Rotations and Schedules | Department of Internal Medicine | UC Davis Health

** Includes specialty clinics, continuity clinics
*** Interns work 2-3 Sunday Night Float shifts on CCU and at the VA during PGY-1 year

** Includes specialty clinics, continuity clinics
*** Residents can take up to 4 weeks of elective research time per year in PGY-2 and PGY-3 years

** Includes specialty clinics, continuity clinics
*** Residents can take up to 4 weeks of elective research time per year in PGY-2 and PGY-3 years

** Includes specialty clinics, continuity clinics
*** Residents can take up to 4 weeks of elective research time per year in PGY-2 and PGY-3 years

** Includes specialty clinics, continuity clinics
*** Residents can take up to 4 weeks of elective research time per year in PGY-2 and PGY-3 years

** Includes specialty clinics, continuity clinics
^ Includes about 10 weeks of TEACH Wards, 6 weeks of UC Wards
*** Residents can take up to 4 weeks of elective research time per year in PGY-2 and PGY-3 years

A robust ambulatory experience is provided to train residents to care for patients from many backgrounds with a goal of working toward delivering high-quality outpatient care.  There are 4 different continuity experiences offered so trainees have an opportunity to tailor their training experience to best align with their career goals. 

• Diverse continuity clinic options: Sacramento County Clinic, Kaiser Permanente, UC Davis Health or Sacramento VA.
• True continuity experience:
  • All 4 clinics provide the opportunities for continuity of care in a structured training environment throughout 3 years of residency. The continuity experiences emphasizes true continuity in patient care.
• Emphasis on interprofessional teams:
  • Each site has a focus on patient centered care and integrating ancillary staff into your medical practice, including pharmacists, case managers, nurses, NPs, medical assistants, and social workers.
• 4+1+1 and 4+4 structure:
  • Two to four dedicated ambulatory weeks in a row allows the provider ample time to care for their ambulatory panel without competing interests.
• Range of sub-specialty clinics in various health systems:
  • All residents have the opportunity to rotate through a broad range of clinics in varying subspecialties. See list of ambulatory site rotations for more information.
• Mentorship opportunities:
  • Access to a variety of outpatient general medicine and sub-specialty physician educators lending itself to opportunities to develop mentoring relationships throughout residency.
• Wellness time:
  • The ambulatory schedule includes Wellness half days, which can be used for catching up or wellness activities, such as going to the doctor, dentist, or gym. Every resident gets one half day of Wellness time per week when on their Ambulatory (AMB) rotation – so that is 8-12 wellness half days per year.

• All primary care, TEACH, Combined Internal Medicine/Psychiatry, and categorical residents have continuity clinic over their entire 3 years.
  • We use a 4+1+1 (interns) or 4+4 (R2 and R3) schedule.
    
    • Residents do four weeks of an inpatient rotation, followed by two weeks (1+1) or four weeks (+4) of elective, ambulatory block, or vacation.
    • Residents do not have continuity clinic during their four weeks of inpatient work.
    • During the "plus" weeks, they have 2-3 continuity clinics.
• We have 4 continuity clinic sites: UC Davis, Kaiser, VA and Sacramento County.
• The majority of the residents have their continuity clinic at the UC Davis General Medicine Clinic.
  • This clinic comprises 32 exam rooms and over 40 staff supporting 70+ residents in the residency clinic, our general medicine faculty practice, and endocrinology, infectious disease, rheumatology, and allergy clinics.
  • Residents learn to practice with patients who have HMO, PPO, and Medicare insurances.
  • 4-12 residents are in clinic each half-day with outstanding general medicine faculty.
  • Residents work in small groups called Firms, and every resident has a dedicated Firm Attending who helps out at any time with any clinical questions about the resident’s patients.
  • Each intern is paired with an upper level resident “buddy” to help out with clinic issues.
  • Our residents work in a multidisciplinary environment that help them provide excellent care. Some features of our clinic are:
    • An outstanding telephone nurse triage system
    • A pharmacist-run medication refill system
    • A pharmacist-run pain management program
    • Pharmacist-run hypertension,diabetes and medication management clinics
    • Procedure clinics
    • Psychiatry clinics
    • Readily available interpreters
    • Social work and care coordinators
    • Collaborative psychiatric care model with LCSW counselor
    • Epic EMR platform
• 10 residents have their continuity clinic at Kaiser Clinics.
  • Here, each resident sees patients with a single faculty within that doctor’s practice, over their entire three years.
  • Residents love this apprentice model due to its close mentoring and role modeling.
  • Residents also like working in the highly efficient, patient-centered Kaiser closed-HMO model.
  • Epic EMR platform
• VA Continuity Clinic at the Sacramento VA Medical Center. Six to nine residents have continuity clinic here per year 
  
  • The VA provides strong team-based care in their Patient Aligned Care Team (PACT) model.
  • Residents work in the Academic PACT, which has an academic attending, social worker, administrative lead, pharmacist, and nurse. Residents will also rotate through the Women's Health Clinic regularly.
  • Great bread-and-butter chronic care.
  • CPRS EMR platform
• Approximately 28 residents have their continuity clinic at the Sacramento County Clinics—we call it the TEACH Clinic.
  • This clinic cares primarily for low income Medi-Cal patients and undocumented residents of Sacramento County. Residents love caring for this very underserved population.
  • The third year TEACH residents all have their continuity clinic here during their third year.
  • All of these residents work as a group practice to care for their patients.
  • Epic EMR platform

• Most of our electives are at the UC Davis Medical Center. 
• We have electives in GI/Hepatology, Rheumatology, Inpatient Nephrology, Outpatient Nephrology, Inpatient Pulmonary, Outpatient Pulmonary, MICU, Inpatient Cardiology, Outpatient Cardiology, Inpatient Hematology-Oncology, Outpatient Hematology-Oncology, Infectious Diseases, TB Clinic, Antibiotic Stewardship, Inpatient Endocrinology, Outpatient Endocrinology, Palliative Care, Toxicology, CHF, Physical Medicine and Rehabilitation, Psychiatry, Screening Hospitalist, and Master Clinician Educator.  
• Some residents create custom electives for areas not represented.
• Residents can take electives in two- or four- week blocks.

• North Kaiser is a hybrid rotation, where residents spend half of their time on the floors and half of their time in the MICU.  This is a large community hospital, and most of the patients are admitted by the large hospitalist and ICU services.  Given the size of the Kaiser system in our area, the hospital admits an incredible variety of medical patients. 
• Residents take a distinct minority of the admissions to medicine (the rest go to a non-teaching service) – so the admitting hospitalists cherry pick the best cases for the housestaff teams. Kaiser has a long history of supporting our residents so that they receive optimal educational experiences.
  
  • The Academic Floor Team is staffed by a subset of hospitalists who are dedicated to resident education.
  • The Academic ICU Team has ICU attendings who are dedicated, experienced intensivists that have a track record of winning teaching awards. 
  • At night, there is a Tele-Critical Care attending available to assist the residents at all times for critically ill patients and codes. There are also in-house hospitalists who can assist with bedside patient care of sick patients.
• There are four teams at Kaiser at a given time: two teams of one resident, one intern, and one 3rd-year medical student that manage the ICU; and one daytime floor team of one resident, two interns, and two third-year medical students, and one night team comprised of one resident.
• The night resident cross-covers on the housestaff patients in the ICU and on the floors Monday through Friday. They admit patients overnight to the floor and ICU. There is no night resident on weekends, when the hospitalists and ICU staff at Kaiser provide cross-coverage.
• The daytime floor team admits daily on Monday through Saturday (Sunday is the resident day off).
• The ICU teams take call during the daytime every other day. The night resident covers at night, except on Saturday and Sunday when the intensivist faculty cover the unit without residents.

• We have an active and outstanding group of cardiologists practicing at the cutting edge, including an advanced heart failure program, interventional, and structural heart disease program (Mitra-clip service, TAVR, etc).
• This is a combined CCU and cardiology floor rotation--residents admit to the floor and the unit. There are two teams of two upper level residents, two interns, one fellow and one attending. Pulmonary Critical Care consultants assist with management of ventilated patients or other critically ill patients when necessary.
• There are two large teams (Gold and Platinum) that alternate taking admissions. We have day and night shifts of residents. There is a cardiology fellow in house 24-7.

• Residents work for two weeks in their third year in this top notch, very busy ED.  Residents can also choose to do electives in the ED. Residents play a key role as the first evaluator of many common and complex patient problems. 
• During this rotation, residents have ample opportunities to perform procedures and get experience with bedside ultrasound with our ER faculty.

• Upper level residents (two at a time) provide consultation to non-medical services under the supervision of the general medicine faculty. 
• This team co-manages many of the surgery patients, performs many preoperative evaluations, and helps manage many common post-operative problems. 
• We have a set curriculum that all residents finish during their training. 
• After this experience, residents are well-prepared to perform perioperative consultation and management.

• UC Davis is one of only 41 nationally recognized National Cancer Institute Comprehensive Cancer Centers. The HONC team primarily cares for patients seen at the Cancer Center, patients admitted through the ER with new cancer diagnoses or complications of cancer, and transfers from other facilities for our extensive services.
• This service concentrates on patients with solid tumors, patients needing workups for probable malignancy, patients with nonmalignant hematology issues (e.g. TTP, sickle cell chest crisis, aplastic anemia, hemolytic anemia). Patients with bone marrow transplants, acute leukemia on chemotherapy, and other malignant hematologic problems are managed on a new, non-teaching Malignant Hematology Service. Interested residents can do elective rotations on this service and the Bone Marrow Transplant Service.
• For educational reasons, interns do not care for routine chemotherapy patients. These are handled by a separate service.
• This service is staffed by four interns and two hospitalist attendings. The interns share admissions daily until 3 p.m. under the supervision of the hospitalist. There is no overnight call, as patients are covered by the UC Night Float intern.

• The MICU is probably the favorite rotation for most of our residents.  This is because of the incredible medical pathology, the great fellows and attendings that supervise this service, and a true multidisciplinary care team of nurses, nutritionists, physical therapists, and respiratory therapists.
• There are 2 mega teams, each of which has a day shift and a night shift.  Each team has two senior residents (one for day and night), two day interns, and one night intern.  There is a fellow for each team and there is always a fellow in house at night.
• Sometimes there is a junior resident on elective that works during the day and some nights assisting with evaluations and admissions.
• The teams alternate admitting days.  There is no overnight call.

• All residents do two weeks on our inpatient Neurology Services – both the Vascular and General Neurology teams.
• Here they learn the basics of acute inpatient stroke care, secondary prevention measures, management of seizures, and neurologic examination skills.

• All interns do 1-2 weeks of night float, where they cross-cover on UC floor patients on the medicine and hematology-oncology services. 
• They have on-site backup from more senior medicine residents on ICU, Cardiology and General Medicine services and hospitalists who are also in-house overnight. They also have phone back-up from fellows and attendings. 

• This is our flagship rotation, with an amazing patient population and disease mix. The majority of patients admitted on this service come through our very busy Emergency Department, but we also get tertiary referrals from other hospitals in the Central Valley and Northern California areas. 
• There are five teams, each comprised of an R3, two interns, one attending, two 3rd-year medical students, and usually a 4th-year medical student.
• The interns and residents work days only on this rotation, and take Day Call every 5th day – admitting up to 4 patients before 4 p.m.  They have two “pick up” days where they take admissions in the morning that were done overnight.
• A team of two R2s on the R2 Night Medicine Rotation admit patients overnight and do after-hours general medicine consultations. These R2s present the new admissions to their team in the morning during bedside rounds, before they go home. So there is built in bedside teaching for the teams and the night residents get excellent teaching after their long night’s work.
• Discharge planners and Transitions of Care navigators are assigned to each team, which is very helpful.
• The supervising faculty are primarily hospitalists and general internists who are very experienced at inpatient care. They are wonderful clinical mentors and great role models of clinician-educators.

• The VA ICU team admits CCU and ICU level patients under the direct supervision of the pulmonary critical care faculty (cardiology consults on CCU level patients to co-manage them). They also admit floor cardiology patients under the direct supervision of the cardiology faculty.  
• This is a one resident, two intern team that admits ICU and cardiology patients daily.
• There are cardiology and pulmonary fellows on the service as well.
• Night admissions and cross-cover are provided by the overnight floor medicine team.
• The team rounds with the ICU team at 8 a.m. and the CCU team (cardiology fellow and faculty) at 10 a.m. every day.
• The attending for the ICU team is one of our UC Davis pulmonary faculty who rotates at the VA. The CCU attending is one of several outstanding VA cardiology faculty.  There are in house hospitalists at night for direct assistance, and the fellows are on call and come in for sick patients when required.

• There is a small Surgery Service at the VA, but for the most part this 60-bed hospital is run by the Internal Medicine Service.  This allows for our residents to see what it is really like to work in a community hospital and see virtually everything that comes their way. Add to this the wonderful VA patients, with their “bread and butter” medical problems and their great spirit, and this becomes a great rotation.
• The floor at the VA is covered by four teams with one resident, two interns, and one third-year medical student. One of these teams is a Family Medicine team. 
• There one short call and one long call team on every day. A night team manages admissions and cross coverage overnight.
• There is an in-house hospitalist 24-7 to assist the residents when needed.

• All interns and residents get four weeks of vacation per year. These are taken in one- to two-week blocks over the course of the year (during the “plus” time of 4+1+1 and 4+4 schedules). We do our best to meet the requests of our residents.
• Of course, all residents get one day off per week on average when on inpatient rotations per ACGME guidelines. 
• On electives and Ambulatory rotations, residents are not required to work weekends, except when they are covering night shifts or providing backup services to other residents who are unable to work (there are a couple of electives that do have weekend shifts).
• Residents on Ambulatory rotations are given one half-day off per week to pursue wellness activities. Residents can schedule this in advance to go to personal appointments or other wellness activities.