The UCLA Combined Residency Program in Internal Medicine and Pediatrics (Med-Peds) trains physicians who are both internists and pediatricians through a comprehensive braod-based curriculum and clinical experiences with an emphasis on academic medicine. Med-Peds physicians have a unique perspective on the care of patients throughout the life span. The multigenerational approach to the patient and family affords insight into not only the comprehensive medical care of the patient but the important context of family and community systems.

The framework that our residency training program utilizes as a foundation for our curriculum is the Life Course Health Development (LCHD) model (Halfon and Hochstein, 2002). The LCHD framework was created to explain how health trajectories develop over an individual's lifetime. More importantly, the LCHD model recognizes that health is the consequence of multiple determinants operating in nested genetic, biological, behavioral, social and economic contexts that change as a person develops. Based on the relationship between experiences and the biology and psychology of development, the LCHD framework offers a conceptual model for health development and a more comprehensive approach to understanding diseases. Med-Peds training produces physicians who have firsthand experience observing the development of these health trajectories and understand the early origins of adult disease processes.

Med-Peds physicians fill a very important niche in academic medical centers, which is the ability to understand issues regarding transition of care of patients with chronic illnesses from Pediatrics to Internal Medicine. Med-Peds physicians also have a better understanding of adolescent medicine and the issues pertinent to this population. Finally, Med-Peds physicians maintain the interdisciplinary integration within medical centers and facilitate communication between departments.

The goals of the UCLA Med-Peds Residency Training Program are to produce physicians who will have the following skills:

1. Are proficient in obtaining clinical data by patient interview, physical examination, and interpretation of laboratory data.
2. Are proficient in utilizing clinical data to prioritize problems, and formulate differential diagnoses. Residents will formulate diagnostic and therapeutic plans demonstrating awareness of risks, benefits, costs, patient preferences, and ethical and psychosocial issues.
3. Utilize excellent communication skills with patients, families and other members of the health care team, demonstrating respect, compassion and integrity.
4. Demonstrate a commitment to ethical principles and to their professional responsibilities.
5. Achieve a broad knowledge base by reading regularly in texts and in the original literature.

Provide a 4-year curriculum with the following elements:

1. a. comprehensive clinical experiences that prepare the resident to care for patients of all ages in multiple settings
   
   b. appropriate educational and clinical experiences that fulfill the eligibility requirements of both the American Board of Internal Medicine (ABIM) and the American Board of Pediatrics (ABP)
   
   c. opportunities to pursue individual interests that may lead to careers in subspecialties, research, administration, public health, or education
   
   d. curricular experiences focused on understanding practice based learning and systems based practice, with an emphasis on culturally competent care and reducing health disparities
2. Provide a combined ambulatory, continuity clinic experience caring for both adults and children in a medically underserved community.
3. Provide adequate mentoring to ensure an optimal residency experience for Med-Peds residents, recognizing the unique issues of the dual-department status of
   these residents.
4. Provide appropriate role models of Med-Peds graduates at UCLA and elsewhere to enlighten and educate Med-Peds residents about future professional
   opportunities.
5. Educate the greater UCLA medical community regarding the role and training of Med-Peds residents and graduates.
   

The competencies listed below are achieved through a required set of rotations, a didactic curriculum, scholarly activity, use of simulator lab, computer modules, and an individualized set of electives. Our residents, faculty and program are continuously evaluated to ensure success in achieving these competencies, goals, and objectives.

Patient Care
Residents must be able to provide patient care that is compassionate, appropriate, and effective
for the treatment of health problems and the promotion of health. Residents are expected to:

1. Communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families
2. Gather essential and accurate information about their patients
3. Make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment
4. Develop and carry out patient management plans
5. Counsel and educate patients and their families
6. Use information technology to support patient care decisions and patient education
7. Perform competently all medical and invasive procedures essential for the practice of general internal medicine and pediatrics.
   
   a. This includes competency in performing, using appropriate indications, contraindications and informed consent and evaluating the results of the following procedures: nasogastric tube placement, foley catheterization, pelvic examination and pap smears, EKG interpretation, PPT interpretation,
   CXR interpretation, basic life and advanced life support, phlebotomy, arterial puncture, paracentesis, thoracentesis, arthrocentesis of the knee, central venous line placement, and lumbar puncture.
8. Provide health care services aimed at preventing health problems or maintaining health
9. Work with health care professionals, including those from other disciplines, to provide patient-focused care

Medical Knowledge
Residents must demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care. Residents are expected to:

1. Demonstrate an investigatory and analytic thinking approach to clinical situations
2. Demonstrate a sufficient level of understanding of the clinical, basic and social sciences that underlie the practice of internal medicine and pediatrics and be able to demonstrate that they can apply their knowledge to patient care, patient education, and the education of other members of the health care team
   
   a. Areas of knowledge will include understanding the pathogenesis, pathophysiology, epidemiology, historical issues, relevant physical findings, test utilization, means of confirming a diagnosis, treatment, monitoring and prevention of the most common inpatient and outpatient clinical disorders cared for by internists
3. Understand how various aspects of disease are affected by gender, age, ethnicity, culture and disability
   

Practice-Based Learning and Improvement
Residents must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices. Residents are expected to:

1. Analyze practice experience and perform practice-based improvement activities using a systematic methodology
2. Learn how to self-evaluate cognitive, technical, attitudinal and procedural aspects of care
3. Locate, appraise, and assimilate evidence from scientific studies related to their patients' health problems
4. Obtain and use information about their own population of patients and the larger population from which their patients are drawn
5. Apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness
6. Use information technology to manage information, access online medical information; and support their own education
7. Facilitate the learning of students and other health care professionals
8. Prior to the completion of training, all residents will demonstrate scholarly activity.
   At a minimum this will include:
   
   a. Presentation of a 50 minute senior talk
   b. Presentation of original research or case report at a regional or national meeting
   c. The application of evidence-based medicine skills through ongoing participation in journal club, junior resident rounds, senior resident rounds
   

Interpersonal and Communication Skills
Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patients families, and professional associates. Residents are expected to:

1. Demonstrate effective written, verbal and nonverbal communication when participating in patient care, consulting and collaborating with colleagues and coworkers, teaching and presenting in the academic center and most importantly during information exchange and collaboration with patients and their families
2. Create and sustain a therapeutic and ethically sound relationship with patients
3. Use effective listening skills and elicit and provide information using effective nonverbal, explanatory, questioning, and writing skills
4. Work effectively with others as a member or leader of a health care team or other professional group

Professionalism
Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. Residents are expected to:

1. Demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients and society that supercedes self-interest; accountability to patients, society, and the profession; and a commitment to excellence and ongoing professional development
2. Demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, and business practices
3. Demonstrate sensitivity and responsiveness to patients' culture, age, gender, and disabilities

Systems-Based Practice
Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. Residents are expected to:

1. Understand how their patient care and other professional practices affect other health care professionals, the health care organization, and the larger society and how these elements of the system affect their own practice
2. Know how types of medical practice and delivery systems differ from one another, including methods of controlling health care costs and allocating resources
3. Practice cost-effective health care and resource allocation that does not compromise quality of care
4. Advocate for quality patient care and assist patients in dealing with system complexities
5. Know how to partner with health care managers and health care providers to assess, coordinate, and improve health care and know how these activities can affect system performance