Key to the UCSF Pediatric Residency Training Program is the rotation through five medical centers, each distinct in providing valuable components to overall training:

• Children's Hospital at UCSF
• UCSF/ Mount Zion Pediatrics
• San Francisco General Hospital (SFGH)
• San Francisco Kaiser Permanente Medical Center
• California Pacific Medical Center (CPMC)

Commanding a majestic view of San Francisco and the Golden Gate, UCSF is the only one of the ten campuses of the University of California to devote itself entirely to the Health Sciences and their relationship to people and the environment. The campus includes outstanding Schools of Dentistry, Pharmacy and Nursing, in addition to Medicine, all with missions that include teaching, research, patient care, and public service. The School of Medicine has ranked consistently in the top 10 choices for students nationally and first or second in NIH funding for the past two decades.  UCSF is proud to claim several Nobel Laureates among its current faculty.

Incorporated within the main campus is the UCSF Medical Center, which serves as a primary health care center for the local community, as well as a major regional referral center for northern California and the western United States. Founded in 1864, the original hospital became part of the University of California in 1873 and moved to its present location in 1898. Currently, patient care is provided in a 550-bed general hospital complex, in addition to an ambulatory care facility and a 70-bed neuropsychiatric hospital.

Children's Hospital at UCSF

The Department of Pediatrics occupies the entire sixth and seventh floors and portions of the fifteenth floor of the contiguous Moffitt and Long Hospitals, as well as the second floor of the Ambulatory Care Center, forming a Children's Hospital within the general hospital complex. Pediatric clinical services provided at the Children's Hospital are: Inpatient Services, including general pediatrics, pediatric intensive care, and bone marrow transplant units, intensive-care and well-baby nurseries, and the Pediatric Clinical Research Center; and Ambulatory Services, including general pediatrics, adolescent medicine, and the full range of pediatric subspecialties. Our location within the main hospital complex allows for rich interplay and extensive utilization of resources across departments and professional disciplines.

The 65-bed pediatric ward treats infants, children, and adolescents. It is a tertiary-level referral center and is also the hospital for children in the local community who receive their primary care through the UCSF faculty practices, including the Mt. Zion practice. Consequently, there is a diverse patient population which exhibits the full range of medical and social problems. At the end of September, 2008, two general hospitalist teams provide care to hospitalized patients (with specialists in consultation roles), each team consists of a supervising R-3 resident, 3 R-1 residents, medical student(s), and an attending hospitalist physician.  There will also be a separate team for the higher-end, quaternary care level patients who are on Dialysis or have Organ Transplantation (the "DOTS" team) as their primary diagnosis. These three teams will also be managed by a dedicated "Night Float" team consisting of one R-3 supervisory resident and two R-1 residents, all from the same pool of residents assigned to the inpatient service for that 4 week block.

In addition, there is a separate hematology/oncology team consisting of residents, a fellow, and an attending physician who provide care to Hematology/Oncology patients on the ward and in the state-of-the-art Bone Marrow Transplant Unit.

A 24-bed Pediatric Intensive Care Unit receives emergent patient referrals from throughout northern California and the western states. Staffed by 4 residents, a fellow, and two attendings, the Unit provides care for both medical and surgical patients, including patients in the Pediatric Cardiac Intensive Care Unit.

Newborn services are provided at all levels, in a nursery with its own radiology suite and operating room. The 50-bed Level III Intensive Care Nursery, admits over 650 patients a year and is staffed by two teams which include house staff, neonatal fellows and attending neonatologists. Special care areas are also established for infants requiring intermediate level care (20 beds) and for Extracorporeal Membrane Oxygenation. Well Baby services are provided to over 2000 newborns each year by a team consisting of two R-1 residents, 2 nurse practitioners, a medical student and an attending pediatrician.

The Rehabilitation and Recovery Service provides rehabilitative or transitional consultation and care for children with acute or chronic conditions, such as head trauma or rheumatologic disease. This service will provides a unique opportunity for residents on the inpatient teams to work with an extensive multidisciplinary team, as well as community-based services, to provide care within the framework of a long-term plan.

The 10-bed inpatient and outpatient Pediatric Clinical Research Center as part of the Clinical and Translational Science Institute is one of a few such units in the country, devoted exclusively to pediatric clinical investigation. The Center is funded extramurally and staffed at a high nursing-to-patient ratio. It offers residents the opportunity to experience innovative approaches to pediatric diagnosis and treatment occurring at the interface between research and clinical care.

The UCSF Ambulatory Care Center houses two General Pediatric Practices which combine residents' continuity and faculty practices, Adolescent Medicine and an Urgent Care Clinic. Additional clinics for 10 subspecialties provide patient care and clinical teaching opportunities.

Altogether, there are over 50,000 pediatric outpatient visits annually to the Ambulatory Care Center.

Pediatric emergency medicine experience at the Children's Hospital is incorporated into ambulatory rotations. Pediatric housestaff care for approximately 3,000 children per year through the Emergency Department, ranging from acute-care general pediatrics to complicated subspecialty patients.

Residents spend an average of 40-50% of their time over the three training years based at the UCSF Children's Medical Center.

UCSF/ Mount Zion Pediatrics

Residency Program Site Director: Jane Anderson, M.D.

UCSF/Mount Zion Hospital and Medical Center is one of San Francisco's oldest medical institutions, with a long-standing commitment to clinical care, teaching, and research. Located between the city's Pacific Heights and Western Addition districts, Mount Zion serves 10,000 general pediatric outpatients annually and is a primary care center for children from the surrounding community. Although there had long been affiliation between the training programs and patient care services at Mount Zion and UCSF, the two institutions merged formally in 1990.

The General Pediatric rotation is based in the primary care practice of the UCSF/Mount Zion Pediatric Group, where residents' continuity clinic practices are integrated with the faculty practice. A senior consulting resident, two PL-1s and a medical student comprise the monthly team working with the Mount Zion faculty.

The UCSF/Mount Zion setting provides an atmosphere and philosophy conducive to the clinical teaching of general pediatrics. Particular features include an ethnically and socioeconomically diverse group of patients and a large adolescent patient population seen in an environment prepared to support them. Supervised opportunities to hone teaching skills, from presenting a conference to participating in critical literature review seminars are also emphasized. The "Mount Zion Violence Prevention Program" is based in the pediatric practice and promotes collaborative work with a number of local community groups to address the many aspects of of violence affecting our patients and their families.

Subspecialty clinics such as the intensive care nursery follow-up clinic and the Young Women's Clinic, which provides obstetrical and gynecological services to teens from the community, are also located there. Residents spend an average of 6% of their time at Mount Zion during their training, more for those residents doing Continuity Clinic there.

San Francisco General Hospital (SFGH)

Residency Program Site Director: Susan Sniderman, M.D.

Located in the city's multicultural Mission district, "The County" is the City and County hospital for San Francisco. It provides primary health care for many in the city, and is also the designated regional trauma center. Caring mostly for the medically underserved, the hospital offers residents a rewarding pediatric experience in an acute-care, general hospital setting.

Residents at SFGH have a good deal of autonomy, with full responsibility for diagnostic evaluation and treatment of patients in consultation with the Chief Residents. Supervision and back-up by attending faculty is also readily available. Rotations include the inpatient ward, the newborn and newborn intensive care nurseries, and ambulatory services, including primary care practice and emergency room.

The ward team, consisting of a family medicine R-1, medical students, and a supervising R-3 pediatric resident, is responsible for the 50-90 patients per month admitted to the 12-bed pediatric ward for medical or surgical illness; all pediatric patients admitted to the Intensive Care Unit are included in this responsibility. Surgical patients are managed jointly by pediatrics and the relevant surgical specialty service.

The Community Level III Nursery admits over 1600 babies each year. It is staffed by one PL-3, one PL-1, an intern from family medicine, medical students and one of 4 full-time neonatologists. This rotation offers residents a busy, hands-on experience ranging from delivery room resuscitation and routine care for normal newborns to intensive care for infants with moderately severe neonatal conditions or those requiring mechanical ventilation.

The Children's Health Center, with more than 34,000 visits per year, provides all aspects of well-child care, including residents' continuity clinic practices, drop-in acute care, and specialty visits. The Children's Health Center emphasizes all aspects of social pediatrics and includes CASARC, the regional referral center for child neglect, abuse and sexual abuse.

The Emergency Department is the designated regional trauma center; pediatric housestaff are involved in the assessment, stabilization and care of all pediatric patients and trauma victims. Pediatric housestaff see approximately 6,000 children per year through the emergency room, ranging from basic general pediatrics to major trauma.

Residents spend an average of 20-30% of their time at San Francisco General Hospital over the three years of training.

San Francisco Kaiser Permanente Medical Center

Residency Program Site Director: Carlos Botas, M.D.

Kaiser Permanente is the largest Health Maintenance Organization in the United States, with over 2.4 million members in Northern California. San Francisco Kaiser Permanente serves as a primary care center for children residing in San Francisco, providing care for over 25,000 pediatric patients. The San Francisco Kaiser facility is also a tertiary care referral center for the entire Northern California Kaiser Permanente population.

Residents receive training by practicing primary care pediatrics in an HMO setting with adequate volume to develop strong skills in efficiency and clinical confidence. This program component provides excellent resources for learning preventive pediatrics and the practice of cost-effective medicine.

Pediatric Ward: One PL-2, 1-2 PL-1s and a medical student manage the 10-bed ward service under supervision of a staff pediatrician.

Nursery: One PL-3 is assigned to the 14 bed Level III Nursery in conjunction with a staff neonatologist. One PL-1 and one medical student provide care for the well newborns together with a general pediatrician and a nurse practitioner. There are over 2,000 deliveries per year, and ample opportunity to learn and participate in the early discharge/home care aspects of newborn care.

Primary Care/Continuity Clinic: Residents are organized into three group practices, with each group averaging 6 residents and 2 attendings, who function as consultants/supervisors for the residents in clinic.

Specialty Care: All major subspecialties are represented, with particularly active adolescent and diabetes services available as consultants for resident's primary care patients.

Residents may spend an average of 10-15% time at Kaiser San Francisco during their training.

California Pacific Medical Center (CPMC)

Residency Program Site Director: Molly Linehan, M.D.

California Pacific Medical Center was created in 1991 by the merger of Children's Hospital of San Francisco and Pacific Presbyterian Medical Center. It is located in the Laurel Heights neighborhood of San Francisco (know as the California Campus) and serves a large portion of the city's private pediatric practice community. CPMC has San Francisco's largest obstetric service with over 5000 deliveries per year, providing an outstanding newborn experience.

The 27 bed Pediatric Ward has an average census of 14 patients, an excellent mix of general and subspecialty Pediatric care. The ward team (one PL-2, 1 or 2 PL-1's and medical students) is supervised by a pediatric hospitalist and works directly with community pediatricians and subspecialty attendings.

The 8-bed Pediatric Intensive Care Unit has an average daily census of 5 patients. Residents may refer patients to the PICU, where attendings care for a variety of critically ill children.

In the Well Baby Nursery full-time faculty, private pediatricians and lactation consultants from the Perinatal Education Center provide care to the newborns there. Residents may spend time in the regular newborn nursery during a clinic rotation at CPMC.

As a part of CPMC's Family Health Center, the Pediatric Clinic provides primary care and some specialty services to approximately 4,000 children from a socioeconomically and ethnically diverse population. Residents and students in the Clinic are supervised by 2 full-time General Pediatric faculty. Subspecialty clinics are available in gastroenterology, pulmonary, cardiology, endocrinology, hematology/oncology, child development and neurology; continuity clinics and a block rotation are available at the CPMC clinic.

Residents may spend an average of 10% of their time at California Pacific Medical Center during their training.