Internal Medicine Residency Overview
Our belief is that residents learn most efficiently in a supportive and collegial environment. Our goal is to optimize the potential development of each resident in the program, regardless of one's ultimate niche in medicine.
We seek self-motivated individuals who share our enthusiasm about medicine. We strive to have residents who will, at the completion of their training, be superbly trained clinicians, excel in crystallizing and synthesizing medical problems, understand how to think about medicine, and appreciate the subtleties of patient-physician interactions and the bio-psychosocial process.
Residents are busy enough to be challenged and stimulated, yet have enough time for medical reading, relaxation with family, or various outdoor and cultural activities, which abound in this area (hiking, bicycling, windsurfing, fishing, music, dance, theater, etc.).
The program offers an excellent balance between common community medical problems and more esoteric problems, which outlying community hospitals refer to Santa Barbara Cottage Hospital. The excellent locale coupled with outstanding medical facilities has provided for a competitive medical environment where well-trained subspecialists, hospitalists, and primary care physicians have collaborated and flourished.
Most of these physicians happily volunteer their time and energy to the teaching faculty; a comfortable rapport exists between the private voluntary faculty and the residency program. The bulk of the clinical teaching is done on a one-to-one basis between attending physicians and residents.
The level of care in the community is comprehensive and state-of-the-art. Available services include a busy invasive cardiology and cardiac surgery program, state-of-the-art radiology technology, a 20-bed MICU and 21-bed SICU (as well as separate telemetry units), a busy Emergency Department with more than 50,000 visits per year, a Trauma team with Level I Trauma Center designation, and active surgery and radiology residency programs. A strong feeling of collaboration and mutual support exists among all the residency programs.
The Internal Medicine Residency Program is affiliated with the Department of Medicine at the University of Southern California (USC) School of Medicine. Although medical residents do not rotate between hospitals, 3rd and 4th year students from USC participate in IM and MICU rotations at Santa Barbara Cottage Hospital.
Since there is no County Hospital in Santa Barbara, the residents at Santa Barbara Cottage Hospital care almost exclusively for non-private patients, not only from the Santa Barbara area but also from the neighboring cities. An affiliated County-operated ambulatory care facility is located at the Santa Barbara County Public Health Department, which includes primary care, Internal Medicine continuity, and referral clinics to accommodate the needs of the indigent patients of Santa Barbara County. These clinics are staffed in large part by Cottage internal medicine and surgery residents.
While on the ward and MICU rotations, R1’s never have overnight call. Instead nighttime cross-coverage is provided by Residents who have no daytime responsibilities. The longest scheduled shift for any R1 is 14 hours, though patient care may extend that to a duration of 16 hours.
R2s and R3s
We have a very efficient and effective night float schedule for R2’s and R3’s. The residents have no overnight call during their ward or MICU rotations. Other senior residents cover from 8:30 p.m. to 7:30 a.m. for one-week blocks, with no daytime responsibilities. Each R2 and R3 has approximately 3.5 blocks of night float per year.
Each ward team manages both private and non-private patients. About 5% of the inpatients are private; their care is supervised by the private attending. The remainder of the service consists of non-private patients, whose care is supervised by Drs. Bookspan, Hosea, Fitzgibbons and Bordofsky. Critically ill patients are managed by a separate, multidisciplinary ICU team under the direction of Dr. Jeffrey Fried.
There are 13 four-week rotations during the year. First-year Preliminary and Categorical residents have approximately 24 weeks of general medical wards and 12 weeks of MICU. Second- and third-year residents have 4-5 rotations on general medical wards per year. The usual team consists of two supervising second- or third-year residents and two interns. Although there are ongoing changes in the yearly schedule, a predicted schedule would be close to the following examples.
Intensive Care Unit Rotation
There is a dedicated ICU team under the supervision of Dr. Jeffrey Fried, a full-time faculty member. This team serves as the primary caregivers for MICU patients and participates in multi-disciplinary rounds, led by Dr. Fried, on a daily basis.
- General Medical Wards 24 * weeks
- ICU (including approx. 4 weeks of night coverage) 12 weeks (4 weeks daytime ICU and 8 weeks Night Medicine ICU, consisting of 14 nights on per 28 day rotation)
- Emergency Department 4 weeks
- Electives 8 weeks
- Vacation 3 weeks
R2 - R3 (approx.)
- General Medical Wards 18-19 weeks
- ICU 4 weeks
- Electives 14 weeks
- Night Float 3 - 4 weeks
- Primary Care Clinics (County) 4 weeks
- Subspecialty Clinics (County) 4 weeks
- Vacation 4 weeks
Noon Conferences for the Residents are held each weekday. Among the conferences there are weekly Medical Grand Rounds featuring a nationally or locally prominent speaker and a daily resident conference covering Internal Medicine and its subspecialties, as well as a multitude of other core topics.
Morning Report is attended by all residents and medical students on general ward rotations, as well as by other residents when feasible. It is led by a faculty member, customarily Dr. Hosea, and occurs each weekday morning. In a very participatory manner, one or two cases are discussed by the entire group. The focus is on clinical analysis and integration rather than upon dissecting details.
General Acute Care Ward Rotations
Inpatient resident teams care for diverse members of the community, with approximately 5% private and 95% non-private patients.
Intensive Care Unit Rotation
Jeffrey Fried, M.D. leads a dedicated ICU resident team, which serves as the primary caregivers for MICU patients. Dr. Fried attends with the team and provides extensive rounds and teaching on a daily basis.
Subspecialty rotations are usually 2-4 weeks' duration. Residents work closely with a preceptor of their choice, spending the vast majority of their time in the private office of the preceptor. While there, the resident assumes significant responsibility for the care of private patients. The resident also performs initial evaluations and ongoing care of consultations at Santa Barbara Cottage Hospital under the supervision of the preceptor. These rotations provide the resident with an excellent opportunity to learn the outpatient procedures regularly performed by specialists. Rotations are available in Santa Barbara in all subspecialty areas.
In addition to a weekly I.M. continuity clinic for all residents, each second and third year resident spends 8 weeks per year at the County Clinic. The ambulatory experience is further enhanced by numerous elective outpatient rotations per year during the second and third years.
Each R1 spends 4 weeks in the Emergency Department supervised by Board Certified Emergency Physicians. The resident has "first contact" with patients across all specialties, diagnoses, and socioeconomic classes. There are currently approximately 50,000 visits annually to our ED.
Dr. Fitzgibbons, Program Director, is Board Certified in Internal Medicine and Infectious Diseases, and oversees the HIV and Infectious Disease clinic at the Santa Barbara County Public Health Department. She has a particular interest in HIV medicine in underserved populations, having spent a year as a volunteer clinical faculty in Mbarara, Uganda prior to completing her Infectious Disease training. She has been associated with the teaching program since 2015, and joined the permanent faculty in 2016. Dr. Fitzgibbons is a Clinical Associate Professor of Medicine at USC and the Director of Research and Quality for the Residency.
Dr. Andy Gersoff, FACP is Designated Instituitional Official (DIO), Internal Medicine Residency and former Director of the HIV Clinic at the Santa Barbara County Public Health Department. Dr. Gersoff is Board Certified in Internal Medicine, a Clinical Professor of Medicine at Keck-USC School of Medicine and has been involved with the teaching program since 1980.
Dr. Thad Bordofsky is Associate Program Director, Internal Medicine Residency. A Clinical Assistant Professor of Medicine at Keck-USC School of Medicine, Dr. Bordofsky has particular interests in Human Rights Medical Training, bedside teaching and education theory. Raised in Santa Barbara, Dr. Bordofsky returned home in 2007 to join our program.
Dr. Antony is the Director of the Internal Medicine Clinic at the Santa Barbara County Public Health Department and the usual supervising physician for the Internal Medicine Residents’ Continuity Clinic. Board Certified in Internal Medicine and Geriatrics, she joined the program in January 2010. Dr. Antony also has an MPH from the University of California, Berkeley.
Dr. Bookspan is Director of Internal Medicine Education. He is Board Certified in Internal Medicine and Rheumatology. Dr. Bookspan is the Director of the Arthritis Clinic at the Santa Barbara County Public Health Department and has been involved with the teaching program since 1978. He is a Clinical Professor of Medicine at the Keck-USC School of Medicine.
Dr. Fried is Director of Critical Care Medicine at SBCH. He is a specialist in Pulmonary and Critical Care Medicine who became the full-time hospital ICU Attending at SBCH in August 2004. He is Board Certified in Internal Medicine, Critical Care, and Pulmonary Medicine. Dr. Fried has been in practice in Santa Barbara since 1988 and an active and valued member of our faculty since then. Since leaving his private practice in 2004, Dr. Fried has served on an ongoing basis as the teaching Attending for the Residents’ ICU team.
Dr. Hosea is Director of Clinical Care, Internal Medicine. Dr. Hosea is Board Certified in Internal Medicine and Infectious Diseases and a Clinical Professor of Medicine at Keck-USC School of Medicine. He has been associated with the teaching program since 1981 and customarily runs morning report.
Drs. Bookspan, Bordofsky, Fitzgibbons and Hosea are always the Hospitalist Attendings for the IM Resident inpatient teams
More than 100 local physicians volunteer their time to teach residents, both in the hospital and in private offices. They play an integral part in the educational process and serve as outstanding mentors for our residents.