Residency Frequently Asked Questions (FAQ)

What Educational Conferences and Activities are offered for Housestaff?

Noon conference is held each weekday from 12-1pm. A calendar is distributed at the beginning of each month outlining the month’s schedule. The conferences cover a wide array of topics including every medical subspecialty, and are conducted by our core faculty and invited sub-specialists from UCSF/SFGH or other community hospitals. Some conferences are standing weekly sessions like Tuesday Chest Conferences, Medical Grand Rounds, monthly Journal Club, and bimonthly EKG conferences. Evening Board Review Courses are held weekly and offered to the senior residents.

Our Frank Solomon Library is staffed 9AM – 5 PM Mo-Fri and is accessible 24/7. It is located in the center area of the Department of Medical Education. Medical Textbooks can be checked out and all major in-print journals are available in print and/or online. You can access Up-to-Date, Pub Med, MD Consult and the New England Journal of Medicine from any computer terminal on the wards/ICU, clinic or call room. In addition, residents complete assigned Johns Hopkins Medical Consult online modules during their Hospitalist rotation.

Can I accomplish my Academic Goals while at St. Mary’s?

The core faculty at St. Mary’s places utmost emphasis on residents’ individual academic goals and activities. All categorical residents must fulfill scholarly activity requirements prior to graduation: these may include preparing a formal presentation for Grand Rounds, running a Morbidity and Mortality conference, writing up case studies, and being involved in clinical research activities. Our residents routinely present posters of clinical vignettes and research outcomes at national and regional medical meetings. In fact, in the last two years more than half of our residents’ abstracts were accepted for poster presentations at the regional ACP Conferences in San Francisco, Sacramento and in Monterey, and several have presented posters at national or international meetings. For the past two years, one of our residents has placed second in the research division. All residents who participate are allowed time off from residents’ duties to attend, and all conference expenses for resident ACP presentations are paid for by the training program.

Residents and interns play a key role in teaching third medical students from Creighton University and UCSF on the wards, and in our outpatient clinic.

Will I have Support in achieving my Professional Development and Career Goals?

Our training program emphasizes the importance of individualized training. Aside from required rotations, our residents have ample opportunity to design their own training track with input from the program director. Every categorical resident also has an assigned faculty mentor who meets with the resident throughout her/his training and functions as personal adviser and career counselor. Preliminary residents also have access to our mentors, but are not formally assigned. Many of our graduates have had the opportunity to rotate through custom designed clinical and research experiences allowing them to explore their special interest and form their own career tracks. A number of residents have subsequently matched in a fellowship at the site of their “designer” elective.

What is the Call Schedule, and is there a Night Float System in Place?

Our ward call schedule is q4 from 8AM to 8PM. At 8PM a night float team, consisting of 2 interns and a senior resident, covers Sunday through Thursday 8PM- 8AM. When call lands on a Friday or Saturday, the day ward team stays overnight. We do not have short call for the ward teams, although we have 1-2 hospitalist and consult residents admitting up to 4 patients each everyday until 4PM. Most of us find that this system is much more conducive to our education, and to our personal lives.

What is the Average Census per Team while on General Medicine Wards?

The residency program at St. Mary’s strictly adheres to the work hours and patient caps set forth by the ACGME. Interns cannot follow more than 10 patients while on medicine wards, and cannot work on average more than 80 hours per work. Interns typically carry 6-8 patients and work 60-65 hours while on general medicine wards.

What are the Call rooms like at St. Mary’s?

Unless you are on a night float rotation, the call rooms are rarely used at St. Mary’s. However, when you are on call, you will have a private room and bathroom that is equipped with basic cable TV and a window. Call rooms are equipped with computers that allow you to view labs, X-rays, EKG’s, write orders, and conduct literature searches on the internet. Our resident lounge is equipped with computers, comfortable couches and a giant-screen television.

How often do you hold a Housestaff Report to discuss Medical Cases?

Combined Resident/Intern ICU Morning Report is held every Monday from 9:00-10:00 AM. This report is attended by teaching faculty from specialties including Internal Medicine, Radiology, Neurology and Sub-Specialties in Critical Care, Pulmonary and Cardiology. Residents’ Report is held Tuesday, Wednesdays and Fridays from 9:00 to 10:00 AM. Interns’ Report is held on Thursdays from 9:00-10:00 AM. These are very popular sessions moderated by the Chief Resident and the Program Director. The post call/ nightfloat team presents 1 to 2 of their recently admitted patients and allow the housestaff to experience and evaluate the patient as they are presented to the ward team. The goal of these sessions is to train the housestaff to think critically about their patients’ presentation and laboratory data and apply evidence-based medicine while planning their diagnostic evaluation and management.

What Electives and Rotation Sites are offered at St. Mary’s?

Although our core rotations are at St. Mary’s, our program offers the opportunity to experience many different educational settings. On average, residents rotate in eight electives of their choice over two years. We are the only community hospital affiliated with UCSF offering several guaranteed rotations at San Francisco General Hospital, including ED, nephrology, endocrinology, hematology/oncology, and neurology. Additionally there are opportunities to set up rotations at various university-based hospitals in our vicinity such as the VA hospital, UCSF Parnassus Campus, Stanford and UC Davis. This unique and highly educational experience is truly enjoyed by our residents.

What are the Attending Physicians like at St. Mary’s?

Just as we have varied experience at teaching sites, we also have a variety of attendings. The vast majority of attendings at St. Mary’s are extremely friendly and approachable. Most of the core faculty attendings hold academic appointments at UCSF, Creighton University and some at Stanford University. Our ward teaching attendings are part of the core faculty and have dedicated time for clinical teaching at the bedside.

Clinic preceptors form a longitudinal relationship with the residents and their patients and many of them are experienced community physicians; others are core-teaching faculty with both general internal medicine and subspecialty backgrounds.

Housestaff routinely have direct interactions with general surgeons, cardiothoracic, orthopedic and neurosurgeons as well as medical subspecialists. At St. Mary’s we work with both hospitalists and private attendings. Our core hospitalist service consists of a group of physicians highly dedicated towards medical education who hold core faculty appointments. They contribute significantly in our professional development by closely supervising us in all in-patient related activities. Hospitalists care for all patients from our Sister Mary Philippa Health Center who are admitted to the hospital, and for those who have no primary physician or whose physicians do not have admitting privileges at our hospital. The variety in our attendings gives us the opportunity to see different styles of patient care and management. Unlike many institutions, consultations are staffed by experienced subspecialist attendings instead of first-year fellows, allowing our housestaff to learn directly from the attending consultant rather than a fellow in training. We find that frontline interaction with an experienced clinician facilitates the learning process and often allows for more hands on direct patient care.

Do Residents have a Voice at St. Mary’s Medical Center?

Housestaff have a powerful voice in changing our program. At St. Mary’s, we have an elected group of housestaff who form the resident action committee (RAC) in order to represent the housestaff as a whole to the Department of Medical Education and the hospital administration. Meetings are held monthly, and any issues or concerns that housestaff raise are discussed and brought forward by the RAC president to the Program Director or appropriate hospital administrator. In the past, many program changes have been instituted in response to resident concerns and feedback, including the elimination of suboptimal elective rotations and changes to the nightfloat system and call schedule. An annual retreat is held at the scenic Marin Headlands Institute where a critical review of the training program by both housestaff and faculty takes place. In addition, we hold a monthly changeover meeting with the Program Director, where concerns can be voiced directly in an open forum discussion.

In 2009 one of our residents created a journal review website for residents which lists major trials and is updated on a regular basis. Please feel free to look at it: www.smjr.org

Will I have the opportunity to perform medical procedures?

Our residents have the opportunity to perform all core Internal Medicine procedures including central & arterial line placement, thoracentesis, paracentesis, lumbar punctures, and intubation while rotating in ICU, ED and wards. Our ED physicians/ hospitalists/ cardiologists/ chief residents provide the required support of supervision whenever the need arises. Simulation models are available for central line placement training and we plan the purchase of a heart sound model. Mock codes are conducted by the Chief Residents to facilitate confidence and skill in running real codes. A popular Anaesthesia elective rotation is designed to focus on line placement, intubation and mask ventilation.