Internal Medicine Residency Training Program - Clinical Training
There are seven inpatient services that residents rotate on at Cedars-Sinai Medical Center:
- General medicine wards
- Hematology and oncology wards
- Cardiology / Heart Failure ward
- Medical intensive care unit
- Respiratory intensive care unit
- Cardiac Intensive Care unit
- Consultation services
There are five inpatient services residents rotate on at the West Los Angeles VA:
- General medicine wards
- Medical intensive care unit
- Acute Cardiology Service
- Consultation services
- Geriatrics / Palliative Care
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.
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. Patients are admitted for the management of acute myocardial infarction, decompensated heart failure, unstable valvular disease as well as a variety of other acute cardiac illnesses.
All internal medicine subspecialty services have residents and fellows performing subspecialty consultations on both hospitalized and ambulatory patients.
Our consultation services include:
- Infectious Diseases
- Medicine Consultation
- 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.
This 32 bed unit serves as a step down unit for monitoring of patients with advanced heart failure who do not require intensive care. Patients admitted to this unit may be pre-cardiac transplant, or post-transplant with non-surgical issues, as well as non-transplant candidates with advanced heart failure. The medical team consists of two Interns and three Residents, as well as a combination of general Cardiology Fellows and advanced Heart Failure Fellows. Rounds with as attending specializing in Heart Failure occur daily.
This service admits a wide variety of patients with medical problems that range from the common to the esoteric. The majority of Patients are uninsured or have Medi-cal and have no Primary Care Physician. Teams admit patients every fourth day.
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.
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.
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.
This service admits patients with a wide variety of bread and butter medical problems. 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. Teams admit Patients on long call every fourth day as there is an additional 5th team designated as a "Hospitalized Service" comprised of Senior Residents and Attendings. Residents admit patients to the service daily with no weekend or night admissions. This design allows Senior Residents to experience a model similar a true Hospitalist practice.
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.
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.
This service provides a multi-disciplinary approach to the care of Geriatric inpatients. Led by Board certified attendings and Fellows, the service allows Residents to care for symptoms and diagnoses that maybe specific to this patient population.
Continuity Ambulatory Experience
Categorical residents will have two ongoing continuity-of-care clinical experiences. Each of our clinical training sites deals with a unique patient population of varied cultural and socioeconomic backgrounds. On call rotations will have continuity clinics two 1/2 days a week. All residents will have continuity clinics at the West Los Angeles VA Ambulatory Clinic. Additionally, Residents will have a choice of 1 Cedars Affiliated clinic for their other continuity experience. .
- 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'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.
- 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 two to four week block of ambulatory subspecialty clinics, 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.