Rotation: Internal Medicine Inpatient Consult Rotation - NWTH

Site:

Instructors:

Make up of Team:

Days per Week:

Rotation Description:

Evaluation of patients in ER for possible admission or follow up care when requested by ER physician
In-house medical consults required by other services (i.e. ortho/surgery/gyn/neurosurgery)
Medical consult in Pavilion when requested by psychiatrist
No ICU consults - done by ICU resident on call
Rounding on all consult patients with the attending. The resident should evaluate and write a progress note before attending rounds each day. Should have seen patients beforehand

Usual Time of Attending Rounds (meeting place):

Usually before or after Morning Report, occasionally after 5 pm, according to resident and attending schedule. Meeting place - 5S or 5N/or Pavilion

Type of Patients Encountered:

Education Goals/Competencies:

Patient Care:

Proper evaluation of the patient presenting to ER with acute problems - with history and physical and utilization of appropriate labs and diagnostic modalities
Proper disposition of patient with either admission to general medical ward/ICU or discharge home with proper out patient follow up arrangements
Proper pre/preoperative risk assessment based on published guidelines
Management of chronic medical problems (hypertension/Diabetes/COPD/CHF) in preoperative period
Evaluation of delirium
Management of medical problems arising in post operative period - i.e. DVT/Pulmonary/Embolism/Atelectasis/Pneumonia, etc.
Procedural proficiency in: Central line, Paracentesis, Thorarocentsis, Arthrocentesis - (knee), Lumbar Puncture

Medical Knowledge:

Preoperative evaluation and risk assessment
Management of chronic medical problems in pre & perioperative period - i.e. HTN/Diabetes/COPD/CHF
Evaluation & management of delirium
Prevention and management of medical problems arising in post operative period - i.e. DVT/Pulmonary/Embolism/Atelectasis/Pneumonia, etc.

Interpersonal/Communication Skills:

Obtaining proper information in caring manner from patient/family/caregivers and medical records.
Communication with the patient on their disease, progress and plan of action
Daily progress note in timely and legible fashion. Notes should be clear and precise. Direct verbal communication with the consulting physician when possible
Proper check out to the on call resident

Professionalism:

Treat patients with respect irrespective of their illness (self inflicted or not) and beliefs
Treat all consultants/fellow residents and all the members of the health care team with respect

Practice Based Learning and Improvement:

System Based Practice:

To learn discharge planning and how to properly utilize resources in collaboration with hospital-based social work utilization review and discharge planning services
To understand different coverage of services provided by insurance companies and properly select patients who need rehab/skilled nursing or extended care facilities
To utilize psychiatry and substance treatment programs available at NWTH

Text/Reference to be Consulted:

Method of Evaluation:

By attending physician
1. Based on assessment & management of the problem
2. Thoroughness of evaluation
3. Documentation in medical record
4. Communication with consultants and paramedical staff
5. Knowledge base
By other staff (paramedical) and consultant - based on their experience with you. Usually given only when their experience is very good or very bad