Here at UCLA, we have a long tradition of focusing a substantial amount of our subspecialty training in the ambulatory setting. In this way, trainees are exposed to the breadth of internal medicine in each of the subspecialties that will best prepare them for a career in internal medicine. In order to continue in this tradition and to improve our residents’ experiences in their continuity clinics, as of July 2014, we switched over to the popular 4+1 block scheduling model for our program. With the 4+1 model, all residents, beginning from day 1 of internship, will be able to manage busy continuity panels without the fragmentation and tension with busy inpatient rotations that unfortunately has become increasingly prevalent in the traditional model. Residents have one week of protected ambulatory medicine and continuity clinic every five weeks starting from intern year. Each of these weeks includes five continuity clinic sessions at one of four clinic sites and also incorporates small group teaching conferences, selected subspecialty clinics, simulation training, and didactic activities. Residents have their own panel of patients that they serve and build over the course of the three year program. Each resident has four ‘clinic partners’ who are available to help take care of his or her patients while busy on other rotations. This permits cross coverage and minimizes competition between busy inpatient and outpatient duties.
Residents also provide primary ambulatory care to low-income patients at the Simms-Mann Health and Wellness Center, a free clinic in Santa Monica. This clinic is part of the Venice Family Clinic which is the largest provider of healthcare to the underserved in the United States. During every continuity week, residents have one half day of dedicated didactic time that focuses on outpatient practice management and lectures from faculty members on outpatient diseases.
In addition to the protected weeks of ambulatory clinics, residents also have the opportunity to experience blocks of outpatient clinic training in a variety of subspecialty clinics. Subspecialty clinics include: cardiology/pre-op, endocrinology, gastroenterology, hematology-oncology, pulmonary medicine, and rheumatology. Outpatient exposure to these disciplines allows the housestaff to work closely with our outstanding faculty and provides exposure to the common diseases typically treated by these specialists. Additionally, junior and senior residents also have significant elective time in their outpatient schedules to design a curriculum based on their career goals. UCLA offers a broad range of ambulatory electives including but not limited to women’s health, allergy-immunology, east-west medicine, radiology, dermatology, sports-medicine, student health, procedures, HIV, nuclear medicine, medical student education, pathology, nutrition/obesity, and palliative care. Residents are encouraged to create their own elective rotations from their interests and are not limited to pre-set electives.
For additional details on our categorical ambulatory training sites, please click here.
The inpatient rotations have also benefited from the 4+1 schedule. Residents no longer have outpatient clinic responsibilities that interrupt inpatient rotations. This increases the number of days when the entire team is together, improving team cohesiveness and patient continuity. More time is spent on teaching activities such as patient presentations, pre-rounds and work-rounds, procedures, and patient centered points of interest learning topics.
Ronald Reagan General Medicine Wards
Our medicine ward team at Ronald Reagan hospital is comprised of one resident and two interns. There are 6 general teams. The full complement of each team also generally includes one to two 3rd year medical students and one 4th year subintern. Most of the attendings are part of the UCLA hospitalist group. Interns rotate through the general medicine wards at least twice during their intern year and residents have the opportunity to lead the team once a year.
Ronald Reagan Medicine Wards Team 7
A unique medicine wards team at Ronald Reagan hospital that is comprised of one resident and one intern. This team admits only Monday through Friday and focuses on bedside teaching and learning physical exam skills.
Intensive Care Unit
The medical ICU at Ronald Reagan hospital is comprised of two attendings, four residents, and four interns. Call is every fourth day for the resident and intern.
Cardiac Care Unit
The CCU at Ronald Reagan hospital is comprised of two attendings, four residents, and four interns. Call is every fourth day for the resident and intern. There is a separate Cardiology Observation Unit that is comprised of one senior resident and one cardiology attending. This service cares for floor-status cardiac patients and admits Monday through Friday.
The Solid Oncology service at Santa Monica hospital cares for patients with solid organ malignancies. The team is comprised of an oncology attending, an oncology fellow, two second or third year residents, and two interns. Housestaff learn the pathophysiology of common malignancies and gain competency in managing complications associated with cancer and its treatment. Residents and interns are on call every fourth night until 9pm (not overnight).
All second and third year residents rotate on the Hospitalist service at Santa Monica hospital one or two months a year to experience a community hospitalist practice model. This innovative rotation incorporates residents into a busy hospitalist practice as junior attendings. Residents enjoy a collegial style of supervision. The rotation provides seniors an opportunity to function independently as community physicians. Long call is every sixth night.
Night Float/Night Admitting Rotation
During this 2 week rotation residents admit overnight patients and distribute these patients to the general medicine teams in the morning. All interns spend 2-4 weeks on night rotations as either the night-float for general medicine wards or the ICU. Second year residents have one 2 week rotation of night float at Santa Monica Hospital covering the hospitalist and solid oncology services, or one 2 week rotation of night float at the West LA VA covering the general medicine wards.
Geriatrics Rotation at Santa Monica Hospital
This rotation offers exposure to a multidisciplinary geriatrics ward in a community hospital setting. There are two teams, each comprised of a geriatrician and two second or third year residents. A primary objective of the rotation is to offer residents an opportunity to function as junior attendings. Another is to provide evidence-based training in geriatric medicine. A nurse practitioner also participates in patient care. Residents take home call every fourth night.
VA General Medicine Wards
The medicine ward teams at the West Los Angeles VA are made up of five traditional teams (each comprised of an attending, one resident, two interns, and at least one UCLA medical student). These teams admit on a Q5 day call schedule. Other important members of the multidisciplinary team include a case manager, social worker, clinical dietitian and clinical pharmacist.
VA Intensive Care Unit
The Medical ICU at the West Los Angeles VA is compromised of four teams, each with one resident and one intern. A dedicated night float intern provides overnight intern coverage for the on-call team. Residents take overnight call every 4th night.
VA Cardiology Telemetry Ward
The Cardiology Telemetry ward at the West Los Angeles VA is comprised of 3 teams (each with one resident and one intern).
VA Geriatrics/Palliative Care Rotation
The VA Geriatric service is an inpatient service that admits patients over 70 years of age. The focus is on learning how to take care of geriatric patients in an inpatient setting. Teams admit patients Monday through Friday and there is no overnight call. The service is comprised of a board-certified geriatrician, fellow, and two senior residents.
VA Emergency Medicine Department
The VA Emergency Medicine is a busy full service emergency department which evaluates 33,000 patients annually, with both medical and surgical emergencies. The ED receives non-trauma related emergency ambulance traffic from the surrounding area. Interns and residents staff the ED in 10 and 12 hour shifts from 8am to midnight.
Olive View-UCLA Medical Center Wards
Interns will rotate at Olive View-UCLA Medical Center general medicine wards for one month during their first year. Senior residents may elect to do an additional month at Olive View during their third year. Olive View-UCLA Medical Center is a county hospital with an underserved, primarily Spanish-speaking population.