Internal Medicine Residency Training University of California, Irvine

1. Internal Medicine Residency Training University of California, Irvine We are very pleased that you are considering our Internal Medicine residency, and we look forward to meeting you on interview day. In this presentation, we have highlighted the most salient information about our Program. More extensive information is available on our website: www.medicine.uci.edu/intmed. Please also feel free to e-mail me with questions at lrucker@uci.edu Lloyd Rucker, MD, Program Director Welcome and Introductions Please refer to the packet. This packet contains a number of important documents including our curriculum document, samples of our web site, information on our residents and our graduates, and information on our Research Pathway. One of the most important enclosures is a copy of the RRC Program Accreditation Requirements for Internal Medicine. I would suggest that you review this document because it sets forth the standards for Internal Medicine Residency training. As you work through your choices for residency programs, it would be important to have a knowledge of this document and understand its implications.Welcome and Introductions Please refer to the packet. This packet contains a number of important documents including our curriculum document, samples of our web site, information on our residents and our graduates, and information on our Research Pathway. One of the most important enclosures is a copy of the RRC Program Accreditation Requirements for Internal Medicine. I would suggest that you review this document because it sets forth the standards for Internal Medicine Residency training. As you work through your choices for residency programs, it would be important to have a knowledge of this document and understand its implications.

2. UCI Internal Medicine Residency Core Philosophy Our goal is to train the extraordinary internist: Clinically astute Academically rigorous Committed to the highest professional standards Able to access the broadest range of career options The core training of the internist should prepare him or her for any of the possible internal medicine career tracks. Clinical skills and knowledge are key, but the internist must have a grasp of the precepts of research, population health, and professionalism. These areas enhance the spirit of intellectual inquiry and commitment which are core to the practice of internal medicine. In addition, we wish to foster those individuals who are committed to academic or research career tracks through our Research Pathway. We are offering the Research Pathway, however, not just to benefit the few who might participate directly but because we believe that these individuals will enhance the academic milieu of the entire program.The core training of the internist should prepare him or her for any of the possible internal medicine career tracks. Clinical skills and knowledge are key, but the internist must have a grasp of the precepts of research, population health, and professionalism. These areas enhance the spirit of intellectual inquiry and commitment which are core to the practice of internal medicine. In addition, we wish to foster those individuals who are committed to academic or research career tracks through our Research Pathway. We are offering the Research Pathway, however, not just to benefit the few who might participate directly but because we believe that these individuals will enhance the academic milieu of the entire program.

3. Defining Program Characteristics Diversity of Training Experiences Our residents train in diverse environments and with extraordinary patient populations. Our hospitals include the primary teaching hospital of the University of California, Irvine; the Long Beach Veterans Health System Hospital; and Long Beach Memorial Medical Center Our outpatient clinics range from indigent care sites to faculty private practice to our NCI-comprehensive Chao Cancer Center We believe now and have always believed that the core of an outstanding residency training program is outstanding house staff. We consistently recruit and matriculate these excellent individuals. Our residents generally come from the top 25% of their classes. But beyond class standing, we look most especially for individuals who are team players and who enjoy taking care of patients. We believe in the less than 80 hour work week. We believe in at least one day off per week because it is the right thing to do. We value resident input into policy and curriculum. When people do have problems, we believe in supporting them to the fullest and avoiding a punitive approach to Program Management.We believe now and have always believed that the core of an outstanding residency training program is outstanding house staff. We consistently recruit and matriculate these excellent individuals. Our residents generally come from the top 25% of their classes. But beyond class standing, we look most especially for individuals who are team players and who enjoy taking care of patients. We believe in the less than 80 hour work week. We believe in at least one day off per week because it is the right thing to do. We value resident input into policy and curriculum. When people do have problems, we believe in supporting them to the fullest and avoiding a punitive approach to Program Management.

4. Defining Program Characteristics Diversity of Patient Populations We serve an extraordinarily diverse patient population including long established and recently immigrated communities. We serve patients across the economic spectrum. More than 50% of our patients are economically disadvantaged. Neighborhoods in our area include persons from China, the Middle East, Southeast Asia, Latin America, Persia and many others. We care for patients with conditions like leprosy, TB, rheumatic heart disease and HIV as well as the breadth of diseases seen in the general US population.

5. Defining Program Characteristics We present unique, longitudinal curricula in clinical skills, EBM, Quality, and Palliative Care. Each house officer has at least 9 months of elective time for clinical, research, externship, or international experiences, with 2 elective blocks (8 weeks) in the first year. We are committed to our mission of education and measure service in the context of educational value.

6. Defining Program Characteristics Our flexible curriculum allows residents to tailor their experience to their career track. We encourage couples matching. We offer coordinated acceptance for IM & Occupational Medicine. We offer career pathways in research, hospitalist medicine and primary care.

7. Defining Program Characteristics Third year residents can pursue a learning track focused on hospitalist careers or primary care. We believe in a supportive and success oriented environment. 60% of our fellowship positions are filled by our own residents. Our philosophy of governance is inclusive and supportive. We have resident representatives on all of our standing and ad hoc committees. We regularly survey the residents for the input on issues. We meet with each resident twice a year to provide them with feedback and to obtain their feedback on how we are doing.Our philosophy of governance is inclusive and supportive. We have resident representatives on all of our standing and ad hoc committees. We regularly survey the residents for the input on issues. We meet with each resident twice a year to provide them with feedback and to obtain their feedback on how we are doing.

8. UCI Fellowships and UCI Residents 2001-2011

9. Curriculum Development and Oversight: Recent Innovations Doctoring Skills Rotation Fellowship & Career Mentoring from the first day of orientation The Science of Decision Making Conference Business of Medicine and Career Development A longitudinal curriculum in Teaching Skills for all residents An experience in Palliative Care Hospitalist and Consult Service Curriculum Resident-Driven Process Improvement Programs A Curriculum in Life-Long Learning Skills to enhance commitment to knowledge and skills after graduation Resident Morale Project to continuously identify ways to improve the well-being of our residents Academy of Internal Medicine: Weekly 2.5 hour protected time for case conferences and board review.

10. Doctoring Skills Rotation The Doctoring Skills Rotation (DSR) Patient-Centered, Learner-Driven Focused on: History taking and communications skills Physical diagnosis Real patients and patient simulation technology Decision-making skills Life-long learning skills Clinical teaching skills Direct Feedback from Specially Trained Teaching Faculty

11. Doctoring Skills Rotation: More on the Rotation In July 2005, we introduced our Doctoring Skills Rotation. Each intern participates in this patient and learner-centered pure learning experience. Each learning team consists of an attending and 2 interns. During the morning, the team interviews patients and works on communication, history-taking, physical diagnosis, EBM, and decision-making. They develop problem-based learning issues which form the core of discussion for the next day’s learning sessions. Although every discussion is centered on a patient, the teams do not have patient care responsibilities. The focus is entirely and absolutely learning, not service. The faculty members who teach in this rotation have been chosen for their teaching skills. They are paid to teach and trained to provide formative, specific, real-time feedback in a nurturing learning environment. Interns do not take call during this rotation and the formal sessions all occur in the morning with teaching, study and continuity time reserved for the afternoon.

12. The Academy of Internal Medicine Weekly protected 2.5 hour conference All residents not on inpatient services required to attend Focus on Clinical cases and unknowns Basic clinical science review Board review

13. UCI Institutional Distinctions Among the School of Medicine’s distinctions: The University of California with all its programs and resources An outstanding medical school with diverse and accomplished student body One of a handful National Cancer Institute Comprehensive Cancer Centers in the US Diverse Centers of Excellence for research in basic clinical sciences Top 20% of NIH Research dollars per Faculty Member UCIMC: A Leapfrog Group designated top hospital for quality, safety and outcomes Our curriculum defines our core competencies. You can see these in the curriculum document in your packets. You can look to this document to find what we feel is important and where we teach it. All residents participate in the core curriculum rotations and conferences. Where appropriate, we believe in innovation that enhances the learning experience.Our curriculum defines our core competencies. You can see these in the curriculum document in your packets. You can look to this document to find what we feel is important and where we teach it. All residents participate in the core curriculum rotations and conferences. Where appropriate, we believe in innovation that enhances the learning experience.

14. Philosophy of Program Governance Our philosophy of governance is inclusive and progressive. Residents are included on the Curriculum Committee and on the ROC (policy committee). They have equal voting power with the faculty and Program Director. We regularly survey residents about every aspect of the Program including rotations, faculty, teaching, educational resources, and resident satisfaction. And as always, residents are a big part of the process.And as always, residents are a big part of the process.

15. Residency Oversight Committee The Residency Oversight Committee (ROC) sets all major policies for the program. The Competence Subcommittee of the ROC has responsibility for ensuring the academic and professional success of every house officer. To this end, we track each resident and, when necessary, provide support for academic, personal, learning of professional goals. Our ultimate goal is the success of each of our outstanding residents. These are some of the recent renovations or innovations in the curriculumThese are some of the recent renovations or innovations in the curriculum

16. Curriculum CommitteeDevelopment and Oversight The Curriculum Committee reviews every aspect of the curriculum on a regular basis: - clinical rotations - conferences - goals and materials Residents have creative input into the Committee, are members of the Committee and participate on a regular basis. Many enhancements emanate from residents’ suggestions or requests. In the past 12 months we have dramatically enhanced the quality of our Grand Rounds. Grand Rounds occurs each Tuesday morning at 8 AM and is broadcast to the LBVAMC and LB Memorial Medical Center. These conferences have a strong research emphasis with a commitment to show clinical relevance. About 50% of speakers are from outside UCI and these speakers have included Nobel Prize Laureates and other recognized leaders.In the past 12 months we have dramatically enhanced the quality of our Grand Rounds. Grand Rounds occurs each Tuesday morning at 8 AM and is broadcast to the LBVAMC and LB Memorial Medical Center. These conferences have a strong research emphasis with a commitment to show clinical relevance. About 50% of speakers are from outside UCI and these speakers have included Nobel Prize Laureates and other recognized leaders.

17. Curriculum Development and Oversight How do we approach curriculum? We have defined our vision of the internist, and we tailor our core curriculum to that vision. However, we understand the many and varied career paths open to internists. Therefore, we ensure that each resident has at least 6 elective opportunities in their first 2 years at least and 9 electives overall. This allows for considerable flexibility and for exploration of career options.

18. Curricular Elements:Conferences The Core Lecture Series is regularly updated and maintained in concert with subspecialties. Innovative Morning Report, Intake Rounds, Chief’s Rounds. Teaching Rounds on all inpatient rotations. Rotation-based, web-based curricular outlines are available on our website. Grand Rounds with more than 50% of speakers recruited from across the nation for their expertise and experience. Daily or twice daily conferences at all our sites.

19. Curriculum:Rotations Year 1 Ward 4 blocks ICU/CCU 3 blocks Doctoring Skills Rotation* 2 weeks Geriatrics* 2 weeks Electives 2 blocks Cardiology – Practice based block* 1 block Day Float * 1 block Vacation 4 weeks Continuity, Primary Care Ambulatory Rotation 1 block * Call Free Rotation

20. Curriculum:Rotations Year 2 Wards 3 blocks ICU/CCU 2 blocks Neurology 2 weeks Palliative Care 2 weeks Women’s Health 1 block Electives/Research* 4-5 blocks Vacation 1 block *Minimal or no calls

21. Curriculum:Rotations Year 3 Ward/ICU/CCU 2-3 blocks Hospitalist/consult 1 block Geriatrics/Palliative Care 2 weeks Ambulatory Oncology 2 weeks Emergency Medicine 1 block Community-based Clinic 1 block Electives* 4 blocks Vacation 1 block * Minimal or no calls

22. Preliminary Medicine Curriculum Critical Care: 4 blocks Total Memorial MICU 1 block VA MICU VA CCU UCI MICU 3 blocks Total UCI CCU Ward Medicine: VA Wards UCI Wards 4 blocks Total Ambulatory Medicine: VA Clinics 1 block Electives: * 4 blocks *Vacation= 4 weeks during these elective and ambulatory rotations

23. Morning Conferences

24. Noon Conferences

25. Meeting the Duty Hours& Working Conditions Requirements Beginning in July 2011 the ACGME will implement a new set of Duty Hours and Working Conditions Requirements. At this time the exact nature of those requirements is not clear. Responsible UCI individuals including the Chair of Medicine, the Dean of the School of Medicine, and the hospital CEOs of each of our sites have committed to full implementation and compliance with those requirements. High level committees are working on strategies for implementation. While we cannot fully describe those strategies at this time, we reiterate our commitment to a supportive and collegial work environment focused on education priorities and paradigms.

26. Team Structure & Call Responsibilities for this Year UCIMC Ward services: Q 5 Call with Float call coverage of admissions from Midnight to 7 AM VA Ward Services: Q5 call with Float call coverage of admissions from 7 PM to 7 AM Units: No call for unit residents, Q4-5 for interns Admission Caps of 10 per team, per call R-1: Electives average 1 call per week R-2, 3: Electives and research are call free One day off per week minimum Strict adherence to the Duty Hours Rules To be modified for 2011-2012 after the new regulations are certified.

27. UCI Medical Center(UCIMC) University hospital with 330 active beds New Hospital opened in February 2009 100 total IM Beds General medicine Hospitalist and consult team experience ICU/CCU Oncology As the faculty’s and community’s hospital we attract a wide range of ethnicity, disease and social status Uniquely a student and resident hospital: No “private patients” UCIMC is an academic health center. About 70% of the patients are departmental patients and another 30% are private patients of the faculty. Faculty patients are cared for on the ward services in exactly the same way as departmental patients, and residents write the orders on all patients. Patients of the general medicine faculty and oncology division are cared for by single hospital-based physicians so that residents are not required to contact many different attendings. The patient population of UCIMC is diverse and interesting. Because we sit a a hub for many different ethnic groups, we regularly treat patients with diseases not generally seen outside of the third world: leprosy, tuberculosis, congenital or rheumatic heart disease, malaria. We have 24 hour access to translators for most of the major groups we care for.UCIMC is an academic health center. About 70% of the patients are departmental patients and another 30% are private patients of the faculty. Faculty patients are cared for on the ward services in exactly the same way as departmental patients, and residents write the orders on all patients. Patients of the general medicine faculty and oncology division are cared for by single hospital-based physicians so that residents are not required to contact many different attendings. The patient population of UCIMC is diverse and interesting. Because we sit a a hub for many different ethnic groups, we regularly treat patients with diseases not generally seen outside of the third world: leprosy, tuberculosis, congenital or rheumatic heart disease, malaria. We have 24 hour access to translators for most of the major groups we care for.

28. Long Beach VA Healthcare System Recently updated and refurbished Excellent teaching patients with longer length of stay for more in-depth teaching Great depth of common Internal Medicine illnesses Outstanding academic faculty, full members of the Department of Medicine Outstanding clinical and basic science research Resident & student oriented health system Important resources in geriatrics training The Long Beach VA is one of the largest institutions in the VA system. It serves an active inpatient and ambulatory patient population. Most common at the VA are diseases which would be common in the practices of most internists: cancer, heart disease, diabetes, COPD. Because of amount of pathology, it provides a great opportunity to treat patients with a the full spectrum of manifestations of each of these entities. The VA is clean, modern, recently renovated and fully staffed.The Long Beach VA is one of the largest institutions in the VA system. It serves an active inpatient and ambulatory patient population. Most common at the VA are diseases which would be common in the practices of most internists: cancer, heart disease, diabetes, COPD. Because of amount of pathology, it provides a great opportunity to treat patients with a the full spectrum of manifestations of each of these entities. The VA is clean, modern, recently renovated and fully staffed.

29. Long Beach Memorial Medical Center Outstanding facility with an IM Associate Program Director & long-standing commitment to teaching with programs including IM, Surgery, Peds, Ob/Gyn, EM, PM&R, cardiology, pulmonary medicine and radiology Cardiology, Neurology, and ICU Teaching Services with dedicated, supervising teaching faculty Outstanding, practice-based ambulatory and subspecialty experiences in areas such as women’s health, cardiology, allergy, oncology, & emergency medicine One of the top centers in the country for cardiac care Long Beach Memorial Medical Center is one of the premier community hospitals in California. Memorial provides another window into the world of “private” medicine and a more middle class working population. This 700 bed facility is perhaps best known for its cardiology and critical care services which are the 2 areas we currently take the most advantage of. We also have community-based rotations at LBMMC as well as some ancillary disciplines like Women’s Health and Sports Medicine.Long Beach Memorial Medical Center is one of the premier community hospitals in California. Memorial provides another window into the world of “private” medicine and a more middle class working population. This 700 bed facility is perhaps best known for its cardiology and critical care services which are the 2 areas we currently take the most advantage of. We also have community-based rotations at LBMMC as well as some ancillary disciplines like Women’s Health and Sports Medicine.

30. Community-based Sites UCIMC Continuity Clinic with a unique practice model VA Continuity Clinics UCIMC Faculty Practice Sites Community-based Managed Care at Kaiser Health Care Continuity clinic protected with back-up provided for inpatient rotation responsibilities Dedicated ambulatory curriculum on clinic rotations In 1998, the NEJM reported on the workings of 5 of the most successful managed care medical groups in the country. One of those was Bristol Park Medical Group in Orange County. Each of our residents spends a block at Bristol Park, seeing patients in a managed environment and getting a first-hand view of the world of managed care medicine. We also have elective rotations which allow residents to work with Medical Group Medical Directors and to get an inside view of the medical managers world.In 1998, the NEJM reported on the workings of 5 of the most successful managed care medical groups in the country. One of those was Bristol Park Medical Group in Orange County. Each of our residents spends a block at Bristol Park, seeing patients in a managed environment and getting a first-hand view of the world of managed care medicine. We also have elective rotations which allow residents to work with Medical Group Medical Directors and to get an inside view of the medical managers world.

31. Faculty 160 Full Time Faculty and several hundred active volunteers Representing the Full Range of Subspecialties, including Epidemiology and Occupational Medicine Accomplished and Distinguished Researchers Chosen for & Committed to Teaching Available to residents for clinical rotations, research and mentoring

32. Housestaff Clearly our most important asset Excellent Match performance, representing US Medical Schools from across the country Supportive, collegial, accomplished, diverse IM Board Results: 3 year average >95% Excellent Access to Fellowships and PC Jobs We have several parties per year, and we try to make the residents aware of each others interests so that friendships and collaborations can form.We have several parties per year, and we try to make the residents aware of each others interests so that friendships and collaborations can form.

33. Resident Positions Number Level/Year Salary 23 Preliminary PGY1 $48,259 22 Categorical PGY1 $48,259 22 Categorical PGY2 $50,003 22 Categorical PGY3 $52,069

34. Where our Residents Went 2010 Chief Resident: 5 IM Fellowships: 10 (60% of UCI Fellowship slots filled by our own Residents) Primary Care in CA: 2 Hospitalist in CA: 6

35. Other Information on Our Website: www.ucihs.uci.edu/intmed Core curriculum, Clinics, rotations and the detailed curriculum Policies and Procedures How to contact us Research Opportunities Detailed descriptions of our institutions, locale and the School of Medicine Our fellowship programs Salaries and benefits The Research Pathway

36. University of California Irvine Thanks for taking the time to review this presentation. Please feel free to contact us for further questions. Lloyd Rucker, MD Vice Chair, Education; Program Director e-mail: lrucker@uci.edu Our Program provides outstanding clinical training in an academic and supportive environment. We believe in a culture of participation and collegiality. We offer a diverse patient population, outstanding faculty, and most importantly, a committed, skilled, and engaging bunch of residents. If there are any burning questions, I can take a couple right now. However, you will have a chance a little later to sit down in small groups with one of the Program Directors who will answer all of your questions so you can save questions up for that forum if you prefer. Our Program provides outstanding clinical training in an academic and supportive environment. We believe in a culture of participation and collegiality. We offer a diverse patient population, outstanding faculty, and most importantly, a committed, skilled, and engaging bunch of residents. If there are any burning questions, I can take a couple right now. However, you will have a chance a little later to sit down in small groups with one of the Program Directors who will answer all of your questions so you can save questions up for that forum if you prefer.