UCPC Residency Curriculum

Primary Care General Internal Medicine Resident (UCPC) - First Year (Internship)

The UCSF Primary Care General Internal Medicine Residency (UCPC) "home base" is the Division of General Internal Medicine (DGIM) at the UCSF/Mount Zion campus of the University of California, San Francisco (UCSF). Similar to categorical interns, UCPC interns spend 9 months in hospital and emergency medicine department rotations, two months in ambulatory care, and one month in a procedures/quality improvement elective. During inpatient time, UCPC interns rotate through the three teaching hospitals of UCSF:  Moffitt-Long Hospital, Zuckerberg San Francisco General and the Veterans Affairs Medical Center.  Interns have three weeks of vacation each year, additional vacation days during the winter holiday season, and a week of vacation at the end of internship year.

UCPC interns spend one half-day per week in continuity practice at the Mount Zion General Medicine Clinic (GMC), a certified Patient-Centered Medical Home. In GMC, interns develop a patient panel that they care for during their three-year residency. Once monthly, they attend a support group hour with their peers and a facilitator who is not affiliated with UCPC leadership.

UCPC interns also spend two “block” months in ambulatory care at GMC. The first of these ambulatory months is an immersion month where interns intensively practice at GMC along with their co-UCPC intern cohort. During this month, interns participate in interactive seminars focused on ambulatory clinical topics as well as skill building in patient interviewing, working with team members in a patient-centered medical home and utilizing the electronic health record. During their second ambulatory month, in addition to seeing patients in GMC, interns also see patients in the UCSF/Parnassus Screening and Acute Care Clinic and SF Community Clinic Consortium (SFCCC) Street Outreach Services (SOS. Interns also attend regularly scheduled ambulatory care conferences and a day-long retreat with other UCPC residents and DGIM faculty to cultivate resiliency and build reflective skills for personal and professional development.  A sample schedule for a UCPC intern can be seen HERE

Primary Care General Internal Medicine Resident (UCPC) Resident - Second Year

In the second year, UCPC residents spend more than six months in the ambulatory setting developing skills in primary care practice, quality improvement, leadership, scholarship and self-improvement. Residents develop skills in continuity care through outpatient practice, case conferences, subspecialty seminars, core clinical didactics, journal clubs and elective clinical rotations. During an extensive behavioral medicine curriculum, residents develop interviewing skills, learn to counsel patients for behavior change, and learn to manage psychiatric conditions commonly seen in primary care. Research and scholarship skills are developed through independent resident projects mentored by general internal medicine research faculty and through electives that teach research methods. Residents may select an additional continuity clinic in the surrounding community, thereby improving skills in community-based primary care. We provide a core didactic seminar series to teach hands-on clinical skills, as well as other aspects of general internal medicine including medical and non-medical specialties, sports medicine, palliative care, ethics, nutrition, geriatrics, occupational medicine, public health and health policy.

The remaining months of the second year of residency are devoted to inpatient rotations at both the San Francisco General Hospital and Moffitt-Long Hospital (approximately 5 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 learn telephone triage, by sharing call responsibility with faculty for one week each year. Residents have 4 weeks of vacation each year. A sample schedule for a second-year resident can be seen HERE.

Details:

Ambulatory time is divided into eleven components:

1. Three half-days per week in continuity care for the resident’s own panel of patients. This allows residents to develop skills in panel management and longitudinal care.
2. 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, Community Practice HIV Clinic, San Francisco State Student Health Services, San Francisco Free Clinic, Kaiser Primary Care, Housecalls, clinics in the Community Health Network of San Francisco and other community settings. These supplemental continuity clinics provide opportunities to develop 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, UCSF Mission Bay, the Veterans Affairs Medical Center, other hospital-based and community clinics, managed care settings, and physicians' private offices. Residents may choose from over 90 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 Acute Care Clinics at Parnassus and Montgomery Streets; these experiences provide opportunities to treat ambulatory patients with acute problems.
4. 1-2 half-days per week are devoted to Residents' Scholarly Projects (RSP). Resident projects may include independent research, scholarly reviews, community projects, medical education research or quality improvement. Each resident works closely with a DGIM mentor. Bimonthly research conferences 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. Residents present their scholarship at the end-of-year Department of Medicine Research Symposium and/or at regional and national internal medicine meetings.

   

5. In addition to an independent project, residents may elect to take a one-month course in Designing Clinical Research. This course guides participants through the essential components for writing a clinical research protocol based on the resident’s clinical research question. During this elective, residents attend bi-weekly group lectures, small seminar groups, and a peer review session. The course covers developing and refining study questions, hypotheses, specific aims, study types, sample size estimation, power calculations, and data analysis.
6. 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 and faculty in GMC and the GMC social worker who practices in the General Medicine Clinic 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, palliative care, sports medicine, nutrition, geriatrics, occupational medicine, public health and 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.

   

7. Residents may select optional teaching opportunities. 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 rotation at the General Medicine Clinic.
8. Residents may elect to participate in a two- or four-week inpatient elective in a subspecialty medical area of the residents' choosing.
9. Residents may elect to participate in the Graduate Medical Education Pathway Program. These Pathways allow residents to devote curricular time to a particular subject area. Primary Care Residents may elect to participate in a Health Professions Education Pathway, Health Equities Academic Advocacy Training Pathway, or a Leadership and Health Systems Pathway.
10. 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 that are facilitated by professionals who are not affiliated with our program.
11. 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 receive funding to attend the Society of General Internal Medicine National Meeting.

The GME Pathways Programs:

Health Professions Education Pathway

This program is for residents who are interested in making medical education a key 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 obtain hands-on experience teaching and mentoring with a community of like-minded faculty and trainees. Residents participate in a didactic curriculum that includes teaching methods, curricular development, learning theory, assessment, medical education research, and leadership skills. Participants also complete a mentored scholarly project relating to medical education and formally teach medical students on the UCSF campus.

Department of Medicine faculty contact: Patricia O'Sullivan, EdD

Health Equity: Academics and Advocacy Training (HEAAT)

The Internal Medicine Health Equity Residency Training Program is centered at Zuckerberg San Francisco General Hospital. All residents receive training in Social Medicine, which is 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. All residents are strongly encouraged to complete and present mentored scholarly projects that are community or advocacy based.

Department of Medicine faculty contact: Joan Addington-White, MD

Leadership and Health Systems

This program seeks participants with a strong interest in leadership and system change. Future career 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 for didactics in leadership development, quality and safety, and health policy. Residents are paired with a 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.

Department of Medicine Faculty Contact: Edgar Pierluissi, MD

Primary Care General Internal Medicine (UCPC) Resident - Third Year

During the third year, UCPC residents spend approximately five months on hospital rotations and approximately seven months in ambulatory care.

During inpatient months, one month is spent in the medical intensive care unit at Zuckerberg San Francisco General Hospital, one month in the Coronary Care Unit at Moffitt-Long Hospital, and one month 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.

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 on the Department of Medicine Website.