Internal Medicine at San Francisco

Internal Medicine Curriculum

Inpatient Program

Our Inpatient program encourages residents to become fully involved in the decision-making process and management of patients. We have four conventional medical ward teams, each consisting of two interns, one resident, and a hospitalist attending. Each team carries up to a maximum of 16 patients. Additionally, there is a fifth team comprised of a resident on a hospitalist rotation who works with an attending to manage twelve medical patients. A staff internist is based in the hospital at all times to provide supervision, teaching, and backup for the residents.

We emphasize the concept of graded responsibility, providing residents the support they need for their level of training and expertise. Major management decisions are made in conjunction with the attending physician. In addition to patient care, resident responsibilities include supervision and teaching of interns and medical students. Interns are responsible for examining and managing patients admitted to their service under the supervision of the resident and the attending physician.

Outpatient Program

We have a long-standing tradition of excellence in primary care and offer solid training in outpatient care. Health plan members make approximately 260,000 visits each year to the Department of Medicine.

The ambulatory care program includes a weekly continuity clinic, a 4-week ambulatory care block during each residency year, a 4-week community geriatrics rotation in the third year, and subspecialty outpatient clinics. Didactics are covered at weekly primary care conferences.

The continuity clinic for categorical residents emphasizes an integrated approach to health care where the resident, functioning as the primary care physician, provides comprehensive care to the patient, with assistance from allied health professionals and under the guidance and supervision of the precepting staff physician. The continuity clinic experience is designed so that each resident builds his/her own practice with increasing time spent in clinic. By the end of the third year, residents typically have a personal panel of 200-250 patients. The resident-to-attending ratio in all clinics is 2:1.

Outpatient electives include:

• Urgent care
• Dermatology
• Neurology
• Head and Neck Surgery
• Rheumatology
• Endocrinology
• Extended Continuity Clinic
• Ophthalmology

Teaching Programs

Our program emphasizes exposure to a broad array of clinical situations that will allow the resident to master the skills needed to become an expert internist. Teaching occurs in various formats from formal didactic rounds to pearls learned in brief encounters on the wards or elsewhere. We use a multidisciplinary approach to patient care in all settings with an emphasis on evidence-based medicine.

Daily Teaching Program

• Morning Report: 8:00-9:00 a.m. Residents present complicated or interesting cases, both inpatient and outpatient, for discussion and advice on diagnostic or management strategies. A focus is made on evidence-based medicine.
  
• Medicine Noon Conference: 12:45-1:45 p.m. Residents and faculty attend this daily teaching conference. Monthly, there are Morbidity and Mortality, Complications, and Journal Club conferences. In addition, cutting edge topics in internal medicine are presented by our own faculty, as well as local and national guest speakers.
  
• Ward Attending Team Rounds: This clinically oriented, small-group teaching session is based on patient cases from the inpatient teams. Team rounds typically occur at the end of work rounds each morning and are conducted by the HBS attending.
  
• Cardiology and Intensive Care Rounds: These are conducted each morning with the ICU/CCU team by the attending cardiologist and HBS intensivist.
  
• Subspecialty Rounds: Residents on subspecialty electives attend these teaching and consultation rounds, which are conducted several times per week.

• Academic Half Day: 10:00 a.m.-2:00 p.m., Tuesdays A new addition for 2007-2008, residents have protected educational time for a weekly seminar with focused board review and multidisciplinary lectures.
  
• Intern Report: This weekly one-hour session is led by the chief resident and invited faculty. A core curriculum has been designed to ensure that interns become comfortable with the recognition and management of all common problems encountered during the year and are prepared for the USMLE Step III examination.
  
• Outpatient Teaching Sessions: Besides review of each patient with an attending, key topics are presented to the residents weekly. These sessions occur at the individual intern/resident continuity clinics. In addition, a weekly Medicine Noon Conference reviews the essentials of primary care medicine as outlined in the outpatient core curriculum.