Categorical Internal Medicine PGY1: Yearly Schedule

7 - 8 months of direct inpatient care consisting of:

• 6 - 7 months of general medicine wards
• 1 - 2 months of critical care
• 1 month emergency medicine at San Francisco General Hospital* (*All categorical, 4 preliminary interns)
• 2 months electives, one of which may be used for research
• 1 - 2 months night float

Q: How does our program cover the wards and do we have a night float?

A: Wards are covered by four-day teams (four residents and eight interns) while the MICU is staffed by one-day team (one resident and two interns.) Interns on ward medicine are on call every fourth day until 8 PM, and begin to accept admissions at 8 AM. Interns in the ICU are on call every third day and admit with one resident. At night, one resident and two interns cover the medical wards and the ICU night float resident admits with one intern. There is in general no short call. A jeopardy intern covers unexpected absences.

Q: How does our program adhere to work hour regulations and RRC rules?

A: The safety of our patients and residents is equally important to us. The training program assures and enforces strict work hour regulations to allow for adequate rest and sleep between shifts. Interns take overnight call only on Fridays and Saturdays and during their ICU rotations. During ward and ICU rotations interns will have one scheduled day per week off. We apply the admission caps established by the American College of Graduate Medical Education (ACGME) of 5 admissions plus two partial admissions (e.g. transfers from ICU) per intern per 24 hours.

Q: What teaching will you receive while on the wards?

A: Medicine teaching/attending rounds are held at least four times a week for a total of five hours on the wards. Post-call work rounds are often attended by the faculty-hospitalist. Attending teaching rounds occur five times a week and a critical care core curriculum is covered during two weekly didactic sessions. Morning report is run by a chief resident and the program director. Other faculty may attend. Daily noon conferences cover didactic curricula in all subspecialties and specialties. Journal club takes place once a month in the afternoon.

Q: What teaching opportunities will you have as an intern?

A: Our program has a formal academic affiliation with Creighton University Medical School. Third year students spend one of their medicine core rotations at St. Mary’s. Each ward team has two Creighton students who work under the supervision of interns and residents. Sub-interns may be present on the team.

Q: Where do interns gain ambulatory medicine experience?

A: Categorical and preliminary interns attend one continuity clinic per week throughout most of the year excluding the ICU and night float rotation. The Sr. Mary Philipa Health Center is the centerpiece of St. Mary’s large annual charity contribution to the to city of San Francisco. Together with other city clinics, it forms an important safety net by providing comprehensive primary care to an urban underserved population.

St. Mary's is the first community hospital training program that is participating in the recent implementation of "Healthy San Francisco". This pioneering univeral health plan provides medical homes to all residents of San Francisco who do not qualify for Medicare or MediCal or cannot afford private health insurance. Our resident run clinic is unique for its large South East Asian population in addition to Hispanics, African-Americans and many other ethnic groups representative of San Francisco. Interpreters are available onsite to facilitate optimal communication.

Residents and interns form five teams. The concept of a group practice and continuity care is applied by an ongoing effort to keep assigned patients within the same resident’s team throughout the academic year. Nurses, medical assistants and social workers are steady members of the team and the residents form a longitudinal relationship with their teaching attendings. A walk-in clinic is available for urgent care to all established clinic patients. Other on campus ambulatory experiences offered include Women’s Health, Radiology and Urgent Care.