatment team model that includes nursing, social workers, case managers, psychologists and recreational therapists.
• Our residency program is known for its balance in providing solid training in both the biological and psychotherapeutic aspects of practicing Psychiatry.

The Diagnostic Radiology residency is a four-year program with ACGME accreditation. Eight (8) positions are recruited each year.

• Our program is combined between two primary clinical sites: St. Joseph’s Hospital and Medical Center and Valleywise Health. We believe diversity enhances the educational experience of our residents and faculty while strengthening our specialty and profession.
• Both sites are home to a busy Level I Trauma Center and Emergency Department. The residents also have exposure during rotations to complex imaging interpretation and procedures through Barrow Neurological Institute, Norton Thoracic Institute and Center for Liver/Hepatobiliary Disease, Phoenix Children’s Hospital and Phoenix Veteran’s Administration Medical Center. We offer a team approach to patient care with interdepartmental collegiality.
• Our radiology residency program provides residents a comprehensive and solid foundation in general diagnostic radiology, yet is flexible, allowing additional areas of interest in the curriculum.

The Surgery residency is a five-year program with ACGME accreditation. Eight (8) categorial and 12 preliminary positions are recruited each year. 

• Our program is focused on training surgeons to be independent within the typical five-year training period. Several of our graduates choose to go into practice straight out of residency and are successful. For those who choose fellowship, they have matched at highly competitive programs, including Harvard (transplant), UC Irvine (colorectal), Johns Hopkins (endocrine), Mayo Clinic Rochester (cardiothoracic), Cleveland Clinic (breast surgical oncology) and University of Tennessee (trauma/critical care).
• Our two main hospitals (Valleywise Health Medical Center and Dignity Health St. Joseph’s Hospital and Medical Center) align with the Creighton mission to provide care for the underserved, including routine, tertiary and destination care for the Phoenix area, the state of Arizona and beyond.

Our one-year program offers comprehensive training in advanced endoscopy procedures, focusing on managing complex pancreaticobiliary disorders and other clinical scenarios requiring advanced endoscopic interventions. Trainees will engage in clinical research and attend educational courses, providing them with excellent opportunities for professional development. Our aim is for fellows to emerge as experts in the field upon completion of the program.

The Cardiovascular Disease fellowship is a three-year program with ACGME accreditation. Five (5) positions are recruited each year. 

• The purpose of this program is to prepare physicians who already possess a background in internal medicine for a career in cardiovascular medicine.
• Comprehensive training in all major aspects of clinical cardiology is combined with training in basic and clinical cardiovascular research. Opportunities exist in a variety of research disciplines.
• Our mission is to produce cardiologists who embody the Ignatian value of cura personalis in both the learning and clinical practice environment and provide the highest quality cardiovascular care to patients across the region with a focus on clinical excellence, patient safety, and delivering evidence-based medicine in a cost-effective manner.

The Child and Adolescent Psychiatry fellowship is a two-year program with ACGME accreditation. Two (2) positions are recruited each year.

• The primary goal of the program is to train psychiatrists to become proficient in the diagnosis and treatment of a wide range of psychiatric disorders in children and adolescents. Our training program is based on the biopsychosocial approach, with an emphasis on child and adolescent development within the context of family, school and community.
• Our program is based on the biopsychosocial approach, with an emphasis on child and adolescent development within the context of family, school, and community.
• Clinical skills are developed at a variety of sites within the Omaha community including our clinical partner, CHI Health and Children’s Nebraska. Our didactic content is robust, and we partner with other programs across the nation in inter-institutional case conferences to broaden our base of learning.

The Colon Rectal Surgery fellowship is a one-year program with ACGME accreditation. One (1) position is recruited each year. 

• We prepare surgeons to practice the subspecialty of colon and rectal surgery, competently, independently, and with the highest ethical standards. It is expected that graduating fellows will ultimately achieve board certification in colon and rectal surgery. 

The Endocrinology fellowship is a two-year program with ACGME accreditation. One (1) position is recruited each year.

• The program provides fellows with a well-rounded, comprehensive two-year curriculum in endocrinology, diabetes and metabolism that will instill the fundamentals to pursue any career path (within the broad field of endocrinology) they choose. This includes exposure to the multiple areas of competent, caring expertise, procedures and practice varieties available to the endocrinologist without sacrificing a comprehensive/intensive experience managing the acute and chronic diseases commonly encountered by endocrinologists.
• We will train excellent, independent practitioners who will be leaders in professionalism, and will increase awareness of health disparities and the need for quality improvement in medical care.

The Obstetrics fellowship is one year and is ACGME accredited. Two (2) positions are recruited each year.

• This fellowship recognizes the important and expanding role of family medicine in population health and acknowledging the finite numbers of clinicians offering obstetric care in rural and urban healthcare environments.
• Our goal is to ensure our fellows graduate with the ability to manage high-risk obstetrical patients until they can get the next level of care. We prioritize cesarean sections for the fellow and expect 75-100 during the one-year fellowship. 
• Passion for cura personalis, or care for the whole person and family, is seen throughout our faculty and program.

The Gastroenterology fellowship is ACGME accredited with both one- and two-year options. One (1) position is recruited each year.

• The Division of Gastroenterology will support the Creighton University mission by increasing Creighton’s effect on the education and provision of healthcare at the local and national levels.
• We aim to:
  • Train top fellows and residents who share our intellectual, social, and spiritual values.
  • Provide excellent medical care to patients, within an environment of intellectual rigor to foster delivery of the best practices to the individual and the community as a whole.
• In addition to clinical breadth, fellows have world-class support in clinical and translational sciences, genetics and GI malignancies. Current fellows have investigated topics related to esophageal and motility issues, gastric cancer in Lynch Syndrome, hepatitis C eradication, and various other clinical and quality improvement projects.

The Global Surgery fellowship is 12 months and non-ACGME but is categorized under “additional training”. One (1) position is recruited each year.

• The purpose of the Creighton University Global Surgery Fellowship program is to significantly impact the absence of acute surgical care in low-resource, rural and marginalized communities in the United States and low and middle income (MIC) countries.
• The fellowship will use the preferential option for the poor to guide all activities for patients, trainees, employees and co-volunteers while providing free surgery to save the lives of underserved patients and surgical training for developing country trainees.

The Hospice and Palliative Medicine fellowship is 18 months and is ACGME accredited. One (1) position is recruited each year.

• The fellowship will prepare you for a fulfilling career as a leader in hospice and palliative care through a combination of inpatient, ambulatory, home-based and long-term care experiences.
• The program is dedicated to creating transformative physician leaders who will, though excellent clinical care, operational innovation and scholarly rigor, contribute to the promotion or local, regional and national practice of hospice and palliative care.
• Our program enjoys an integrated Core Lecture Series with other HPM fellows in the Omaha metro area, which promotes camaraderie and professional development. It also boasts a unique integration with Creighton’s medical humanities program, which we believe will enhance our graduates’ practice and leadership in the field.

The Infectious Disease fellowship is a two-year program with ACGME accreditation. One (1) position is recruited each year.

• The Infectious Diseases Fellowship offers outstanding clinical training in a culturally inclusive medical center. It is a two-year postgraduate training program with an option for an additional year of training in Critical Care Medicine.
• The program offers mentored scholarly activity, public health and stewardship training, collaborative didactics (micro lab and pharmacy), and a collegial learning environment with a good work/life balance.
• To maximize educational training, the program includes;
  • 4 months of inpatient care at Creighton University Medical Center – Bergan Mercy
  • 4 months of inpatient care at the VA Medical Center in Omaha
  • 1 month of solid Organ Transplant and Oncology ID
  • 3 months research/scholarly activity, including quality improvement

The Interventional Cardiology fellowship is a one-year program with ACGME accreditation. One (1) position is recruited each year.

• The mission of the fellowship is to produce physicians embodying the Ignatian value of cura personalis who aspire to become transformative leaders in their practice, institution and community by emphasizing clinical and scholastic excellence, patient-centered care, lifelong learning and wholesome development of the individual.
• We aim to train our fellows to be well prepared to navigate the complex world of interventional cardiology by fostering competence in the clinical knowledge, procedural skills, clinical judgment, professionalism, and interpersonal skills required as a specialist in interventional cardiology.
• Our fellows get a comprehensive experience in the ever-complex world of interventional cardiology, including performing over 500 coronary interventions.

The Methodist-Creighton Head and Neck Oncologic Reconstructive fellowship is a one-year program with ACGME accreditation. One (1) position is recruited each year.

• Fellows will gain a vast, diverse and excellent operative experience encompassing both the ablative and reconstructive aspects of head and neck cancer surgery, endocrine surgery, robotic surgery, and the utilization of ultrasound, which are all vitally important skills for a technically sound head and neck surgeon to have.
• Fellows complete their training understanding three things:
  • The holistic approach to the comprehensive care and treatment of patients with head and neck cancer.
  • The importance and interplay of mental health, spiritual health, and physical health on the impact of cancer care.
  • How to be the primary advocate for his or her head and neck cancer patients.

The Pulmonary and Critical Care fellowship is a three-year program with ACGME accreditation. Four positions are recruited each year.

• We prepare physicians to practice the subspecialties of pulmonary disease and critical care medicine competently, independently, and with the highest ethical standards. It is expected that graduating fellows will ultimately achieve board certification in these medicine subspecialties.
• The teaching faculty of the Pulmonary and Critical Care Medicine Fellowship Program are united by their unwavering commitment to respect in the face of diversity, interprofessional collaboration, life-long scholarship, and compassion for those who are suffering.
• The program is learner-focused academically rigorous, prioritizes well-being and sense of purpose without sacrificing education, and allows recruitment of trainees with the highest moral character.

The Cardiovascular Disease fellowship is a three-year program with ACGME accreditation. Five (5) positions are recruited each year. 

• The purpose of this program is to prepare physicians who already possess a background in internal medicine for a career in cardiovascular medicine.
• Comprehensive training in all major aspects of clinical cardiology is combined with training in basic and clinical cardiovascular research. Opportunities exist in a variety of research disciplines.  
• Our mission is to produce cardiologists who embody the Ignatian value of cura personalis in both the learning and clinical practice environment and provide the highest quality cardiovascular care to patients across the region with a focus on clinical excellence, patient safety, and delivering evidence-based medicine in a cost-effective manner.

The Child and Adolescent Psychiatry fellowship is a two-year program with ACGME accreditation. Four (4) positions are recruited each year.

• We aim to develop future child and adolescent psychiatrists who are knowledgeable, empathic and able to provide leadership in the care of a diverse population of children.
• Fellows staff the Valleywise Behavioral Health Center – Mesa, as part of the treatment team on an innovative inpatient adolescent unit based on a Collaborative and Proactive Solutions model developed by Dr. Ross Greene.
• Fellows also staff the Mesa Outpatient Clinic, providing comprehensive assessment and psychiatric care including medication, psychotherapy and parent guidance for children and families in need.
• Fellows have access to unique training experiences with specialized populations throughout the Valley, including rotations focused on child maltreatment, children birth to five and school consultation with Native American children.

The Emergency Medicine Ultrasound fellowship is a one-year non-ACGME accredited program . Two (2) positions are recruited each year. 

• As of 2021, the program obtained full accreditation under the Emergency Ultrasound Fellowship Accreditation Council (EUFAC). As a result, we allow our fellows to become certified through the American Board of Emergency Medicine (ABEM) in advanced EM Ultrasonography via the Focused Practice Designation (FDP) upon graduation.
• We train our fellows to be experts in all facets of emergency point-of-care ultrasound, including administration, education, and research.
• The fellowship is based at two Valleywise Health hospital campuses. The main campus serves as a tertiary level 1 trauma center that houses a three-year EM residency program, and the secondary campus serves as a freestanding emergency department.

The Gastroenterology fellowship is a three-year program with ACGME accreditation. Two (2) positions are recruited each year. 

• We train gastroenterologists who will provide high quality, evidence-based, compassionate patient care and demonstrate lifelong learning. The lifelong learning tradition developed during their training will allow the graduating fellows to stay up to date with the gastrointestinal and hepatologic diseases literature.
• Our major training sites are Dignity Health St. Joseph’s Hospital and Medical Center and Valleywise Health. The tertiary and quaternary care centers offer exceptional environments for educational experiences through high volume and complex cases, with exposure in areas of general gastroenterology, pancreato-biliary disorders, inflammatory bowel diseases, motility disorders, hepatology and liver transplant related care.

The Global Women’s Health fellowship is a two-year non-ACGME accredited program. One (1) position is recruited each year.

• Our program is designed for OB/GYN physicians who desire advanced training in the delivery of women’s healthcare around the world through a combination of clinical experience, education and mentorship.
• Fellows spend approximately half of their fellowship working abroad clinically with partners in Tanzania, China or Botswana.
• The other half of the fellowship is spent as academic faculty in the OB/GYN department at Valleywise Health Medical Center.
• We have partnerships with the Valleywise Health Women’s Refugee Program and Maricopa County Department of Public Health for advanced training and experience in healthcare delivery to traditionally underserved populations in the greater Phoenix area.

The Health Disparities fellowship is a one-year non-ACGME accredited program. One (1) position is recruited each year.

• Our fellowship provides the opportunity for participants to grow in their training at the Society of St. Vincent de Paul (SVdP) clinic, a broad-scale, human services organization with a 75-year history in Arizona and a commitment to provide critical services, including access to quality healthcare for the most vulnerable in the community.
• The Virginia G. Piper Fellow in Health Disparities will work to provide high quality healthcare to uninsured, underserved patients and to decrease healthcare disparities through continued research, training, and teaching at the Piper Medical Clinic at SVdP.

The Hospice and Palliative Medicine fellowship is a one-year program with ACGME accreditation. Two (2) positions are recruited each year.

• The program aims to train top-notch academic Hospice and Palliative Medicine physician leaders who advance the field of Palliative Medicine through innovation and human kindness.
• We are dedicated to creating transformative physician leaders who will, through excellent clinical care, operational innovation, and scholarly rigor, contribute to the promotion of local, regional, and national practice of hospice and palliative care.

This three-year fellowship is accredited by the ACGME (Accreditation Council for Graduate Medical Education). Currently, our program recruits for 14 positions each year.

• The fellowship prepares future leaders in high-risk obstetrics through comprehensive clinical training, cutting-edge research and a commitment to health equity.
• Our vision is to graduate Maternal Fetal Medicine specialists who are not only highly skilled clinicians but also compassionate advocates for women and infants.
• Fellows gain expertise in complex pregnancies, fetal procedures and patient-centered care at Valleywise Health and Dignity Health St. Joseph’s Hospital and Medical Center.

The Surgical Critical Care fellowship is a one-year ACGME-accredited program, with two approved positions annually at Valleywise Health Medical Center in Phoenix.  

The Burn-Surgical Critical Care fellowship is a one-year program at the Arizona Burn Center at Valleywise.

• Candidates for either fellowship include general surgery residents who are on track to complete their General Surgery Residency training.
• Our program is focused on providing candidates with advanced clinical training to produce academic leaders in the areas of critical care and trauma.
• The program provides an integrated, multidisciplinary critical care training experience that encompasses all clinical disciplines.

The Women’s Imaging fellowship is a two-year non-ACGME accredited program. One (1) position is recruited each year. 

• Our fellowship is designed as a post-residency transition to academic practice, subspecialty fellowship, or private practice for graduating residents in Obstetrics and Gynecology or Radiology.
• Combined training is provided through the Department of Obstetrics and Gynecology and the Department of Radiology in women’s imaging, with ultrasound as the primary modality.