Most trainees have acquired substantial medical knowledge, clinical skills, problem solving ability, and clinical experience by the time they become junior residents. The primary purpose of the Internal Medicine CTU rotation for junior residents is to consolidate and expand that knowledge, skills, and judgement through additional supervised clinical experience, and in turn facilitate the transition from student to independent practitioner. The major responsibilities for junior residents on the General Medical CTUs include:
Each junior resident will be assigned up to 8 active patients on the service, under the supervision of the senior resident and Attending Physician.
The junior resident will be expected to carry out a complete history and physical examination on all new admissions assigned to his/her care, and complete:
A comprehensive problem list incorporating a differential diagnosis for each active problem, and a plan of investigation and treatment.
Clear, concise and comprehensive admission orders.
As part of the admission process, junior residents will review old medical records available for background information. The resident will also contact the family physician both to acquire additional patient information, and to establish clear lines of communication to facilitate discharge planning and a smooth transition of care from the hospital back to the community. Junior residents are expected to contact other consultants involved in the patient’s ongoing management when appropriate, to improve continuity of care.
All junior residents are expected to maintain complete but concise daily progress notes on patients under their primary care, in a problem oriented format. Accurate documentation is a legal as well as a medical requirement. As part of this process, junior residents are expected to identify new patient care problems as they arise, and initiate additional investigations and treatment as required.
Junior residents will participate actively in discharge planning for all patients under their care, including initiating appropriate consultations to OT, PT, social worker and home care when required, as well as completing discharge orders, arranging follow up, ensuring that the patient has sufficient medications at discharge, and completing a discharge summary.
When on call, junior residents are expected to manage all admissions to their service, as well as providing coverage for the other patients on the CTU. If covering for another team, junior residents should receive hand over from the team they are covering. Junior residents may be asked to provide back up and support for students or other junior residents on call for the other medical CTUs.
The primary educational goal for junior residents is to improve their medical knowledge, clinical skills, and clinical problem solving ability. The rotation also provides junior residents with an opportunity to enhance their interpersonal skills, not only in dealing with the patients and their families, but also in daily interactions with other house staff, nursing personnel, allied health care professionals, consulting services, and supervising faculty. Finally, junior residents on General Medical CTUs have an opportunity to learn a number of common medical procedures.
For further information, you can refer to the CIM aimrs.ca site for more information.