What will the 2021-22 interview season look like in view of the evolving COVID-19 pandemic?
For the 2021-22 season, we will interview from mid-October 2021 through mid-January 2022. All interviews will again be conducted virtually. In view of the evolving pandemic and public health guidance, we have decided to not host in-person visits. However, we will host virtual evening mixer events throughout the interview season to facilitate more interactions between applicants and residents.
For applicants to our preliminary internal medicine track, we prefer but do not require a Department of Medicine Summary Letter of Evaluation as one of your letters of recommendation.
For applicants to our combined Internal Medicine/Preventive Medicine residency track, please note that those invited to interview will have two separate interviews – one with our internal medicine residency program, and one with the faculty of the preventive medicine program at UCSF. Both are scheduled separately and will fall on different days.
Will the program be participating in the supplemental ERAS application pilot this season? Is the supplemental ERAS application required to apply to this program?
After careful consideration, we have decided to opt in and participate in this pilot. This is uncharted territory, which may raise concerns for both applicants and programs alike. At the same time, we see this as an opportunity for applicants to share useful information about their experiences and interests, information that we hope will allow for a more holistic review and better assessment of how applicants might fit with our program mission and culture. Additionally, we hope that participation in this pilot will contribute to the larger effort to improve the residency application process. Please refer to the AAMC website for more information about the supplemental ERAS application.
Because it is a new process that is being piloted, we will not require the supplemental ERAS application to apply to our program and are committed to giving equal consideration to all applications.
How will the COVID-19 pandemic affect my training?
As disruptive as the pandemic has been, we have been fortunate to be part of a large, integrated health system with a robust infrastructure and coordinated response to these unprecedented challenges. Since the very beginning of the pandemic, we have maintained our commitment to prioritize resident education and safety. We successfully converted our educational venues to a virtual format that preserved their educational value; rapidly pivoted to telemedicine visits in the ambulatory setting, allowing residents to meet the changing needs of our patients; ensured that residents had proper training in infection control protocols and access to appropriate personal protective equipment; provided COVID-19 vaccine access to all residents, who were part of the first group of vaccinated providers at our medical center; and placed additional emphasis on resident wellness.
We have learned much from our experiences over the past year and a half and are well prepared to adapt our learning environment in response to the evolving pandemic to optimize the educational experience, safety, and wellness of our learners.
I am a rising fourth-year medical student and interested in doing an away rotation at Kaiser, San Francisco. Will there be any opportunities this year in view of the COVID-19 pandemic?
Yes! We are excited to be resume hosting visiting fourth-year students at our medical center. We are currently offering 4-week Acting Internship rotations on the Inpatient Medicine Wards, as well as 2-week elective rotations in cardiology, gastroenterology, hematology/oncology, and nephrology. We accept applications via the Visiting Student Application Service (VSAS) of the AAMC.
How many residents and interns are there in the program?
There are 44 residents and interns in our program plus 2 chief residents. Each intern class has 12 categorical positions (2 of which are in the combined Internal Medicine/Preventive Medicine track) and 8 preliminary internship positions.
I’m going to be so busy during residency. How will the program help me take care of myself and thrive?
Resident wellness is an integral part of our culture at Kaiser San Francisco. We believe that physicians cannot operate at their full potential unless they attend to their own physical, psychological, and emotional wellbeing. Our rotations are structured in a way to promote work life balance. Residents participate in activities such as group hikes, intramural team sports, and receive a stipend to join a gym of their choosing. Each year, interns and residents each have their own full-day retreat. There is a full range of free counseling and mental health services available to residents, and there is a Wellness curriculum that provides education about physician burnout and specific techniques, such as a personal mindfulness practice, to build one’s resiliency.
All residents are matched with a faculty advisor, who meets regularly with the resident to provide professional guidance and support.
I am committed to working with the underserved and vulnerable population and to address social determinants of health. I’ve heard great things about training in Kaiser Permanente’s integrated system of health care, but what opportunities will I have to work with this population or in other health care settings?
At Kaiser Permanente San Francisco, we serve an urban patient population that has tremendous socioeconomic, ethnic, gender and cultural diversity. In San Francisco, people who identify as non-Hispanic whites comprise less than half of the population, and nearly half of all households speak a language other than English at home.
In addition to our patients with traditional Kaiser health coverage, we care for more Medicare patients than any other health system, many of whom have multiple complex medical conditions. Homelessness, substance use disorders, food/housing insecurity, and low health literacy are common challenges for our patients, which we work to address through a multidisciplinary approach in our fully integrated health care system.
We also believe it is important for our residents to experience other health care settings and thus encourage electives outside of our system. All second-year residents spend two weeks rotating in the emergency department at Zuckerberg San Francisco General Hospital, our county’s safety net hospital. Residents care for uninsured patients at the Clinic By The Bay during their Ambulatory rotation and have opportunities to work at local community FQHC clinics under the supervision of our Community Medicine fellow. Lastly, we encourage interested residents to pursue away rotations at other institutions or international medical experiences through the KP Global Health Program.
How does the program promote a diverse and inclusive resident workforce?
Equity, inclusion, cultural competency, and diversity are core tenets of our residency program and Kaiser Permanente. We seek residents from a variety of backgrounds, life experiences, and nontraditional paths, and believe that training the next generation of diverse and culturally competent health care providers is vital to address the health disparities that exist today.
Our resident-driven diversity committee was formed to help with the outreach and recruitment of underrepresented minorities to our internal medicine residency program. Our residency participates in outreach efforts with organizations such as the Student National Medical Association and the Latino Medical Student Organization, and we are proud to host medical students in the Kaiser Permanente Introduction to Integrated Health Care program.
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 residency program. We value our residents’ input and routinely seek their input through anonymous surveys and resident hours. Here are some important new developments:
- In addition to the already established fellowships based at San Francisco in Gastroenterology, Cardiology and Hematology/Oncology, we recently added new fellowships in HIV Medicine in July 2020, Community Medicine and Urban Health in July 2021, and Nephrology in July 2022.
- Residents will have the opportunity to care for underserved patients at local community FQHC clinics under the guidance of the Community Medicine and Urban Health fellow.
- Equity, Inclusion and Diversity (EID) curriculum: what originally began as a Health Disparities curriculum years ago has been shaped by recent events to take on a broader EID focus that includes aspects of foundational knowledge, health disparities, the role of race in health outcomes, discrimination in healthcare, responding to microaggressions in the workplace.
- Mentoring: in addition to assigned residency program advisors for all residents, each incoming intern will have a hospitalist “coach” who will help support and mentor during this important year.
- We are adding a new Lifestyle Medicine curriculum led by Dr. Rakesh Jotwani, one of our faculty who is board-certified in both internal medicine and lifestyle medicine. Lifestyle medicine uses evidence-based therapeutic approaches to prevent, treat, and even reverse chronic disease through lifestyle changes.
Newly refurbished resident lounge and workspace. In early August, the residents will move back into their dedicated space, complete with a state-of-the-art videoconferencing system, expansive whiteboard space, plentiful workstations, full kitchen, and brand-new call room space.
Why are there separate admitting and rounding inpatient teams?
Separate Admitting and Rounding roles were created in response to resident feedback and have significantly improved the educational experience in each setting. Notably, the change replaced the previous short/long call system with a round robin system of distributing newly admitted patients. The elimination of “boluses” of new admissions in favor of a “drip system” has contributed to a more predictable workday, an improved learning experience, and better work/life balance. For those interested in hospital medicine, this also prepares them for a model commonly seen in hospitalist practices.
Admitting teams are comprised of one resident and one intern. They work closely with the attending hospitalist in the Emergency Department to evaluate patients at the time of their initial presentation. The Admitting team diagnoses, treats, and admits patients, 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, they can better focus their attention on their hospitalized patients and experience fewer interruptions to teaching rounds and patient care activities. Rounding teams assume care for newly admitted patients after admission and with a warm handoff from the admitting team.
How often will I be on call?
We do not have a traditional on-call system. For the wards, we have a system of Admitting and Rounding teams as described above. In the ICU, there is a Night Float team.
Are there ‘caps’ on the number of patients on the medicine wards?
Yes. We have 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) for conventional ward teams, and no more than 3 new admissions for the hospitalist ward team.
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 from 6:30 p.m. to 6:30 a.m.
What ancillary services are available to residents?
Kaiser Permanente San Francisco offers 24/7 coverage for phlebotomy, respiratory therapy, radiology services, patient transportation, and clerical support. Residents are not expected to perform these services. Residents also enjoy robust support from medical social workers, discharge planner nurses, and unit assistants.
I’m interested in primary care. What can I expect from my continuity clinic experience?
Residents are precepted in their continuity clinics by a group of seasoned primary care providers 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 to ambulatory medicine. Residents are assigned to one of two primary care clinic sites: the main Geary campus, or the Mission Bay medical office building.
We feel it is vital for residents to cultivate their own patient panel and have a meaningful continuity clinic experience. Upper-level resident schedules have alternating blocks of inpatient and outpatient rotations, ensuring that residents can see their patients in continuity clinic on a regular basis.
How is the internal medicine residency program at Kaiser Permanente San Francisco different from the other Bay Area Kaiser Permanente internal medicine training programs?
Some distinguishing characteristics of our program are:
- We are a tertiary referral center for various specialty care services, including structural heart disease, pulmonary hypertension, adult congenital heart disease, advanced endoscopy, complex liver disease, inflammatory bowel disease, gastrointestinal and gynecological oncology, transgender care, high-risk obstetrics, hepatobiliary surgery, and cardiac surgery.
- Our combined Internal Medicine/Preventive Medicine residency program is a joint collaboration with the UCSF Division of Preventive Medicine & Public Health and the UC Berkeley School of Public Health. In contrast to most internal medicine programs that also offer an MPH year, our graduates are eligible for dual board certification by both the American Board of Internal Medicine and the American Board of Preventive Medicine.
- We are home to the Northern California Kaiser Permanente Cardiovascular Disease Fellowship program and one of the busiest cardiac care programs in northern California in terms of volume of percutaneous coronary intervention, cardiac surgery, and transcatheter valve procedures.
- We are also the site of the Northern California Kaiser Permanente Gastroenterology, Hematology/Oncology, and Nephrology Fellowship programs.
- 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, and we pride ourselves on providing the flexibility necessary to achieve these goals. 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 have a GME Research Program Manager, Aida Shirazi, PhD, whose role is to support resident research efforts. Previously, she worked at the UC Berkeley School of Public Health, and 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 a remarkable 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 healthcare 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 2016-2018 is 88%.
How much time off will I have? How much vacation time do I get?
Compliance with the ACGME clinical and educational work hours requirements is a top priority. All residents have a minimum of one day in seven free of clinical work and required education when averaged over four weeks, and at least eight hours off between all scheduled periods of clinical work and education.
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 very competitive salaries and generous benefits. The residency program pays for resident parking fees, medical licensing fees (for categorical residents), gym membership, and provides a $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 Permanente San Francisco residents receive an additional housing stipend of up to $3500 each year.
Can I connect with the chief residents or some of the residents to ask them questions?
We encourage interested applicants to speak with one of our program leaders or chief residents. Contact our residency coordinator, Whenalyn Espinosa, by email or by phone at (415) 833-6345.
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