The Primary Care (PC) Internal Medicine Residency Program was started as a separate track within the UC Davis Internal Medicine Residency Training Program in 1979. As categorical medicine residency programs are traditionally quite adept at training residents for subspecialty and inpatient medicine, the initial goal of the PC Program was, and remains today, to train physicians to provide comprehensive inpatient and outpatient primary care. It accomplishes this goal through combining the strengths of the categorical training program with an intensified and diverse ambulatory care experience. A second major goal is give residents a solid clinical and didactic background in evidence-based general internal medicine.

The PGY1 year is identical to the categorical intern schedule, which already has a solid base of outpatient training with its weekly general medicine continuity clinic, and two ambulatory care blocks. Dr. Keenan (PC Program Director) works with the residents as one of their main continuity clinic attendings over this year. Over the PGY2 and PGY3 years, residents have three-block-long Primary Care Rotations alternating with three-block-long Non-PC Rotations, with each block comprising four weeks. Two of the sessions will actually be 3.5 blocks long in order to divide the 13 blocks evenly. A visual example of this schedule for a given two-year period for a single resident is diagrammed below. The capital letters represent individual PC residents:

2005 - 2006

2006-2007

The PC Rotation is entirely ambulatory. Residents on the PC Rotation have continuity clinics in General Medicine Clinic twice weekly, Geriatrics Clinic once weekly, and CARES (HIV) Clinic once every two weeks. Residents also rotate through a large number of medicine subspecialty clinics and non-medicine specialty clinics. Residents are able to choose most of these elective clinics (list of available clinics below) based upon their own perceived educational needs. Residents can also create their own clinic experiences in other clinics if desired (e.g. refugee clinic). During non-PC Rotation blocks, residents rotate through inpatient medicine wards, Medical ICU (MICU), Cardiology Inpatient Service (CIS), ER, night float, general medicine consults, and subspecialty consultation or research electives. During the non-PC Rotations, residents have their General Medicine continuity one half-day per week.

Please also refer to the Categorical program description for details on inpatient rotations and the intern year rotations.

In addition to the clinical rotations, each Primary Care Resident is expected to complete an annual scholarly project. The scope and content of the project can be quite variable. In the past, projects have ranged from scholarly literature reviews to clinical research studies. Residents are required to work with faculty mentors (many are available, especially from our Center for Health Services Research in Primary Care) who will assist with their projects. Research seminars are held several times during the year where each resident updates the group on his/her project, giving an opportunity for group feedback, group problem solving, and project improvement. Each resident is expected to present his or her project to their resident colleagues at a Monday Academic Conference session at the end of the academic year. Residents are encouraged to submit their research project for publication and/or for presentation at regional and national meetings.

We constantly review the program with the PC residents, in order to make positive changes aimed at improving the quality of training, quality of patient care, and resident satisfaction.

During Primary Care Rotations

A. Continuity Clinics and Primary Care Program Specialty Clinics

• General Internal Medicine Clinic: average of 2 half-day sessions per week.
• Geriatrics Clinic: one half-day session per week.
• CARES (HIV) Clinic: one half-day session every 2 weeks.

B. Specialty and Subspecialty Clinics

• Cardiology
• CHF Clinic
• Women's Cardiovascular Health Clinic
• Exercise Treadmill Clinic
• Pulmonary Clinic
• UC Asthma Network (UCAN) Clinic
• Gastroenterology Clinic
• Hepatology Clinic
• Endocrinology Clinic - includes thyroid, osteoporosis, diabetes and general endocrinology
• Nephrology Clinic
• Neurology Clinic
• Rheumatology Clinic
• Dermatology Clinic (VA Medical Center and UC Davis community clinic in Elk Grove)
• Urology Clinic
• Breast Cancer Clinic
• Hematology Clinic
• Infectious Diseases Clinic
• ENT Clinic
• Urgent Care/Procedure Clinic
• Allergy Clinic
• Occupational Health Clinic
• Pre-Op Clinic
• High-Rish Foot Clinic
• Student Health Clinic (UC Davis campus)
• Gynecology Clinic (Sacramento County Health System)

During Non-PC Rotations

Residents will have 13 blocks of a combination of these rotations over their two years:

• General Medicine Wards (UC Davis and VA Medical Centers)
• North Kaiser Wards (NKW)
• Medical ICU
• Cardiology Inpatient Service
• GenPro - a combination of outpatient urgent care and procedure clinic experience, the General Medicine Consultation Service
• Subspecialty Elective Consult Services
• Emergency Room
• Night Float

Internal Medicine Academic Conference (weekly)
This weekly seminar series is for the entire medicine residency program, and meets each Monday from 1:30 - 4 p.m. It takes the place of the more conventional noon conferences. Residents from all clinical sites attend these seminars, which cover a broad internal medicine curriculum over the course of the year. It is also a great opportunity for socializing among residents and faculty. The time includes a regular M&M conference.

Psychiatry in Primary Care Seminar Series (monthly)
This seminar series is run in concert with faculty from the Department of Psychiatry, with Dr. James Bourgeois assisting with its coordination. It includes a series of seminars covering common psychosocial topics pertinent to primary care. Topics include: somatization disorder, depression, anxiety disorders, eating disorders, psychiatric emergencies, elder abuse, the psychotic patient, personality disorders, sexual dysfunction, and dementia.

Medical Interviewing and Communication Skills Seminar (monthly)
This seminar series entails reviewing videotaped patient encounters. Each resident videotapes patient encounters in the clinic, and the tape is then reviewed as a group. We concentrate on interview techniques, patient-physician communication skills, and pyschosocial aspects of patient care. It is an eye-opening and valuable experience for the residents and is a great hands-on opportunity to discuss these important topics.

PC Resident Journal Club (weekly)
Residents meet together with a faculty member and critically review articles from the medical literature with their colleagues, applying the basic tenets of Evidence Based Medicine. All medicine interns have an intensive research block during their ambulatory have an 8-week Evidence-Based Medicine course that is taught during the internship year.

Resident Research Seminars (approximately four times per year)
All UC Davis interns participate in the Intern Research Block during the second half of their internship year. This is an excellent introduction to assist in the annual Scholarly Project that each PC resident completes each year. These seminars are used to share progress on the scholarly project for each resident. Research technique and resources are reviewed, and problem-solving on individual projects allow group learning.

Outpatient Morning Report (weekly)
PC residents attend UC Davis morning report and present educational cases from clinic, to allow focused discussion on common outpatient problems.

General Medicine Pre-Clinic Conference (weekly)
Case-based discussions with accompanying articles addressing common ambulatory care topics. This includes a monthly Pre-Clinic Journal Club prepared by one of the categorical residents each month.

Resident Teaching Seminars (monthly)
Residents are taught by faculty skills and techniques for more effective teaching of fellow residents and students.

Health Care Policy Seminars (monthly)
We are discussing the basics of how health care policy are developed and how we as physicians can affect health care policy and be true advocates in our current health care system. We also discuss issues of population health and medical financing.

Clinical Reasoning/EBM Seminars (monthly)
This seminar series expands upon the basics of EBM supplied in the intern seminar series. PC residents run these interactive seminars to elucidate the fine points of clinical reasoning, with the help of faculty facilitators.

The proposed schedules for PC PGY2 and PGY3 years are outlined below. Please not that these numbers are subject to change, depending on a variety of factors.

Primary Care residents work closely with UC Davis faculty in a wide range of specialties. The main contributors to the clinical education are listed below, but there are many other faculty who contribute their time and expertise that are not listed.

For the Match, there will be three positions for the Primary Care Internal Medicine Training Program in the National Residency Match Program, available to incoming interns. The remaining three PC Program positions that remain after the Match will be filled from the intern class each Winter, utilizing the application process outlined below. This allows those medical students who are less certain of their career goals at match time to get six more months of experience as interns. After this experience, the interns can make a more informed decision on whether to pursue a primary care career. Those that wish to focus on PC training in our program are then strongly urged to apply.

For the two-year cohort starting in July, half of the Primary Care class was filled through last year’s match. The remaining slots will be filled with members of the current UC Davis categorical medicine intern class. We do this purposefully so that individuals unsure of pursuing primary care as they leave their third year of medical school have the opportunity to pursue this program after they have more clinical experience. The applications for these slots will be sent out in late November, and final selection will take place in late January. Preference will be given to those residents interested in pursuing primary care internal medicine as a career, or those who plan to do subspecialty training in fields that involve significant ambulatory practice.

Any questions about the Primary Care Internal Medicine Residency Program can be directed to the Program Director, Dr. Craig R. Keenan, at craig.keenan@ucdmc.ucdavis.edu.