The ambulatory experience includes the resident continuity clinic, ambulatory care rotations in the PGY1 and PGY2 years, and subspecialty clinic experiences. Interns have 1-2 clinics per week, except while in the MICU. The PGY2 and PGY3 schedule separates inpatient and ambulatory experiences by giving all residents discrete clinic blocks. Each residents will complete 12 weeks of clinic block annually, usually organized in
2 week intervals. Please refer to the schedule for more information. One continuity clinic is at the VACCHCS, the other at the Family Health Care Network (FHCN) at CRMC.

Schedule

The academic year is divided into 4-week blocks. Housestaff receive 3 weeks paid vacation and 1 week of paid educational leave annually. They intern schedule is a traditional 4-week block model.  PGY2 and PGY3 residents take advantage of the new x+y model (JGIM 2013; 28(8): 1100-4). Our implementation of this model is 4 weeks inpatient training, followed by 2 weeks ambulatory training, followed by 2 weeks subspecialty training (4+2+2). This new model has been shown to increase resident satisfaction with ambulatory experiences, reduce fragmentations of care, and enhance learning.

Inpatient medical teams include a PGY-2 or 3 level resident working with two PGY-1 residents and a dedicated internal medicine faculty member. Medical students on core internal medicine clerkships or 4th year students completing a sub-internship are often part of the medical team.

Subspecialty elective rotations are available and provide greater in-depth knowledge and experience. Resident responsibilities include both inpatient consultations and outpatient clinics. By the completion of the three-year program, residents will have completed rotations in most of the subspecialty fields: cardiology, dermatology, endocrinology, gastroenterology, hematology/oncology, infectious diseases, nephrology, neurology, rheumatology and pulmonary medicine and more.

Didactic Schedule

• Medical Emergencies Lecture Series daily in the summer
• Academic half days – protected time from 1-5pm for all residents to focus on education and team based learning
  • PGY1s Wed PM
  • PGY2/3s Tues AM
  • Team Based Learning didactic over a three year curriculum
  • Resident cases with facilitation/faculty backup
  • Rotating: Board Review, Journal Club, Ethics, Wellness, Simulation, Jeopardy, QI, High Value Cost Conscious Care, EBM, other
  • Content is training year specific
• Noon Lectures: M&M twice a month, UCSF Special Lecture Series weekly, Housestaff meetings 1-2 per month
• Morning Lectures: weekly Grand Rounds, Chest Conference

Gaining an understanding of evidence-based medicine (EBM) and developing skills in literature searching and appraisal is fundamental to life-long learning in medicine.  As part of our core curriculum, we present interns with the foundations of EBM and prepare them to lead our senior resident journal club.

Intern Evidence-Based Medicine Workshops

For over 10 years, we have taught the fundamental skills of EBM in our six-session workshop series.  These interactive workshops utilize a team-based learning approach to understanding the medical literature.  Based on the Users’ Guides to the Medical Literature, we cover topics such as PICO, therapy articles, assessing harm, diagnostics studies, and more.

Interns will learn to:

• Formulate clinical questions,
• Find the best relevant evidence,
• Appraise risk of bias of various study types,
• Assess the results,
• Generalize the results to their patients, and
• Engage patients in making a shared-decision.

Resident-Led Journal Club

During the PGY2 and PGY3 years, residents will lead their peers in an interactive journal club.  Residents choose articles from a repository of the most influential articles of the prior year.  Paired with a faculty mentor, the lead large group discussions of assessment and appraisal.

Our sessions follow a novel peer-reviewed format that incorporates principles of active learning and adult education.  The process helps residents learn to draw their own conclusions from the study design and results that are independent of the author’s conclusions, fostering independent critical-thinking skills.

We provide an unparalleled opportunity to develop procedural competencies while in residency.  Our graduates complete training with a broad set of procedural skills.  All resident will become privileged in the following procedures:

• Central venous catheter insertion
• Arterial catheter insertion
• Lumbar puncture
• Thoracentesis
• Paracentesis
• Arthrocentesis
• Pelvic exam

In addition to our required procedural competencies, many residents develop competencies in endotracheal intubation, incision & drainage, and punch biopsies.

In just this last academic year, our residents logged over 1400 procedures.

how do we do this?

It all starts on day one.  During Intern Bootcamp you will be exposed to the fundamentals of sterile technique, ultrasound-guidance for central line insertion, and endotracheal intubation.

In 2015, we created a procedure rotation to add more opportunities and focused experience in procedural training.  All interns will spend a minimum of 2-week on the rotation.  The rotation includes dedicated time in one of our state of the art simulation centers, training in ultrasound techniques, and bedside procedural training.

Additionally, residents will perform various procedures on their patients while rotating on our robust critical care and wards rotations.

While the number and variety of procedures that internists perform has dwindled elsewhere over the years, the strength of our procedural training has only grown.  We ensure that all of our graduates have the confidence and competence to perform all of the common medicine bedside procedures.

As an example, below is the tally or procedures logged by each of our recent grads: