The Medicine Service

The Medical Service at the University of California, San Francisco consists of six to seven teams providing comprehensive inpatient care to acutely ill medicine patients.

I. Educational Goals

A. Second-year house officer (R2)

At the completion of this rotation, the R2 should be able to:

1. Function as an effective team manager, leader and teacher.
2. Discuss the differential diagnosis and direct the evaluation of diverse inpatient medical problems.
3. Demonstrate baseline competency and improvement in physical diagnosis and medical interviewing skills.
4. Demonstrate baseline competency and improvement in managing the wide range of medical conditions seen in the inpatient setting utilizing an evidence-based and humanistic approach.
5. Demonstrate baseline competency and improvement in knowledge and clinical skills in critical care medicine.
6. Work effectively as a member of a health care team to ensure proper care and welfare of patients.

B. First-year house officer (intern)

At the completion of this rotation, the R1 should be able to:

1. Formulate a differential diagnosis and outline a plan for evaluating and managing diverse inpatient medical problems.
2. Demonstrate organizational skills necessary for the care of medicine inpatients.
3. Efficiently and effectively chart in the medical record.
4. Anticipate and formulate comprehensive discharge plans.
5. Demonstrate leadership and teaching skills through interactions with members of the medical team.
6. Discuss the appropriate utilization of consult services and diagnostic studies.
7. Explain the indication, contraindications, risks and process of venipuncture, arterial puncture, lumbar puncture, paracentesis, joint aspiration, thoracentesis, placement of nasogastric tubes, placement of Foley catheters. R1's should also gain competence in performing all required procedures by the completion of the R1 year.

II. Team Structure and Responsibilities

A. Team structure

The Medical Service consists of six to seven teams, each comprised of an Attending physician, a second year medicine resident, one to two medicine interns, and, during most months of the year, a sub-intern (MS4) and a third-year medical student (MS3). A social worker is assigned to each team to aid in identifying and meeting discharge needs. A pharmacy student provides helpful input regarding medications.

B. Attending physician

1. Holds appropriate clinical privileges at the University of California, San Francisco.
2. Supervises and assumes ultimate responsibility for the care of inpatients admitted to his/her team, including appropriate continuing care, discharge planning and medical follow-up. To achieve this, the attending should conduct daily management rounds which include the following:
a. Interact at regular intervals with his patients.
b. Communicate effectively and frequently with the resident staff regarding management.
3. Conducts daily teaching rounds.
a. Teaching rounds must be patient-based sessions in which a few cases are presented as a basis for discussion of such points as interpretation of clinical data, pathophysiology, differential diagnosis, specific management of the patient, appropriate use of technology and disease prevention.
b. The attending should work with the resident physician to establish and achieve didactic goals for teaching rounds.
c. Teaching rounds must include direct resident and attending interaction with the patient. The teaching sessions must include demonstrations and evaluation of each resident's interview and physical examination skills i.e. teaching rounds must include bedside teaching.
4. Oversees order writing, but residents must routinely write all orders for patients under their care. In those unusual circumstances when the attending writes an order on the team's patient, the attending must communicate his or her action to the resident in a timely manner.
5. Responsible for providing verbal feedback and written evaluation of the resident physician, intern, sub-intern (MS4) and third-year medical student (MS3). Resident evaluations must include assessments of interview and physical examination skills, communication of treatment plans and discharge planning.
6. Responsible for writing admission notes by the end of the day following admission.
7. Responsible for co-signing and ensuring dictation of discharge summaries for each patient in a timely fashion.

C. Second-year house officer (R2)

Under the guidance of the attending physician, the R2 directs the comprehensive inpatient care of acutely ill medicine patients, including those admitted to the MICU, CCU, telemetry unit and regular medicine wards. The specific responsibilities include:

1. Responsible for coordinating the day-to-day function of the team and directly supervising interns and sub-interns.
2. Responsible for attending conferences as required by the Medical Service and the National Internal Medicine Residency Review Committee. Attendance will be monitored with a sign-in sheet. Residents will need to demonstrate at least 60% attendance at each of the required conferences and will be expected to attend as many teaching conferences as allowed by patient care responsibilities. Required conferences are designated as:
a. Daily Residents' Report.
b. Weekly Grand Rounds.
3. Directs the admission and initial evaluation of patients to the medical service.
a. R2s will oversee the initial history, physical examination and review the laboratory data and medical records for all patients admitted to his/her team.
b. R2s will be on-call every fourth night on average.
c. Resident physicians will distribute admissions among members of their individual teams.
i. Interns will be responsible for no more than five admissions per twenty-four hour period and no more than eight admissions per forty-eight hours.
ii. Sub-interns will be responsible for no more than five admissions per twenty-four hours and no more than eight admissions per forty-eight hours.
iii. Resident physicians will be responsible for admitting patients and writing detailed admission notes in excess of five admissions per intern or sub-intern per twenty-four hour period.
iv. Total admissions per medicine team will not exceed twelve per twenty-four hour call day; a Jeopardy resident will be activated for any admissions in excess of twelve per medicine team per twenty-four hour call day; it is the responsibility of the medicine resident to notify the Chief Medical Resident on call (719-9612) in order to activate the Jeopardy system.
v. Resident physicians will be responsible for writing a brief admission summary for each patient admitted to the intern or sub-intern within twenty-four hours of the admission.
vi. Admissions in excess of five per intern or sub-intern (up to a total of eight patients per intern or sub-intern) will be re- distributed to the intern or sub-intern on the post-call day.
vii. Resident physicians will be responsible for ensuring that individual intern and sub-intern patient loads do not compromise patient care and educational goals.
viii. Resident physicians will be responsible for notifying the chief residents if admissions exceed the maximal cap or if patient care is compromised; jeopardy or night float residents will be mobilized by the chief residents to cover any additional admissions to the medical service.
4. R2's direct the interns and medical students in providing continuing hospital care to all of the patients to his/her team.
a. Oversee the daily interval history, focused physical examination, and new laboratory data for each patient on his/her team.
b. Oversee the rational use of consultants and laboratory tests.
c. Oversee the discharge planning and transitional care of all patients.
d. Ensures compassionate communication with patients and families regarding the ongoing care of patients.
5. Ensures adequate communication of patient care issues among members of the team, including the attending physician.
6. Assumes primary responsibility for supervising sub-interns (MS4s).
7. Responsible for providing feedback on the performance of the intern, MS4 and MS3.
8. Responsible for providing written evaluation of the attending physician, intern, MS4 and MS3.
9. Responsible for dictating and co-signing discharge summaries for each patient within forty-eight hours of discharge.
10. Residents will not work in excess of an average of eighty hours per week during any inpatient ward month.
11. Residents will have at least one day off per week. The Attending physician will cover the responsibilities of the resident on his/her day off. The Attending physician shall be available to discuss patient care issues.

D. First-year house officer (intern)

1. All responsibilities and clinical privileges of the intern are under the guidance and supervision of the Attending and Resident physicians.
2. Responsible for patient care in concert with other members of the team.
3. Responsible for attending conferences as required by the Medical Service and the National Internal Medicine Residency Review Committee. Attendance will be monitored with a sign-in sheet. Interns will need to demonstrate at least 60% attendance at each of the required conferences and will be expected to attend as many additional teaching conferences as allowed by patient care responsibilities. Required conferences are designated as:
a. Weekly Interns' Report.
b. Weekly Grand Rounds.
4. Responsible for up to five admissions per twenty-four hour period, or up to eight admissions per forty-eight hour period.
5. Responsible for writing up to five admission notes; supervising residents will be responsible for admitting patients and writing admission notes in excess of five per twenty-four hour period.
6. Responsible for writing or co-signing medical students' daily progress notes on all patients assigned to them.
7. Primary responsibility for supervising MS3s.
8. Interns will not work in excess of an average of eighty hours per week during any inpatient ward month.
9. Interns will have at least one day off per week. The responsibilities of the intern will be covered by his/her resident during the designated day off.

UCSF DEPARTMENT OF MEDICINE

Medicine | Cardiology | CRI | LTU | Consult | ED

The Cardiology Service

The Cardiology Service at the University of California, San Francisco consists of four teams providing comprehensive inpatient care to acutely ill patients with cardiovascular problems.

I. Educational Goals

A. Third-year house officer (R3)

At the completion of this rotation, the R3 should be able to:

1. Function as an effective team manager, leader and teacher.
2. Discuss the differential diagnosis and direct the evaluation of diverse inpatient medical problems.
3. Demonstrate baseline competency and improvement in physical diagnosis and medical interviewing skills.
4. Demonstrate baseline competency and improvement in knowledge and clinical skills in critical care medicine.
5. Function as an effective consultant to R1, R2 and non-medicine colleagues.
6. Work effectively as a member of a health care team to ensure proper care and welfare of patients.
7. On completion of the R3 year, housestaff will be able to provide a reasoned and concise assessment and plan for common clinical scenarios, as outlined in the Clinical Competencies section of Graduate Education in Clinical Medicine: a resource guide to curriculum development (Federated Council for Internal Medicine Task Force on the Internal Medicine Residency Curriculum. 1997. American College of Physicians, Philadelphia, PA).

B. Second-year house officer (R2)

At the completion of this rotation, the R2 should be able to:

1. Function as an effective team manager, leader and teacher.
2. Discuss the differential diagnosis and direct the evaluation of diverse inpatient medical problems.
3. Demonstrate baseline competency and improvement in physical diagnosis and medical interviewing skills.
4. Demonstrate baseline competency and improvement in managing the wide range of medical conditions seen in the inpatient setting utilizing an evidence-based and humanistic approach.
5. Demonstrate baseline competency and improvement in knowledge and clinical skills in critical care medicine.
6. Work effectively as a member of a health care team to ensure proper care and welfare of patients.

C. First-year house officer (intern)

At the completion of this rotation, the R1 should be able to:

1. Formulate a differential diagnosis and outline a plan for evaluating and managing diverse inpatient cardiology problems.
2. Demonstrate organizational skills necessary for the care of medicine inpatients.
3. Efficiently and effectively chart in the medical record.
4. Anticipate and formulate comprehensive discharge plans.
5. Demonstrate leadership and teaching skills through interactions with members of the medical team.
6. Discuss the appropriate utilization of consult services and diagnostic studies.
7. Explain the indication, contraindications, risks and process of venipuncture, arterial puncture, pacemakers, pulmonary artery catheters. R1's should also gain competence in performing all required procedures by the completion of the R1 year.

D. Specific educational goals for cardiology housestaff

1. Develop the expertise needed to evaluate and appropriately manage a critically ill patient with any of the following conditions: Unstable angina, myocardial infarction, arrhythmia, valvular disease, congestive heart failure, pericardial disease, aortic disease, etc. (including history & physical exam skills).
2. Develop a physiologic approach to the evaluation and management of the cardiovascular system including techniques for invasive and non-invasive hemodynamic monitoring.
3. Integrate mechanical support systems such as intra-aortic balloon pumps ventricular assist devices into the clinical management of critically ill patients.
4. Become familiar with cardiovascular pharmacology and the application of these medications in both the critical care and outpatient settings.
5. Develop the ability to obtain central venous access.
6. Develop the ability to competently read an electrocardiogram.
7. Develop an understanding of the indications for cardiac pacing and become familiar with the basic functions of a pacemaker and how they malfunction.
8. Develop the ability to manage a cardiac arrest using the Advanced Cardiac Life Support (ACLS) protocol.

II. Team Structure and Responsibilities

A. Team structure

The Cardiology Service consists of four teams, each comprised of an Attending physician, a second or third year medicine resident, one medicine intern, and, during several months of the year, a sub-intern (MS4). A social worker is assigned to each team to aid in identifying and meeting discharge needs. A pharmacy student provides helpful input regarding medications.

B. Attending physician

1. Holds appropriate clinical privileges at the University of California, San Francisco.
2. Supervises and assumes ultimate responsibility for the care of inpatients admitted to his/her team, including appropriate continuing care, discharge planning and medical follow-up. To achieve this, the attending should conduct daily management rounds which include the following:
a. Interact at regular intervals with his patients.
b. Communicate effectively and frequently with the resident staff regarding management.
3. Conducts daily teaching rounds.
a. Teaching rounds must be patient-based sessions in which a few cases are presented as a basis for discussion of such points as interpretation of clinical data, pathophysiology, differential diagnosis, specific management of the patient, appropriate use of technology and disease prevention.
b. The attending should work with the resident physician to establish and achieve didactic goals for teaching rounds.
c. Teaching rounds must include direct resident and attending interaction with the patient. The teaching sessions must include demonstrations and evaluation of each resident's interview and physical examination skills i.e. teaching rounds must include bedside teaching.
4. Oversees order writing, but residents must routinely write all orders for patients under their care. In those unusual circumstances when the attending writes an order on the team's patient, the attending must comunicate his or her action to the resident in a timely manner.
5. Responsible for providing verbal feedback and written evaluation of the resident physician, intern, and sub-intern (MS4). Resident evaluations must include assessments of interview and physical examination skills, communication of treatment plans and discharge planning.
6. Responsible for writing admission notes by the end of the day following admission.
7. Responsible for co-signing and ensuring dictation of discharge summaries for each patient in a timely fashion.

C. Second- (R2) or third-year (R3) house officer

Under the guidance of the attending physician, the R2/R3 directs the comprehensive inpatient care of acutely ill cardiology patients, including those admitted to the MICU, CCU, telemetry unit and regular medicine wards. The specific responsibilities include:

1. Responsible for coordinating the day-to-day function of the team and directly supervising interns and sub-interns.
2. Responsible for attending conferences as required by the Medical Service and the National Internal Medicine Residency Review Committee. Attendance will be monitored with a sign-in sheet. Residents will need to demonstrate at least 60% attendance at each of the required conferences and will be expected to attend as many teaching conferences as allowed by patient care responsibilities. Required conferences are designated as:
a. Daily Residents' Report.
b. Weekly Grand Rounds.
3. Directs the admission and initial evaluation of patients to the cardiology service.
a. R2s/R3s will oversee the initial history, physical examination and review the laboratory data and medical records for all patients admitted to his/her team.
b. R2s/R3s will be on-call every fourth night.
c. Resident physicians will distribute admissions among members of their individual teams.
i. Interns will be responsible for no more than five admissions per twenty-four hour period and no more than eight admissions per forty-eight hours.
ii. Sub-interns will be responsible for no more than five admissions per twenty-four hours and no more than eight admissions per forty-eight hours.
iii. Resident physicians will be responsible for admitting patients and writing detailed admission notes in excess of five admissions per intern or sub-intern per twenty-four hour period.
iv. Total admissions per medicine team will not exceed twelve per twenty-four hour call day; a Jeopardy resident will be activated for any admissions in excess of twelve per medicine team per twenty-four hour call day; it is the responsibility of the medicine resident to notify the Chief Medical Resident on call (719-9612) in order to activate the Jeopardy system.
v. Resident physicians will be responsible for writing a brief admission summary for each patient admitted to the intern or sub-intern within twenty-four hours of the admission.
vi. Admissions in excess of five per intern or sub-intern (up to a total of eight patients per intern or sub-intern) will be re- distributed to the intern or sub-intern on the post-call day.
vii. Resident physicians will be responsible for ensuring that individual intern and sub-intern patient loads do not compromise patient care and educational goals.
viii. Resident physicians will be responsible for notifying the chief residents if admissions exceed the maximal cap or if patient care is compromised; jeopardy or night float residents will be mobilized by the chief residents to cover any additional admissions to the medical service.
4. R2's/R3's direct the interns and subinterns in providing continuing hospital care to all of the patients to his/her team.
a. Oversee the daily interval history, focused physical examination, and new laboratory data for each patient on his/her team.
b. Oversee the rational use of consultants and laboratory tests.
c. Oversee the discharge planning and transitional care of all patients.
d. Ensures compassionate communication with patients and families regarding the ongoing care of patients.
5. Ensures adequate communication of patient care issues among members of the team, including the attending physician.
6. Assumes primary responsibility for supervising sub-interns (MS4s).
7. Responsible for providing feedback on the performance of the intern and MS4.
8. Responsible for providing written evaluation of the attending physician, intern, and MS4.
9. Responsible for dictating and co-signing discharge summaries for each patient within forty-eight hours of discharge.
10. Residents will not work in excess of an average of eighty hours per week during any inpatient ward month.
11. Residents will have at least one day off per week. The Attending physician will cover the responsibilities of the resident on his/her day off. The Attending physician shall be available to discuss patient care issues.

D. First-year house officer

1. All responsibilities and clinical privileges of the intern are under the guidance and supervision of the Attending and Resident physicians.
2. Responsible for patient care in concert with other members of the team.
3. Responsible for attending conferences as required by the Medical Service and the National Internal Medicine Residency Review Committee. Attendance will be monitored with a sign-in sheet. Interns will need to demonstrate at least 60% attendance at each of the required conferences and will be expected to attend as many additional teaching conferences as allowed by patient care responsibilities. Required conferences are designated as:
a. Weekly Interns' Report.
b. Weekly Grand Rounds.
4. Responsible for up to five admissions per twenty-four hour period, or up to eight admissions per forty-eight hour period.
5. Responsible for writing up to five admission notes; supervising residents will be responsible for admitting patients and writing admission notes in excess of five per twenty-four hour period.
6. Responsible for writing or co-signing medical students' daily progress notes on all patients assigned to them.
7. Primary responsibility for supervising MS3s.
8. Interns will not work in excess of an average of eighty hours per week during any inpatient ward month.
9. Interns will have at least one day off per week. The responsibilities of the intern will be covered by his/her resident during the designated day off.

UCSF DEPARTMENT OF MEDICINE

Medicine | Cardiology | CRI | LTU | Consult | ED

The Hematology/Oncology Service

The CRI (Hematology/Oncology) Service at the University of California, San Francisco consists of two teams providing comprehensive inpatient care to acutely ill patients with hematologic/oncologic problems.

I. Educational Goals

A. Second-year house officer (R2)

At the completion of this rotation, the R2 should be able to:

1. Function as an effective team manager, leader and teacher.
2. Discuss the differential diagnosis and direct the evaluation of diverse inpatient hematologic and oncologic problems.
3. Demonstrate baseline competency and improvement in physical diagnosis and medical interviewing skills.
4. Demonstrate baseline competency and improvement in managing common hematologic/oncologic conditions seen in the inpatient setting utilizing an evidence-based and humanistic approach.
5. Work effectively as a member of a health care team to ensure proper care and welfare of patients.

B. First-year house officer (intern)

At the completion of this rotation, the R1 should be able to:

1. Formulate a differential diagnosis and outline a plan for evaluating and managing common inpatient hematologic/oncologic problems.
2. Demonstrate organizational skills necessary for the care of medicine inpatients.
3. Efficiently and effectively chart in the medical record.
4. Anticipate and formulate comprehensive discharge plans.
5. Demonstrate leadership and teaching skills through interactions with members of the medical team.
6. Discuss the appropriate utilization of consult services and diagnostic studies.

C. Specific educational goals for hematology/oncology housestaff

1. Develop the ability to evaluate and manage a variety of oncologic emergencies.
2. Develop the ability to appropriately evaluate and manage patients with disorders of white blood cells, red blood cells, and platelets; especially patients with leukemia, myeloproliferative states, and myelodysplasia states.
3. Develop the ability to evaluate and manage the complications of the neutropenic patient.
4. Develop the ability to ability to accurately interpret a peripheral blood smear.
5. Learn the indications for bone marrow biopsy and acquire the skills the perform one.
6. Learn the indications for transfusing a variety of blood products from the blood bank and understand how to evaluate and manage the different transfusion reactions.
7. Develop an understanding of the side effects and complications of chemotherapy.
8. Develop an understanding of the different catheters available for obtaining long-term central venous access.
9. Develop an understanding of the indications for and the complications of total parenteral nutrition.

II. Team Structure and Responsibilities

A. Team structure

The Hematology/Oncology Service consists of two teams, each comprised of an Attending physician, a second or third year medicine resident, two medicine interns, and, during several months of the year, a sub-intern (MS4). A social worker is assigned to each team to aid in identifying and meeting discharge needs. A pharmacy student provides helpful input regarding medications.

B. Attending physician

1. Holds appropriate clinical privileges at the University of California, San Francisco.
2. Supervises and assumes ultimate responsibility for the care of inpatients admitted to his/her team, including appropriate continuing care, discharge planning and medical follow-up. To achieve this, the attending should conduct daily management rounds which include the following:
a. Interact at regular intervals with his patients.
b. Communicate effectively and frequently with the resident staff regarding management.
3. Conducts daily teaching rounds.
a. Teaching rounds must be patient-based sessions in which a few cases are presented as a basis for discussion of such points as interpretation of clinical data, pathophysiology, differential diagnosis, specific management of the patient, appropriate use of technology and disease prevention.
b. The attending should work with the resident physician to establish and achieve didactic goals for teaching rounds.
c. Teaching rounds must include direct resident and attending interaction with the patient. The teaching sessions must include demonstrations and evaluation of each resident's interview and physical examination skills i.e. teaching rounds must include bedside teaching.
4. Oversees order writing, but residents must routinely write all orders for patients under their care. In those unusual circumstances when the attending writes an order on the team's patient, the attending must communicate his or her action to the resident in a timely manner.
5. Responsible for providing verbal feedback and written evaluation of the resident physician, intern, and sub-intern (MS4). Resident evaluations must include assessments of interview and physical examination skills, communication of treatment plans and discharge planning.
6. Responsible for writing admission notes by the end of the day following admission.
7. Responsible for co-signing and ensuring dictation of discharge summaries for each patient in a timely fashion.

C. Second-year house officer (R2)

Under the guidance of the attending physician, the R2 directs the comprehensive inpatient care of the CRI patients, including those admitted to the MICU, CCU, telemetry unit and regular medicine wards. The specific responsibilities include:

1. Responsible for coordinating the day-to-day function of the team and directly supervising interns and sub-interns.
2. Responsible for attending conferences as required by the Medical Service and the National Internal Medicine Residency Review Committee. Attendance will be monitored with a sign-in sheet. Residents will need to demonstrate at least 60% attendance at each of the required conferences and will be expected to attend as many teaching conferences as allowed by patient care responsibilities. Required conferences are designated as:
a. Daily Residents' Report.
b. Weekly Grand Rounds.
3. Directs the admission and initial evaluation of patients to the hematology/oncology service:
a. R2s will oversee the initial history, physical examination and review the laboratory data and medical records for all patients admitted to his/her team.
b. R2s will be on pager call every other night and will come in to the hospital in the evening only when patients are admitted or a patient's condition worsens.
c. Resident physicians will distribute admissions among members of
their individual teams.
i. Interns will be responsible for no more than five admissions
per twenty-four hour period and no more than eight admissions per forty-eight hours.
ii. Sub-interns will be responsible for no more than five
admissions per twenty-four hours and no more than eight
admissions per forty-eight hours.
iii. Resident physicians will be responsible for admitting patients and writing detailed admission notes in excess of five admissions per intern or sub-intern per twenty-four hour period.
iv. Total admissions per medicine team will not exceed twelve per twenty-four hour call day; a Jeopardy resident will be
activated for any admissions in excess of twelve per medicine team per twenty-four hour call day; it is the responsibility of the medicine resident to notify the Chief Medical Resident on call (719-9612) in order to activate the Jeopardy system.
v. Resident physicians will be responsible for writing a brief
admission summary for each patient admitted to the intern or sub-intern within twenty-four hours of the admission.
vi. Admissions in excess of five per intern or sub-intern (up to a total of eight patients per intern or sub-intern) will be re- distributed to the intern or sub-intern on the post-call day.
vii. Resident physicians will be responsible for ensuring that
individual intern and sub-intern patient loads do not
compromise patient care and educational goals.
viii. Resident physicians will be responsible for notifying the
chief residents if admissions exceed the maximal cap or if
patient care is compromised; jeopardy or night float residents will be mobilized by the chief residents to cover any additional admissions to the medical service.
4. R2's direct the interns and subinterns in providing continuing hospital care to all of the patients on his/her team.
a. Oversee the daily interval history, focused physical examination, and new laboratory data for each patient on his/her team.
b. Oversee the rational use of consultants and laboratory tests.
c. Oversee the discharge planning and transitional care of all patients.
d. Ensures compassionate communication with patients and families
regarding the ongoing care of patients.
5. Ensures adequate communication of patient care issues among members of the team, including the attending physician.
6. Assumes primary responsibility for supervising sub-interns (MS4s).
7. Responsible for providing feedback on the performance of the intern and MS4.
8. Responsible for providing written evaluation of the attending physician, intern, and MS4.
9. Responsible for dictating and co-signing discharge summaries for each patient within forty-eight hours of discharge.
10. Residents will not work in excess of an average of eighty hours per week during any inpatient ward month.
11. Residents will have at least one day off per week. The Attending physician will cover the responsibilities of the resident on his/her day off. The Attending physician shall be available to discuss patient care issues.

D. First-year house officer (intern)

1. All responsibilities and clinical privileges of the intern are under the guidance and supervision of the Attending and Resident physicians.
2. Responsible for patient care in concert with other members of the team.
3. Responsible for attending conferences as required by the Medical Service and the National Internal Medicine Residency Review Committee. Attendance will be monitored with a sign-in sheet. Interns will need to demonstrate at least 60% attendance at each of the required conferences and will be expected to attend as many additional teaching conferences as allowed by patient care responsibilities. Required conferences are designated as:
a. Weekly Interns' Report.
b. Weekly Grand Rounds.
4. Responsible for up to five admissions per twenty-four hour period, or up to eight admissions per forty-eight hour period.
5. Responsible for writing up to five admission notes; supervising residents will be responsible for admitting patients and writing admission notes in excess of five per twenty-four hour period.
6. Responsible for writing or co-signing medical students' daily progress notes on all patients assigned to them.
7. Interns will not work in excess of an average of eighty hours per week during any inpatient ward month.
8. Interns are on-call every fourth night and have at least one day off per week. The responsibilities of the intern will be covered by his/her resident during the designated day off.

UCSF DEPARTMENT OF MEDICINE

Medicine | Cardiology | CRI | LTU | Consult | ED

The Liver Transplant Service

The LTU (Liver Transplant) Service at the University of California, San Francisco consists of a team providing comprehensive inpatient care to acutely ill patients with severe liver disease.

I. Educational Goals

A. First-year house officer (intern)

At the completion of this rotation, the R1 should be able to:

1. Formulate a differential diagnosis and outline a plan for evaluating and managing common problems in patients with acute and chronic liver disease.
2. Demonstrate organizational skills necessary for the care of medicine inpatients.
3. Efficiently and effectively chart in the medical record.
4. Anticipate and formulate comprehensive discharge plans.
5. Demonstrate leadership and teaching skills through interactions with members of the medical team.
6. Discuss the appropriate utilization of consult services and diagnostic studies.
7. Explain the indication, contraindications, risks and process of venipuncture, arterial puncture, paracentesis, placement of nasogastric tubes.

B. Specific educational goals for LTU interns

1. Develop an understanding of the perioperative care of a patient.
2. Develop the ability to evaluate and manage acute and chronic liver failure including infectious, toxic, infiltrative, and vascular causes.
3. Develop an understanding of how to most effectively clinically evaluate and treat patients with multi-system failure requiring intensive care management.
4. Learn the indications for transfusing a variety of blood products from the blood bank and understand how to evaluate and manage the different transfusion reactions.
5. Develop an understanding of cardiovascular pharmacology with application to critically ill patients.

II. Team Structure and Responsibilities

A. Team structure

The Liver Transplant Service consists of a team comprised of an Attending physician, a surgery fellow, a gastroenterology fellow, and four interns. A social worker is assigned to each team to aid in identifying and meeting discharge needs. A pharmacy student provides helpful input regarding medications.

B. Attending physician

1. Holds appropriate clinical privileges at the University of California, San Francisco.
2. Supervises and assumes ultimate responsibility for the care of inpatients admitted to his/her team, including appropriate continuing care, discharge planning and medical follow-up. To achieve this, the attending should conduct daily management rounds which include the following:
a. Interact at regular intervals with his patients.
b. Communicate effectively and frequently with the resident staff regarding management.
3. Conducts daily teaching rounds.
a. Teaching rounds must be patient-based sessions in which a few cases are presented as a basis for discussion of such points as interpretation of clinical data, pathophysiology, differential diagnosis, specific management of the patient, appropriate use of technology and disease prevention.
b. The attending should work with the resident physician to establish and achieve didactic goals for teaching rounds.
c. Teaching rounds must include direct resident and attending interaction with the patient. The teaching sessions must include demonstrations and evaluation of each resident's interview and physical examination skills i.e. teaching rounds must include bedside teaching.
4. Oversees order writing, but fellows/interns must routinely write all orders for patients under their care. In those unusual circumstances when the attending writes an order on the team's patient, the attending must communicate his or her action to the fellows/interns in a timely manner.
5. Responsible for providing verbal feedback and written evaluation of the fellows and interns. Intern evaluations must include assessments of interview and physical examination skills, communication of treatment plans and discharge planning.
6. Responsible for writing admission notes by the end of the day following admission.
7. Responsible for co-signing and ensuring dictation of discharge summaries for each patient in a timely fashion.

C. Surgery/Gastroenterology fellow

Under the guidance of the attending physician, the surgey and gastroenterology fellows direct the comprehensive inpatient care of the LTU patients, including those admitted to the MICU, CCU, telemetry unit and regular transplant wards. The specific responsibilities include coordinating the day-to-day function of the team and directly supervising interns and sub-interns.

D. First-year house officer

1. All responsibilities and clinical privileges of the intern are under the guidance and supervision of the Attending physicians and fellows.
2. Responsible for patient care in concert with other members of the team.
3. Responsible for attending conferences as required by the Medical Service and the National Internal Medicine Residency Review Committee. Attendance will be monitored with a sign-in sheet. Interns will need to demonstrate at least 60% attendance at each of the required conferences and will be expected to attend as many additional teaching conferences as allowed by patient care responsibilities. Required conferences are designated as:
a. Weekly Interns' Report.
b. Weekly Grand Rounds.
4. Responsible for up to five admissions per twenty-four hour period, or up to eight admissions per forty-eight hour period.
5. Responsible for writing up to five admission notes; supervising residents will be responsible for admitting patients and writing admission notes in excess of five per twenty-four hour period.
6. Responsible for writing or co-signing medical students' daily progress notes on all patients assigned to them.
7. Interns will not work in excess of an average of eighty hours per week during any inpatient ward month.
8. Interns are on-call every fourth night and have at least one day off per week. The responsibilities of the intern will be covered by the fellows/other interns during the designated day off.

UCSF DEPARTMENT OF MEDICINE

Medicine | Cardiology | CRI | LTU | Consult| ED

CONSULT

Medicine Consultation Service

I. Educational Goals

A. Second-year (R2) or third-year (R3) house officer

1. Develop facility with preoperative medical evaluation, including assessing the risk of perioperative medical complications.
2. Learn the utility and limitations of preoperative testing
3. Be able to recommend risk reduction strategies, including DVT prophylaxis and perioperative use of beta-adrenergic blockade
4. Be able recognize common perioperative medical complications, formulate an appropriate differential diagnosis, and with the attending's supervision, manage and correct the problem
5. Develop effective consultation skills, such as professionalism, optimal communication, and the ability to work as a team with surgeons.
6. Gain further efficiency in conducting literature reviews to find evidence-based answers to clinical questions

II. Team Structure & Responsibilities

A. Team Structure:

The Medicine Consult Service is composed of a single R2 or R3 and an attending physician from the hospitalist group at Moffitt-Long. Both the resident and the attending physician serves either a half or full month on the Service.

B. Resident Responsibilities:

1. The Medicine Consult Service should be available to referring physicians at all times. The Medicine Consult Resident will respond to consult requests on weekdays, from 8 a.m. to 5 p.m. In addition, the consult resident will come in on the 2nd and 4th weekends to assist the attending physician with rounding.
2. Overnight and on weekends, the Cardiology resident (R3) or Nightfloat resident (R2 or R3) will respond to consult requests.
3. Residents will not work in excess of an average of eighty hours per week, averaged over the course of the rotation.
4. The Medicine Consult Resident will do inpatient preoperative evaluations and manage both acute and chronic medical problems in surgical or psychiatric patients. In addition, the resident will help determine whether such patients should be transferred to an inpatient Medicine service.
5. Residents may be responsible for providing coverage for the inpatient teams as needed to achieve patient care and educational goals of the program.
6. New consults will be performed by residents in a timely manner. In general, patients should be seen within a few hours of the consult request.
7. Residents will formulate their own assessment and recommendations, but have a low threshold to call the attending for advice. Unstable patients, requests to transfer patients to Medicine, and patients scheduled for surgery should be presented urgently.

C. Attending Responsibilities:

1. The attending physician is responsible for the service from Monday 8 a.m. until Friday 5 p.m. During that time, the attending should be readily available to provide advice or back-up for the consult resident or overnight covering residents.
2. The attending physician will round on all patient followed by the resident daily, and write or dictate initial consult reports and progress notes. Initial consult reports from the attending must be in the chart within 24 hours of the referral, including weekend and holidays.
3. On weekends, an attending physician from the hospitalist group or the Division of General Internal Medicine covers the service from Friday 5 p.m. until Monday 8 a.m. During this time, the weekend coverage attending has the same rounding responsibilities and availability requirements as the regular Medicine Consult Attending
4. The attending physician will meet with the resident every weekday to:
a. Discuss clinical matters related to patients on the consult service
b. Work with the resident physician to establish didactic goals.
c. Provide educational materials and didactic lectures in consultative medicine.
5. The attending physician will give feedback on resident performance throughout the rotation as well as a formal evaluation at its completion.

UCSF DEPARTMENT OF MEDICINE

Medicine | Cardiology | CRI | LTU | Consult | ED

Medicine Residents Rotating in the Emergency Department at UCSF

We, the EM faculty, are pleased to be able to provide the R3 medicine residents with a comprehensive emergency medicine experience during their month rotation at UCSF. We appreciate their hard work and professionalism and our goals are to provide an interactive and instructional month during the rotation.

The rotation is set up with 19-20 clinical shifts per month, at 10 hours per shift. The residents will work a total of approximately 190-200 hours per month and on any given week, will not work more than 60 hours. Residents will be scheduled for no more than 5 clinical shifts in a row, with rare exception. The housestaff will do a total of 6 night shifts for the rotation, again, with rare exception. The residents will attend one of their clinics during one of their ED shifts and one on a day off. All schedule requests must be submitted one calendar month prior to the rotation and all efforts will be made to honor those requests.

The residents should be able to function as effective team leaders. As R3's, we expect that the residents will be prompt and thorough in their evaluations. Their goals should include evaluation of all patients in the ED setting, to prioritize and stabilize them and to coordinate their disposition in a timely fashion. This includes a variety of patient populations at Moffit, anywhere from minor trauma to critical medical codes. The housestaff will also be encouraged to see surgical sub-specialty cases as well to enhance their experience.

The residents should be able to perform an accurate, thorough history and physical exam. At that time, the resident should present the patient to the ED attending(all patients must be presented and evaluated by the ED attending). Then, diagnostic testing and treatment will be rendered and finally disposition then discussed. The residents will have the opportunity to interact with varied consultants, outside attendings and staff.

At the conclusion of the rotation, the residents should be knowledgeable with the following:

Develop competency in management of all patients presenting to the ED.
Demonstrate baseline skills in history taking, a targeted physical exam, use of appropriate diagnostic tests, effective use of consultants, and coordinating timely dispositions.
Learn to coordinate the care of multiple patients simultaneously, with emphasis on those most critically ill
Effectively work within the ED with the colleagues, nursing and clerical staff
Perform procedures under the supervision of the ED attending
Learn to admit patients to the hospital in an appropriate and timely fashion
Demonstrate the appropriate use of body fluid precautions
Learn to organize and coordinate medical resuscitations