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 two-block-long Primary Care Rotations alternating with two-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.

PGY-2 Year

PGY-3 Year

The PC Outpatient time is entirely ambulatory, except for an occasional weekend night float shift.  Residents on the PC Outpatient time have continuity clinics in General Medicine Clinic twice weekly and Geriatrics Clinic once weekly.  They rotate through the local HIV Clinic (CARES) 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, with a core of them being required.  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.
Each resident has another PC resident partner that is on an opposite schedule (i.e. one is always on PC Outpatient time when the other is on more “inpatient” months).  This pair of residents shares in the care of a small panel of Geriatrics Clinic patients.  During the Non-PC Rotations, residents have their General Medicine continuity clinic approximately one half-day per week.  Their Clinic partner helps to manage their outpatients during this time, if necessary.
Please also refer to the Categorical program description for details on inpatient rotations and the intern year rotations.

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 Healthcare Policy and Research) who will assist with their projects. Seminars are held 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 the end of the academic year. Residents are encouraged to submit their project for publication and/or for presentation at regional and national meetings.

UC Davis serves a diverse ethnic and socioeconomic group.  Residents work with this diverse group in all of the clinics that they work in. Additionally, they get to work with the wonderful VA, County medically indigent, and Kaiser patient populations, which rounds out the experience even more.  

The residents’ continuity clinic also serves this diverse population, and residents learn the ins and outs of dealing with many payer types. (HMO, PPO, Medicaid, Medicare), which is valuable for future work.   It is a very rewarding population to work with.

The Resident Internal Medicine Clinic is a very nice clinical setting with excellent support staff and nurses.  It has received awards in 2007 and 2008 for excellence based on patient perceptions – a rare achievement for resident clinics. The Clinic has a  top notch Full EMR system (inpatient and outpatient) with the ability for home access, and with online secure communication with patients.  We also have outstanding triage nurses, and a pharmacist run refill system that cuts down on busywork for the physicians. Pharmacists run a Hypertension Clinic and a Medication Consultation Clinic (especially helpful on educating patients, reviewing medications, and assisting with getting expensive medications) that can really help care for patients in a multidisciplinary manner.   The General Medicine Clinic Attendings are a carefully selected group  also an outstanding group of clinician educators dedicated to our residents.   Endocrinology, Geriatrics, and Rheumatology clinics often run simultaneously with the resident clinics to allow for “on the fly” consultations and advice for our patients. This is a wonderful resource.   Overall, the clinic experience will definitely train you well for practice after you complete your training.

During Primary Care Rotations

A. Continuity Clinics and Primary Care Program Specialty Clinics

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

B. Specialty and Subspecialty Clinics

• Cardiology (UC Davis Medical Center)
• Women's Cardiovascular Health Clinic (UC Davis Medical Center)
• Exercise Treadmill Clinic (UC Davis Medical Center)
• Pulmonary Clinic (UC Davis Medical Center, VA)
• UC Asthma Network (UCAN) Clinic (UC Davis Medical Center)
• Gastroenterology Clinic (UC Davis Medical Center)
• Hepatology Clinic (UC Davis Medical Center)
• Endocrinology Clinic (UC Davis Medical Center)
• Nephrology Clinic (Sacramento County Health System)
• Neurology Clinic (UC Davis Medical Center, Mercy Health Care)
• Rheumatology Clinic (UC Davis Medical Center)
• Dermatology Clinic (VA Medical Center and UC Davis community clinic in Elk Grove)
• Urology Clinic (UC Davis Medical Center)
• Breast Cancer Clinic (UC Davis Medical Center)
• Hematology Clinic (VA Medical Center )
• Infectious Diseases Clinic (UC Davis Medical Center)
• Adolescent Medicine Clinic (UC Davis Medical Center)
• ENT Clinic (UC Davis Medical Center)
• Urgent Care/Procedure Clinic (UC Davis Medical Center)
• Allergy Clinic (UC Davis Medical Center, Mercy Health Care)
• Pre-Op Clinic (UC Davis Medical Center)
• Podiatry Clinic (Mercy Health Care)
• Sports Medicine Clinic (UC Davis Medical Center and UC Davis undergraduate campus)
• Geriatrics Clinic (Mercy Health Care)
• Gynecology Clinic (Sacramento County Health System)
• Medicine-Psychiatry Clinic (UC Davis Medical Center)

We can also help arrange for residents to go to a myriad of other clinics that run at UC Davis on ad hoc basis, based upon individual residents’ desires (e.g. occupational health, physical medicine and rehabilitation, ENT, etc)

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

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

PC residents on PC Block meet every Tuesday morning (8 to noon) for interactive seminars.   In addition, they attend the Department academic seminar series on Monday afternoons.

• Internal Medicine Academic Conference 

This weekly seminar series is for the entire medicine residency program, and meets each Monday from 1:30 to 3:30 (or so) for Residents and 10-noon for Interns. It takes the place of the more conventional noon conferences, and attendance is dramatically higher than classical noon conferences. Residents from all clinical sites attend these seminars, which cover a broad internal medicine curriculum, QI presentations, and M&M conferences over the course of the year.  It is a great opportunity for socializing among residents and faculty.

• Other Medicine Conferences 

We have a monthly Clinical Grand Rounds on Wednesday at noon, which reviews interesting and M&M cases with faculty and residents over a great lunch.  Of course, we also have Grand Rounds every Thursday morning, which is videocast to all hospital sites. 
When on subspecialty rotations (consults or CCU), residents can also attend the subspecialty conferences, which are regularly held. While at the VA, residents attend noon conferences on a daily basis.

• Psychiatry in Primary Care Seminar Series (monthly, Tuesday PC Seminars)

This seminar series is run in concert with faculty from the Department of Psychiatry, with Dr. Raheel Khan 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, bipolar disorder, competency assessment (forensic psychiatry), eating disorders, psychiatric emergencies, the psychotic patient, personality disorders, delirium, and dementia.

• Medical Interviewing and Communication Skills Seminar (quarterly) 

This seminar series entails reviewing both basic and advanced interviewing skills, including motivational interviewing techniques.  Residents also videotape patient encounters in clinic, which we review as a group. We concentrate on interview techniques, patient-physician communication skills, and psychosocial 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 (2-3 times monthly, Tuesday PC Seminars)

PC Residents meet together during their Tuesday morning sessions with faculty members and critically review articles from the medical literature with their colleagues, applying the basic tenets of Evidence Based Medicine.

• Outpatient Morning Report (weekly, Tuesday AM) 

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 

Once or twice monthly, we meet for 30 minutes before clinic to discuss common outpatient conditions, quality improvement, and practice management techniques.  We supplement this with the excellent web-based Ambulatory curriculum (developed and maintained by Johns Hopkins) that residents complete on their own time.

• Teaching Residents to Teach Seminars 

Residents are taught by faculty the skills and techniques for more effective teaching of fellow residents and students.

• Health Care Policy Seminars (Tuesday PC Seminars)

Common policy topics are reviewed and discussed in depth, including healthcare financing, health system structure, 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, universal vs. non-universal health care and insurance systems.

• Race in Medicine (Tuesday PC Seminars)

New in 2009, this is a serial seminar looking at the implications of race in society and medicine.  Obviously this also covers the issues of diversity and healthcare disparities in medicine as well. This is led by a national leader on this topic, Dr. Jann Murray-Garcia. 

• Clinical Reasoning/EBM Seminars (Tuesday PC Seminars)

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.

• Intern Resident Research Block 

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.

The proposed schedules for PC PGY2 and PGY3 years are outlined below. Please note that these numbers are subject to change, depending on a variety of factors. Vacations (4 weeks per year) are taken during outpatient time, in general).

Primary Care residents work very closely with UC Davis faculty in a wide range of specialties, including General Medicine.

For the 2010 Match, there will be 3-4 positions for the Primary Care Internal Medicine Training Program in the National Residency Match Program, available to incoming interns. The remaining 2-3 PC Program positions that remain after the Match will be filled from the intern class the following winter.  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, these interns can make a more informed decision on whether to pursue a primary care career.

The applications for the slots to be filled from our active interns are sent out in November, and final selection will take place in late January each year. 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