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Clinical Training at San Francisco General Hospital (SFGH)

SFGH is a 382-bed acute care hospital that is fully integrated into the UCSF teaching program. As a public hospital with the most active emergency service in the city, it admits large numbers of acutely ill patients. The spectrum of patients at SFGH is representative of that commonly encountered in a City/County institution. Most patients are admitted because of an acute illness rather than electively. These illnesses include infectious diseases, severe asthma, drug overdoses, complicated pleural problems and pulmonary complications of HIV infection.

Fellows spend one-third of their first year at SFGH, during which they rotate twice through 3 different clinical services: Pulmonary Consultation and Diagnostic Service, Medical ICU (MICU).

Consultation and Diagnostic Service

The SFGH Pulmonary Consultation Service is staffed by one-two Fellows and an Attending Physician. Often there is a senior Internal Medicine resident and a medical student on the service as well. The fellow is responsible for organizing the daily activities of the service and for immediate supervision of the resident and student. Approximately 50 new consultations are seen each month. In addition, approximately 60 patients per month with known or suspected HIV infection undergo screening evaluations for respiratory complaints. The majority of these latter patients do not require full consultation or bronchoscopic procedures.

There are daily rounds with the attending physician, who is available at all times. Fellows do not take in-house call, but are available by telephone or pager. In addition, there are daily rounds with an attending chest radiologist to review all radiographic studies performed on patients being seen by the Consultation Service and all patients in the Medical ICU. There is a very close working relationship between the Department of Radiology at SFGH and the Consultation and ICU services. While on the consultation service the fellow is responsible for performing bronchoscopies under the immediate supervision of an attending physician. Approximately 30 bronchoscopic procedures are performed each month. Biopsies are reviewed on a regular basis with staff pathologists, and there are weekly pathology and surgical conferences. The fellows are responsible for performing special studies of lung function and for interpreting all routine pulmonary function tests and screening sleep studies. These studies are reviewed daily with an attending physician.

Medical Intensive Care Unit

During the consult months, the pulmonary fellows are responsible for consultation in the Medical ICU. The ICU is staffed by four senior Medical Residents and an attending physician. Primary responsibility for patient care remains with the ward housestaff team and they are supervised in all aspects of patient care by the ICU resident and attending who is the physician of record for each patient admitted to the unit. There are approximately 50 admissions each month. Of these, approximately 50% require mechanical ventilation and approximately 30% undergo invasive hemodynamic monitoring. Unit rounds are scheduled twice a day. The attending physician is available at all times. The fellow also spends time with Respiratory Therapists learning details of ventilators and of overall operation of a Respiratory Therapy Department.

Pulmonary and Critical Care Fellows also spend 1 month of their first year assigned full-time to the MICU. During this month fellows are responsible for care of patients with diverse medical problems leading to single or multi-organ dysfunction and failure including: severe sepsis, septic shock, respiratory failure, hepatic failure, renal failure, drug toxicity, cardiac dysfunction, and central nervous system dysfunction. In addition, they supervise an ICU team of 4 senior internal medicine residents, 3 internal medicine interns, and 1 family practice second-year resident.

Outpatient Consultation Service

The Consultation Service fellows and attending physician are available daily to see outpatients for whom consultation is requested, usually from 1-3 PM. Consultations are received from a variety of community and SFGH clinics and are answered within one working day.