Introduction to Clinical Years

A required six-week clinical clerkship in Psychiatry is provided for Junior and Senior medical students, utilizing the clinical services and facilities of six of the UCLA teaching hospitals: West Los Angeles VA Medical Center, Harbor-UCLA Medical Center, UCLA/Neuropsychiatric Institute (NPI), Cedars-Sinai Medical Center, and San Fernando Valley Combined Programs (Sepulveda VA Medical Center and Olive View-UCLA Medical Center). The clerkship is designed to provide the opportunity for students to assume primary responsibility under close supervision for the evaluation of patients seeking help for psychiatric disorders. The program includes experience in adult inpatient, adult and child outpatient, and consultation\liaison (psychosomatic) services.

Educational objectives include: 1) familiarization of students with the clinical psychopathological disorders of adults, adolescents and children; 2) knowlege of methods and modalities of evaluation, diagnosis, management, treatment and disposition of patients; 3) ability to communicate their findings and formulations clearly and efficiently both through verbal presentations and through written documentation in the patients' charts when appropriate. Patient contact and case-based learning are emphasized. Students are expected to read about and discuss the various syndromes and disorders they encounter. Since the stated objectives cannot be achieved merely through unsupervised independent study, active participation and attendance during the assigned hours are required.

Students are evaluated on the basis of their clinical work, their participation in seminars and classes, and their performance on the psychiatry subject examinations of the National Board of Medical Examiners. The overall course textbook is Modern Synopsis of the Comprehensive Textbook in Psychiatry (latest edition) by Kaplan and Sadock. Additional readings are suggested by the various teaching staff at the six hospitals and different services therein. Each student works in an Emergency Room one night a week during the six-week clerkship under the supervision of the resident on call. On-call schedules are handled by the course coordinator at each hospital.

A required four-week clinical clerkship in Family Medicine is offered at the twelve teaching sites listed below. Each of these sites has unique advantages and different patient demographics. A detailed description of each site is available in the Student Affairs Office and the Family Medicine Predoctoral Office (50-071 CHS).

The goal of this clerkship is for the student to learn family-centered primary health care that is humanistic, comprehensive, cost-effective, continuous, and sensitive to psychosocial, ethical, and financial issues. Because family physicians take care of families, the clerkship will include family dynamics, the family's influence on health, and the impact of illness on the family.

Our clerkship provides an opportunity for students to learn about the diagnosis and management of patients with common problems. Students will be expected to learn a comprehensive approach to the patient with these problems that entails consideration of etiology, incidence, pathophysiology, clinical presentation, course, prognosis, treatment, and appropriate aspects of patient education, disease prevention, and health promotion. Students should develop sensitivity to social, familial, ethical, legal, cultural, and economic issues encountered in an ambulatory setting.

The clerkship is a predominantly ambulatory-based experience. Students see patients within the ambulatory setting of the assigned site Monday through Thursday. All the students from the eight sites will return to UCLA every Friday for workshops and tutorial group learning experiences. During the 4 weeks, each student gives one case presentation that leads to a discussion on one aspect of 4 major themes: health promotion and disease prevention, family issues, biobehavioral medicine, and health education. The tutorial group experiences are designed to be interactive and to promote enjoyment in learning.

There may be one evening or night call per week. The evening or night call will vary by site and will allow students to experience other aspects of family medicine (e.g., delivering babies, admitting patients to the hospital, volunteering in a free clinic).

The final evaluation of the student is based on clinical performance at the assigned site, a final written exam, participation in the tutorial group, and the student's case presentation.

UCLA Family Health Center
The UCLA Family Health Center is the busiest outpatient area at the UCLA Medical Center with over 48,000 patient visits per year. The faculty is composed of twenty-two members with areas of expertise in Family Medicine, including sports medicine, geriatrics, allergy, dermatology, and women's health. The faculty includes a psychiatrist, social worker, nutritionist, and OB nurse practitioner. Four full-time fellows and twenty-four family medicine residents complete the core group of health-care providers.

Students will see patients with a variety of faculty and resident preceptors with a continuity on a weekly basis. Independent evaluation of patients will be emphasized. One evening per week will be spent in the busy Urgent Care Center within the Family Health Center seeing patients with acute problems. Students will see patients independently with supervision in this setting.

General Hospital, Ventura County
Ventura County Hospital is a 203 bed hospital which provides care for 42,000 patients per year and is the only acute care county facility in Ventura County.

Students will participate in an orientation at the beginning of the rotation and attend several educational conferences offered at Ventura County Hospital. Students will be assigned to see patients at one of the four practices described below.

Glendale Adventist Medical Center
Glendale Adventist Medical Center is a community-based, 360 bed hospital. Nine full-time faculty, twenty-eight residents, a licensed psychologist, one pharmacist, a nutritionist, and a patient educator make up the teaching group. In addition, multiple community preceptors participate in teaching residents and students.

Approximately 24,000 patients with a variety of health care plans are seen in the outpatient center per year. Forty-eight percent of the patients are HMO members. Students will spend much of their time at the outpatient Family Medicine Center doing patient care. In addition, students will participate in daily specialty clinics, student-faculty conferences, and daily noon conferences. A day with a private community family physician is also an optional part of the curriculum.

Long Beach Memorial Medical Center
Long Beach Memorial Medical Center is a private 816 bed hospital which provides care to patients from various cultural and social backgrounds. The teaching group is made up of eight full-time faculty (family physicians, a psychologist, and a pharmacist) and twenty-four residents. Approximately 90 to 100 patients are seen per day in the Family Medicine Center.

Students will participate in patient care alongside residents and faculty in their continuity clinics and will have their own schedule of patients.

Whittier Presbyterian Intercommunity Hospital (PIH)
USC-PIH is a 356 bed, non-profit community hospital, affiliated with USC. Six full-time family physician faculty, a psychologist, a behavioral scientist, a part-time pediatrician, a part-time OB/GYN, and thirty residents make up the teaching team. Patients have a variety of health-care plans.

Seeing patients in the medical clinic makes up the bulk of experience for students. They also take part in daily reports on the patients that have been admitted during the night, and those being followed on In-Service. Weekly, the student visits the neighboring Skilled Nursing Facility, and makes home visits to our geriatric population. Also, the students are taken on Home Care rounds with three HospitalÇs Home Care Nurses to see continuity of care issues as they are dealt with in the home setting. Hospice and terminal care are also experiences to which they are exposed. Finally, the students are encouraged to attend the weekly clinical conferences that Family Practice Residents are required to attend.

Northridge Foundation Hospital
The Family Practice Center of the Northridge Hospital sees 15,000 patients per year and serves a largely lower income population. Five full-time faculty, 20 residents and more than 100 community physicians are involved in teaching.

Students will see patients with the faculty and residents, attend tutorials with the nutritionist, attend sessions on home health-care and geriatrics, and participate in computer education. One morning per week will be devoted to learning about in-patient family medicine issues.

Harbor-UCLA Medical Center
Harbor-UCLA Medical Center is a 568 bed hospital with a Family Medicine Center that serves approximately 22,000 patients per year. The teaching team is composed of seven full-time faculty, five part-time faculty including a psychologist, and twenty-two residents.

The area surrounding Harbor-UCLA is a health professional shortage area. The patient population of the clinic is 50% Spanish speaking and includes a large number of other ethnic minorities,including recent immigrants.

Students will be involved in seeing patients at the continuity clinic with the various faculty and residents. Morning report is held daily and students will be required to attend and present one case in the month. One evening in a month is spent in a homeless clinic at a local church.

Santa Monica-UCLA Medical Center
The Santa Monica Medical Center is a 399 bed hospital. The outpatient training facility is the Les Kelley Family Health Center. Six faculty physicians, psychologists,social workers, nurse practitioners, and a nutritionist make up the teaching team. The program uses the health team model to care for the over 80-90 patients seen per day at the outpatient clinic. These patients are of varying socioeconomic status.

Students will be involved in continuity clinic and will attend medicine and pediatric rounds. A daily noon conference covering core family practice issues will be held. Responsibilities will include patient calls, outpatient care,and hospital admissions.

Kaiser-Permanente Sunset
Kaiser-LA Family Practice is based in Kaiser-Permanente Sunset Medical Center, a 615 bed facility. Twenty-four residents in Family Mdicine work with eight full-time teaching faculty and three nurse practitioners as well as hundreds of other faculty at this major teaching center.

Students will be involved in continuity clinics with faculty and residents. They also participate in several evening clinics at the Venice Family Clinic and the Los Angeles Free Clinic.

Kaiser-Permanente Woodland Hills
Kaiser-Permanente Woodland Hills Hospital is a 212 bed hospital. Family Medicine is the only residency in this hospital.

Students work with the 12 full-time faculty and 10 residents as well as other practitioners while on their rotation. Approximately 20-25 patients are seen per day by each practitioner at the Family Health Center. An urgent care experience with the faculty is optional.

Kaiser-Permanente Culver-Marina
Kaiser-Permanente Culver-Marina is a Kaiser outpatient office. It is a satellite office for Kaiser Cadillac, a 300 bed inpatient Kaiser facility. Ten full-time faculty physicians and one nurse practitioner provide care for over 50,000 patient visits per year. There is no prenatal care or obstetrics. Students work with staff physicians to see a diverse patient population. Clinic rotations may also require inpatient attending rounds, depending on schedule, for no more than four half days per rotation. PARKING IS PROVIDED. No cafeteria.

Kaiser-Permanente Fontana
Kaiser-Permanente Fontana Medical Center is a 425 bed facility. The Family Medicine Department, the largest clinical department at the medical center, sees 13,000 patients per month.

Twelve full-time teaching faculty, along with over fifty other faculty members and twenty eight residents provide care for the full spectrum of Family Medicine at this community-based medical center.

Medical students rotating through Kaiser-Permanente Fontana will work with residents and faculty seeing patients in continuity clinic and they will participate in daily family medicine noon conferences where lunch is provided.

Riverside General Hospital - University Medical Center
The Family Care Center (FCC), adjacent to Riverside General Hospital, houses the Family Medicine Residency training program and the faculty practice clinic. It is one of eleven clinics that delivers health to the medically underserved throughout Riverside County.

Residents and faculty see approximately 90 patients each day. Medical students have their own assigned patients and work closely with both faculty and residents in the clinic and hospital setting. While the emphasis of the experience in Riverside is ambulatory care, there are many other opportunities available. Arrangements can be made for students to see patients at the Public Health Clinics, which offer students the opportunity to satisfy their own individual needs and interests.

San Bernardino County Medical Center
SBCMC is a County hospital with four ambulatory care centers. In the Family Medicine Department, there are 72 residents and 26 full-time faculty who see 75,000 ambulatory patients a year. The Family Practice residency teaching program is one of the largest in the country. Students have access to primary family care, which involves many procedural activities including colposcopies, sigmoidoscopies, and dermatological procedures; they will also be able to attend the various lectures and conferences that are scheduled. Our diverse population affords a wealth of pathology for the students who will be able to perform patient care with a great deal of autonomy and supervision. Housing is free for medical students.

The required two-week clerkship in Neurology is given on the Neurology Services of three UCLA teaching hospitals: Center for Health Sciences, Harbor-UCLA Medical Center, and West Los Angeles VA Hospital. Students are assigned patients to interview, examine, write up, care for, and follow, participating in the Neurology Service team with supervision by the resident and attending faculty. They join in ward rounds, conferences, clinics and seminars. They may meet in small groups for case discussions and didactic sessions with a neurology faculty member. The required Neurology and Medicine clerkships are prerequisites for electives in Neurology. The grade is derived from ward performance, conference participation, and case presentation. A list of recommended readings will be provided on the first day. There is little to no on-call.

The Radiology Clerkship consists of a well constructed didactic lecture series and representative teaching cases. This controlled experience in the description, analysis, and diagnosis of radiological case material is supplemented by participation in planned conferences. The clerkship is offered at both CHS and Harbor. A practical examination is given as a learning experience on completion of the course at CHS. At Harbor, a case presentation is required in lieu of an examination, though a practical examination may be added later in the year. Recommended readings will be available the first day. Students evaluate the course and receive evaluations on their individual performance. There is no on-call schedule or weekend call. It is highly recommended that this course be taken in the 3rd-year because of its fundamental importance to other disciplines.

The Ophthalmology Clerkship offered at Jules Stein Eye Institute, Harbor-UCLA Medical Center, Sepulveda VA Medical Center, and West Los Angeles VA Medical Center is a practically and clinically oriented rotation designed to introduce the student to basic ophthalmic skills and procedures required for all physicians. Exposure to clinical ophthalmology is accomplished by attendance at scheduled teaching rounds, participation in the consultation service, observation of ophthalmic surgical procedures, and attendance at the Wednesday afternoon conferences. Audiovisual teaching programs are available. By the end of the five-day rotation, the student should be familiar with the basic skills of history taking, be able to perform a preliminary ophthalmic examination, and identify common ophthalmic disorders. The clerkship is graded on a pass\fail basis. Selected chapters from several ophthalmology texts are assigned during the week; these books will be provided. There is no on-call schedule. A written or oral exam will be administered at the end of the course.