Clinical Faculty: Peter Hui, M.D.
Year: Fourth Year
Duration: 4 weeks
Enrollment: 1 student per block maximum

Description of the Rotation

• During this rotation, the MS4 will directly aid in the work up and management of
  patients with common cardiac conditions such as chest pain, valvular heart disease, heart failure, acute coronary syndromes, and arrhythmias. There will be a special emphasis on critically ill patients admitted to the CCU with primary cardiac diagnoses including (but not limited to): STEMI/ACD, unstable arrhythmias, decompensated CHF, heart transplant, pulmonary hypertension, cardiomyopathy, and heart block. There is NO overnight call and you will receive a minimum of 4 days off in a 4 week block.

Educational Component of Rotation

• Morning rounds involve the residents, a cardiology fellow and the cardiology
  attendings, both in the CCU and on the Telemetry floors. There is focus on case
  presentations by the medical students and residents and active discussion of the
  patient’s disease process and overall treatment plan, through review of EKGs and
  hemodynamic monitoring and an emphasis on physical exam findings.
• There are electrophysiology rounds and cath conferences in addition to daily general cardiology teaching topics.
• There are additional educational conferences such as Morning Report, Intern Report and Noon Conferences.

Objectives and Goals of the Rotation

During this rotation you will gain experience and improvement in each of the 6 ACGME core competencies:

1. Medical Knowledge — By managing complex medical illness you will improve your medical knowledge and will display an analytical approach to your patients and their clinical situations.
2. Communication and Interpersonal Skills — You will demonstrate the ability to communicate clearly, respectfully and compassionately to your patients and their families. You will also exhibit effective listening and writing skills. You will also function effectively as part of the health-care team, communicating with fellow interns, your residents, attendings and other members of the team including case-managers, social workers and nurses.
3. Professionalism — You will demonstrate respect, compassion and integrity in your care of patients. You will demonstrate sensitivity to issues such as confidentiality, culture, age, sexual orientation, gender and disability.
4. Patient Care – Clinical and Management Skills — You will perform thorough and appropriate histories and physical examinations and any necessary procedures. You will make and carry out informed patient management decisions.
5. Practice Based Learning and Improvement — You will analyze your own medical practice on a case-by case basis and apply knowledge gained in the care of future patients. You will access medical literature to aid in your patient care. You will facilitate the learning of other team members.
6. Systems Based Practice — You will gain understanding of types of medical practice and healthcare delivery systems and how they impact patient care. You will also gain experience in working with multiple health-care team members including case managers, social workers, physical and occupational therapists.

Evaluation

Your grade will be based on written evaluations from your Resident and Attending. Final grades of Pass, Honors or Fail will be given.

Clinical Faculty: Jesse Liu, M.D.
Year: Fourth Year
Duration: 4 weeks
Enrollment: 1 student per block 

Description of the Rotation

By performing medical consultation on inpatient gastroenterology patients, medical students will gain exposure to common acute and chronic gastrointestinal disorders and will learn the principles of screening for disease in populations as well as diagnosis and treatment of gastrointestinal disorders. Students will have an opportunity to develop an understanding of the indications for and risk of gastrointestinal procedures and can gain experience in procedures including abdominal paracentesis, flexible sigmoidoscopy and placement of nasogastric tubes. Students may also have the opportunity to observe additional procedures such as upper intestinal endoscopy, ERCP, liver biopsy, and placement of tubes for gastro and esophageal tamponade. Learning will be primarily case oriented with attention given to the social, cultural, ethical and humanistic aspects of patient management as well as the specifics of each patient’s gastrointestinal illness. In addition, specific topics in gastroenterology will be addressed in conferences with the gastroenterology attendings and fellows.

Educational Component of Rotation

• Morning Report – M, W, Th, F –  You are required to attend morning report unless scheduled for GI clinic/conference or endoscopy experience or involved in a medical emergency.
• GI Grand Rounds – these rounds are held every Wednesday morning from 8:00 am to 10:00 am at UCSF.
• CPMC GI Conference – This conference is held weekly.
• Outpatient GI Lab – The endoscopy suite at the CPMC California Campus is the busiest GI lab in Northern California with up to 35 procedures performed daily. The resident is encouraged to schedule time at the GI lab to gain experience and seek proficiency in flexible sigmoidoscopy.

Objectives and Goals of the Rotation

During this rotation you will gain experience and improvement in each of the 6 ACGME core competencies:

• Medical Knowledge — Through your consultations you will gain medical knowledge about multiple gastrointestinal disorders. A core article collection forms a curriculum covering topics such as GI bleeding, acute and chronic diarrhea, pancreatitis, motility disorders, hepatology and others.
• Communication and Interpersonal Skills — You will demonstrate the ability to communicate clearly, respectfully and compassionately to your patients and their families. You will also exhibit effective listening and writing skills, and will strengthen the skills required to perform a comprehensive subspecialty consultation and communicate your recommendations to the treating team.
• Professionalism — You will demonstrate respect, compassion and integrity in your care of patients and in your communication with other members of the medical team. You will demonstrate sensitivity to issues such as confidentiality, culture, age, sexual orientation, gender and disability.
• Patient Care – Clinical and Management Skills — You will perform thorough and appropriate histories and physical examinations and any necessary procedures. You will make and carry out informed patient management decisions.
• Practice Based Learning and Improvement — You will analyze your own medical practice on a case-by case basis and apply knowledge gained in the care of future patients. You will access medical literature to aid forming evidence-based recommendations for patient care. You will facilitate the learning of other team members.
• Systems Based Practice — You will gain understanding of types of medical practice and healthcare delivery systems and how they impact patient care. You will also gain experience in working with multiple health-care team members including nurses, GI lab technicians, and case-managers.

Clinical Faculty: Caroline Behler, M.D.
Year: Fourth Year
Duration: 4 weeks
Enrollment: 1 student per block maximum

Description of the Rotation

The student will work closely with the housestaff team in admitting patients for routine chemotherapy treatments and in caring for those patients who have therapy related complications. Patient responsibilities will also include managing the terminally ill as well. There will be a teaching attending who will meet with the residents, interns and medical students each month. Education will include patient focused discussion, as well as bedside rounds and the rounds as described below. There is NO overnight call and you will receive a minimum of 4 days off per 4 week block.

Educational Component of Rotation

• Patient related rounds will consist of daily work rounds with your team and attending rounds three times per week.
• Weekly multidisciplinary rounds occur Wednesday mornings to discuss the psychological and social aspects of individual patient care.
• Weekly tumor board occurs Thursday mornings.
• The following additional educational rounds (not Heme-Onc specific) are held:
  • Intern Report
  • Noon conference
  • Morning Report 

Objectives and Goals of the Rotation

During this rotation you will gain experience and improvement in each of the 6 ACGME core competencies:

• Medical Knowledge — By managing patients admitted to the hematology-oncology service, you will improve your medical knowledge in related diagnoses and in areas such as: tumor staging, complications of chemotherapy, chemotherapy regimens, lymphoma/leukemia, solid tumors.
• Communication and Interpersonal Skills — You will demonstrate the ability to communicate clearly, respectfully and compassionately to your patients and their families. You will also exhibit effective listening and writing skills. You will also function effectively as part of the health-care team, communicating with fellow interns, your residents, attendings and other members of the team including case-managers, social workers and nurses.
• Professionalism — You will demonstrate respect, compassion and integrity in your care of patients. You will demonstrate sensitivity to issues such as confidentiality, culture, age, sexual orientation, gender and disability.
• Patient Care – Clinical and Management Skills — You will perform thorough and appropriate histories and physical examinations and any necessary procedures. You will make and carry out informed patient management decisions. You will also help manage the increased emotional and care needs in oncologic patients.
• Practice Based Learning and Improvement —You will analyze your own medical practice on a case-by case basis and apply knowledge gained in the care of future patients. You will access medical literature to aid in your patient care. You will facilitate the learning of other team members.
• Systems Based Practice — You will gain understanding of types of medical practice and healthcare delivery systems and how they impact patient care. You will also gain experience in working with multiple health-care team members including case managers, social workers, physical and occupational therapists.

Evaluation

Your grade will be based on written evaluations from your Resident and Attending. Final grades of Pass, Honors or Fail will be given.

Clinical Faculty: Helena Wang, M.D.
Year: Fourth Year
Duration: 4 weeks
Enrollment: 2 students per block maximum

Description of the Rotation

The rotation is four weeks in duration. Students will work closely with supervising interns, residents, fellows and attendings in the diagnosis and management of critically ill patients in an ICU setting. You will be exposed to patients with diverse socioeconomic, cultural and ethnic backgrounds and with wide-ranging diagnoses such as respiratory failure, acute renal failure, sepsis, CVA and subarachnoid hemorrhages, malignant hypertension and massive gastrointestinal bleeding. You will also learn the indication for and how to perform various procedures. There is NO overnight call. You will receive a minimum of 4 days off per month. You will be expected to manage 2-3 patients at a time. 

Educational Component of Rotation

• Patient related work rounds occur twice a day in the ICU.
• Didactic session on a variety of ICU related topics are held twice weekly.
• 12:00 pm Conference

Objectives and Goals of the Rotation

During this rotation you will gain experience and improvement in each of the 6 ACGME core competencies:

• Medical Knowledge — By managing critically ill patients you will be exposed to and gain knowledge in the following areas:
  • Acute abdominal pain
  • Acute chest pain
  • Acute intoxication
  • Acute liver failure
  • Acute renal failure
  • Altered mental status, coma
  • Hypotension, shock
  • Life-threatening arrhythmia
  • Massive gastrointestinal bleeding
  • Massive hemoptysis
  • Respiratory distress or failure
  • Severe hypertension
  • Status epilepticus
• Communication and Interpersonal Skills — You will demonstrate the ability to communicate clearly, respectfully and compassionately to your patients and their families. You will also exhibit effective listening and writing skills. You will also function effectively as part of the health-care team, communicating with fellow interns, your residents, attendings and other members of the team including case-managers, social workers and nurses.
• Professionalism — You will demonstrate respect, compassion and integrity in your care of patients. You will demonstrate sensitivity to issues such as confidentiality, culture, age, sexual orientation, gender and disability.
• Patient Care – Clinical and Management Skills — You will perform thorough and appropriate histories and physical examinations and any necessary procedures. You will make and carry out informed patient management decisions.
• Practice Based Learning and Improvement — You will analyze your own medical practice on a case-by case basis and apply knowledge gained in the care of future patients. You will access medical literature to aid in your patient care. You will facilitate the learning of other team members.
• Systems Based Practice — You will gain understanding of types of medical practice and healthcare delivery systems and how they impact patient care. You will also gain experience in working with multiple health-care team members including case managers, social workers, physical and occupational therapists.

Evaluation

Your grade will be based on written evaluations from your Resident and Attending. Final grades of Pass, Honors or Fail will be given.

Clinical Faculty: Phil Kennedy, M.D.
Year: Fourth Year
Duration: 4 weeks
Enrollment: 3 students per block maximum

Description of the Rotation

The rotation is four weeks in duration. During the Sub-internship, students will assume the role of the intern. The rotation is on a 5 day call cycle and the student will take the same call as the team. There is no overnight call. You will work closely with your supervising senior resident in the admission, work-up and day to day management of patients admitted to the medicine service. You will be exposed to patients with diverse socioeconomic, cultural, and ethnic backgrounds, and with wide ranging acute and chronic medical diagnoses. You will be expected to manage 4-6 patients at a time.

Educational Component of Rotation

• Patient related rounds will consistent of daily work rounds with your team and attending rounds daily.
• The following additional educational rounds will be held:
  • Intern Report 
  • Noon Conference 
  • Morning Report 
• There will also be 4th year student teaching sessions with the Program Director and Associate Program Directors on Wednesdays from 2:00pm to 3:00pm in the Department of Medicine GME office. These rounds may consistent of case presentations, discussions, and interactive lectures. These sessions are required.

Objectives and Goals of the Rotation

During this rotation you will gain experience and improvement in each of the 6 ACGME core competencies:

• Medical Knowledge — By managing complex medical illness you will improve your medical knowledge and will display an analytical approach to your patients and their clinical situations.
• Communication and Interpersonal Skills — You will demonstrate the ability to communicate clearly, respectfully and compassionately to your patients and their families. You will also exhibit effective listening and writing skills. You will also function effectively as part of the health-care team, communicating with fellow interns, your residents, attendings and other members of the team including case-managers, social workers and nurses.
• Professionalism — You will demonstrate respect, compassion and integrity in your care of patients. You will demonstrate sensitivity to issues such as confidentiality, culture, age, sexual orientation, gender and disability.
• Patient Care – Clinical and Management Skills — You will perform thorough and appropriate histories and physical examinations and any necessary procedures. You will make and carry out informed patient management decisions.
• Practice Based Learning and Improvement — You will analyze your own medical practice on a case-by case basis and apply knowledge gained in the care of future patients. You will access medical literature to aid in your patient care. You will facilitate the learning of other team members.
• Systems Based Practice — You will gain understanding of types of medical practice and healthcare delivery systems and how they impact patient care. You will also gain experience in working with multiple health-care team members including case managers, social workers, physical and occupational therapists.

Evaluation

Your grade will be based on written evaluations from your Residents and Attendings. Final grades of Pass, High Pass, Honors, or Fail will be given.

Clinical Faculty: Kasra Eliasieh, M.D.
Year: Fourth Year
Duration: 4 weeks
Enrollment: 2 student per block maximum

1. Acquire the ability to obtain the skill of ophthalmic history-taking and understand its correlation with the general medical history.
2. Acquire the ability to perform a general eye exam including:
   • Recording visual acuity - distance and near.
   • Testing pupils to detect abnormal responses.
   • Testing for strabismus and abnormal eye movements.
   • Performing confrontation visual fields.
   • Examining anterior segment with slit lamp.
   • Performing direct ophthalmoscopy to detect fundus abnormalities.
   • Learn basics of measurement of intraocular pressure by tonometry.
3. Understand the steps required to evaluate a red eye.
4. Observation of ocular surgical procedures.
5. Achieve a basic understanding of outpatient eye care.

Clinical Faculty: Stephanie Wilson, M.D.
Year: Fourth Year
Duration: 4 weeks
Enrollment: 1 student per block

The medical students will spend time on both the Inpatient Psychiatry Unit with a treatment team and on the Consultation Liaison services in either the Emergency Room or Hospital Ward settings.  CPMC serves a diverse population and the student will encounter a full range of major psychiatric disorders including patients suffering from co-morbid medical problems. During the rotation, there will be opportunities to participate as an integral member of a multi-disciplinary treatment team within a biopsychosocial framework under the supervision of experienced attendings and senior residents.  During the consultation liaison portion of the rotation, students will collaborate with various services (medicine, surgery, transplant and emergency services), formulate differential diagnoses and utilize brief psychotherapy and psychopharmacological interventions.

The student will also participate in a day of child and adolescent psychiatry outpatient settings in our Outpatient Mental Health Clinic and the CPMC Kalmanovitz Child Development Center.

Educational Component of Rotation

The medical student will attend didactics, Grand Rounds and Journal Club with the Psychiatry residents.  Medical students will also present at least once at Inpatient Case Conference and readings will be assigned.

Objective and Goals of the Rotation

During this rotation you will gain experience and improvement in each of the ACGME core competencies.

1. Medical Knowledge — Medical students will be part of a treatment team and will be asked to display an analytical approach to the clinical situations of patients.
2. Communication and Interpersonal Skills — Students will demonstrate the ability to communicate clearly, respectfully and compassionately to patients and their families. Students will also hone effective listening and writing skills. Students will be part of a health-care team communicating thoroughly and concisely with fellow students, residents, attendings, social workers and nurses.
3. Professionalism — Students will demonstrate respect, compassion and integrity in care of patients.  Sensitivity to issues such as confidentiality, culture, age, orientation and disability will be demonstrated
4. Patient Care-Clinical and Management Skills — Students will assist in performing thorough and appropriate histories. Under the supervision of attendings and residents, students will take an active role in treatment as part of the care team.
5. Practice-Based Learning and Improvement — Students will analyze their own work on a case-by-case basis and apply learned knowledge to future patients. Through didactic sessions and a case presentation, students will access medical literature that will aid in patient care and facilitate the learning of other team members.
6. Systems-Based Practice — Students will gain an understanding of types of medical practice through the inpatient and consultation liaison services and how they impact patient care. Experience and perspective will also be gained in working with multiple healthcare teams and members.

Evaluation

Your grade will be based on written evaluations from your attendings. Final grades of Honors, Pass or Fail will be given.

Clinical Faculty: Helena Wang, M.D.
Year: Fourth Year
Duration: 4 weeks
Enrollment: 1 student per block maximum

Description of the Rotation

The medical student will work closely with the pulmonary fellow and the attending pulmonary physician, actively participating in primary and consultative care of patients on the hospital wards. Appropriate diagnostic procedures will be discussed and performed in the course of providing care to patients with pulmonary problems. There is NO overnight call. The student will receive a minimum of 4 days off per 4 week block.

Educational Component of Rotation

The medical student will attend weekly Thoracic Tumor Board, and the following conferences held on Mondays and Thursdays:

• Journal Club
• Pathology Case Conference
• Interstitial Lung Disease Case Conference
• Board Review
• Pulmonary Function Test Quality Assurance
• Bronchoscopy Quality Assurance
• Morbidity and Mortality

Objectives and Goals of the Rotation

During this rotation you will gain experience and improvement in each of the 6 ACGME core competencies:

1. Medical Knowledge — You will learn to interpret pulmonary function studies and exercise studies; You will acquire additional experience in evaluation and managing respiratory problems such as obstructive pulmonary disease, infiltrative pulmonary disease, and pleural effusions; You will acquire additional knowledge regarding the indications, methodology, complications, and interpretation of results of the following procedures:
   • pleural biopsy
   • thoracentesis
   • percutaneous arterial puncture and cannulation
   • fine needle aspiration
   • tube thoracostomy
   • central venous lines
   • pulmonary artery catheters
   • endotracheal intubation
   • fiberoptic bronchoscopy
   • sleep studies
   • pulmonary artery balloon flotation catheterization
   • tube thoracostomy (introduction)
2. Communication and Interpersonal Skills — You will demonstrate the ability to communicate clearly, respectfully and compassionately to your patients and their families. You will also exhibit effective listening and writing skills. You will also function effectively as part of the health-care team, communicating with fellow interns, your residents, attendings and other members of the team.
3. Professionalism — You will demonstrate respect, compassion and integrity in your care of patients. You will demonstrate sensitivity to issues such as confidentiality, culture, age, sexual orientation, gender and disability.
4. Patient Care – Clinical and Management Skills — You will gain experience in evaluating and managing patients with pulmonary diseases who are critically ill and hospitalized in the Critical Care Unit.
5. Practice Based Learning and Improvement — You will analyze your own medical practice on a case-by case basis and apply knowledge gained in the care of future patients. You will access medical literature to aid in your patient care. You will facilitate the learning of other team members.
6. Systems Based Practice — You will gain understanding of types of medical practice and healthcare delivery systems and how they impact patient care. You will also gain experience in working with multiple health-care team members including nurses, respiratory therapists, pulmonary lab technicians.

Curriculum of the Rotation

• Obstructive lung diseases, including asthma, bronchitis, emphysema, bronchiectasis and cystic fibrosis
• Pulmonary malignancy – primary and metastatic
• Pulmonary infections, including tuberculosis, fungal and those in the immunocompromised host
• Diffuse interstitial lung disease
• Pulmonary vascular disease, including primary and secondary pulmonary hypertension, the vasculitis and pulmonary hemorrhage syndromes
• Occupational and environmental lung diseases
• Iatrogenic respiratory diseases including drug induced disease
• Acute lung injury, including radiation, inhalation and trauma
• Pulmonary manifestations of systemic diseases including collagen vascular disease and diseases which are primary in other organs
• Respiratory failure, including the adult respiratory distress syndrome, acute and chronic respiratory failure and obstructive lung diseases and neuromuscular respiratory drive disorders
• Disorders of the pleura and mediastinum
• Genetic and developmental disorders of the respiratory system
• Sleep disorders
• Basic sciences – molecular biology
• Basic sciences – pulmonary physiology
• Pulmonary function tests to assess respiratory mechanics, gas exchange and respiratory drive, including spirometry, flow volume studies, lung volumes, diffusing capacity, arterial blood gas analysis and exercise studies
• Calibration and operation of hemodynamic recording systems
• Ventilatory support, weaning and respiratory care techniques (introduction)
• Examination and interpretation of sputum, bronchopulmonary secretions, pleural fluids/tissue, and lung tissue for infectious agents, cytology and histopathology
• Pulmonary immunology
• Inhalation challenge studies
• Imaging procedures, including x-rays, ct scans, radionuclide scans, pulmonary angiograms
• Research project (optional)
• Sleep studies

Evaluation

Your grade will be based on written evaluations from your Resident, Fellow and Attending. Final grades of Pass, Honors or Fail will be given.

Clinical Faculty: Nobl Barazangi, M.D., Ph.D.
Year: Generally Fourth Year - student must have completed a Neurology Clerkship before this rotation.
Duration: 4 weeks
Enrollment: 1 student per block maximum - acceptance on a case by case basis.

Students will work directly with the Stroke/Neurocritical Care service attending and fellow. They are expected to see patients on both the Pacific and Davies campuses (there is a hospital shuttle). They will be directly responsible for the work-up, admission, and management of stroke patients or patients with neurocritical care needs both on the floor and the ICU. Students will also perform consults (neurovascular/stroke). Students will be expected to round daily with the stroke/NCC on ICU rounds, and round informally with the attending or fellow on floor patients. Students will be on call every 4th night (call is taken from home and student will be expected to come into the hospital for acute stroke cases) and are expected to round and take call 2 out of the 4 weekends on service. There will also be opportunities for students to observe neurointerventional procedures and vascular neurosurgical procedures pertaining to their patients. They are expected to present a topic (15-20 minute) presentation at the end of the rotation based on a literature search on a neurovascular/neurocritical care topic.

Educational Component

Students will have didactic teaching at the bedside daily. They should attend all general ICU housestaff/student lectures (twice a week), daily noontime lectures for medicine housestaff (patient care takes precedence to these lectures), and all Neurology/Neurosurgery conferences (every Thursday).

Rotation Objectives and Goals

1. Medical Knowledge — Learn to manage neurovascular disorders such as ischemic stroke, TIA, intracerebral hemorrhage, subarachnoid hemorrhage), and disorders frequently encountered in neurocritical care (such as status epilepticus, hypothermia post-cardiac arrest, encephalopathy, neuroinfectious diseases, neuromuscular disorders, (neurotrauma); understand the pathophysiology of such disorders; learn the diagnostic and therapeutic options for such disorders.
2. Communication and Interpersonal Skills — Including thorough patient presentations and write-ups, daily notes, and communication with patients and families and other members of the health-care team.
3. Professionalism — Respect, compassion, and integrity expected in all aspects of patient care and interactions with other members of healthcare team.
4. Patient Care — Perform thorough history and physicals, including neurologic examination; procedures with appropriate supervision; informed patient management decisions.
5. Practice Based Learning and Improvement — Including use of medical literature, evidence-based medicine, and application of knowledge gained for future patients.
6. Systems Based Practice — Learn different types of medical practice and health-care delivery systems, and how they impact patient care.

Evaluation

Grade will be based on written evaluations by the Stroke attending(s), as well as Fellow/Residents if applicable; grade provided will be Honors, Pass, or Fail.