"Of all the forms of inequality, injustice in health is the most shocking and inhuman" - Martin Luther King, Jr.
(Medical Committee for Human Rights Convention 1966)

Mission

The University of California San Francisco (UCSF), Internal Medicine Residency Primary Care track at San Francisco General Hospital Medical Center (SFGH) is an academic primary care residency devoted to training physicians to be leaders in the care of the underserved. We emphasize meeting the complex needs of poor and vulnerable patients and developing methods of primary care that are effective, efficient and accessible to all people. One measure of the successfulness of our training is that the majority of our graduates continue to work with the underserved, whether in research, clinical, public health, health policy or advocacy careers.

Based at SFGH and its affiliated Community Health Network, the publicly funded county hospital and network of primary care health centers that serve all residents of the City and County of San Francisco regardless of their insurance status, the residency is a three-year program leading to Board eligibility in Internal Medicine. Six positions are offered each year. Although residents are based at San Francisco General Hospital, they are fully integrated into the Department of Medicine at UCSF and have the opportunity to rotate to a variety of different practice settings including UCSF Moffitt/Long Hospitals and their managed care clinics, San Francisco VA Medical Center, community clinics, private practices and other federally and state-funded clinics.

The residency program is affiliated with the SFGH Division of General Medicine (DGIM) and the DGIM Primary Care Research Center. The Primary Care Research Center is a nationally renowned center that focuses on research issues involving the underserved such as access to care, disparities in medical outcomes in minority populations, and improving health outcomes in vulnerable populations.

In order to broaden our mission, the SFGH Primary Care track is also the home of the Health Equities Area of Distinction. This program allows residents from all UCSF internal medicine tracks to participate in our Social Medicine curriculum and to arrange clinics and mentorship opportunities similar to those available to the SFGH primary care residents.

Our faculty and residents feel that we can best meet the needs of a diverse population by training physicians who appreciate the community, cultural background and language of our patients. This view is reflected in our commitment to recruit underrepresented minority residents to our program. The faculty is explicitly committed to providing the mentorship and support necessary to help each individual fulfill his/her career goals.

San Francisco General Hospital

It is the mission of San Francisco General Hospital (SFGH) to deliver high quality, humanistic, and culturally competent health services to the residents of the City and County of San Francisco.

Located in the vibrant Mission District of San Francisco, SFGH provides world-class care to a truly diverse clientele. Just a few of the outstanding services available at SFGH are:

• Comprehensive outpatient clinics staffed by award wining UCSF faculty and resident physicians.
• World-renowned AIDS clinical care and research
• A nationally regarded, state of the art trauma center
• Rigorous research mission
• Innovative patient care programs to improve care to vulnerable patients

Although many patients are attracted by the excellence of medical care, many also choose SFGH because of the hospital's commitment to providing care to all patients. This commitment includes:

• A policy that no patient will be turned away for financial reasons.
• Extensive interpreter services. Professional interpreters of Arabic, Cantonese, Russian, Spanish, Tagolog and many more languages are available to assist patients and health care providers.
• Culturally sensitive psychiatric and social services

Curriculum

Internship

Primary care medicine interns complete a program similar to the other internal medicine interns at UCSF. Ten months are spent in hospital-based and emergency department rotations and two months are spent on ambulatory block. Interns assume the care of a panel of patients at the SFGH General Medical Clinic one half-day a week throughout the year. An intern outpatient curriculum is delivered during the half- day of clinic during internship. In addition, each primary care intern spends two months in the ambulatory setting divided between General Medicine Practice, urgent care, subspecialty clinics, riding the homeless medical van and receiving a special curriculum that includes sessions on caring for the homeless, geriatrics, community medicine and making home visits. During their ambulatory months, 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.

Support groups are held monthly and interns attend the residency retreats held in the fall and the spring.

R2 and R3 years

The second and third years are divided into two month blocks; half of these blocks are devoted to inpatient rotations common to residents in all UCSF internal medicine programs. The other blocks are what distinguish the SFGH primary care residency from the other UCSF internal medicine tracks. The SFGH Primary Care ambulatory blocks include more intensive primary care experiences and rotations through core subspecialty clinics and outpatient electives, and curricula in ambulatory care, and behavioral and social medicine. Most residents also complete research, community, educational or quality improvement projects during this time.

Continuity and Core Clinics

Throughout the three years of residency, residents have one-to-three half days of continuity clinic in the General Medical Clinic at SFGH. This clinic has a rich diversity of patients reflective of the diversity of our city. About half are uninsured and the rest are marginally or publicly insured. About half do not speak English as their first language. Our patients bear a heavy burden of chronic illness.

In addition, second and third year residents select a second continuity clinic site at a community-based primary care clinic exposing them to different populations of patients and systems of care. Residents also rotate through a orthopedic, rheumatology, dermatology, women's health, geriatrics, psychosocial medicine, addiction medicine, prison health care clinics and health care outreach to the homeless. Residents' schedules allows them to develop areas of particular clinical expertise, clinical services projects and perform research on the care of vulnerable patients.

Social Medicine

The Social Medicine curriculum concentrates on examining the social, economical and political determinants of health and incorporates these factors into patient care, particularly within the context of the doctor-patient relationship and healthcare delivery systems. The curriculum includes a series on health care disparities, cross-cultural medicine and advocacy. The textbook "The Medical Management of Vulnerable and Underserved Patients: Principles, Practice and Populations," was written by residency faculty in support of the curriculum. Residents go on field trips and meet with activists and other important community and health care leaders.

Behavioral Medicine

Behavioral Medicine is directed by a psychiatrist with a particular interest in cross-cultural medicine and teaching, and consists of didactic seminars on psychiatric disease and interventions and interviewing skills.

Complementing these are the ambulatory curriculum, which features evidence-based approaches to outpatient medicine and our programs in quality improvement, high user case-management, projects, Primary Care Grand Rounds and journal club.

Innovations in Primary Care

During the second and third years residents participate in the AAMC Chronic Care Collaborative, working on ways to redesign health care delivery systems in the General Medicine Clinic to improve diabetes care provided to our patients. As part of this curriculum a series of didactic sessions geared to teach residents a structured approach to improving health care in the ambulatory setting, including understanding the Chronic Care Model, issues around health care financing, and other primary care innovations (e.g. group medical visits, motivational interviewing techniques) that are described in the medical literature.

Projects

Most residents complete a residency project. These may be community, service, quality improvement, educational or research oriented. Residency faculty often mentor these projects; residents can also choose to work with faculty from other sites at UCSF.

Conferences/Journal Club

Primary Grand Rounds are jointly sponsored by SFGH Primary Care Residency and the Family and Community Medicine Residency based at SFGH and feature talks on ambulatory care medicine, social justice and medicine, public health and the care of vulnerable patients. Clinic conferences are held each clinic day. Residents have the opportunity to attend local CME conferences. At DGIM Journal Club, residents and faculty present and discuss the current literature, especially around issues directly relevant to our patients. Each year a joint journal club is held with the SFGH Family and Community Medicine faculty and residents and another with UCSF/Moffitt DGIM faculty and residents.

Retreats/Mentors/Support

Semi-annual retreats (one evening and one weekend) are held for the residents and faculty to discuss program issues in a more relaxed environment.

We also have a faculty/resident mentoring program, a Big Sibs program and a resident-run monthly support group.

International Health Program

In response to the high level of resident interest in international training opportunities, UCSF has developed an International Health Program. This program was launched in July of 2003. Third-year residents may use one elective month to complete the International Health Program Rotation. Residents receive support to rotate in one of the international sites. Rotations are currently located in Kampala, Uganda, Saipan, Mexico and Beijing, China.

Flexible Pathways 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.

Residency Faculty

All DGIM faculty members are active participants in the Primary Care Residency Track and in the General Internal Medicine Clinics. Current faculty are:

• Sharad Jain, MD (Track Director)
• Leila Alpers, MD
• Kirsten Bibbins-Domingo, MD
• Andrew Bindman, MD (SFGH/DGIM Chief)
• Robert Brody, MD
• Alice Chen, MD
• Alicia Fernandez, MD
• Richard Fine, MD
• Claire Horton, MD
• Beth Harleman, MD
• Margot Kushel, MD
• Joe Roll, MD
• Hilary Seligman, MD
• Dean Schillinger, MD
• Michelle Schneidermann, MD
• Margaret Wheeler, MD
• Dan Wlodarczyk, MD

Program Residents 2008-2009

PG Year I

• David Brody - UCSF
• Anna Chodos - Harvard
• Basim Khan - UCLA
• Mia Lozada - U. Chicago
• Larissa Thomas - Emory
• Jennie Wei - Harvard

PG Year II

• Jason Andrews - Yale
• Soraya Azari - Univ. Pennsylvania
• Bonnie Chen - UCSF
• Risha Irby - Harvard
• Jenny Siegel - Harvard
• Vanessa Thompson - UCSF

PG Year III

• Chitra Chandran - UCSF
• Damon Francis - UCSF
• Reena Gupta - Harvard
• Ana Miranda Maldonado - Stanford
• Meg Pearson - Yale

About the Application Process

The UCSF Medicine//SFGH Primary Care Track seeks applicants with demonstrated commitment to serving medically underserved populations. In addition, applicants should have above average performance in medical school as reflected by letters of recommendation and evaluations. We are committed to recruiting a diverse group of trainees.

Applications for the 2009-2010 UCSF Medicine Residency/San Francisco General Hospital Primary Care Track will be done through the Electronic Residency Application Service (ERAS).

For information on how to apply: US medical school students or graduates:
Contact your school's student affairs office
Contact ERAS at: http://www.aamc.org/audienceeras.htm

Foreign medical school students or graduates:

Contact the Education Commission for Foreign Medical Graduates (ECFMG) ERAS Program PO Box 13467, Philadelphia, PA 19101-3467, USA Fax (215) 387-9963.

Contact ERAS at: http://www.aamc.org/audienceeras.htm

In addition to the required application and fees please submit the following materials to ERAS:

Department of Medicine Chairman's Letter
Two additional letters of recommendation
Dean's Letter
An official transcript
A personal statement specifically addressing why you want to work in a public hospital setting and care for a vulnerable and medically underserved population

Deadline for receipt of application materials is NOV.14, 2008

Please do not send applications or materials directly to our program as they will not be processed nor reviewed. However, if you have questions please contact the Program Administrator, Kay Judish, at (415) 206-5164 or via e-mail: kjudish@medsfgh.ucsf.edu

For additional information on UCSF Medicine Residency Programs go to http://medicine.ucsf.edu/residency/overview/index.html