Harbor-UCLA Internal Medicine Residency: The Training Program

The Training Program

Harbor-UCLA Internal Medicine Residency:
Training at Harbor-UCLA
The Department of Medicine at Harbor-UCLA Medical Center offers both a Categorical and Preliminary Year Medicine Training Program. Please select from the following programs to learn more.

Categorical Medicine: Post-Graduate Year 1 (Intern)

Preliminary Medicine: Post-Graduate Year 1 (Intern)

Residency Program in Medicine: Second and Third Post-Graduate Years (Resident)

Categorical Medicine, Post-Graduate Year 1 (Intern)
The training program offers a Post-Graduate Year 1 in Categorical Medicine. This is the first postgraduate year of training in our three-year internal medicine program. We are offering 17 positions for 2011-2012. The information describes the current program and is subject to change.

Rotations
The year is divided into 13 rotations of 4 weeks each:
20 Inpatient Medicine
4 Inpatient Neurology
4 Medical Intensive Care Unit
4 Cardiology Inpatient/Coronary Care Unit
4 Emergency Medicine
8 General Medicine Clinics
4 Elective
4 Vacation

Inpatient medicine rotations
The first-year resident works under the supervision of a second or third-year resident and a faculty attending physician, and is responsible for the admission evaluation, orders, medical records, and daily management of his or her patients. Procedures such as lumbar punctures, diagnostic pleural and peritoneal aspirations, central line placement, and proctosigmoidoscopy are performed under the supervision of the more senior residents. Phlebotomy services are provided by clinical laboratory personnel. Nurse IV teams are available 24 hour per day, seven days a week. Laboratory results and clinical imaging are available on computer terminals located in all patient care areas.

The inpatient medicine rotation strongly emphasizes continuity and the team care approach, and all patients are admitted to a resident team. Each ward team is made up of an attending physician (full-time faculty member), two second or third-year residents, and three first-year residents. There is usually a third year medical student and occasionally a fourth year student on the team. The first-year residents admit patients along with a more senior resident from the team. The frequency of night call is every fifth night on the inpatient medicine rotation. Subspecialty expertise is provided by active consultative services representing all subspecialties. Patients admitted to the Medical ICU are followed jointly by the ward team and an ICU consultant team. Predominant responsibility for all patients rests with the attending physician-resident team; final and legal responsibility rests with the attending physician.

Inpatient rotations for the first-year resident also include one month each in the Coronary Care Unit/Inpatient Cardiology and the Medical Intensive Care Unit, where the frequency of night call is every 4th night. These experiences provide exposure to critically ill patients, invasive monitoring, and evaluation and management of complex inpatient problems. The Coronary Care Unit/Inpatient Cardiology rotation is designed to provide an intensive cardiology teaching and patient care experience. Patients with primarily cardiac problems (including those admitted to the CCU) are managed by the Cardiology team under the supervision of faculty from the Division of Cardiology. First-year residents will also have one month of inpatient Neurology.

Outpatient medicine rotations
Continuing Care Clinic (generally weekly), two 4-week General Medicine clinic rotations, and two 2- week blocks of Emergency Medicine form the core of the outpatient experience during the first year. These rotations include Urgent Care Clinic, an experience that provides unique experience in ambulatory medicine. First-year residents will gain skills in outpatient orthopedics, ENT, gynecology and ophthalmology. During clinic the resident assumes responsibility for the complete evaluation of patients new to the clinic, including history, physical examination, and interpretation of laboratory data. Patients evaluated during the clinic rotations are subsequently followed in the resident's own Continuing Care Clinic (continuity experience) in addition to patients discharged by the resident during his or her inpatient rotations. The Continuing Care Clinic consists of a weekly four-hour clinic throughout the three years (except during vacations and Emergency Medicine rotations). The Emergency Medicine rotation includes work in a busy acute care emergency room, and supervision is provided by Emergency Medicine residents and full-time faculty from the Department of Emergency Medicine.

Instruction and Supervision
Resident education is provided by close supervision and small group instruction, as well as didactic sessions and conferences. Residents are closely supervised in all aspects of patient care. Attending physicians on inpatient services are jointly responsible for patient management with the resident teams. In addition, teaching rounds focused on developing clinical skills, interpretation of clinical data, and resident education are held several times a week on inpatient rotations. Close supervision and instruction are maintained during the other rotations, including Emergency Medicine, Ambulatory Clinics, CCU, and the ICU.

Didactics
The core of the didactic program consists of four weekly required conferences: Medical Grand Rounds, Morbidity and Mortality Conference, the Evidence-Based Medicine Lecture and House Staff Discussion Series, and the Primary Care Lecture Series, a weekly core curriculum conference dedicated to primary care topics. Each week there is also an "Interns' Report" which offers a unique opportunity for in-depth case discussion and teaching focused directly on first-year residents. First-year residents have a major role in promoting the educational excellence of the Department. In particular, they have the important responsibility and privilege of teaching medical students on their team. About one-third of the medical students from the David Geffen School of Medicine at UCLA have an internal medicine experience at Harbor-UCLA Medical Center.

Stipend, Benefits and Living Conditions
The annual stipend for first-year residents beginning June 24, 2010 was $43,956. Meals, uniforms, laundering of uniforms, parking, health insurance, professional liability insurance, and disability insurance are provided at no cost. Meals are provided to residents without cost while on duty or on call and available for duty.

There are 20 days of vacation time per year. Also, all County employees receive 8 days of sick leave per year accumulated at a rate of 1 day per month to a maximum of 8. The County of Los Angeles permits Parental Leave. Sick time and vacation time are used for Parental Leave. In compliance with the Family and Medical Leave Act, up to 12 weeks of unpaid leave may be taken as parental leave or to provide care for children, parents, or close relatives. However, the total length of absence may affect the overall duration of the residency training necessary to meet the requirements for certification by the American Board of Internal Medicine or licensure by the State of California.

The County of Los Angeles insures all employees against liability for bodily injury and property damage resulting from actions in the course of duty. This includes malpractice coverage for members of housestaff when they are acting in their official capacity as employees of Los Angeles County. This coverage includes legal defense and protection against awards from claims reported or filed after completion of graduate medical education if the alleged acts or omissions of the house officer are within the scope of the education program.

There is excellent housing in the immediate vicinity of the hospital. Housing is available at reasonable rates in the surrounding communities. Popular areas within a twenty minute drive from the hospital include Redondo Beach, Palos Verdes, Hermosa Beach, Manhattan Beach, Torrance, San Pedro and Long Beach.

Licenses
First-year residents are not required to have a California State Physician's and Surgeon's License, but must obtain one at the end of the first postgraduate year if they plan to continue in the program.

Preliminary Medicine, Post-Graduate Year 1 (Intern)
This designed as a first postgraduate year of training in internal medicine for those planning specialty medicine careers in radiology, anesthesiology, neurology, dermatology, emergency medicine, and other specialties. We will be offering 4 positions for 2011-2012.

Rotations
The year is divided into 13 rotations of 4 weeks each. The schedule is the anticipated schedule for Categorical Medicine residents, but Preliminary Medicine PG1s may request rotations in perioperative medicine, surgery ICU, pediatrics, or other areas depending on career goals, interests, and requirements of the particular future specialty.

Weeks Rotation
20 Inpatient Medicine
4 Inpatient Neurology
4 Medical Intensive Care Unit
4 Cardiology Inpatient/Coronary Care Unit
4 Emergency Medicine
8 General Medicine Clinics
4 Elective
4 Vacation

Responsibilities for First-Year Residents
Responsibilities are the same as for Categorical Medicine residents (see above).

Instruction and Supervision
Instruction and supervision are the same as for Categorical Medicine residents (see above).

Licenses
First-year residents are not required to have a California State Physician's and Surgeon's License

The Residency Program in Medicine (Second and Third Postgraduate Years)

Accreditation
The Internal Medicine Residency Program at Harbor-UCLA Medical Center is fully accredited for three years of training by the Accreditation Council for Graduate Medical Education.

Selection
Second- and third-year resident positions in medicine (post-graduate years two and three) are filled by the first-year categorical medicine residents continuing in the program. Open positions, if any, are filled by residents selected from qualified physicians, with emphasis placed on performance during internship and residency, academic ability and background, teaching ability and interpersonal relationships.

Goals and Objectives
The training program emphasizes the development of well-rounded internists prepared for a career in general internal medicine or subspecialty internal medicine. Each resident rotates on several blocks of inpatient general medicine each year, through a variety of medical subspecialty services during the two years of training, and on a number of general internal medicine rotations that include inpatient consultation, ambulatory care clinics, and managed care.

On the inpatient services, the teaching program gives broad and intensive patient care responsibility to the resident team. Residents on inpatient rotations are expected to work effectively with appropriate supervision, but also to know when to seek additional guidance from the faculty. Subspecialty consultation services give residents the opportunity to acquire in-depth knowledge of subspecialty medicine and learn to become effective consultants. The general internal medicine rotations focus primarily on outpatient medicine, including geriatrics, managed care, and ambulatory procedural skills.

After completion of residency, many residents have entered practice in general internal medicine. Others have elected fellowship training at excellent general internal medicine or subspecialty training programs throughout the U.S. or have chosen to continue training at Harbor-UCLA Medical Center.

Schedules
There is some flexibility in scheduling, but the second-year residency program generally includes four months on inpatient medicine (one at the Ronald Reagan UCLA Center for the Health Sciences in Westwood), one in the General Medicine Clinic, one in Urgent Care Clinic, five medical subspecialty rotation months, one elective month, and four weeks of vacation (13 rotations of 4 weeks each).

The third-year residency program places additional emphasis on in-depth training in various subspecialties and general internal medicine. Most third-year residents will have three months assignment on inpatient medicine and one month on inpatient cardiology. Four months are spent on medical subspecialty rotations, one month as a general medical consult to non-medicine services, one month in ambulatory managed care, one month in subspecialty medicine ambulatory clinics, one month in emergency medicine, and four weeks vacation (13 rotations of 4 weeks each).

A range of elective rotations is offered, including evidence-based medicine, critical care medicine, and research, and residents may design their own elective rotation subject to approval. The schedule is sufficiently flexible to allow up to three months of research during the residency for highly-motivated residents.

A sample schedule is as follows:

Second-year Resident (Post-Graduate Year 2)
Weeks Rotation:
16 Inpatient Medicine Wards (including 1 month at UCLA Center for the Health Sciences)
4 General Medicine Clinic
4 General Medicine/Urgent Care Clinic
4 Gastroenterology
4 Nephrology and Hypertension
4 Infectious Diseases
4 Pulmonary Medicine
4 Cardiology
4 Elective
4 Vacation

Third-year Resident (Post-Graduate Year 3)
Weeks Rotation:
12 Inpatient Medicine Wards
4 Inpatient Cardiology/CCU
4 General Medicine Inpatient Consultation
4 General Medicine/Ambulatory Managed Care
4 Emergency Medicine
4 Endocrinology and Metabolism
4 Rheumatology
4 HIV Medicine
4 Elective
4 Vacation

Responsibilities
Residents on inpatient medicine are responsible for the complete work-up and management of patients; guidance, teaching and supervision of first-year residents and medical students; procurement of consultations; and the overall administration. Patients in the Intensive Care Unit remain under the aegis of the resident team in consultation with the ICU team. Formal teaching attending rounds are held for two hours at least three times per week, as well as daily work rounds with the attending physician, ensuring that every patient is adequately reviewed and residents appropriately supervised. Each resident has his or her own Continuing Care Clinic scheduled 1-3 times/week. These clinics allow residents to see patients initially evaluated during the General Medical Clinic rotation, patients discharged by the resident from inpatient medicine, and a group of patients assigned from a graduating senior resident. Residents rotating onto medical subspecialties function as consultants to the medicine inpatient services and to non-medical services (e.g., Surgery, OB/Gyn, Psychiatry). The General Medicine Consult resident provides consultations for patients with medical problems on non-medical services, including perioperative evaluation and management.

Conferences
Residents on inpatient medicine attend Morning Report four days per week. This conference, moderated by the Department Chair, Associate Chair, or other faculty member, is an interactive discussion of selected patients intended to develop skills in differential diagnosis, initial approach to management, and interpretation of clinical data. Residents are required to attend the weekly Medical Grand Rounds, Medical Morbidity and Mortality Conference, the Evidence-Based Medicine and House Staff Discussion Series, and the Primary Care Lecture Series. A number of other conferences are held approximately monthly, including the Medical Informatics Discussion Series, Journal Club, and Ethics Conference.

Instruction and Supervision
The attending physician and full-time staff provide direct supervision and instruction during lectures, rounds, clinics and conferences. All of the attending physicians assigned to inpatient medicine are fulltime faculty members. The subspecialty consultative services are supervised by faculty physicians (95% full-time) who maintain close daily supervision of the residents assigned to their services.

Research
There are many options for resident participation in the active research programs within the Department of Medicine. Residents have worked under the direction of faculty members in all areas of internal medicine, and have been involved with both basic science and clinical research projects. Residents who participate in research are encouraged to present their research at local and national meetings.

Stipend, Benefits, and Living Conditions.
The yearly stipends starting July 1, 2010 were: PGY-2 $49,177 PGY-3 $53,284 Meals, uniforms, uniform laundry, parking, health insurance, disability insurance, and professional liability insurance currently are provided at no cost. (See Benefits provided for Interns.)

Housing is available at reasonable rates in the surrounding communities. Popular areas within a twenty minute drive from the hospital include Redondo Beach, Palos Verdes, Hermosa Beach, Manhattan Beach, Torrance, San Pedro and Long Beach.

Licenses
Appointees will be required to present a California State Physician's and Surgeon's Certificate at the time of appointment or a letter acknowledging registration with the California State Board of Medical Examiners. Residents are required by California State Law to have a valid license before the start of their twenty-fifth month of post-graduate training, regardless of the location or specialty of prior training. Appointees are also required to obtain a DEA number. Residents must obtain Advanced Cardiac Life Support (ACLS) certification during their second-postgraduate year.

Residency Application Procedure
The Department of Medicine at Harbor-UCLA Medical Center conforms to the agreement on Uniform Date for Appointment of Residents for residents seeking an appointment for July 2011. This applies only to those applicants for second-year resident positions (PGY-2) who are first-year residents during 2010- 2011. The number of positions available for second- or third-year residents coming from outside the program is very limited, and, most years, there are no such positions at all.

A physician interested in residency training may apply on an official Resident Physician Application Form of the County of Los Angeles Civil Service Commission. These forms and further information may be obtained by writing to:
Darryl Y. Sue, M.D. Program Director
Department of Medicine Harbor-UCLA Medical Center, Box 400
1000 West Carson Street
Torrance, California 90509-2910

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