Department of Medicine

Clinical Programs

The clinical curriculum emphasizes inpatient, outpatient and research experiences. Stanford and its affiliated hospitals offer academically oriented programs where teaching sessions have a high priority in the housestaff's daily activities. Days are structured to include work rounds, X-ray rounds and attending/teaching rounds, as well as daily Residents' Report. A core curriculum series of lectures is delivered in three noon conferences weekly, and there are weekly Medicine Grand Rounds, Mortality and Morbidity Rounds, Chief's Rounds, Interns' Report, primary care skills sessions and evidence-based medicine conferences. CCU rounds and ICU rounds are held twice daily. All housestaff complete general medicine ward, CCU and ICU rotations, as well as all major subspecialty rotations. There also are numerous ambulatory care month-long rotations and monthly journal club is run by residents and held off-campus after hours.

Inpatient Experience

On the inpatient medical services, the intern assumes primary responsibility for all patient care. Only interns are allowed to write orders, unless permission is granted for others. Each general medical team consists of 1 resident, 2 interns, and 1 to 2 medical students. Call is every fourth night, and the number and variety of patients provides comprehensive experience in inpatient care. Short-call, night float, and a "cap" system distribute the workload among teams and ensure effective learning. A jeopardy back-up system provides coverage for residents and interns who must be absent due to illness or family emergencies, and a mechanism is in place for allowing time off for residents and interns.

Outpatient Experience

Housestaff training at Stanford includes experience in all aspects of outpatient care in primary care and subspecialty clinics. From internship through senior year, residents have a weekly general medicine continuity clinic. Each resident builds a practice of patients for whom he/she will provide care throughout residency. The pre-clinic teaching conferences cover a wide spectrum of ambulatory care topics. These are available on the web for review. In addition, weekly primary care skills sessions offer the opportunity for residents to gain experience in all aspects of general medicine practice in a small-group interactive teaching environment.

All residents have the opportunity for several general medicine ambulatory care month long rotations over the course of the residency, during which they have concentrated experiences in primary care-related areas such as dermatology, ophthalmology, women's health, as well as in general internal medicine. These block rotations include sites at Stanford University Hospital, the Palo Alto VA Medical Center, Vaden Student Health Center on campus, a Women's Health rotation at offices and clinics throughout the area, a Managed Care rotation at the Palo Alto Medical Clinic, a Menlo Medical Clinic rotation and an outpatient Livermore VA experience.  Housestaff on subspecialty rotations also participate in active outpatient clinics staffed by the respective faculty members of the division. In fact, subspecialty rotations truly reflect the practice of that subspecialty; many subspecialty rotations, such as endocrine, rheumatology, and others, have their major experience concentrated in the clinics. All residents participate in both ER and walk-in clinic experiences.

Teaching Hospitals

The clinical training of residents occurs at Stanford University Hospital and Clinics, the Palo Alto Veterans Administration Medical Center and the Santa Clara Valley Medical Center, a large county hospital. These three sites provide the Stanford housestaff with diversity and complementary patient populations and experiences. Interns rotate through all three sites.

Stanford University Hospital is a 663-bed teaching hospital which provides experience with both university and community patients who present a broad spectrum of common and rare diseases. In addition to being a tertiary care referral hospital, Stanford University Medical Center is the community hospital for Palo Alto and the surrounding South Bay area. Admissions originate from the Hospital's general medicine and subspecialty clinics, the SUH ER, the Stanford Medical Group (a Hospital-based group of internists), the offices of community physicians, including large HMOs, specialty HIV clinics, and from referrals throughout Northern California and neighboring states and outside the U.S. As the contract provider for Medi-Cal (California Medicaid) patients in the area, Stanford provides care for a large indigent patient population. There is the opportunity to care for general medicine patients for whom you are the primary physician, as well as to diagnose and manage diseases of patients referred for tertiary care.

Stanford University HospitalStanford University Hospital and Clinics also has a 60-bed ICU, a 20-bed Compromised Host Unit, and a 25-bed Coronary Care Unit/ Coronary Surveillance Unit. The facilities offer excellent ancillary services and amenities, such as 24-hour online literature searching and computer access and a housestaff gym. Housestaff work with and teach medical students. Patient care is supported by well-trained, highly skilled nursing, case manager, and pharmacy personnel. Pharmacists attend work rounds and provide current literature. These resources help housestaff and faculty to deliver cost-effective care in a busy managed-care environment.

Palo Alto VA Medical CenterThe Palo Alto VA Medical Center, located just a few miles from SUH, is one of the largest referral centers in the VA system. A new acute care hospital opened in 1997. It includes 60 internal medicine beds staffed by 4 medicine teams. As a referral hospital in the VA system, the Palo Alto VA also provides housestaff with the opportunity to see both the common diseases of the VA population and unusual tertiary care problems, as patients are referred to the PAVA from the region. At the VA, housestaff provide the primary care for all ward, ER, and clinic patients. In addition, they rotate through the VA ICU.

SCVMCThe Santa Clara Valley Medical Center is a 427-bed county hospital in San Jose, about 20 minutes south of Stanford. Members of the medical faculty and house-staff program are affiliated with Stanford. Residents and interns from the two institutions frequently exchange ward and subspecialty rotations. In particular, Stanford interns and residents have active ward rotations at Santa Clara Valley, providing a county hospital experience complementary to that of the Stanford University and VA Medical Centers.

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