Unique Aspects of Our Curriculum and Work Environment

We believe that unique aspects of California Pacific Medical Center’s Internal Medicine Residency place it at the cutting edge of Internal Medicine training in the United States. Below are some of the features that we think will interest you.

Evidence Based Medicine Course and Journal Club

Given the voluminous amount of new medical knowledge published these days, it is vital that residents receive good teaching in how to read and evaluate the medical literature. This weekly 2 hour seminar occurs during residents' ambulatory rotations during their 2nd and 3rd years of residency. Taught in a highly-interactive format that is individualized to residents' learning needs, this course covers study design; how to evaluate articles on diagnosis, therapy, screening, prognosis, and meta-analysis; searching the medical literature, and medical statistics terms. During their elective rotations, residents apply these skills to choose and present an article for our monthly journal club. Journal club takes place over dinner at a faculty member's home.

Medical Humanities Curriculum

Very few Internal Medicine Residency programs in the United States have formal means of addressing the medical humanities. This program was begun in 2005 and during its several year tenure has been presented at national meetings and been very well received by our house staff and students; in fact, these 2-3 conferences are one of the most enthusiastically attended noon conferences by faculty, students and residents. These conferences have included poetry readings, faculty and resident music performance and physicians in the media. There are also two "Reflections" Journal Cubs where an article about a topic (e.g. Women and balancing a career in Medicine) is distributed well in advance for discussion. These Journal Clubs occur at a program director's home and are very well attended given their relevance.

Morton Kirsch Medical Economics Lectures

These lectures began in the 2006-07 academic year and were made possible by the generous support of Mr. Morton Kirsch. This lecture series educates students and house staff about the macro and micro economics of health care. Lectures have included: Medical Economics 101, The Economics of Running a Successful Urban Hospital, New Paradigms for Outpatient Care, The Economics of Hospitalists and Funding of Graduate Medical Education.

Resident Leadership Lectures

This lecture series, also known as Management 101 for Physicians, began in the 2008-09 academic year and is an effort to better prepare residents for their roles as leaders of teams and enhance their skills in systems-based practice. Lectures include: Giving Feedback on the Fly, Managing Change, Conflict Resolution, and Effective Communication.

Residents As Teachers Curriculum

This portion of the curriculum began in 2005 during resident retreats with the goal of improving resident skills in teaching students, interns and patients. In addition to teaching-focused retreats, new noon lectures include: Learner Centered Education, Teaching on the Fly and How will you learn and teach as a busy resident?

Neuroncalisthenics

Neuroncalisthenics is a teaching technique developed by the Program Director to aid in rapid recognition of word and symptom patterns in Board Review questions as well as in teaching sessions and patient care. It is utilized regularly by Chief Residents to teach at Residents' Report and by the Program Director at his noon conference Board Review sessions as well as at his evening Accelerated Review for the Boards. It's hard to explain in this small space so you'll just have to come and do your training at CPMC to learn more about Neuroncalisthenics.

Images in Medicine

Images in Clinical Medicine are used regularly in Residents' Report to emphasize clinical training. Our clinical photo library contains a wealth of patient clinical findings, radiology images, blood smears and pathologic specimens at CPMC. The program directors actively encourage residents to submit these images to journals where many have been published in recent years in New England Journal of Medicine, Journal of Hospital Medicine, American Journal of Medicine, and Clinical Infectious Diseases. There is also a periodic Images in Medicine contest sent out by email to all of the residency program for which the top 3 winners receive PEETS or Starbuck's gift cards. The response to this enjoyable and educational contest has been overwhelmingly positive.

Reflection Evenings (Part of the Medical Humanities Curriculum)

These evenings actually began as part of the Medical Humanities program and occur 2-3 times each academic year. They occur at a program director or faculty member's home and include dinner. The purpose of these sessions is to engage residents and faculty in self-reflection about the joys, challenges, and experiences of becoming a doctor as well as to help to nurture our supportive residency community. Each session is set up to discuss an important question in the process of becoming a doctor. For example, "How has residency changed you?" and, "What do you wish you had known about medicine before you went to medical school?"

Residency and Faculty Shared Drive

The Shared Drive is available on most computers in the hospital and allows sharing of articles, files, talks, clinical photos, handouts and photos of fun house staff events, such as retreats, journal clubs and the end of the year graduation party. It has been invaluable in storing presentations done at noon conference and Residents' Report for residents and interns on off-site rotations, vacation or night float rotations so that they can easily review talks of interest to them.

"Common Things Are Common Core Articles Collection" (on residency shared drive)

This collection of articles, stored in PDF format in specialty folders on the shared drive, is available on almost any computer in the hospital. It can be easily moved onto a flash drive for use at home or other sites outside the hospital. It is based on the most common diagnoses seen in most American hospitals. In theory, if a resident reads one of the core Internal medicine articles in the "Medicine" folder, he/she will see that disease within the week on the wards (e.g., cellulitis, community acquired pneumonia, upper GI Bleed, sepsis.) There are also multiple choice question sets written by the program directors for some of the articles which can be used to reinforce important learning points and to make reading the article more interactive.

This collection received a Commendation from the Residency Review Committee at our last ACGME site visit in 2006.

Internet Based Sign-out System

Given the importance of teams, cross-coverage and excellent communications, a top notch sign out system is vital for a strong residency program. Working collaboratively with the CPMC IT department, our residents developed and implemented this system "from the ground up". It is quite popular with house staff and has been widely adapted by non-house staff services within our institution. A similar sign-out system to assist residents in caring for their continuity clinic patients is in development and will launch during the 2008-09 academic year.

Quality Improvement (QI) Curriculum

Numerous interns and residents have participated in Quality Improvement projects over the last 2 years. They are educated about Quality Improvement by our QI Department and then focus in on areas of the hospital or patient care that they feel should be improved. We feel it is important for our residents to feel empowered to participate in change rather than feel like passive spokes in the wheel of patient care. Examples of these projects include: retrospective evaluation of PORT criteria and pneumonia admissions at CPMC (done by 2 preliminary interns), VTE prophylaxis compliance performance improvement plan, sliding scale insulin and blood sugar control on 2 selected nursing units at CPMC and addressing barriers to efficient patient flow in the outpatient clinic. Residents have presented these projects at regional and national meetings as well as at noon conferences.