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    Internal Medicine Residency Program

    Frequently Asked Questions on:
    General Information | For Categorical Applicants | For Preliminary Applicants | Our Program | Your Schedules | Other Important Details

    Frequently Asked Questions: Your Schedule

    For your convenience, we have prepared the following questions and answers frequently raised by applicants. Please click on a question to be presented with the answer.

    Starting July 1, 2017 ACGME has extended the maximum duty hours per shift for interns to 24 hours. Is CPMC going back to 24 hour shifts for interns?

    No. Although the new regulations permit interns to work 24 hour admitting shifts and to stay in the hospital for up to 4 additional hours to finish up work and sign out patients (the so called, “24 + 4 rule”), we will not be extending the length of intern shifts. Part of the reason that the ACGME cited for adjusting intern duty hour length starting July 2017 was due to disruption in the medical team by differing shift lengths for PGY-1 residents vs. upper level residents. At CPMC, we have avoided this issue by designing both the PGY-1 and PGY-2/PGY-3 schedules to not exceed 16 hour shifts, except for very rare occasions (see below).


    Chi Chu, MD, Matt Yee, MD, Melanie Manaku, MD & Jacklyn Katz, MD
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    What about R2/R3s? Are they still working 24 hour shifts?

    No. Since July 2011, all CPMC residents are no longer working 24 hour shifts.
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    Does an R2 or R3 ever work longer than 16 hours?

    Yes. There are still a few shifts where a senior resident may come in at 5pm on Friday (Cardiology Nights) and stay until noon (shift length 19 hours) on a Saturday. These shifts are very rare, however.


    Medicine Rounds
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    How many patients does each intern follow?

    On most inpatient services, each intern will admit 2-4 patients per admitting day and will carry an average census of 6-8 patients (maximum of 10 patients).

    However, census varies from service to service with the higher intensity services, such as Hematology/Oncology, having slightly fewer patients. Intern services are strictly "capped" at 10 patients and interns may admit no more than 5 new patients in a 24 hour period.


    2015 R2 Retreat

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    How much primary care is there?

    We have a very strong continuity clinic located at the California Campus which is a 7-minute shuttle ride from the main inpatient campus. The clinic offers exposure to a broad range of patients in a well-supervised setting. We believe that our outpatient clinic is one of the best available to train residents in outpatient primary care medicine. The patient base includes 50% HMO patients. Most of these patients work in the local community. Approximately 25% of our ambulatory patients are Medicare seniors (age>65), and twenty five percent age indigent (Medicaid).

    We have a very strong continuity clinic located at the California Campus which is a 7-minute shuttle ride from the main inpatient campus. The clinic offers exposure to a broad range of patients in a well-supervised setting. We believe that our outpatient clinic is one of the best available to train residents in outpatient primary care medicine. The patient base includes 50% HMO patients. Most of these patients work in the local community. Approximately 25% of our ambulatory patients are Medicare seniors (age>65), and twenty five percent age indigent (Medicaid).

    Starting July 2017, R2 and R3 residents will transition to a modified block schedule in which every inpatient month is followed by dedicated outpatient or elective time during which continuity clinic takes place. The modified block schedule was instituted in response to resident feedback that having continuity clinic during dedicated outpatient or elective time would be less disruptive to the inpatient teams and patients and would enhance their outpatient experience. R1 interns will continue to have the traditional half-day continuity clinic every 1-2 weeks, but will also get the experience of dedicated outpatient time with two 2-week outpatient rotations. Over the course of three years, categorical residents will have a total of 6.5 months of mandatory rotations in the outpatient setting (including one ER month, 5 ambulatory care months and two weeks of geriatrics). The ambulatory care rotations include exposure to the following activities: urgent care of the uninsured ("Free Clinic"), office orthopedics, dermatology, geriatrics, travel medicine, podiatry, rheumatology, among others.

    Elective months can be devoted to further enhancing primary care exposure. Residents can choose to work for one month in the office of a group of primary care internists and/or care for indigent ambulatory patients.

    Although we do not have primary care track, residents can select to spend up to 35-40% of their time during their second and third years in ambulatory training sites. We encourage house staff who are interested in a primary care career to use assigned rotations and electives to design a comprehensive ambulatory care training experience.

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    How much elective time is scheduled and what electives are available?

    Each first year resident (R-1) has over two months of elective time. Electives can be chosen in any subspecialty area. Commonly selected electives include: anesthesiology, cardiology, dermatology, gastroenterology, infectious diseases, nephrology, research, quality improvement (QI), and rheumatology. It should be noted that during one elective month, the intern may be "at risk", otherwise known as "On jeopardy call". At risk means that the intern may be called in from elective in the event that a colleague becomes ill or for other extenuating circumstances.

    R-2 and R-3 schedules include over two months of elective time per year and several "selective" months. All second and third year residents also have "selective" rotations that include nephrology, geriatrics, palliative care, endocrinology, neurology and infectious disease during their 3 years at CPMC.

    Residents take most of their electives at California Pacific. Electives can also be taken at Bay Area Hospitals including: UCSF hospitals (Moffitt-Long, the VA and SF General), Stanford, and Alameda County ("Highland") Medical Center.

    Elective opportunities are available in all traditional subspecialties of internal medicine and in many related fields, including HIV medicine, complementary medicine, rehabilitation medicine, and end of life care/hospice medicine. Research electives are encouraged as part of the scholarly activity of our house officers. One month of research is allowed each year. Quality Improvement and Residency Program Improvement electives are readily available and have been popular, productive and successful.

    Recently a Global Health Elective in Haiti has been added and available to Categorical R3’s.

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