The UCSF program has a long history of producing leaders in academic medicine, public health, and clinical practice. The program provides all trainees with a broad mastery of the knowledge, skills, and attitudes needed to be an outstanding general internist.
Beyond these competencies, trainees are encouraged to individualize their pathways during residency so that they can pursue customized educational opportunities that will allow them to enter the next phase of their careers. This also allows residents to track into smaller groups within the large program to maximize the time spent with residents and expert faculty who share similar interests. We want our housestaff to be outstanding clinicians, teachers, and leaders and also pursue and excel in their other academic interests during residency.
Our program by the numbers:
TRACKS & HOSPITAL SYSTEM
The PGY1 year is roughly the same for all residents in all tracks except for the content of the block months. Though specifics may change slightly from year to year and vary slightly from intern to intern, below are the current rotations for the R1 year:
|General Medicine Wards (a mixture of ZSFG, Moffitt, VA)||4-6 months|
|Emergency Department (Moffitt)||3 weeks|
|Liver Transplant Unit (Moffitt)||2-4 weeks (not all interns)|
|Cardiology at Moffitt ("CCU") and/or ZSFG||1 month|
|ICU (ZSFG)||2-4 weeks|
|Night Float (cross-cover)||1-3 weeks|
|Night Float(admitting)||2 weeks (not all interns)|
|Outpatient Medicine||1 month of ambulatory block and 1 month of Clinic Immersion|
|Vacation||3 weeks (usually taken during outpatient months and during the ICU/night float rotation at SFGH). All interns have an additional week off during the holidays (December/January).|
PGY2 AND PGY3 YEARS
During the PGY2 and PGY3 years, all residents alternate every other month of inpatient or emergency department experience with one month of ambulatory/elective or research experience. Thus, the program offers residents the flexibility to select at least 12 of 36 months based upon their track and specific interests. Every attempt is made to tailor all clinical experiences to a resident's educational needs and career goals. A key overriding goal is to provide each resident with a smaller group within the large program as a way of facilitating mentoring and career development. Regardless of the track through which a resident enters the program, each resident is provided with the guidance and training opportunities needed to succeed in any facet of internal medicine.
As with the intern year schedule, residents' schedules and specifics may change. Listed below are current examples of rotations for these years:
|Medicine Ward Months (Moffitt, ZSFG, VA)||2-3 months|
|Cardiology (ZSFG)||1 month (most but not all R2's)|
|Emergency Department (ZSFG)||1 month (most but not all R2's)|
|ICU (Moffitt)||2-4 weeks (not all R2's)|
|Float (day and night)||1 month|
|Block (Ambulatory or Elective or Research; for specifics, see descriptions of the three tracks)||6 months|
|Medicine Ward Months (Moffitt, ZSFG, VA)||1-2 months|
|CCU (Moffitt)||1 month (most but not all R3's)|
|Float (day and night)||1 month|
|ICU (VA)||1 month (not all R3's)|
|ICU (ZSFG)||1 month (most but not all R3's)|
|Block (Ambulatory or Elective or Research; for specifics, see descriptions of the three tracks)||7 months (with Jeopardy during one month)|
|Medicine Consult||2 weeks (categoricals only)|
Residents' Report: Residents' report occurs 4 days a week at all 3 training sites. These conferences are chief resident run and all are welcome to attend.
Interns' Report: Once a week, there is a dedicated interns' report, run in the style of the daily residents' report.
Noon Conferences: Content of the daily noon conference ranges from subspecialists' and hospitalists' updates in their fields to the famous quiz game "Championship of the World". As well, there is a Morbidity and Mortality conference and a Medical Grand Rounds weekly at each of the training sites.
Curricular Half Days
With the educational challenges posed by duty hour requirements, the structure of the day for residents is arranged so that they can consistently attend educational activities. Major portions of the curriculum have been shifted to dedicated teaching "half days" for both interns and residents which allow protected time for education. These have also allowed us to further focus material to the various levels of training.
- Fundamental Intern Training (FIT)
Interns attend a monthly half day (Wednesday morning) during which they receive four uninterrupted hours of a core curriculum while the residents cover the interns' inpatient responsibilities. The topics are high-yield and practical and include small group workshops and simulation training.
- Core Ambulatory Conference Series
During their block months, PGY2s and PGY3s participate in a bimonthly core ambulatory conference series every other Friday afternoon (the alternating Friday afternoons are filled with "Track-Specific Didactics"). This curriculum focuses on important aspects of ambulatory medicine, including primary care, preventive medicine, chronic disease management, and urgent care. In order to support all of the residents pursuing scholarly projects during the residency, didactics in clinical epidemiology and critical review of the literature (a.k.a. "journal clubs) have been embedded into the curriculum.
- Track-Specific Didactics
Each track has bimonthly teaching sessions specifically designed to address the interests of that group.
- ZSFG Primary Care Didactics: In addition to weekly pre-clinic conferences, SFPC residents have core didactics on Thursday and Friday mornings during their block months. These seminars focus on common outpatient problems, quality improvement, behavioral medicine, and social medicine topics. Residents also participate in journal club and have a facilitated support group during those times.
- UC Primary Care Didactics: UC Primary Care residents attend various dedicated didactics during their block time. These didactics include a Behavioral Medicine seminar focused on doctor-patient communication and a Primary Care Systems and Quality Patient Care Conference focused on caring for the chronically ill as well as utilizing systems to optimize delivery of care. UC Primary Care residents also participate in a Core Seminar series focused on ambulatory clinical topics.
Pathways-Specific Didactics. During the outpatient/elective months of the R2 and R3 years, residents have dedicated time for didactics in their Pathways to Discovery.
Journal Clubs: There are a total of 3 journal clubs in each block and residents will have the opportunity to facilitate 1-2 journal clubs in the PGY2 and PGY3 year. Two of these journal clubs are during the core seminar series and one is in the evening. The purpose of the evening journal club is to bring together all core categorical residents in a more relaxed setting, enjoying dinner at a colleague's house while discussing the literature. PRIME, UCPC, SFPC also have designated times for their track-specific journal clubs, to which all residents are invited.
Intern Retreat: We recognize that the transition from intern to R2 can feel more intimidating than the step from medical student to intern. In the spring of intern year, all the interns spend a day reflecting on their year and planning for the R2 year. Large and small group sessions are designed to cover team management and leadership skills, tips at incorporating teaching into the daily routine, how to thrive in ambulatory clinic as an R2, and keys to self-care and well-being. A happy hour follows.
R2 Retreat: In the spring, all R2s spend a half-day reflecting on the year and on the upcoming role as R3s. Large and small group sessions focus on advanced leadership skills, effective feedback, and other teaching skills. A happy hour follows.
CLINICAL WORK HOURS
The UCSF Internal Medicine residency is dedicated to providing high-quality and safe patient care and maximizing continuity while ensuring housestaff quality of life. With extensive resident, chief resident, and faculty input, we designed inpatient rotations which comply with the new 2017 ACGME Clinical Work Hours Guidelines and which maintain our core values of patient-centered care, teamwork, teaching and intellectual curiosity. At all 3 sites there are non-resident (hospitalist) services which have helped achieve compliance. We are committed to not compromising the overall educational mission of the program. With ongoing housestaff, chief resident, and faculty input, we continue to make adjustments to individual rotations as needed.
UCSF GLOBAL HEALTH PROGRAM/ELECTIVE
In response to resident interest in international training opportunities, a Global Health Elective Program was launched. Residents may participate in this elective and obtain further training abroad. Roughly 40% of all R3s go abroad each year.
Listed below are the current sites:
A residency exchange program with Peking Union Medical College (P.U.M.C.) in Beijing was begun in 2004. Residents participate in a one month clinical rotation at P.U.M.C. Residents spend 2 weeks on the inpatient general medicine ward and 2 weeks on the subspecialty ward of their choice. UCSF residents are actively involved in the teaching of P.U.M.C. residents by conducting morning report, delivering didactic sessions, and conducting round table discussions on medical education.
During the 2005-6 academic year, the site in Saipan was added. Residents from pediatrics, internal medicine and nephrology fellows can elect a four-week rotation in Saipan.
In 2006, a new site in Kismu, Kenya was added. Residents spend four weeks at the FACES clinic learning to evaluate and manage HIV patients.
Indian Health Services- Gallup & Shiprock
Residents have the opportunity to spend one month at either the Gallup Indian medical Center in New Mexico on the Navajo Reservation border or Northern Navajo Medical Center (Shiprock,NM).
Our program encourages residents to engage in a research or scholarly activity during residency. To facilitate this activity, categorical residents may dedicate up to 3 months for research over the last 2 years of residency. PRIME residents may take up to three months (while still attending scheduled didactics) and have half to one day per week during ambulatory block months. Residents in the UCPC program have a half day per week during ambulatory blocks and may take an additional 1 month during the last 2 years of training. SFPC residents have 2-3 half days per week during ambulatory blocks and may take an additional one month as well.
At national conferences throughout the year and at the annual UCSF Floyd Rector Resident Research Symposium, residents are given a chance to present their projects.
QUALITY AND PATIENT SAFETY
The UCSF Internal Medicine Residency is dedicated to providing the highest quality and safe patient care. We are also dedicated to ensuring our housestaff are trained in the fundamentals of quality and safety and we have a 3-year curriculum to achieve this goal. The training involves everything from the dedicated Procedures/Quality/Jeopardy (PQJ) rotation in intern year to individual quality improvement projects done during the 3rd year.
We have collaborated with the hospitals to build a unique program which provides housestaff financial incentives to improve quality. For example, the housestaff received additional salary for improving patient satisfaction, improving hand hygiene rates, and reducing the mean decision to admit time in the ED.