INPATIENT TRAINING
The inpatient training includes rotations in adult medicine, maternity care, surgery, and care
of children. The teams for each service are composed of first-year and second-year residents
who rotate taking primary call and a third year resident who is chief of service. The on-call
resident experience varies for each rotation. While on call, residents are typically responsible
for admissions and cross cover for the specific service. During the first several call nights
each first year resident is paired with a third year resident; after that there is always one third
year resident in the hospital to supervise the first year resident’s work and help second year
residents. Second year residents function more independently. Third year residents primarily
supervise, teach, and organize the functioning of the team. Unlike first year and second year
residents, who take call only on inpatient services, third year residents take call on some outpatient
rotations as well. Faculty and private community physicians provide attending back
up. The attending physicians are readily available twenty-four hours a day.
 Teams aspire to maintain a cooperative spirit, with everyone pitching in to help overburdened
or post-call residents. Every effort is made to get the post-call resident on each team
out of the hospital by noon (often by 8 am); it is only on rare occasions that this does not
happen. There is compensation for overtime work.
On weekends, only the on-call and post-call residents work in the hospital. Rounding is done
by the on-call and the post-call residents. All of the teams work together, so that patients are
rounded on in a timely fashion. Post-call residents are free to leave when all patients have
been seen, usually by noon.
ADULT MEDICINE
The goals of the adult medicine service are to know and to care. Knowledge-driven, evidence-
based medicine reflects our commitment to the importance of basic science in the
solution of clinical problems. Compassion in the practice and delivery of that care reflects
our purpose. We recognize these goals as life-long challenges of medicine and they comprise
the educational foundation of the adult medicine service, which forms the core of the adult
medicine curriculum. First-year and second-year residents take primary call, admitting
patients through the emergency room. A night float system is employed to reduce the burden
of call, increase resident education, and improve patient care. When a patient has no other
physician, the admitting resident serves as his or her family doctor throughout the patient’s
hospitalization. Ideally, the resident will continue to follow these patients after discharge in
his/her own practice. Residents on the adult medicine service also follow patients admitted
to our two intensive care units and hospitalist service, as well as participate in the care of
patients who are admitted by private family doctors and internists from the community.
These arrangements provide us a patient population with a wide range of medical problems.
 The adult medicine team meets twice daily with the attending chief of service: at morning
report to review the previous night’s admissions and participate in selected didactic discussions,
and again at noon to review the progress of all patients on the service. The attending
chief rounds with the residents on all new admissions daily. Consultant or guest attendings
will round with residents for one-on-one teaching. Faculty members are available every
day to assist residents with patient care. Conferences include daily ICU rounds and weekly
rounds in radiology, cardiology, gastroenterology, infectious disease, and nephrology to
discuss current patients in the hospital, as well as common topics.
MATERNITY CARE
The residency program considers maternity care an important part of family medicine. The
program emphasizes a family-centered approach to childbirth. With a good mix of low-risk
and complicated higher-risk patients, residents can participate in a wide variety of deliveries.
Sutter Medical Center, our primary rotation site, has on average 160 deliveries each
month and the residents perform about half of these. In addition to deliveries done while on
the maternity care service, residents follow obstetrical patients in their own continuity panel,
handling all of the prenatal care and managing the labor and deliveries. Residents also spend
time in various outpatient settings providing prenatal care with community physicians and
midwives. Community family physicians are the first-line faculty for the service and are on
site during approximately half the weekdays for teaching and supervision. Obstetricians
provide additional weekday, night, and weekend coverage backup. Certified nurse midwives
have an active teaching role.
The residency also offers elective opportunities for advanced maternity care at Kaiser, Sutter,
and other UCSF community sites in the network. Residents with interest and appropriate
experience can function as primary surgeons in c-sections with advanced training.
Other obstetrical experiences are gained in High Risk OB Clinic, Sweet Success Clinic, (for
prenatal patients with diabetes) and public health antenatal clinics. A maternal health educator
works closely with the residents and their patients. Doula services and lactation consultations
are available to resident patients and for resident education.
SURGICAL CARE OF PATIENTS
The surgery experience has been designed to train the resident to perform minor surgery,
to recognize when a surgeon should be consulted, to assist on surgical procedures and to
diagnose inpatient and outpatient surgical conditions. During the focused surgery rotations;
residents evaluate patients as they present to the ER, obtain surgical consults when needed,
participate in trauma resuscitation and assist in the OR. The resident works with an attending
of the month in a one to one relationship. Call may be taken from home on this service
if the resident is within 20 minutes of the hospital. Residents also develop outpatient
procedural skills through focused rotations with family medicine faculty and longitudinal
experiences in the Family Practice Center.
CARE OF CHILDREN
The care of children is both a focused rotation and a longitudinal experience. The rotation
consists of inpatient and outpatient components. Currently, the residents on the team manage
the pediatric units at Kaiser Hospital and Sutter Medical Center and the Family Practice
Center outpatient pediatrics clinic. The team also has additional experiences in the Kaiser
ambulatory center and the neonatal intensive care units, mother/baby units, and emergency
rooms at both hospitals. The residency has a well-developed, well-established pediatrics
lecture series for which protected time is provided during the rotation. Call may be taken
from home on this service if the resident is within 20 minutes of the hospital. In addition to
the Sutter and Kaiser experiences, the residents have the opportunity to spend time at the
pediatric emergency room at Oakland’s Children’s Hospital. The longitudinal experience
includes primary care of children at all ages of life in the Family Practice Center.
NIGHT FLOAT
 Adult Medicine Night Float: During the first year and second year residents spend two weeks
a year as night float on the adult medicine service. The system provides the opportunity for
shift work rather than overnight call. The remainder of the adult medicine team rotates a
short call schedule during the days and evenings.
Third-Year Night Float: This month provides third-year residents with a challenging and
unique opportunity to teach and assist first- and second-year residents on all in-house services.
Four nights per week, from 6 p.m. to 7 a.m., the assigned senior resident is the first line
of contact for R-1’s on the in-patient services. He/she provides backup for residents who are
called into the operating room and will first assist or act as primary surgeon on C-sections
that occur during the night. The third-year examines and reviews patients admitted by firstyears
and provides teaching whenever possible. In performing these duties, particularly during
the first few months of the year, the night float resident provides an invaluable service as
both mentor and guide to those just embarking on their residency experience.
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