How many residents and interns are there in the program?
There are 42 residents in our program. In each intern class, we offer 10 categorical positions (2 of which are combined Internal Medicine/Preventive Medicine positions) and 8 preliminary internship positions.
I’m going to be so busy during residency. How can I take care of myself and thrive?
Resident wellness is an integral part of our culture at Kaiser San Francisco. As part of this commitment, we have a wellness curriculum and a Resident Wellness Committee comprised of all residents and led by one of our faculty, Dr. Rakesh Jotwani. The curriculum includes monthly didactics and experiential learning, including concepts drawn from Tending the Flame, a course developed by the Remen Institute for the Study of Health and Illness (RISHI©) to combat the epidemic of physician burnout.
We believe that the capacity to find joy and meaning in one’s work correlates with professional and personal resiliency and, to that effect, our wellness curriculum aims to connect residents with the meaning of their work through narrative medicine and storytelling.
We also believe that physicians cannot operate at their full potential unless they attend to their own physical, psychological, and emotional wellbeing. Our residents participate in activities such as group hikes, intramural team sports, and free boot camp or yoga classes on campus. They also receive a stipend to join a gym of their choosing. Each year, the intern class and upper level residents each have their own full-day retreat. There is a full range of counseling and mental health services available to residents, and we provide education about physician burnout and specific techniques such as a personal mindfulness practice to build one’s resiliency.
We want each of our residents to find their niche in medicine where they are passionate about their work. As a resident in our program, you will have a dedicated faculty member who will regularly meet and work with you to discover your passion in medicine, and then work with you to make that vision a reality.
What recent changes have there been in the program, and what additional changes can I expect in the future?
We are constantly striving to improve our program. Here are some important new developments:
- Spearheaded by one of our outgoing chief residents, we now have in place a robust Health Disparities curriculum, including a series of conferences over the course of the year that focus on health as a human right, case studies, health disparities research, strategies to reduce health disparities, and cultural competency and cultural humility.
- Point-of-Care Ultrasound (POCUS): We are fortunate to have two faculty members, Dr. Marc Kurtzman and Dr. Joel Cho, who are POCUS experts and instructors at the national ACP and SHM conference pre-courses. With their assistance, we have implemented a year-long curriculum that includes formal lectures, standardized patients, image review, and integration of POCUS into regular Morning Report and Journal Club sessions. Our long-term goal is to prepare our residents to earn the SHM/Chest Point-of-Care Ultrasound Certificate of Completion.
- The addition of a Community Medicine and Urban Health Fellow based at Kaiser San Francisco starting in July 2019 will facilitate our residents working in local community primary care clinics (such as Tenderloin Health Services and Clinic by the Bay) to a diverse group of underserved patients.
- Kaiser Longitudinal Integrated Clerkship (KLIC): Beginning in January 2019, a cohort of third-year medical students from UCSF will begin this innovative, year-long clinical training program at Kaiser San Francisco and complete all of their core clerkship rotations at our medical center.
Why are there separate admitting and rounding inpatient teams?
Separate Admitting and Rounding roles were created in conjunction with resident feedback and has significantly improved the educational experience in each setting. Notably, the change eliminated the previous short/long call system on the wards and replaced it with a round robin system of distributing admitted patients. The elimination of “boluses” of new admissions in favor of a “drip system” has helped to make for a more manageable daily workload and, as a result, an improved learning experience and work/life balance.
Admitting teams are based in the Emergency Department and work closely with the attending hospitalist to evaluate patients at the time of their initial presentation. On non-admitting days, the resident is on the Procedure service and gains ample experience in performing common procedures. The Admitting team stabilizes, diagnoses and admits patients for further care, and in doing so, hones their skills at clinical reasoning, differential diagnosis, and triage. Rounding teams are based on the wards and are not responsible for admitting patients from the Emergency Department. Because of this, the Rounding team is free to focus their attention on their hospitalized patients and have time for teaching rounds, patient care, questions from nurses, family meetings, etc.
How often will I be on call on the wards?
We do not have an on-call system in the traditional sense. Instead, we have a system of Admitting and Rounding teams on the wards as described below.
Are there ‘caps’ on the number of patients on the medicine wards?
Yes. We have had a strict census cap of 14 patients per ward team, or 7 patients per intern. The hospitalist ward team with one attending and one resident has a cap of 12 patients. There is also a limit to the number of new admissions during a 24-hour period: no more than 3 new patients per intern (6 per team) can be admitted. For the hospitalist ward team, the limit is 4 new admissions in 24 hours.
Additionally, ward teams take admissions in a round robin rotation, thereby avoiding boluses of admissions by spacing them out. The net effect is a more manageable daily workload and improved educational experience.
Is there a night float system?
Yes. Admissions to ward teams after 8 p.m. are handled by the Night Float resident and on-call hospitalist attending until 8 a.m. the next morning. The Night Float intern handles cross-cover responsibilities from 7 p.m. until 7 a.m. the following morning. Our ICU also has a night float system.
What ancillary services are available to residents?
Kaiser San Francisco offers 24/7 coverage for phlebotomy, respiratory therapy, radiology services, patient transportation, and clerical support.
I’m interested in primary care. What can I expect from my continuity clinic experience?
In an effort to provide a more robust ambulatory clinic experience, we recently moved from one half-day weekly continuity clinic to one full-day continuity clinic every other week during wards rotations. The resident has no inpatient responsibilities on these clinic days, which do not count towards the mandatory one day off per week. During outpatient/elective blocks, residents have weekly or more frequently scheduled continuity clinic. There is no clinic scheduled during ICU, night float, or admitting rotations.
Resident continuity clinics are staffed by a group of seasoned internists who were selected for their teaching skills and interest in medical education. Faculty preceptors utilize the Yale Office-Based Medicine Curriculum as a framework to emphasize an evidence-based approach for ambulatory medicine.
The opening of the Mission Bay medical office building in 2016 gives residents the opportunity to work in a state-of-the-art facility.
I’ve heard great things about training in the integrated system of healthcare that is Kaiser Permanente, but won’t I miss working in other healthcare settings? It’s important to me to care for underserved patients. What opportunities will I have to work with this patient population?
While in many ways Kaiser San Francisco is an ideal place to train, we feel it is important that our residents also experience working in other healthcare settings and thus encourage our residents to do electives outside of our healthcare system. This can take several different forms: away rotations at other medical institutions; the mandatory 2-week emergency medicine rotation at San Francisco General Hospital for all second-year residents; caring for uninsured patients at Clinic By The Bay every Thursday during the month-long Ambulatory elective; working with the new Kaiser San Francisco-based KP Community Medicine fellow at community clinics such as Tenderloin Health Services or Lyon-Martin Health Services; or international medical experiences through the KP Global Health Program.
How is San Francisco Kaiser different from the other Bay Area Kaiser Internal Medicine training programs?
Some distinguishing characteristics of our program are:
- We are a tertiary referral center for various specialty care services, including transgender surgery, transcatheter aortic valve replacement, complex percutaneous interventions, pulmonary hypertension, adult congenital heart disease, advanced endoscopy, inflammatory bowel disease, gastrointestinal oncology, biliary surgery, and high-risk obstetrics.
- Home to the Northern California Kaiser cardiology fellowship program, and one of the busiest cardiac care programs in northern California in terms of the volume of percutaneous coronary intervention, cardiac surgery, and transcatheter aortic valve replacement procedures.
- Starting in July 2019, we will welcome the inaugural class of fellows to our new Hematology/Oncology and Gastroenterology Fellowship programs.
- Our Internal Medicine/Preventive Medicine combined residency program is a joint collaboration with the UCSF Division of Preventive Medicine & Public Health and the UC Berkeley School of Public Health. In addition to earning an MPH, our graduates are eligible for dual board certification by both the American Board of Internal Medicine and the American Board of Preventive Medicine.
- We have a protected, weekly Academic Half Day Seminar, aka “Teaching Tuesday” that dates back to 2005.
I’m interested in conducting research during my training, but I don’t have a lot of experience and am worried that I won’t have time. How can I accomplish this?
Residents are encouraged to pursue research projects during their training. We pride ourselves on our commitment to provide the flexibility necessary to make these pursuits possible. Resident projects vary from individual projects to collaborative efforts with other residents or staff physicians, and often culminate in presentations at medical society meetings and journal publications.
We are fortunate to have in our program a GME Research Program Manager, Aida Shirazi, Ph.D., whose role is to provide support to resident research efforts. She comes to us with a wealth of experience at the UC Berkeley School of Public Health, where she conducted clinical research in health disparities among immigrant populations and was program director for NIH grants. Her interests include community-based research and global health.
Dr. Shirazi is available to assist our residents at each phase of a research project, ranging from the development of a research proposal to study design to statistical techniques to the preparation of manuscripts. She also serves as a liaison with the Kaiser Division of Research, including its researchers, scholars, and the Biostatistical Consulting Unit.
What are my chances of getting into a fellowship after training at Kaiser, San Francisco?
Excellent! We have an exceptional track record of placing our residents in the most competitive fellowship programs, year after year.
I am not interested in specialty training. What are my chances of getting a desirable job as a hospitalist or primary care physician after training at Kaiser, San Francisco?
Also, excellent. Many of our graduates, having realized the benefits of practicing medicine in a fully integrated system, choose to work at one of the many Kaiser Permanente facilities throughout California, while others go on to practice internal medicine in non-Kaiser settings.
How successful are our graduates at passing the internal medicine certification board exam?
Our pass rate for the American Board of Internal Medicine certifying examination between 2015-2017 is 93%.
How much time off will I have? How much vacation time do I get?
Compliance with the ACGME Residency Duty Hours requirements is a top priority. In the inpatient setting, all residents have one day out of seven off when averaged over any four-week period. Outpatient and elective rotations are Monday through Friday with weekends free on clinical duties.
First year residents have 3 weeks of paid vacation, while second and third year residents have 4 weeks of paid vacation. Vacation time is taken during elective rotations. There is also 1 week of educational leave for interns and residents.
Can I afford to live in San Francisco on a resident salary?
Kaiser residents enjoy some of the highest salaries in the nation and generous benefits and stipends. The residency program pays for resident parking fees, medical licensing fees (categoricals), gym membership, and provides $500 educational stipend for first- and second-year residents, and a $750 stipend for third-year residents.
As a highly desirable place to live and work, the Bay Area has always had a relatively high cost of living. To help offset this, Kaiser San Francisco resident physicians receive an additional housing stipend of up to $3500.
I am a rising fourth-year medical student and interested in doing an away rotation at Kaiser, San Francisco. How do I apply? What rotations are available to me?
Interested students are encouraged to contact our program coordinator, Helen Ip, and apply via VSAS. Available rotations include: acting internships in ward medicine, electives in ICU, inpatient cardiology, gastroenterology, nephrology, and neurology. Individualized experiences are available depending on specific interests. More information about our clerkship offering is found here.
When is interview season? What is the deadline for applying?
Interview season starts in mid-October and continues through mid-January. Interview days are primarily on Tuesdays and Wednesdays, with one additional Friday interview day per month. While there is no firm deadline for applying, candidates are encouraged to apply as early as possible.
How can I contact the Program Director or the Chief Resident?
We encourage potential residency applicants to speak with one of our Program Directors or Chief Residents. Contact our Residency Coordinator for Internal Medicine by e-mail or by phone (415) 833-9182. Our chief residents for 2018-2019, Nishant Trivedi and Megan Lockwood, can be reached by email or by phone (415) 833-3814.