Internal Medicine Residency Training Program - Clinical Training

Inpatient Training

There are six inpatient services that residents rotate on at Cedars-Sinai Medical Center:

There are four inpatient services residents rotate on at the West Los Angeles VA:

Each of these services has a team of house staff, which includes a second- or third-year resident, one to three first-year residents and, frequently, a fellow and a junior or senior medical student.

There are daily morning report sessions on all of these services during the week, and attending rounds from five to seven times a week.

CSMC Cardiac Intensive Care Unit (ICU)

Housed in the new, state-of-the art Saperstein Intensive Care Tower, this 12-bed intensive care unit admits patients with a variety of medical conditions. Both full-time faculty and private attending staff consult on the management of patients in this unit. Rounds with both a fellow and a full-time member of the Division of Cardiology occur every day. Responsible attending staff sees patients at least once a day. Daily morning report lectures focus on the management of cardiac emergencies including acute myocardial infarction, unstable angina, congestive heart failure, aortic dissection, cardiac arrhythmias and heart blocks. Overnight call is every third day. Interns get four or five days off on this rotation.

CSMC or VA Consultation Services

All internal medicine subspecialty services have residents and fellows performing subspecialty consultations on both hospitalized and ambulatory patients.

Our consultation services include:

  • Cardiology
  • Endocrinology
  • Gastroenterology
  • Hematology/Oncology
  • Infectious Diseases
  • Medicine Consultation
  • Nephrology
  • Neurology
  • Pulmonary
  • Rheumatology
  • Geriatrics/Palliative Care

Each of these subspecialty rotations differs slightly in its structure, but all include formal didactic sessions and a defined educational curriculum. Teaching attending rounds occur on all these services two to five times a week. Individual teaching sessions with the subspecialty fellows occur more frequently. Both fellows and attendings are available daily for patient care issues.

There is no overnight or weekend call assigned to these services, though second-year and third-year residents will work in the Emergency Department or ICU approximately one weekend shift per four-week rotation.

CSMC General Medicine Wards

This service admits a wide variety of patients with medical problems that range from the common to the esoteric. Both patients with and without private attending physicians are admitted to this service. Residents admit patients every fourth day. There are three to five overnight calls on this four-week rotation.

CSMC Hematology and Oncology Wards

This service admits patients with hematologic-oncologic diseases for diagnostic and intensive therapeutic management. A number of these patients may be getting state-of-the-art stem cell transplantation for solid or hematological malignancies. Attending rounds are daily with both a hematology and oncology fellow and attending. There is no overnight call on this service.

CSMC Medical Intensive Care Unit (ICU)

This is a 12-bed unit in the new Saperstein Critical Care Tower, which is staffed by three house staff teams. Critical care fellows and full-time attendings who are board certified in critical care medicine round on every patient in the ICU daily. Morning didactic sessions supplement the bedside teaching on this rotation. Acute management of medical emergencies, including drug overdoses, sepsis, GI bleeding, hepatic failure, CNS bleeding and stroke are but a few of the issues discussed during these didactic sessions. Overnight call is every third day. Interns get four-five days off on this rotation.

CSMC Respiratory Intensive Care Unit (ICU)

This 12-bed unit in the Saperstein Critical Care Tower is staffed by three house staff teams. Full-time pulmonologists and pulmonary / critical care fellows conduct daily rounds. Bedside rounds and formal didactic sessions teach residents the essentials of respiratory failure and the appropriate management of mechanically ventilated patients. Overnight call is every third day. Interns get four-five days off on this rotation.

West Los Angeles VA General Medicine Ward

This service admits patients with a wide variety of medical problems. The hospital serves as the tertiary referral center for Southern California and Southern Nevada. All patients are admitted to the teaching service, which is led by a full-time faculty member. Other important members of the multidisciplinary team include a case manager, social worker, clinical dietitian and clinical pharmacist. Interns do overnight call every 8th night supervised by a "night call resident" 2nd and 3rd year doing long overnight call. Lond call admit days are every 4th day.

West Los Angeles VA Medical Intensive Care Unit

Housed in a new state of the art ICU, this service is led by a full-time attending physician who is board certified in pulmonary/critical care. The service is also staffed by four housestaff teams: one supervisory resident (R2 or R3) and one R1 on each team and a pulmonary/critical care fellow. Patients have a wide variety of medical illness, including multi-organ system failure, sepsis, drug overdose, DKA, respiratory failure, GI bleeding, hepatic failure, CNS bleeding and stroke. Overnight call is every fourth night.

West Los Angeles VA Acute Cardiology Service

This service is led by a full-time attending physician who is board certified in cardiology and by cardiology fellows. The service is also staffed by two housestaff teams, one supervisory resident (R2 or R3) and one R1 on each team. Patients are admitted for the management of unstable angina, congestive heart failure and cardiac arrhythmias. The hospital does urgent and routine cardiac catheterization, PTCA/angioplasty and bypass surgery, as well as electrophysiologic studies. Beds are located in the telemetry Ward. There is no overnight call.

Olive View Medicine Ward

This rotation takes place in a County hospital with a predominatly poor patient population. Residents will admit a wide variety of patients with common medical problems. Full-time members of the General Internal Medicine Division attend on this service. Residents admit are on overnight call every fourth day. There is one short call admiting day in between overnight calls on this four-week rotation.

Ambulatory Training

Continuity Ambulatory Experience

Categorical residents will have two ongoing cointinuity-of-care clinical experiences. Each of our clinical training sites deals with a unique patient population of varied cultural and socioeconomic backgrounds. Continuity of care clinics are 1/2 day per week. Continuity clinics will be done at 2 of the following sites:

  • Cedars-Sinai's Ambulatory Care Center- At Cedars-Sinai Ambulatory Care Center, residents manage a predominantly poor, immigrant patient population in a traditional hospital-based ambulatory setting.
  • West Los Angeles VA Ambulatory Clinic- At the West Los Angeles VA Ambulatory Clinic, resident will be part of a large integrated outpatient system that accommodates over 1.2 million outpatient visits per year.
  • Cedars-Sinai Medical Group- At Cedars-Sinai Medical Group, residents work with primary care physicians and care for mostly middle-class patients in a managed care practice.
  • The Saban Free Clinic- At The Saban Free Clinic (formerly named the Los Angeles Free Clinic) residents care for indigent patients through a public-private program supported by federal and local resources.

Other Ambulatory Experiences

There are multiple other ambulatory experiences that resident may do on a two to four week block basis. In addition to the community sites listed above, all residents will spend at least two months at the Sepulveda VA PACE Clinic (the model primary care clinic in the nationwide VA system) doing both primary care and ambulatory subspecialty clinics. Residents will do a four to eight week block of ambulatory subspecialty clinics, and four weeks of geriatric medicine at the West Los Angeles VA, and many residents will do two weeks of urgent care clinic at Cedars-Sinai's ACC. Residents will also do two to four week block rotations at The Saban Free Clinic (formerly named the Los Angeles Free Clinic), Venice Family Clinic, Clinica Oscar Romero or the Los Angeles Mission - where they work with a poor and underserved patient population.

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