Internal Medicine Rotation
Internal Medicine Rotation Educational Objectives
The transitional resident spends four months on the Internal Medicine service on three distinct rotations: general medicine wards, night float and intensive care unit. The ward service is organized without subspecialty services, which allows the resident to evaluate and care for a wide array of patients with general internal medicine and subspecialty problems. This experience provides an opportunity to encounter the diseases and to confront the challenges that a general internist faces.
At the beginning of the academic year, the Department of Medicine sponsors a core lectureship series during the noon hour. This series covers topics that provide new residents with the fundamentals to handle many difficult and life-threatening situations. The transitional resident, whether rotating on Internal Medicine or other services, is encouraged to attend as many of these lectures as possible. Prior to the beginning of residency, each transitional resident is required to become board-certified by the American Heart Association in Basic and Advanced Cardiac Life Support. Training is provided by Legacy during orientation.
While on the Internal Medicine rotations, the resident is part of a team, directly supervised by a senior resident and a staff attending physician. During these rotations, the resident is expected to:
- Elicit satisfactory histories and perform thorough physical exams.
- Make initial assessments and write admitting orders.
- Learn rapid and efficient management of the physiologically unstable medical patient.
- Master the systems approach to the care of the critically ill medical patient.
- Function productively as a member of the health care team.
- Insure the provision and prompt interpretation of laboratory tests.
- Complete accurate, descriptive, and concise daily progress notes.
- Write prompt, clear physician orders.
- Help patients and their families to develop emotional and other support systems.
- Assist patients to transition effectively to their usual social settings after discharge.
- Become proficient in technical procedures such as, endotracheal intubation, arterial line placement, pulmonary artery catheter placement, central venous access, bone marrow biopsy and obtaining bodily fluids from the thorax, peritoneum, and joint spaces.
- Learn to interpret diagnostic tests such as arterial blood gases, electrocardiograms and pulmonary function studies.
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The General Medicine Wards
On the medicine wards, the transitional resident performs a complete history and physical examination for each patient admitted to the residency service from the Emergency Department, outpatient clinic or private physician's office. The transitional resident has primary responsibility for planning, record keeping, order writing and continuing management of his/her patients throughout the hospital stay until discharge and serves as the key contact member of the hospital-based team.
Resident supervision is provided by the senior medicine resident as well as hospital-based medicine faculty and private attending physicians. As the transitional resident acquires a solid knowledge base and decision-making capabilities, the degree of direct supervision diminishes. Both senior residents and staff physicians provide bedside and didactic teaching, and conduct evidence-based medical literature evaluation.
While on the general medicine ward rotations at Legacy Emanuel Medical Center , the transitional resident cares for patients in the medical intensive care unit and continues to be responsible for the patient after transfer from the intensive care unit to the wards. At Legacy Good Samaritan, there is a separate ICU team.
Medical Intensive Care Unit
The Intensive Care Unit rotation is a separate and distinct rotation at Legacy Good Samaritan Medical Center. This rotation provides an opportunity to learn in-depth critical care techniques and provide care exclusively to critically ill medicine patients. The rotation also provides additional teaching, with didactic and bedside teaching rounds by intensivists, pulmonologists, the Chief of Medicine and Department of Medicine Faculty Coordinators.
This rotation begins at 8:30 p.m. and ends at 7 a.m. each day. The responsibilities of the transitional resident include management of inpatients who become unstable overnight, as well as admission of patients from the Emergency Department to the general medicine ward service. The transitional resident is supervised directly by a senior medicine resident and teaching is provided by the medicine resident, private attending physicians and daily faculty teaching rounds each morning.
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The core of any training program in general medicine is the experience of taking care of patients on the wards and in the clinics. The experience becomes focused through teaching conferences and rounds. Our teaching attending rounds take place outside of work rounds. Each inpatient team attends Chief of Service Rounds once a week and Attending Rounds four times a week. Morning Report, at which interns present cases and Chief Medicine Residents facilitate, is held twice a week on Tuesday and Thursday before clinic conference. Night Float teams attend Night Float rounds on Tuesday and Thursday following Morning Report.
In addition to bedside teaching, a variety of formal conferences are held. Noon conferences occur at each hospital daily: each week two of these are Noon Report and patient case conferences with the Chief of Medicine, and the other three are didactic conferences led by private attending and internal medicine faculty staff. Each Friday morning, Medical Grand Rounds features local and national speakers in a variety of formats. On Tuesday afternoons the autopsies of the week are reviewed at the Morgue conference, which is led jointly by the Chief of Medicine and a teaching pathologist. Clinic conferences are held biweekly for the residents assigned to the clinic block rotation.