University of California San Francisco
UCSF School of Medicine UCSF Medical Center

The UCSF 49

The UCSF 49

Overview

The UCSF School of Medicine’s curricular framework—The UCSF 49—was designed to educate Bridges Students on the most common diseases and syndromes impacting communities in the San Francisco Bay Area.

Through The UCSF 49, this work further illustrates the School’s commitment to public service, social and health care equity, and community engagement, and reflects the values of the very best practicing physicians: compassionate, accountable, and expert.

The UCSF 49 contribute to a “Uniquely UCSF” medical education: how our students learn, their habits of mind, and the competencies they will bring to the next phase of professional development.

What Are The UCSF 49?

The UCSF 49 are a group of core syndromes and disorders that will anchor UCSF medical students' journey through the Bridges Curriculum. While aspects of the Bridges Curriculum will drive students to the dynamic frontiers of medical knowledge, The UCSF 49 help serve as curricular guideposts. The syndromes and disorders that comprise The UCSF 49 are clustered into related clinical conditions. Organized in this way, The UCSF 49 will help students build robust neural networks for clinical decision making, which requires comparing and contrasting similar clinical presentations.

The UCSF 49

Common Symptoms

  1. Cough & Wheezing
    • Asthma1-6  
    • COPD1-6 
  2. Diarrhea  
    • Acute Infectious1-4 
    • Celiac Disease1,2,4,6 
    • Inflamm. Bowel Disease1-3, 5 
  3. Dizziness  
    • Atrial Fibrillation2-5 
    • Benign Positional Vertigo1,2 
    • Posterior Circulation Infarct3,5 
  4. GI Symptoms, Lower Diverticulitis1-5 
    • Hemorrhoids2-6 
    • Irritable Bowel Syndrome2,4 
  5. GI Symptoms, Upper Gastroparesis1,2,5 
    • GERD1,2,4-6 
    • Ulcer Disease1-6 
  6. Headache  
    • Brain Tumor3,5 
    • Migraine1,2,4
    • Subarachnoid Hemorrhage1-3,5 
  7. Ocular Disturbances  
    • Acute Vision Loss1,3,5 
    • Diplopia1,3,5 
    • Red Eye1,3,5 
  1. Pain
    • Ankle Sprain2,4,5 
    • Fibromyalgia1,2 
    • Low Back2-5 
    • Rotator Cuff1,2,4,5 
  2. Painful Legs  
    • Acute Ischemia3,5 
    • Claudication1,5 
    • Peripheral Neuropathy1,5,6 
  3. Skin Complaint  
    • Drug Eruption2-5 
    • Itch2,4 
    • Pigmented/Raised Lesion2,3,5,6 
  4. Sleep Disorders  
    • Insomnia1,4,5 
    • Narcolepsy1 
    • Obstructive Sleep Apnea1,5 
  5. Upper Respiratory Complaints
    • Allergic Rhinitis/Sinusitis1,2,4 
    • Otitis Externa1,2,4 
    • Otitis Media1,2,4 
    • Streptococcal Pharyngitis1-5 
  6. Urinary Tract Complaints
    • Dysuria1-4 
    • Hematuria1,2,4 
    • Urinary Incontinence1,2 

Urgent Syndromes

  1. Acute Abdominal Pain  
    • Abdominal Ischemia2,3,5  
    • Bowel Obstruction2,4 
    • Pancreatitis2-4  
  2. Altered Mental Status   
    • Coma2,3,5 
    • Delirium2,3,4,6 
    • Psychosis1,3,5 
  3. Cardiac Arrest   
    • Asystole3  
    • Pulseless Electrical Activity3 
    • Wide-Complex Tachycardia3 
  4. Chest Pain   
    • Acute Coronary Syndrome2-5  
    • Angina2-6   
    • Pneumothorax2-5  
  5. Dyspnea   
    • Commun. Acq’d Pneumonia2-5  
    • PE/DVT2-5  
    • Pleural Effusion2,4,5  
  6. Edema   
    • Acute/Chron. Kidney Dz2-6 
    • Cirrhosis2-5  
    • Congestive Heart Failure2-5
  1. Fever
    • Cellulitis2-4 
    • Fever in the Newborn3,5 
    • Postoperative Fever2-4 
    • Staphylococcal Bacteremia2-4 
  2. Muscular Weakness
    • Guillain Barre1,3,4,5
    • Myasthenia Gravis1,4,5 
    • Spinal Cord Compression1,3-5
    • Stroke2-5  
  3. Shock   
    • Anaphylaxis3,5 
    • Cardiogenic Shock2,3,5
    • Hemorrhagic Shock2,3,5  
    • Sepsis & Septic Shock2,3,5
  4. Syncope   
    • Aortic Stenosis2-5  
    • Epilepsy2-5  
    • Orthostatic Hypotension2,4  

Prevention & Wellness

  1. Cardiovascular Risk Factors
    • Hypertension2-6 
    • Diabetes2-6  
    • Dyslipidemia2,4-6  
  2. Diet Disorders   
    • Eating Disorder2,6  
    • Malnutrition2,6  
    • Obesity2,6
  1. Oral Health   
    • Caries & Gingivitis1,4,6
    • Oral Cancer5,6  
    • Dental Pain1,3,5  
  2. Other Prevention & Wellness
    • Adherence, Health Literacy4,6  Counseling, Behavioral Change4,6  
    • Immunizations4,6

Common Aging Issues

  1. Complications of Aging   
    • Falls1,3 
    • Hearing Loss1,5,6
    • Polypharmacy4 
  1. Neurodegenerative Disease
    • Alzheimer Disease1,5,6 
    • Parkinson Disease1,5 
    • Prion Disease1,5 

Common Cancers

  1. Cancer
    • Breast1,5,6
    • Colorectal1,5,6
    • Lung1,5
    • Prostate6

 

Common Developmental Disorders

  1. Devel./Learning Disorders
    • ADD/ADHD1,5
    • Autism5
    • Developmental Delay1,5

 

Common Endocrine Disorders

  1. Endocrine Disorders
    • Adrenal Insufficiency1-3
    • Hypothyroidism1,2,6
    • Osteoporosis1,5,6

 

Common Infections

  1. Herpesvirus Infection
    • EBV Infection1,2
    • Genital HSV1,2,4
    • Herpes Zoster1-5
  2. Blood-Borne Pathogens
    • Hepatitis B2,4-6
    • Hepatitis C2,4-6
    • HIV2,4-6
  1. Global Infectious Disease
    • Malaria1-3
    • Tuberculosis1,2

Common Laboratory Abnormalities

  1. Abnormal Liver-Related Enzymes   
    • Alcoholic Hepatitis1,2,4  
    • Hemochromatosis2,6
    • Hemolysis2 
  2. Anemia
    • B12 & Folate Deficiency1,2,4 
    • Iron Deficiency1,2,4,6 
    • Sickle Cell Anemia1,2,5,6 
  1. Bleeding Disorders   
    • DIC2,3 
    • Thrombocytopenia1,2 
    • Vitamin K Deficiency1,2,4 
  2. Electrolyte Disorders   
    • Anion Gap Acidosis1,3,4 
    • Hyperkalemia3,4 
    • Hyponatremia1,3,4  

Common Rheumatologic Disorders 

  1. Arthritis
    • Osteoarthritis1,2 
    • Rheumatoid Arthritis1,2,5  
    • SLE1-3,5  

 

Mental Health & Illness

  1. Affective Disorders
    • Bipolar Illness2-5
    • Major Depression2,3
    • Suicidality2-5
  2. Stress Disorders
    • Anxiety1,4,5
    • Panic Disorder1,3-5
    • PTSD1,3,5,6
  1. Substance Abuse
    • Alcohol2-4,6
    • Opioid2,3,6
    • Tobacco2,4,6

Trauma & Violence

  1. Head Trauma
    • Concussion2-4,6
    • Subdural Hematoma1-3,5
    • Traumatic Brain Injury2,3,5
  1. Interpersonal Violence
    • Child & Elder Abuse3-6
    • Intimate Partner Violence3-6
    • Penetrating Trauma3,5

Men’s Reproductive Health

  1. Male Genitourinary Disorders
    • Erectile Dysfunction1,4,5
    • Scrotal Mass/Pain2,3
    • Testicular Cancer1,5,6

 

Women’s Reproductive Health

  1. Abnormal Vaginal Bleeding
    • Abnormal Uterine Bleeding2,4,5
    • Ectopic Pregnancy2,3,5
    • Postpartum Hemorrhage3,5
  2. Gynecologic Symptoms
    • Amenorrhea2,4,5
    • Pelvic Pain2,3,5
    • Vaginitis2,4-6
  1. Reproduction & Gestation
    • Contraception4-6
    • Labor & Delivery3-5
    • Prenatal Care4-6

1Recognize & Describe: For symptom or syndrome, describe the classic illness script* for the top three most prevalent causes plus the most emergent cause. For a disease, describes the illness script*.

2Diagnose: In addition to recognizing and describing (above), outlines diagnostic criteria (where applicable), orders and interprets appropriate diagnostic tests (lab and imaging) based on pretest probability and characteristics of the diagnostic test.

3Triage & Resuscitate: Recognizes and communicates condition, including presence of “red flag” symptoms/signs; implements life- or limb-saving treatment while arranging for an appropriate expert team to assume care.

4Manage: Describes evidence-based management strategies, describes criteria for therapeutic success, describes and monitors treatment side effects. Also recognizes epidemiologic factors, comorbidities, and medications that pose risks and require alterations in standard treatment or monitoring. Implements infection control protocols, if indicated.

5Consult: Identifies appropriate consultant to assist in management, and communicates in time frame appropriate to the patient’s needs and pace and severity of the disease.

6Prevent & Screen: Describe and order evidence-based screening recommendations; outline characteristics of individuals needing a different screening approach based on epidemiology, exposure, or family history that conveys higher risk; interpret results of screening tests and initiate timely referral to the appropriate specialist.

*Illness Script: includes epidemiology, time course, signs, symptoms, and underlying disease mechanisms


Glossary of Terms

Category: The broad topic area of health in which the cluster falls into.

Cluster: The UCSF 49 are the identified 49 clusters of diagnoses/syndromes that our graduates will be able to recognize, treat, or act upon appropriately as indicated in the table.

Diagnosis/Syndrome: The more specific diagnosis or syndrome within the identified cluster that students must be able to address or take action in at least one of the ways described below.

Clinical Actions: In the six areas noted in The UCSF 49, the accompanying descriptions identify a level of clinical action. The configuration of “x” marks in the category columns indicate graduating UCSF students’ expected competence for each diagnosis or syndrome. Arrows beside an “x” and spanning adjacent cells indicate the expectation of a continuum of competence. For cells lacking an “x,” either the activity is not applicable or the activity is considered more advanced than that expected of a graduating medical student. As a reminder, please refer to the Bridges Curriculum MD Competency Milestones.