Curriculum

Internal Medicine

Rotation Sites

Rotations for the Internal Medicine Residency Program may take place at five core sites:

Subspecialty and elective rotations may also include work in private clinics and at other Riverside Medical Clinic locations.

Ambulatory

Residents will learn to manage ambulatory medical problems under the supervision and guidance of faculty preceptors. They will provide longitudinal outpatient care for their patients over the course of their training at their continuity clinic site, Riverside Medical Clinic — Temescal Valley (RMC).

Time in the continuity clinic will consist of a total of 10-11 weeks in each of the three years of training. This schedule reflects a 4+1 system where dedicated continuity clinic weeks are separated by four weeks of other rotations. The continuity clinic weeks include time for our online ambulatory curriculum and research.

RMC will provide faculty to assist residents in treating a diverse patient population. It will also provide the residents with a thorough understanding of the clinic site and opportunities to care for patients, encouraging communication among team members and broadening experiences. Training at RMC will focus on prioritizing tasks during time-limited visits and maximizing the effective use of diagnostic tests and prescriptions. While rotating on these blocks, residents will learn how to advocate for their patients with the assistance of home services such as physical therapy and visiting nurse organizations.

To reflect the current experience of the practice of medicine in Southwest Riverside County, most of our subspecialty rotations and electives include an ambulatory experience along with inpatient/consult duties.

Inpatient

The mission of medical training on the inpatient services is to prepare residents to diagnose and treat the more acute manifestations of medical illnesses and to teach them how to assist patients in the safe and effective transition from the inpatient setting to the outpatient setting be it home, a rehabilitation setting or a skilled nursing facility. Similarly, residents will learn how to reconcile medications when patients are admitted to the hospital to ensure a comprehensive and understandable medication plan for discharge.

During inpatient rotations at all sites, residents will have at least four days off per fourweek rotation. No resident shall work more than 80 hours per week, averaged over a four-week period, inclusive of all in-house clinical and educational activities, and clinical work from home.

The majority of inpatient rotations will take place at Temecula Valley Hospital (TVH), including Inpatient Adult Medicine, ICU, Cardiology, Emergency Medicine, Radiology/Interventional Radiology and Night Float. TVH, built in 2013, offers a comprehensive range of services similar to hospitals in large metropolitan areas. The hospital offers major specialty services including interventional cardiology, cardiothoracic surgery, and neuro-interventional services. TVH garners national recognition for patient safety and quality.

To broaden the inpatient experience, some Inpatient Adult Medicine and Night Float rotations will be done at Southwest Healthcare System, which includes Inland Valley Medical Center, located in Wildomar, approximately 14 miles from TVH, and Rancho Springs Medical Center, located in Murrieta, approximately 9 miles from TVH. Inland Valley has a Total Joint Center that features a multidisciplinary team of rehabilitation specialists including physicians, nurses, physical therapists and case managers. The Bariatic Surgery Center of Excellence and the Wound Care Center are two other medicine specialties offered at Inland Valley. Rancho Springs is the main site for obstetrics and pediatric care. Both hospitals were nationally recognized by The Leapfrog Group with an A+ Hospital Safety Grade in Fall 2018.

Corona Regional Medical Center will also host an ICU rotation to enable residents to increase their exposure to critical care. The hospital is located approximately 45 minutes from TVH in Western Riverside County. Specialty services include a stroke telemedicine unit, a maternal-fetal medicine program that specializes in high-risk pregnancies, and the UC Irvine Cardiology Clinic. Corona completed its new $38.5 million Emergency Department wing in 2017.

Subspecialty and elective rotations may have inpatient/consult experiences at one or more of these acute care facilities.

Didactics

The goals of the Internal Medicine Residency didactic program are to:

  1. Educate residents in the broad spectrum of the specialty with an emphasis on delivering continuous comprehensive care to a diverse patient population
  2. Develop the humanistic and culturally sensitive characteristics necessary for effective doctor-patient relationships fundamental to the specialty
  3. Foster a desire for continuous learning and improvement among residents through a supportive, but challenging, curriculum

A variety of didactic conferences are scheduled for residents throughout the week. To ensure some educational opportunities are matched to the level of training, PGY-2s and PGY-3s participate in a “Hot-case” based Morning Report, while PGY-1s have a dedicated afternoon of didactics weekly for basic topics and techniques. Residents learn together at a daily Noon Conference with a variety of topics and formats including Board Review, Ambulatory Clinic Conference, Clinical Pathology Conference, Grand Rounds, Journal Club, Morbidity and Mortality, Resident Report, Peer Teaching, Population Health Integrated and Cross-Disciplinary Value-Based Care Conference, Quality Improvement and Patient Safety, Scholarly Activity Conference, and Wellness Fridays.

Rotations

WeeksPGY-1

1-4Adult Inpatient Medicine
5Continuity Clinic
6-9Adult Inpatient Medicine
10Continuity Clinic
11-14Cardiology
15Continuity Clinic
16-19Adult Inpatient Medicine
20Continuity Clinic
21-24Gastroenterology*
25Continuity Clinic
26-29Medical Intensive Care Unit
30Continuity Clinic
31-34Adult Inpatient Medicine
35Continuity Clinic
36-39Adult Inpatient Medicine
40Continuity Clinic
41-44Endocrinology*
45Continuity Clinic
46-47Adult Inpatient Medicine
48-49Night Float
50Continuity Clinic

WeeksPGY-2

1-4Adult Inpatient Medicine
5Continuity Clinic
6-9Geriatrics
10Continuity Clinic
11-14Pulmonary Disease
15Continuity Clinic
16-19Medical Intensive Care Unit
20Continuity Clinic
21-24Night Float
25Continuity Clinic
26-29Adult Inpatient Medicine
30Continuity Clinic
31-34Medical Intensive Care Unit
35Continuity Clinic
36-39Rheumatology
40Continuity Clinic
41-44Adult Inpatient Medicine
45Continuity Clinic
46-49Hematology/Oncology
50Continuity Clinic
51-52Elective

WeeksPGY-3

1-4Infectious Diseases
5Continuity Clinic
6-9Medical Intensive Care Unit
10Continuity Clinic
11-14Emergency Medicine
15Continuity Clinic
16-19Adult Inpatient Medicine
20Continuity Clinic
21-24Night Float
25Continuity Clinic
26-29Adult Inpatient Medicine
30Continuity Clinic
31-34Nephrology
35Continuity Clinic
36-39Radiology/Interventional Radiology
40Continuity Clinic
41-44Adult Inpatient Medicine
45Continuity Clinic
46-49Elective
50Continuity Clinic
51-52Elective
WeeksPGY-1PGY-2PGY-3
1-4 Adult Inpatient Medicine Adult Inpatient Medicine Infectious Diseases*
5 Continuity Clinic Continuity Clinic Continuity Clinic
6-9 Adult Inpatient Medicine Geriatrics* Medical Intensive Care Unit
10 Continuity Clinic Continuity Clinic Continuity Clinic
11-14 Cardiology Pulmonary Disease* Emergency Medicine*
15 Continuity Clinic Continuity Clinic Continuity Clinic
16-19 Adult Inpatient Medicine Cardiology Adult Inpatient Medicine
20 Continuity Clinic Continuity Clinic Continuity Clinic
21-24 Gastroenterology* Night Float + HOD** Night Float
25 Continuity Clinic Continuity Clinic Continuity Clinic
26-29 Medical Intensive Care Unit Adult Inpatient Medicine Adult Inpatient Medicine
30 Continuity Clinic Continuity Clinic Continuity Clinic
31-34 Adult Inpatient Medicine Medical Intensive Care Unit Nephrology*
35 Continuity Clinic Continuity Clinic Continuity Clinic
36-39 Adult Inpatient Medicine Rheumatology* Radiology/Interventional Radiology*
40 Continuity Clinic Continuity Clinic Continuity Clinic
41-44 Endocrinology* Adult Inpatient Medicine Adult Inpatient Medicine
45 Continuity Clinic Continuity Clinic Continuity Clinic
46-49 Neurology + Night Float Hematology/Oncology* Elective
50 Continuity Clinic Continuity Clinic Continuity Clinic
51-52 Elective Elective Elective

The schedule reflects a 4+1 system, meaning that on a recurring basis, residents rotate through a four-week block rotation followed by a one-week block, which will include Continuity Clinic and research time.

*Within certain limitations, residents may choose when they wish to have most of their subspecialty/EM/Radiology rotations to best match their interests and career planning/goals.

**HOD is House Officer of the Day, a rotation designed to provide an experience in topics related to an “Admitter” hospitalist shift, including ED interactions, triage, and patient flow.

Notes
  • Paid Time Off (PTO): Residents are allowed four weeks (20 days) of vacation per PGY year, inclusive of allowed sick days. Vacation should be taken during elective or subspecialty rotations and not more than two weeks at a time. Vacation will not be considered during Medical Intensive Care Unit, Emergency Department, Continuity Clinic weeks, Senior Cardiology and Night Float rotations. Vacation for a maximum of one week will be considered during wards only if it is an emergency or non-emergency situations like birth of a child or getting married. See Salary & Benefits for additional information.
  • Elective experiences are available in all main subspecialties of Internal Medicine, select non-IM specialties, and research. Additional electives will be considered/designed in consultation with residents with special requests.
  • During designated clinic rotations, selective ambulatory experiences may be available in areas such as Women’s Health, Office Orthopedics, and Sports Medicine.

Research and Scholarly Activity

Our program aims to introduce residents to the basic principles of research and advance their knowledge through scholarly activity. It is our firm belief that those residents seeking a career in clinical practice or as a hospitalist will become better clinicians by participating in research and scholarly activity. Residents will learn how research is conducted, evaluated, explained to patients and applied to patient care. They will develop their research abilities through various activities including Journal Club, Population Health didactics and Clinical Case Conference didactic sessions.

To ensure there is a strong mentoring relationship between the faculty and residents, residents will be assigned faculty mentors in their first year of training who can assist and guide them in reaching their personal and professional goals. Throughout the years of the training program, residents will continue to meet with the same faculty mentor, who will guide the resident through their training program and assist with any scholarly activity needs.

All residents are expected to participate in scholarly activity. Residents are to complete at least two Scholarly Activity Projects over the course of their training, one of which must be a quality improvement project. Residents will participate in hospital performance improvement committees and be exposed to ongoing improvement activities taking place at the hospital such as patient safety efforts and quality improvement.

Scholarly activity begins in the PGY-1 year and grows with experience. The PGY-1 residents will be required to present cases during their scheduled didactics. Evidence-based medicine is the standard and literature review is expected during case presentations. PGY-1s are encouraged to present case reports, vignettes, and abstracts at local and/or national American College of Physicians (ACP) or Society of General Internal Medicine (SGIM) meetings. Journal Club participation is required for all residents, who are mentored by faculty on how to critically analyze, interpret and formally present current literature.

In the PGY-3 year, residents are expected to prepare a Grand Rounds presentation. While all types of scholarly activity will be encouraged, at a minimum, all residents must either co-author an abstract/poster/podium presentation/care report that is presented at a local or regional specialty society meeting or published in a peer-reviewed journal. Similarly, all residents will be required to participate in quality improvement and safety activities. When residents pursue the required scholarly activity or quality improvement studies, a faculty advisor will be designated to provide guidance and track progress in such efforts.

Our didactic curriculum will instruct residents on the fundamentals of research, including but not limited to, epidemiology, research design and statistical analysis through an introductory research lecture provided quarterly. Residents will have an opportunity to briefly present their protocol/project. Grand Rounds and monthly Journal Club will offer a place to develop and support resident research opportunities.