UCSF-based Primary Care Residency Program Curriculum
Primary Care Medical Resident - First Year (Internship)
The primary care medical intern's "home base" is in the Division of General Internal Medicine (DGIM) at the UCSF/Mount Zion campus of the University of California, San Francisco. Primary care medicine interns complete a program similar to the categorical internal medicine interns. Nine months are spent in hospital and emergency department rotations, two months are spent in ambulatory care, and one month is spent in a procedures/quality improvement elective. During their inpatient time, primary care interns rotate at Moffitt-Long Hospital, Zuckerberg San Francisco General and the Veterans Affairs Medical Center.
Primary care interns spend one half-day per week in the Mount Zion General Medicine Practice (GMP), a certified Patient-Centered Medical Home, throughout the year. In GMP, interns develop a patient panel that they will care for through their three-year residency. On the half-days that interns are in the Practice, a special series of didactic presentations on ambulatory care topics are presented by the Program Director, Associate Program Director, Assistant Program Director, other faculty, and senior residents. In addition, a monthly support group hour is reserved for interns. Three weeks are allowed for vacation.
Each primary care intern spends two months in ambulatory care. These two months are designed to be intensive experiences that will help orient interns to the ambulatory clinic setting. One of these ambulatory months is designed as an immersion month for the intern to better learn his/her continuity clinic setting. All UCSF Primary Care (UCPC) interns take this ambulatory immersion month together. During this month, interns receive dedicated didactics focused on ambulatory topics as well as didactics focused on patient interviewing, working with the team members in a patient-centered medical home, working with an electronic medical record, and mentorship. The ambulatory months also give interns increased time in continuity clinic practice. In addition to increased time in continuity practice in GMP, interns work in the UCSF/Parnassus Screening and Acute Care Clinic, SF Community Clinic Consortium (SFCCC) Street Outreach Services (SOS), and UCSF Housecalls. Intern ambulatory seminars are designed to teach management of common ambulatory problems and principles of "doctoring." Interns also attend regularly scheduled ambulatory care conferences and a retreat with other primary care residents and faculty to discuss issues of personal and professional growth and development. A sample schedule for a primary care intern can be seen HERE.
Primary Care Medical Resident - Second Year
In the second and third year, primary care residents spend more than six months in the ambulatory setting. half of their time in the practice of ambulatory and primary care medicine with the remaining portion spent on inpatient rotations. Skills in primary care are developed through continuity care experiences in outpatient medicine, case conferences, subspecialty case discussions, behavioral medicine seminars, core didactic seminars and journal clubs. During each clinical session, general internal medicine faculty are available for consultation and teaching.. Emphasis is also placed on the development of interviewing skills, patient counseling for behavior change, and recognition and treatment of common psychiatric problems through an extensive behavioral medicine curriculum. Research and scholarship skills are developed through independent resident projects mentored by general internal medicine research faculty as well as through electives in research methodology. Residents may select an additional continuity clinic in the surrounding community, thereby improving resident skills in community-based primary care. Residents regularly attend a core didactic seminar series for further development of clinical skills as well as instruction in other aspects of general internal medicine including medical and non-medical specialties, ethics, nutrition, geriatrics, occupational medicine, and health policy.
The remaining months of the second year of residency are devoted to inpatient assignments at both the San Francisco General Hospital and Moffitt-Long Hospital (approximately 5 and one-half months/year). These acute care rotations (wards, CCU, emergency department) consolidate the skills gained during internship and provide the experience of teaching and supervising interns and medical students.
Residents continue to follow their panel of clinic patients in General Medicine Practice. Residents also share telephone call responsibility with faculty for the General Medical Practice one week each year. Four weeks of the second year is allowed for vacation. A sample schedule for a second-year resident can be seen HERE.
Six and a half months are spent in ambulatory care. This ambulatory time is divided into eleven components:
- Three half-days per week in continuity care in the resident's General Medicine Practice.
- Optional: One half-day per week in a supplemental continuity clinic in a community-based primary care setting. Examples of these supplemental continuity clinics include: OnLok Senior Services, Tom Waddell Health Clinic, Over 60 Health Center, Community Practice HIV Clinic, San Francisco State Student Health Services, San Francisco Free Clinic, Kaiser Primary Care, clinics in the Community Health Network of San Francisco and other community settings. These supplemental continuity clinics provide additional opportunities for development of primary care skills with diverse patient populations.
- Four half-days per week in elective clinic rotations are arranged in specialty clinics at Parnassus, Mount Zion, San Francisco General Hospital, the Veterans Affairs Medical Center, other hospital-based and community clinics, managed care settings, and physicians' private offices. Residents may choose from over 70 elective clinic rotations. Electives are composed of internal medicine electives (e.g., rheumatology, gastroenterology, pulmonary, endocrinology, hematology, cardiology, etc.) and other sub-specialties (e.g., dermatology, gynecology, psychiatry, orthopedics, urology, etc). Residents may also select one half-day per week in the UCSF/Parnassus Screening and Acute Care Clinic; this experience offers the opportunity to learn to apply clinical skills in treating ambulatory patients with acute problems. Dr. Elizabeth Griffiths presents her Resident Scholarly Project
- One optional half-day per week is devoted to Residents' Scholarly Projects (RSP). Resident projects may include independent research, scholarly reviews or community projects. Each resident works closely with a Division of General Internal Medicine (DGIM) mentor. Research conferences are held bimonthly to provide a didactic curriculum on research and scholarship as well as to provide a forum for works-in-progress discussions. Many residents devote a month-long elective to their independent project as a second or third year resident. Resident scholarship is submitted for presentation at the end-of-year Department of Medicine Research Symposium and/or at regional and national internal medicine meetings. Residents may elect to take an additional half-day of research per week if they so desire.
- In addition to an independent project, residents may elect to take a dedicated one-month course in Designing Clinical Research. This course guides participants through the essential components for writing a clinical research protocol developed around a clinical research question. During this elective, residents attend bi-weekly group lectures, small seminar groups, and a peer review session. The course covers study questions, hypotheses, specific aims, study types, sample size estimation, power calculations, and data analysis. Residents may take this elective course in order to augment their independent research project. Primary Care residents attend weekly report
- Two half days per week are devoted to educational seminars and didactics. The Behavioral Medicine Seminar taught by DGIM faculty focuses on medical interviewing, management of common psychological and psychiatric problems, counseling for behavior change, substance use disorders, and social medicine. The Primary Care Systems and Quality Patient Care Conference is a once-monthly conference with pharmacy students, pharmacy faculty, nurses in GMP and the GMP social worker who practice in the General Medicine Practice alongside the residents. This interdisciplinary conference focuses on learning how to take care of chronically ill patients, panel management, quality improvement and practice innovation. Core Seminars are designed to emphasize topics requiring additional in-depth study such as ethics, nutrition, geriatrics, occupational medicine and health policy, and to develop a core curriculum in essential clinical areas including dermatology, neurology, cardiology, endocrinology, gastroenterology, pulmonary, women's health, ENT, orthopedics and ophthalmology. Primary Care Grand Rounds are once-monthly lectures on topics relevant to primary care practice. Practice Report is an informal hour-long case conference between faculty and residents. DGIM Research Conference and Resident Research Conference are designed to discuss ongoing faculty and resident scholarship. Journal Club is a monthly meeting to discuss two articles selected from the current medical literature. Residents and faculty lead the discussion. Pre-clinic conferences are held prior to continuity clinic sessions and focus on brief clinical reviews, case studies and recent articles. Residents also attend Department of Medicine conferences including Medical Grand Rounds, Housestaff Conferences, and Ambulatory Morbidity and Mortality Conferences.
- Residents may select optional teaching activities. For example, residents may teach UCSF School of Medicine students in small group instruction. Residents may also select to teach third-year medical students who participate in a longitudinal clinic in General Medicine Practice.
- Residents may elect to participate in a two- or four-week elective in a subspecialty medical area of the residents' choosing.
- Residents may elect to participate in the UCSF Pathway to Discovery Program. These Pathways allow residents to devote curricular time to a particular subject area. Primary Care Residents may elect to participate in Health Professions Education Pathway, Global Health, Health and Society Pathway (Health Equities or Leadership Tracks), and Clinical and Translational Research.
- To support resident wellness, all residents attend a yearly retreat in Marin. This is an opportunity to encourage teamwork and reflect on physician experiences and work-life balance. All residents also attend monthly support groups which are facilitated by outside psychologists.
- To underscore the program’s commitment to clinical and academic excellence, all PGY2 and PGY3 attend UCSF Continuing Medical Education Courses in the fall and spring. Senior residents travel to the Society of General Internal Medicine National Meeting.
Health Professions Education Pathway
This program is geared for residents who are interested in making medical education part of their future career plans--including academic medicine faculty positions (clinician educators and general medicine research), medical education research, and medical education administration. Participants will obtain hands-on experience teaching and mentoring on the UCSF campus and join a local community of like-minded faculty and trainees. Residents will participate in didactic curriculum specifically addressing issues of how to improve one's teaching, curricular development, learning theory, assessments, medical education research, and leadership skills. Participants will also complete a mentored scholarly project relating to medical education and will formally teach medical students on the UCSF campus.
Director: Maria Wamsley, MD
Co-directors: David Irby, PhD, Patricia O'Sullivan, EdD, and Kristie White, MD
Department of Medicine faculty contact: Maria Wamsley, MD
UCSF Global Health
Global health is a two-year curriculum designed to cultivate future leaders in global health medicine. The program involves dedicated cross-disciplinary education through a one-month core elective, bimonthly evening meetings, and bimonthly continuing education during block. Residents are taught basic global health principles through a range of fundamental topics (including core knowledge, disease-specific knowledge, and leadership skills). By participating, residents will gain exposure to multiple career paths within global health and increase networking and mentorship opportunities with global health faculty. All global health residents design and complete projects on a global health topic of their choice and participate in an immersion elective abroad. (Currently, there are training sites in Uganda, Kenya, Saipan, and China). Through these activities we hope residents will gain facility with current issues in global health, increased cross-cultural competence, and exposure to health care in resource-limited settings.
Director: Chris Stewart, MD
Co-director: Mylo Schaaf, MD, MPH, DTMH
Department of Medicine faculty contact: Madhavi Dandu, MD
Health Equity: Academics and Advocacy Training (HEAAT) (Part of the Health and Society Pathway)
The Internal Medicine Health Equity Residency Training Program, which is part of the Health and Society Pathway) is centered at Zuckerberg San Francisco General Hospital. All residents receive training in Social Medicine, and it is this topic that makes up an integral part of the curriculum. Through a series of seminars, lectures, field trips and case conferences, residents explore how social factors influence illness and the practice of medicine and gain an in-depth knowledge of the issues surrounding disparities in health and health care by concentrating on care of vulnerable patients both within the context of the doctor-patient relationship and healthcare delivery systems. The ambulatory/elective time includes such didactic sessions as well as clinical rotations. Training for primary care, subspecialty bound, and international medicine residents will be similar, though clinic elective rotations may be different. All residents are strongly encouraged to complete and present mentored scholarly projects that are community or advocacy based.
Director of Health and Society Pathway: Naomi Wortis, MD
Co-Directors: Alicia Fernandez, MD, Edgar Pierluissi, MD, and Irene Yen, PhD, MPH
Leadership and Health Systems (Part of the Health and Society Pathway)
This program seeks participants with a strong interest in leadership and system change. Future plans could be varied but include: leading or managing a group, division, or department; running programs (including grants, public health initiatives, clinics); medical administration; leading patient safety or quality initiatives; and engaging health policy changes. Participants meet weekly during the ambulatory block for didactics in leadership development, quality and safety, and health policy. They are paired with an individual mentor in a high-level leadership position based on their interest (within or outside of UCSF) and complete a project of their choice designing and implementing a system change. All participants also sit on one decision-making body at UCSF Medical Center based on their interests.
Director of Health and Society Pathway: Naomi Wortis, MD
Co-Directors: Alicia Fernandez, MD, Edgar Pierluissi, MD and Irene Yen, PhD, MPH
Faculty Contact for Leadership and Health Systems: Edgar Pierluissi, MD
Clinical and Translational Research Pathway
The Pathway to Discovery Program in Clinical and Translational Research (CTR) is designed to stimulate passion for discovery and provide training and mentoring that will encourage and allow professional students, residents, fellows and postdoctoral trainees from all four UCSF schools to conduct innovative clinical and translational research. The CTR Pathway offers streamlined, coordinated courses of study within graduate education in health sciences with opportunities for obtaining certificates and advanced degrees in CTR. The Pathway is housed within the UCSF Clinical and Translational Science Institute (CTSI) and is a training program of the Clinical and Translational Research Training Program (CTST). The Pathway builds on two major established UCSF programs that support clinical research training: the Pathways to Careers in Clinical and Translational Research (PACCTR) program for pre-doctoral medical, dental, nursing and pharmacy students at UCSF; and the CTST Resident Research Program for residents. The Pathway requires completion of three CTR-related elements: a mentored project, curriculum devoted to independent work and a legacy product. For more information, please go to Pathways or contact the Program Director, Peter Chin-Hong, MD.
Co-Directors: Joel Palefsky, MD and Doug Bauer, MD
Faculty Contact: Doug Bauer, MD
Primary Care Medical Resident - Third Year
During the third year, the primary care residents spend approximately five months on hospital rotations and approximately seven months in ambulatory care. Approximately one month is spent in the medical intensive care unit at Zuckerberg San Francisco General Hospital, one month is spent in the Coronary Care Unit at Moffitt-Long Hospital, and one month is spent as a senior ward resident at the San Francisco Veterans Medical Affairs Center. One month of inpatient assignment is designated as an elective month in a subspecialty medical area of the residents' choosing so that he/she may acquire a greater depth of knowledge in this discipline. Residents may also elect to do a month-long research elective or elective in boards study.
The schedule of activities in caring for ambulatory patients during the third year is similar to that described above for the second year. By the third year, residents have a large panel of patients (approximately 130) whom they follow as the primary provider. Four weeks of the third year are allowed for vacation. A sample schedule for a third-year resident can be seen HERE.
Global Health Program
In response to the high level of resident interest in international training opportunities, UCSF has developed a Global Health Program. Third-year residents may use one elective month to complete the Global Health Program Rotation. Residents receive support to rotate in one of the following sites: Kenya, Uganda, Saipan, Beijing and the Indian Health Service in Gallup, New Mexico.
General Internal Medicine Group Practice at Mount Zion
In the General Medicine Practice (GMP), faculty internists, residents, nurse practitioners, and medical students work together providing continuity care for patients from many different socioeconomic backgrounds. Approximately one-third of GMP patients have Medicare, one-third have managed care plans, and one-third have Medicaid. GMP patients reflect the rich ethnic diversity of San Francisco with approximately 50% minorities (Latinos, Asians, Pacific-Islanders and African-Americans). The Practice is designed to provide high-quality patient care and to give the residents an experience similar to what they would encounter in the practice of medicine outside of a teaching institution. General Internal Medicine faculty work in the Practice caring for the same types of patients. Faculty and resident physicians work closely together in teams in this integrated practice. Care teams also include nurses, medical assistants, nurse practitioners and administrative staff. The faculty-resident on-call team is also responsible for phone evaluations of patients with acute medical problems after practice hours and on weekends.
The continuity experience in primary care internal medicine is the core of this residency program. Learning in the outpatient setting is different and the challenges posed by patient problems vary considerably from hospital-based medicine. The volume of patients is greater and the length of each encounter is shorter. Preventive medicine and programs for health promotion are a priority, and complicated multi-system medical problems are routinely managed as outpatients. Each of our faculty members has a continuity primary care practice, ensuring that clinical teaching is based on years of ambulatory care experience.
Clinical social workers, an integrated psychiatrist, psychologists, case managers, behavioral health, and nutritionists in the Division of General Internal Medicine complete the Practice team. They assist in evaluating psychological problems, provide for counseling needs of patients, offer alternative therapies for selected conditions, and help identify useful community resources. A faculty psychiatrist joins with the internal medicine faculty to teach the weekly seminar on behavioral and social medicine topics and provide ongoing care to patients as needed. The entire general internal medicine faculty is committed to the complete care of our patients including their psychosocial needs.
The General Medicine Practice at Mount Zion is located in a five-story medical office building at 1545 Divisadero Street, in the heart of San Francisco. Opened in December 2010, the building is located among numerous other medical offices on the UCSF/Mount Zion campus, including the UCSF Osher Center for Integrative Medicine. These buildings also house a full array of medicine and non-internal medicine sub-specialty practices, laboratories and x-ray facilities.
Flexible Pathway Program
In response to the changing needs of residents, UCSF has developed the Flexible Pathway -- a part time residency training track. This track is designed specifically for those residents whose family and/or health dictate a more flexible training experience. Selected residents may join this pathway after their R1 or R2 year. Flexible pathway residents will participate in residency training for 6 months of each year (in 2 or 3 month blocks). The pathway will take from 3 to 5 years to complete. For more information about the flexible pathway, please see the flexible pathway guidelines HERE.