Internal Medicine San Francisco - Curriculum & Rotation Schedule

We have a unique model of inpatient medicine wards that separates Admitting and Rounding roles into two distinct rotations. This change was implemented many years ago in response to resident feedback and has significantly improved the educational experience in each setting. Notably, the change eliminated the previous short/long call system and replaced it with a round robin system of distributing newly admitted patients. The elimination of “boluses” of 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 the model most often seen in hospitalist practice.

Admitting teams, comprised of one resident and one intern, work closely with the attending hospitalist to evaluate patients at the time of their initial presentation in the Emergency Department. The Admitting team diagnoses, treats, and admits patients, and in doing so, hones their skills in clinical reasoning, differential diagnosis, and triage.

Rounding teams are based on the wards and are not responsible for admitting patients from the Emergency Department. This allows them to focus on their hospitalized patients with fewer interruptions to teaching rounds and patient care activities. Rounding teams take over the care of newly admitted patients after they have been admitted to the hospital and the rounding team has received a thorough hand-off from the admitting team.

• Admitting teams are comprised of one resident, one intern, and one supervising hospitalist.

• Three Rounding teams have the traditional structure of a hospitalist attending, one resident, two interns, and often, a medical student. These teams have a cap of 14 patients.
• A fourth Rounding team is comprised of one hospitalist and one senior resident, simulating a “hospitalist rotation”, and has a cap of 12 patients.
• There is no long, short, or overnight call.
• The night float intern covers all cross-cover duties after hours.
• All residents and interns have one day in seven free of clinical work and required education.

• The ICU/CCU team consists of four interns, two residents, a cardiology fellow, and critical care and cardiology attendings.
• There is always an intensivist in-house to provide back-up support and supervision to the residents. There is also cardiology fellow and attending back-up.
• There is no overnight call. There is an ICU night float team consisting of one intern and one resident.
• All residents and interns have two days free of clinical work and required education per two-week block.

• The night float admitting resident works with the on-call hospitalist attending to admit floor patients overnight through the Emergency Department.
• The night float ICU resident works with ICU night float intern and the in-house intensivist on new admissions to the ICU while also caring for established ICU patients overnight.
• There are two night float interns – the ward night float intern provides cross-coverage for ward patients, and the ICU night float intern provides cross coverage for ICU patients and helps the ICU night float resident with ICU admissions.

We recognize the transformative impact of point-of-care ultrasound (POCUS) on modern clinical practice and are committed to providing comprehensive training in POCUS. We have implemented a longitudinal POCUS curriculum that includes structured didactics and hands-on workshops. All inpatient teaching services have their own dedicated portable ultrasound device. Senior residents can take a 2-week POCUS elective, which includes performing bedside procedures under ultrasound guidance, as well as cardiac, pulmonary, abdominal, and vascular ultrasound training through direct instruction from POCUS faculty with feedback on image acquisition. We are fortunate to have faculty members who are POCUS experts and regularly teach at the national ACP and SHM conference pre-courses. Overall, our goal is to hone the ultrasound skills of our residents throughout their training and to help them incorporate POCUS into their clinical reasoning.

• Residents see their patients at one of two dedicated resident clinic sites, supervised by a core group of faculty preceptors.
• Each resident clinic is supported by a team of medical assistants, chronic condition nurses and case managers, pharmacists, clinical health educators, behavioral medicine therapists, and social workers.
• Continuity clinic occurs regularly throughout the year to enable our residents to grow and manage their panel of patients.
• In addition to in-person visits, residents learn how to manage their patients via all modalities of telehealth (telephone, video visits, and electronic communication).
• Subspecialists are available for immediate consultation to facilitate optimal and timely care of clinic patients.
• Third-year residents rotate at community clinics such as the Clinic by the Bay, a community primary care clinic for uninsured, underserved patients.

• We offer elective rotations in all the traditional internal medicine subspecialties, including cardiology, endocrinology, geriatrics, gastroenterology, hematology/oncology, infectious diseases, nephrology, palliative care, pulmonology, and rheumatology.
• There are also many other outpatient elective experiences, including allergy, addiction medicine, dermatology, ENT, HIV, LGBTQ+ medicine, Injury Center, neurology, occupational medicine, ophthalmology, perioperative medicine, physical medicine and rehabilitation, psychiatry, sports medicine, and women’s health.
• Residents interested in working with underserved populations around the world and learning about the health effects of poverty, migration, climate change, emerging infectious diseases, and access to healthcare are encouraged to consider the Kaiser Permanente Global Health Program, which allows our residents to pursue rotations internationally.

• Morning Report: 8:00-8:45 a.m. Interesting and often undifferentiated cases from inpatient and outpatient settings are presented. Case-based discussions are moderated by our chief residents with contributions from faculty discussants, and emphasize diagnostic reasoning, differential diagnosis, and the use of problem representations and illness scripts. This conference is always highly rated by our residents.
• Noon Conference: 12:30-1:30 p.m. At this daily teaching conference, speakers from our own faculty or from outside our institution give lectures on a variety of current topics in internal medicine. Included in these series are regular Morbidity and Mortality, clinical problem-solving cases, Interdepartmental Grand Rounds, EKG Review, Medical Jeopardy, Board Exam Review, and Journal Club conferences. Senior residents present at least one conference and lead one Journal Club session each year.
• Intern Report: 1:45-2:30 p.m. once weekly. Interns are excused from clinical duties to attend this one-hour session that emphasizes essential intern-level skills and topics. The format varies including “chalk talks”, literature reviews, and interactive case presentations.
• Academic Half-Day Seminar: Tuesdays from 10:30 a.m. – 1:30 p.m. Since 2005, we have held a weekly Academic Half Day Seminar, a three-hour block of protected time free from clinical duties where residents can focus on learning in a small group environment.