UCSF Primary Care/General Internal Medicine Residency Program

Table of Contents Cover Letter Introduction Program Objectives Description of Resident Activity First Year (Internship) Second Year Third Year Sample Schedule General Internal Medicine Group Practice Flexible Pathway Program Resident Research Program Stipends Benefits Applications and Contact Information

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Introduction

The UCSF Primary Care/General Internal Medicine Residency is a three-year program designed to train internists in both ambulatory and hospital care. As a part of the Department of Medicine Residency Program at the University of California, San Francisco (UCSF), it combines intensive in-hospital training with structured training in ambulatory medicine in a general internal medicine group practice, in internal medicine subspecialties, and in non-internal medicine specialties essential to the practicing general internist. The primary care residency is fully integrated with the Department of Medicine's other internal medicine residency programs. The primary care residents and the general internal medicine faculty participate in all Department of Medicine teaching and service activities.

Primary care medicine interns complete a program similar to the categorical internal medicine interns. Ten months are spent in hospital and emergency department rotations and two months are spent in ambulatory care. Primary care interns work one half-day per week in one of the General Medicine Practices throughout the year. In addition, each primary care intern spends two months in the ambulatory setting working in their General Medicine Practice, in urgent care, and providing health care for the homeless. Interns attend regularly scheduled ambulatory care conferences, lectures, journal clubs, and additional seminars designed for interns on medical interviewing and management of common outpatient problems. Interns may select from designated ambulatory electives during their ambulatory months. Intern support groups are held monthly and each intern is invited to attend a retreat with other primary care residents and faculty to discuss issues of personal and professional growth and development.

In the second and third year, residents spend half of their time in hospital rotations and half in the practice of ambulatory and primary care medicine. Skills in primary care are developed through continuity care experiences in outpatient medicine, case conferences, lectures, subspecialty case discussions, behavioral medicine seminars, core seminars and journal clubs. During each clinical session, general internal medicine faculty are available for consultation and teaching. Training in non-medical specialties (such as dermatology, gynecology, psychiatry, orthopedics, and urology) is provided through precepted rotations in specialty clinics and practices. Emphasis is also placed in 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 faculty. Residents may select an additional continuity clinic in the surrounding community, thereby improving resident skills in community-based primary care. Residents also regularly attend a core seminar series for further development of clinical skills as well as instruction in other aspects of general internal medicine including clinical epidemiology, medical and non-medical specialties, ethics, nutrition, geriatrics, occupational medicine, and health policy.

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Program Objectives

The three-year residency program fulfills requirements for internal medicine board eligibility. The major goal of the UCSF Primary Care/General Internal Medicine Residency Program is to train highly competent, socially responsible general internists skilled in contemporary methods of primary care. Toward this end, the program has a number of specific objectives:

1. To provide training and a high degree of competence in the management of severely ill hospitalized patients. The resident should understand the role and contribution of various specialists and subspecialists in the acute care process, and learn to provide continuing care of patients hospitalized from their ambulatory practice.

2. To provide an ambulatory care experience that has continuity throughout the three years of training and provides increasing breadth and intensity of experience in the primary care setting. The resident should learn the problems and decision-making processes involved in the long-term care of patients and gain an understanding of how illnesses are integrated into the life patterns of patients. The resident should also acquire an understanding of the natural history of disease and the timing of interventions.

3. To acquire the specialty and subspecialty skills necessary for the practice of internal medicine including skills in cardiology, pulmonary medicine, infectious diseases, hematology, oncology, endocrinology, gastroenterology, rheumatology, neurology, nutrition, ethics, orthopedics, gynecology, dermatology, urology, otolaryngology, occupational medicine and other medical and surgical subspecialties.

4. To develop skills in interviewing and patient communication in order to gather data effectively and to understand illness in the context of patients' life patterns. The resident should also develop skills in several areas of counseling, such as behavior change, stress reduction, marital relationships, sexuality, health education, interpersonal conflicts, aging and daily emotional problems.

5. To learn to function effectively as the internist member of a primary health care team, working with other physicians, psychologists, nurse practitioners, pharmacists, social workers, dieticians and physical therapists. The resident should become familiar with social and community health resources, and be able to utilize them effectively for the care of patients.

6. To learn the skills needed for modern medical practice, including proper use of diagnostic tests and procedures, cost effective approaches to problem solving, the use of office-based preventive services, critical assessment of the medical literature, the application of ethical principles in daily practice, principles of chronic disease management, skills in quality improvement, and the role of generalist physicians in managed care and community-based settings.

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Description of Resident Activity

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/Parnassus and UCSF/Mount Zion campuses of the University of California, San Francisco. Primary care interns work four or five months at Moffitt-Long Hospital, three or four months at the San Francisco General Hospital and two or three months at the Veterans Affairs Medical Center.

Throughout the year, interns provide continuity care to a panel of patients in the General Medicine Practice (GMP) at Parnassus or Mount Zion. Interns spend one half-day a week in the GMP and develop a patient panel that they will care for through the 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, and other faculty. 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. In addition to increased time in continuity practice in GMP, interns work in the UCSF/Parnassus Screening and Acute Care Clinic and Veteran Affairs Urgent Care Center. Interns may also select from designated ambulatory electives during their ambulatory months. Intern ambulatory seminars are designed to teach medicine interviewing skills, management of common ambulatory problems and principles of "doctoring." Each intern also works on San Francisco's Homeless Vans and attends regularly scheduled ambulatory care conferences. A sample schedule for a primary care intern is seen here.

Primary Care Medical Resident - Second Year

Seven months of the second year of residency are devoted to inpatient assignments at both the San Francisco General Hospital and Moffitt-Long Hospital. 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.

Five months are spent in ambulatory care. This ambulatory time is divided into seven components:

1. Two half-days per week in continuity care in the resident's General Medicine Practice.

2. One half-day per week in a community-based primary care setting such as OnLok Senior Services, Tom Waddell Health Clinic, Maxine Hall Health Center, the Lyon-Martin Women's Clinic, UCSF and San Fransico State Student Health Services, San Francisco Free Clinic, and other community settings. These supplemental continuity clinics provide additional opportunities for development of primary care skills with diverse patient populations.

3. 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. 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.

4. One optional half-day per week is devoted to residents' independent projects. 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 discuss ongoing projects. Many residents devote a month-long elective to their independent project as a 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.

5. Two half days per week are devoted to seminars and case discussions. Additional didactic sessions are scheduled throughout the week (sample schedule). The Behavioral Medicine Seminar taught by a psychologist and physician faculty, and focuses on medical interviewing, management of common psychologic and psychiatric problems, counseling for behavior change, and patterns and use of social service resources. Videotapes are used to facilitate these important sessions. Core Seminars are designed to emphasize topics requiring additional in-depth study such as clinical epidemiology and evidence-based medicine, ethics, nutrition, geriatrics, occupational medicine and health policy, and to develop a core curriculum in essential clinical areas including dermatology, neurology, women's health, ENT, orthopedics and opthalmology. Independent study complements these advanced seminars. Primary Care Grand Rounds are bimonthly lectures on topics relevant to primary care practice. Practice Report is an informal hour-long case conference between faculty and residents. Residents spend one hour each week in a seminar learning how to care for patients with chronic illness, how to work with an interdisciplinary health care team, and designing quality improvement projects. DGIM Research Conference and Resident Research Conference are designed to discuss ongoing faculty and resident scholarship. Journal Club is a monthly evening meeting with potluck dinner 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 Morbidity and Mortality Conferences.

6. Two months each year, second year residents spend one half day per week in a specialized didactic seminar focused on the second-year resident. This seminar covers EKG instruction, systems-based instruction (practicing in clinic), telephone medicine, and "how to give a talk" (including instruction on presenting a clinical vignette).

7. Residents may select optional teaching activities. Residents may precept third year medical students in the evening student continuity clinic. Residents may also teach physical diagnosis to second year medical students as part of the Introduction to Clinical Medicine Course.

8. Residents may select to participate in an Area of Distinction. These AOD's allow residents to devote curricular time to a subject area. Examples include: Global Health, Health Equities, Medical Education, and leadership.

9. Resident may elect to participate in a month-long elective in a subspecialty medical area of the resident's choosing.

To follow their own patients, residents continue to practice in the ambulatory General Medicine Practice when on hospital rotations. Residents also share telephone call responsibility with faculty for the General Medical Practice. Four weeks of the second year is allowed for vacation. A A sample schedule for a second-year resident is seen here.

Primary Care Medical Resident - Third Year

During the third year, the resident also spends seven months on hospital rotations and five months in ambulatory care. Approximately one month is spent as the resident in charge of the Emergency Room at Moffitt-Long Hospital, one month is spent in the medical intensive care unit at SFGH, 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. During elective months two half-days are spent in continuity clinic.

The schedule of activities in caring for ambulatory patients during the third year is similar to that described above for the second year. In addition to continuing their primary care practice and participating in the primary care curriculum, residents have an opportunity to teach medical students during ambulatory block time. By the third year, residents have a large panel of patients (approximately 200) 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 is seen here.

International Health Program

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General Internal Medicine Group Practices at Parnassus and Mount Zion

In the General Medicine Practices (GMP's), 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 Practices are 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 Practices caring for the same types of patients. Faculty, resident physicians and nurse practitioners work closely together in teams, sharing responsibility for patients and cross covering for each other when not available. 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 at one of the GMP's, ensuring that clinical teaching is based on years of ambulatory care experience.

Clinical social workers, psychologists, 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. Faculty psychologists join 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 Parnassus is located in the Ambulatory Care Center, a modern, nine-story facility overlooking the Golden Gate Bridge and the San Francisco Bay and located across the street from Moffitt-Long Hospital. The Ambulatory Care Center also houses the practices of medical subspecialists and non-internal medicine specialists, as well as laboratories and x-ray facilities.

The General Medicine Practice at Mount Zion is located in a new five-story medical office building at 1701 Divisadero Avenue, in the heart of San Francisco. Opened in 1998, the building is located among numerous other medical offices on the UCSF/Mount Zion campus, including the UCSF Cancer Center and the 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.

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Example of Primary Care Resident Schedules

This is a sample schedule of a week when the primary care resident is on an ambulatory practice rotation during the second and third year.

Flexible Pathway Program

Resident Research Program

http://www.epibiostat.ucsf.edu/courses/schedule/clin_research_predocs_winter_08.html

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Stipends for current year

$44,200 (annual PGY I)
$45,685 (PGY II)
$47,527 (PGY III)

We also provide a $2,400 relocation allowance to all incoming interns.

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Benefits

Health and life insurance plans are provided at no cost. Annual paid vacations are provided as follows: PGY I, three weeks; PGY II and PGY III, four weeks. In addition, 3-5 days educational leave is available at the discretion of the Program Director. All residents are given 6 days of vacation over the winter holidays.

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Applications

Applicants for PGY I positions must register with the NRMP (National Resident Matching Program) and apply through the Electronic Residency Applications Service (ERAS). Students should check with their student or academic affairs office and the NRMP office for details. All applicants are required to electronically send an official medical school transcription, Dean's letter, a Department of Medicine Chairman's letter (or designated representative), two additional letters of recommendation from Department of Medicine or other Faculty, USMLE Board Scores (Part One), and a personal statement.

Interviews are arranged by invitation only. Interviews will be granted after all letters of recommendation and the completed application have been received and reviewed through the ERAS program. Applications must be completed by December 1, 2006.

The NRMP Code number for the UCSF Primary Care Internal Medicine residency is 1062140M0.

The UCSF Primary Care residency program is fully committed to enhancing the diversity of our program. Applications from women and under-represented ethnic/cultural groups are strongly encouraged.

Applications and all supporting material should be addressed through ERAS to:

Katherine Julian, MD
Program Director
UCSF Primary Care Residency Program

Additional questions may be addressed to Wendy Smith.

Wendy Smith
415-476-4990
wsmith@medicine.ucsf.edu