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Weekly Continuity Clinic Block in the Sr. Mary Philippa Health Center at St. Mary’s
In the X+Y block system, residents attend their continuity/primary clinic during a dedicated week-long clinic block. Senior Residents return every 4 weeks, while categorical and preliminary interns rotate through clinic on average every 4-5 weeks. All patients are seen by residents who take on the role of the Primary Care Physician under supervision of our ambulatory teaching faculty. Residents are assigned to a team and work in a group practice-like setting.
Categorical residents care for an assigned panel of diverse patient: generally the majority of the clinic population is composed of the underserved working poor, many of whom deal with chronic illnesses that require integrated multidisciplinary care. Preliminary residents will focus on urgent and subspecialty care. Patients receive care from a team of healthcare providers that include highly skilled and specialized nurses, medical assistants, social workers and diabetes educators. Our average preceptor to resident ratio of 1:3 allows for timely and effective personalized teaching.
The Clinic Block Rotation Advantages
3-6 Week Ambulatory Block in the Sr. Mary Philippa Health Center, St. Mary’s Medical Center
The required block rotation exposes senior residents to a vast array of clinical scenarios, including urgent and continuity care and subspecialty care, under one-on-one supervision. Residents are expected to develop and present a quality improvement project in their second and third year. An outpatient morbidity and mortality case is prepared for noon conference and case related topics are discussed weekly in Ambulatory Report. The ambulatory resident takes on the important role of safe and reliable follow up for continuity clinic patients discharged from the hospital.
Primary Care Experience in Private Practice Settings
The 2-3 week elective gives senior residents the opportunity to learn about private practice in general internal medicine in the community. Patients are seen under one-on-one supervision by one of our general internal medicine private practice faculty, and settings vary from traditional group practices to solo practice and the paperless practice with a state-of-the art fully established EMR.
Subspecialty Experience in Private Practice Settings
Our sub-specialty faculty offers experience and training in in-patient and out-patient consultative medicine:
During the resident attends outside nursing homes and private clinics as well as our own geriatric clinic under the supervision of our board certified Geriatrician.
Emergency Medicine at UCSF-SFGH
This required rotation for PGY-2s exposes residents to the population accessing care at San Francisco General Hospital. Under supervision of UCSF faculty, residents will encounter a wide spectrum of emergent presentations, including trauma, acute intoxications, cardiovascular emergencies, sepsis, GYN emergencies and more.
Subspecialty Experience at UCSF – SFGH
These three elective rotations expose senior residents to a high number of patients in the clinics and on the in-patient service under supervision by fellows and faculty.
Rheumatology at Highland Alameda Medical Center
This popular ambulatory elective takes place in the county hospital environment of Highland Alameda Medical Center in Oakland.
The 2-3 week elective is designed to expose residents to the spectrum of common gynecological disorders, breast diseases, cardiovascular disease and their prevention in women of all ages. Teaching sites include the GYN clinic, STI clinic of the City of San Francisco, St. Mary’s Breast Clinic and the mammography and stereotactic breast biopsy suite as well as the Urinary Incontinence clinic at the St. Mary’s women’s’ health center and the UCSF high risk OB clinic for endocrine diseases in pregnancy.
ACGME duty hours are consistently enforced and have successfully been implemented without compromising rotations during internship or residency.
Day-Team: (q 4 call, no night call for intern): Ward teams on teaching service are led by PGY-2/3 residents who supervise 2 interns and up to 2 students per team. Teams are assigned to hospitalist faculty and one team admits with our private teaching faculty. Teams admit daily, but will take short, medium or long call. Sixty to 70% of patients are admitted to our hospitalist service who form an important part of our teaching faculty. The remaining 28% of patients are admitted by private medical staff active in teaching. Residents interact closely with sub-specialty physicians and with consultants in the diverse multi-disciplinary fields.
Daily Schedule During Ward Rotation
Pre-Rounds and Sign-Out by NF Intern
PGY-2, 3 is expected to attend rounds for at least the first week of a PGY-1’s ward rotation.
Sign out rounds
Supervised by teaching attending
Team Rounds with Hospitalist Attending
Multidisciplinary Point of Care Rounds
12:00 - 1:00 p.m.
Thursday, Noon – 1 p.m.
Didactic Session with hospitalist
2 p.m. (Tuesday/Thursday)
Discharge Rounds with POC Team
PM Sign-Out Rounds
4:30 – 5:00 p.m. for non-call team
Night Float Team
Our night-float team consists of a senior resident and two interns who cross-cover and admit together 6 nights a week. Except for Rapid Response calls or Code Blues, cross-coverage is provided for patients on the teaching service only. On the sixth night, one intern cross-covers the wards while the resident admits and the other intern is off:
Our ICU is a closed medical/surgical critical care unit and the team consists of a day and night supervising senior resident and three interns. There is a close working relationship among all team members to assure a safe and seamless handoff of patients admitted on day/night shift. Residents are closely supervised by the director of critical care, as well as ICU dedicated faculty who admit patients 24/7 with the team.
D: Day shift: 7 a.m. – 7 p.m.
N: Night shift: 7 p.m. – 9 a.m.
Sign-out rounds with team
Attended by critical care faculty & chief resident
Bedside rounds w/resident
7:45– 8:30 a.m. Mondays
7:30– 8:30 a.m. Fridays
12:00 – 1 p.m.
Mon., Tue., Wed., Fri.
12:00 – 1 p.m. Thursday
PM Sign-Out Rounds
The 3-week in-patient rotation is required of all senior categorical residents and is offered to preliminary residents as an elective rotation. It includes consultations on wards and in the ICU at St. Mary’s.
The mostly in-patient core rotation is usually completed at San Francisco General Hospital and is also offered at St. Mary’s Medical Center.
The 2-week in-patient rotation is offered to all residents of all levels of training, and is often chosen by those who wish to improve their procedure skills such as central line placement and intubation.
Physical Medicine and Rehabilitation
This elective 2-3 week rotation exposes residents to our acute in-patient rehabilitation unit for stroke patients and patients with traumatic injuries. Serves as a formal PMR training site for Stanford University residents.