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

We offer a robust ambulatory experience designed to train residents to deliver high-quality outpatient care to patients from diverse backgrounds and with a wide range of pathology. We have four different continuity clinic sites which allows residents to tailor their training experience to best align with their career goals. 

• Diverse continuity clinic options: Residents rank their preferences among the four continuity clinic sites: UC Davis Health, Sacramento County Clinic, Kaiser Permanente, and the Sacramento VA. While placement at a specific continuity site is not guaranteed, for the most part residents are assigned to one of their top two choices. Each site offers a distinct patient population, practice environment, and mentorship model.
• 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.
• Protected Ambulatory Time:
  • Our 4+2 (intern) and 4+4 (upper level) schedules include protected two to four weeks of ambulatory time, uninterrupted by inpatient responsibilities. This model allows residents to focus fully on their ambulatory panels without competing interests.
• Wide Range of Subspecialty Clinics and 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:
  • Residents will interact with a variety of outpatient general medicine and sub-specialty physician educators, leading to opportunities to develop mentoring relationships throughout residency.
• Wellness time:
  • During ambulatory blocks, residents will have one dedicated "wellness half day" per week, this comes out to 8-12 wellness half days per year. These wellness half days can be used for catching up or wellness activities, such as going to the doctor, dentist, or gym.

• All primary care, TEACH, Combined Internal Medicine/Psychiatry, and categorical residents are assigned to one continuity clinic site for all three years of training.
  • As described above, we use a 4+2 (interns) and 4+4 (upper levels) schedule. We use a 4+1+1 (interns) or 4+2 (R2 and R3) schedule.
    
    • Residents do not have continuity clinic during their inpatient blocks.
    • During the ambulatory and elective weeks, residents have 2-3 continuity clinics.
    • The rest of the residents time on ambulatory blocks are filled with other subspecialty 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.

• Kaiser Permanente's North Sacramento Medical Center is a large community hospital that admits a wide variety of critically ill patients through its high-volume ICU service.
• The academic ICU attendings are incredibly experienced and dedicated intensivists - many of whom have won teaching awards from our residents. 
• The ICU attending selects high-yield, educational cases for the resident team, prioritizing learning opportunities and procedural experience. This is one of the rotations where residents often gain substantial hands-on procedural training - including central lines, arterial lines, and more.
• There are two ICU teams during the day, each consisting of one resident, one intern, and often a third-year medical student. The teams alternate call every other day.
  
  • This is a unique opportunity for our residents to rotate in the ICU and work directly with intensivist attendings as there are no fellows at North Kaiser. 
• A night resident cross-covers both the ICU and academic ward patients Monday through Friday, and on Saturdays and Sundays Kaiser staff provide coverage.
  • At night, a Tele-Critical Care attending is always available to support residents during emergencies and codes. In-house hospitalists are also present and can assist with bedside care of sick patients.

• The wards rotation at North Kaiser takes place at Kaiser Permanente's North Sacramento Medical Center, a large community hospital that serves a diverse and high-volume patient population.
• Because the hospital admits a large number of medicine patients, only a portion are assigned to the resident service. The admitting hospitalists intentionally select cases that are high-yield and educational for the housestaff team.
• Kaiser has a long-standing tradition of supporting resident education, and the academic floor team is staffed by a group of dedicated hospitalists who prioritize teaching and mentorship.
• The daytime floor team consists of one resident, two interns, and one to two third-year medical students.
• During their two-week block, the senior resident spends one week on the daytime floor team and one week on nights. 
  • The night resident cross-covers all resident team patients on both the wards and in the ICU Monday through Friday and admits new patients overnight. 
  • On weekends, overnight coverage is provided by Kaiser hospitalist staff.
• The wards team admits daily, Monday through Saturday (with Sunday as the designated day off for residents and no new admissions).

• 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 ICU. 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 58 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 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.

• 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 quintessential inpatient rotation, with a diverse patient population and an amazing range of pathology. Most patients on this service are admitted through our very busy Emergency Department, but we also receive complex tertiary referrals from other hospitals across the Central Valley and Northern California. 
• There are five teams, each comprised of an R3, two interns, one attending, two 3rd-year medical students, and often a 4th-year medical student.
• Interns and residents work only during the day on this rotation, and each team takes day call every fifth day - admitting up to four patients before 4:00pm. Teams also have two "pick-up" days per cycle, when they assume care of overnight admissions during morning rounds.
• 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 feedback and teaching after their long night’s work.
• Each team is supported by a discharge planner and Transitions of Care Navigator, helping streamline discharge planning and care coordination.
• 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 rotation is primarily an intensive care experience, with the team admitting and managing critically ill patients under the supervision of UC Davis pulmonary critical care faculty.
• While the ICU team may occasionally manage post-procedural cardiology patients (such as post-PCI), the rotation is no longer a combined ICU/CCU service - cardiology patients are typically managed separately by the consult team. 
• The team consists of one resident, two interns, and often a third-year medical student. The ICU team admits patients daily.
• Pulmonary and cardiology fellows are involved in patient care, providing subspecialty teaching and consultation.
• Night admissions and cross-coverage are provided by the overnight resident. 
  • At night, in-house hospitalists are available for direct support, and fellows are on call to assist with critically ill patients if needed. 

• The Sacramento VA Medical Center is a 60-bed hospital where the majority of inpatient care is provided by the Internal Medicine Service. With only a small surgical service, this rotation gives residents a true sense of what it's like to work in a community hospital and see virtually everything that comes their way.
• The patient population is predominantly Veterans, though the VA does not accept ambulances, so residents may occasionally care for non-Veteran ("civilian") patients as well. Many residents find caring for Veterans especially meaningful - not only because of their complex medical needs, but also because of the incredible personal stories and life experiences they often share.
• Residents commonly encounter a wide variety of classic internal medicine cases - this is a great place to solidify skills in managing "bread and butter" conditons.
• The medicine floor is covered by four teams, each consisting of one resident, two interns, and one third-year medical student. One of these teams is staffed by Family Medicine residents.
• There is one short call and one long call team on every day.
• Overnight, a night team consisting of one resident and one intern provides cross-cover and admits new patients. The resident covers ICU patients, while the intern covers the wards. 
  • 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 ambulatory portion of the 4+2 or 4+4 schedule). 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 request to schedule this in advance to go to personal appointments or other wellness activities.