Fresno’s Family and Community Medicine rotation offers students an opportunity to see a wide variety of common health problems in several different outpatient settings. The rotation is based primarily at three residency training Family Medicine Centers; Community Medical Center in Fresno, Clinica Sierra Vista, an urban primary health center, and Selma FMC in the rural community of Selma, 20 miles away. Students have primary responsibility for evaluating and managing patients, with close one-on-one supervision by faculty. Students may also spend time in private practices, admit health center patients to the hospital when necessary, complete in-depth community projects, and take part in a weekly series of behavioral science and ambulatory care seminars. The rotation also includes 8 hours at the Alzheimers and Memory Center and 8 hours with a hospice program, both in Fresno. Enrollment is limited to three students per rotation. A car is necessary to take full advantage of the variety of opportunities.

The core clerkship in medicine is a traditional inpatient experience for 3rd-year medical students from UC Davis as well as for UCSF LIFE (Longitudinal Integrated Fresno Experience) and UC Davis PRIME students. The clerkship takes place primarily at Community Regional Medical Center (CRMC) though the VA Central California Medical Center is occasionally utilized for core students. CRMC is a very large, tertiary, level-1 trauma center with a rich and diverse mix of patients. Core students spend 4 weeks in Fresno, alternating the other 4 weeks in Sacramento. Each student is assigned to one of the inpatient teaching teams and works side-by-side with the interns, senior resident, and faculty on the team. All core students are expected to participate in the regular teaching activities of the UCSF Fresno residency program (ie. teaching conferences, didactics, morning report) and are looked on as integral to the whole academic purpose within the Department of Internal Medicine. Structured feedback and observations by faculty are key throughout the 4 weeks of the core experience. LIFE and PRIME students spend 2 weeks on inpatient medicine near the beginning of their longitudinal experience and then have additional weekend calls throughout their 6-months while in Fresno.

Since its beginning in 1979, Fresno’s Ob/Gyn core rotation has enjoyed a reputation among students for providing a well-rounded clinical experience. Based at Community Regional Medical Center where there are approximately 700 deliveries a month, a student may expect to participate in multiple deliveries over the six week experience. Students also have the opportunity to rotate in the busy ambulatory clinic where they are able to gain valuable experience in performing the pelvic exam under supervision. In addition, students are scheduled to rotate in the high risk obstetric clinic where they work directly with attending perinatologists and observe multiple ultrasound procedures. Students also spend one third of their time in the operating room where the hands-on opportunity has given the rotation an outstanding reputation. A lecture series accompanies the clinical experience and students appreciate the direct working relationship with faculty members. .

The UCSF Fresno program offers a unique, community based, core clerkship in Pediatrics. The rotation experience is based at the Children’s Health Center (CHC) outpatient facility, Community Regional Medical Center (CRMC) and Valley Children’s Hospital (VCH). Medical students spend 2 weeks at CRMC, working closely with a multi-disciplinary team including UCSF Fresno faculty, pediatric residents, social workers and nurses for their newborn and neonatal ICU experience. The ambulatory setting serves as the learning environment for 2 weeks concurrently with the newborn service as for a robust General Pediatrics experience. The remaining 3 weeks are spent at VCH, the only pediatric tertiary care referral center for the entire San Joaquin Valley. Student’s experience is supplemented by a structured core lecture series provided by the Department of Pediatrics primary and specialty faculty, as well as visiting UCSF professors. Although the emphasis is on primary care medicine, the student will see many interesting patients referred from throughout the Central Valley.

“The core clerkship in the Fresno Division of the UCSF Psychiatry Department emphasizes an integration of the biological, psychological, and social dimensions of patients evaluation and treatment. The training sites include a combination of inpatient, outpatient, and consultation-liaison venues at the Community Regional Medical Center and the Fresno VA Medical Center — both core teaching hospitals in the UCSF Fresno Medical Education Program.

The Community Regional Medical Center is a 450-bed facility that houses very busy medical, surgical, and obstetric services, along with the largest emergency department in California and the only Burn and Level I Trauma Centers between Los Angeles and Sacramento. The rotation at the Community Regional Medical Center emphasizes hands-on experience in psychiatric consultation combined with outstanding teaching from UCSF Fresno psychiatry faculty. The patient population is richly diverse both ethnically and socio-economically, and there is an abundance of patients with combined medical and psychiatric disorders.
The Fresno VA Medical Center supports a full spectrum of mental health services for veterans in the Central Valley. The Mental Health Clinic is the site of an 8-week longitudinal outpatient continuity experience for students, wherein they are able to evaluate and manage their own small caseload of outpatients under the close supervision of a senior faculty member.

The Psychiatry 110 clerkship in Fresno also includes a specialized didactic curriculum, an integrated Psychiatry-Neurology weekly case conference, weekly Psychiatry Grand Rounds, an in-depth biopsychosocial case report, and a formally-presented literature review.”

This core clerkship is for third year medical students, is four weeks in duration, and takes place primarily at the VA with some time spent also at Community Medical Center, Kaiser, and the Alzheimer Disease Center. The rotation emphasizes the approach to the Neurologic patient through history and exam and then the analysis of a case and its management. This takes place in both outpatient and in patient settings. Each patient is gone over with one of the core faculty (four at the VA and two at CRMC). There are clinics in covering geriatric Neurology, Movement disorders, general Neurology, and neuromuscular patients. At CRMC there is a stroke unit. There is also exposure to Brain Cutting, Neuroradiology, and cognitive Neuropsycholgy through special sessions. Teaching is accomplished in addition through review of vignettes and in didactic teaching sessions. The students are expected to write notes on the cases they see which will be in the chart of the patient and the notes will be reviewed by faculty. One afternoon a week is spent with Psychiatry as part of the continuity experience. All faculty are strongly committed to teaching.

Core experience in General Surgery in Fresno is provided at Community Regional Medical Center. Busy clinical services providing a spectrum of surgical care, from the simple to the complex, and the opportunity to perform many procedures have made this a popular clinical site for medical students. Daily lectures and an extensive amount of direct faculty contact serve to maximize the educational experience. The use of mid-level practitioners on the surgical services helps to minimize the amount of “scut.”

Students follow patients from clinic or Emergency Department presentation through surgery and the post-operative period. The clerkship includes 4 weeks on the Elective service and two weeks each on the Trauma Service and Burns/Plastics Service for a total of 8 weeks.