Most medical students have had only limited experience in caring for medical inpatients, prior to starting their Internal Medicine rotation. The primary purpose of the Internal Medicine CTU rotation is to provide student interns with experience in managing inpatients with a wide variety of acute and chronic medical problems, while receiving close supervision, teaching, and feedback, to ensure an effective educational experience. The specific responsibilities for SI’s on the General Medical CTUs include:
Each SI is expected to serve as the primary care physician for up to 5 patients on the service, under the supervision of the senior medical resident and the Attending Physician.
The SI will carry out a complete history and physical examination on all patients assigned to his/her care, with the assistance of the other house staff and the Attending Physician.
As part of this process, the SI will develop a comprehensive problem list on each patient under his/her care, together with a focused differential diagnosis for each problem, and clear concise and comprehensive admission orders, again with the assistance of the other house staff and the teaching faculty.
The SI’s will maintain complete, concise, problem oriented daily progress notes on all patients assigned to their care, and identify new medical problems as they arise over the course of the admission. SI’s will participate actively in discharge planning, including the initiation of referrals to OT, PT, dietary, social services, and home care as required. Each student will ensure that patients under his/her primary supervision have an adequate supply of medications at discharge, appropriate clinical follow up, and are responsible for the discharge summary.
SI’s will be on call for their service up to one night in four, and on weekends on a rotational basis. When on call, the student will be responsible for new admissions assigned to them in emergency, assess patients admitted to his/her service, and to provide coverage for the other patients on the CTU. SI’s are not expected to take call the night before the rotation‐end examinations, or past 12:00 AM the night before starting a new rotation.
As outlined above, students will be expected to review the status of all patients under their care after student teaching sessions each weekday morning (currently 0800-0830). Students will participate in the various rounds and teaching sessions outlined in the teaching schedule table.
Like the junior residents, the primary educational goal for student interns on the General Medical CTUs is to improve their medical knowledge, clinical skills, and clinical problem solving ability, while acquiring essential clinical experience. The rotation also provides students with an opportunity to enhance their interpersonal skills, not only in dealing with patients and their families, but also in daily interactions with other house staff, nursing personnel, allied health care professionals, consulting services, and supervising faculty. Students will have an opportunity to learn some common medical procedures as part of the rotation.
Junior and Senior residents may work with medical students who are completing their medicine rotations, and have opportunities to provide bedside teaching. Senior (PGY3) residents also participate in teaching these students during their Academic Half Day. We ask that residents refer to the following "Top Ten Topics", and discuss these with the medical students on the team. Teaching others is an important area of medicine, and educating the medical students around you is a great way to start!
The medical student is expected to demonstrate a reasonable approach to the diagnosis and initial management of the following conditions:
Shock Including hypovolemic, septic, and cardiogenic
Dyspnea Including heart failure, COPD exacerbation, pulmonary embolism, pneumonia, asthma. This includes basic interpretation of CXR, pulmonary function tests and arterial blood gases.
Chest Pain Including angina, myocardial infarction, aortic dissection, gastroesophageal reflux, pulmonary embolism, chest wall pain. This includes basic interpretation of ECGs (hypertrophy, myocardial infarction, bundle branch block, arrhythmias).
Altered level of consciousness Including coma, delirium, syncope, seizure
Hematemesis including gastritis, peptic ulcer, Mallory Weiss tear, esophageal varices
Renal failure Including renal, pre‐renal and post‐renal causes, acid‐base, fluid and electrolyte disturbances, calcium disorders
Hypertension Including primary and secondary causes
Anemia Including iron deficiency and chronic disease
Diabetes Including management of ketoacidosis and hyperosmolar state, awareness of complications and basic management with oral hypo glycemic agents and insulin
Fever Including pneumonia, urinary tract infection, cellulitis, septic joint, meningitis, endocarditis
TOTAL 7 overnight calls – With at least ONE of which MUST be a 24 hour weekend call shift (Saturday or Sunday) and one weekend day (Saturday or Sunday) call from 0900-2200. Please note Friday’s ARE NOT considered a weekend day and STAT holidays ARE considered a weekend day.
No student shall be scheduled for in‐house call duty, or a combination of in‐house and home call duty, on two consecutive days.
Expectations when on call:
New patients from the emergency department or transfers from other units will be triaged by the senior resident on call to the R1’s/student interns during weekends and on weekdays after 5pm. During weekdays, the senior resident on the consult service will speak directly to the senior resident on the team who will triage the patient appropriately depending on patient load/call schedule, etc. The patients you admit remain yours, unless the need for redistribution arises.
Typically, there is someone on call for each team every day, and the patients are triaged in order: CTU A, B, or C.
Ward coverage: Each resident/student intern on call is responsible for any calls related to their team’s patients. If one team does not have a resident/student on call, one of the other junior residents will be responsible for cross coverage and should receive sign over from the senior on that team. Students are not expected to cross cover another team.
When called by a healthcare professional in the wards, ASSESS the patient; CALL the senior resident with ANY questions. If unsure, or patient is deteriorating call the senior immediately, or call the MET team. Student Interns can page the R1’s with any ward questions, who will then review the patients personally with the student. If both the student and the junior resident are unsure, the senior resident on call must be called immediately to discuss issues of concern.
For more information from the UGME office, please refer to the Med 546 Clerkship Rotation Website