Program Director Message

Ivy Darden

Steven Tringali, DO

Program Director



The training program is integrated between Community Regional Medical Center (CRMC), the program’s main teaching hospital and the Fresno Veteran’s Affairs Central California Health Care System (VACCHCS). The curriculum is competency based with a problem based learning format. This increases the opportunity for the program’s trainees to acquire life-long learning skills. The curriculum at all facilities features strong hands-on inpatient experience in caring for patients in intensive care units and on the general medicine wards and telemetry.

The basic curriculum provides balance between acute care/critical care medicine and ambulatory medicine in diverse training settings. Residents typically spend half of their time in inpatient settings and half in subspecialty or ambulatory experiences.

Ambulatory Care
The ambulatory experience includes the resident continuity clinic, ambulatory care rotations in the PGY1 and PGY2 years, and subspecialty clinic experiences. Interns have 1-2 clinics per week, except while in the MICU. The PGY2 and PGY3 schedule separates inpatient and ambulatory experiences by giving all residents discrete clinic blocks. Each residents will complete 12 weeks of clinic block annually, usually organized in
2 week intervals. Please refer to the schedule for more information. One continuity clinic is at the VACCHCS, the other at the Family Health Care Network (FHCN) at CRMC.

Inpatient Care
Inpatient medical teams include a PGY-2 or 3 level resident working with two PGY-1 residents and a dedicated internal medicine faculty member. Medical students on core internal medicine clerkships or 4th year students completing a sub-internship are often part of the medical team.

Subspecialty Care
Subspecialty elective rotations are available and provide greater in-depth knowledge and experience. Resident responsibilities include both inpatient consultations and outpatient clinics. By the completion of the three-year program, residents will have completed rotations in most of the subspecialty fields: cardiology, dermatology, endocrinology, gastroenterology, hematology/oncology, infectious diseases, nephrology, neurology, rheumatology and pulmonary medicine and more.

IM curriculum