Rotation Coordinator: Dr. Roland Mollanji roland.mollanji@nygh.on.ca
Site/Medical Education Administrative Assistant: Jordan Hoeller Jordan.hoeller@nygh.on.ca
The goal of the Hospitalist rotation at NYGH is to ensure that learners gain the Internal Medicine core competencies for inpatient care as developed by the College of Family Physicians of Canada and Family Medicine Program. At the end of the rotation the learners are expected to be able to recognize, assess, and manage a wide range of common acute medical conditions and to optimize the treatment of chronic co-morbidities. The residents who are interested to pursue careers in Hospitalist Medicine will be exposed to a model of care where they learn how to function as attending physicians.
During this rotation, you will provide direct patient care and develop more independence in assessment, management and discharge planning under the guidance of an experienced hospitalist. In a non-resident driven community inpatient setting, the residents will learn how to formulate and coordinate care plans with other physicians and allied health professionals. NYGH is a leading community hospital in implementing EMR in the inpatient setting and residents will be able to learn how to use and take advantages of CPOE (Computerized Provider Order Entry).
At NYGH, the Division of Hospitalist Medicine is located on 8West and is part of the Department of Medicine. There are 3 full-time hospitalists providing comprehensive care for adult patients 18 years of age and older, mostly elderly patients. There are 2 hospitalists on service at any time except for the weekend when one hospitalist will cover all hospitalist patients.
Four weeks prior to starting Hospitalist rotation, you are required to read the Learning Objectives for this rotation and contact the Hospitalist rotation coordinator, Dr. Roland Mollanji, to discuss their schedule, vacation requests, and other expected absences (e.g. religious holidays). You should contact the supervising hospitalist to arrange a time and place to meet on the first day of the rotation for orientation and to discuss your personal learning objectives.
You will be supervised by one hospitalist over a period of one to two weeks. Residents will work with different hospitalists during the rotation but will keep the same patients in order to provide continuity of care. Ideally, you will follow your patients from admission to discharge and be the primary physician directing their care. Besides providing medical care, this includes attending daily interprofessional rounds, working with the allied health team, participating in family meetings, connecting with the family physician, and coordinating discharge. You will work with a dynamic interdisciplinary team and are required to provide your pager or cell phone to the ward secretary and unit coordinator so you can be contacted if needed.
You are expected to work 8AM- 5PM but there will be variation depending on the number of patients and their complexity. There is no overnight call for this rotation. However, you are required to do one weekend call (Saturday and Sunday) for this rotation, ideally with their main supervisor. You are also required to do one evening per week of ER consults with the general internist on-call. See the Internal Medicine page for more details. Please refer to the main Internal Medicine page where the calendar is posted. https://calendar.google.com/calendar/embed?src=5h43ahnrhifq8hk31thi7mldp8@group.calendar.google.com
Educational rounds include Medical Grand Rounds (Tuesdays at 8am, currently on Microsoft Teams, but previously on the Ground Floor, Auditorium 2 & 3). Reading resources available through the NYGH Intranet include UpToDate, Lexicomp, and NYGH Antimicrobial Guidelines.
Patient Care:
Manage around 8 patients with a broad spectrum of clinical conditions seen in general internal medicine including pharmacologic and non-pharmacologic management
Perform a relevant and comprehensive history physical examination, incorporating relevant information from electronic records, physical records and connecting Ontario
Recognize disease presentations that may deviate from usual patterns
Perform patients’ medication reconciliation on Admission, Transfer and Discharge
Obtain appropriate and relevant sub-specialty consultation
Identify and manage patients with acute changes in clinical stability, involving CCRT/ICU when appropriate
Discuss goals of care with patients/substitute-decision makers early in hospitalization
Be aware of potential complications related to patients’ admissions to the hospital (pain, falls, infection, delirium, ulcers, polypharmacy, DVT, etc.) and initiate prevention measures
Perform basic invasive procedures. (e.g. NG tube placement)
Assess patient’s readiness for discharge and need for CCAC support as well as appropriate follow up to ensure safe transition to the community
Medical Expert:
Describe the relevant pathophysiology for common and/or complex medical conditions.
Demonstrate knowledge sufficient to diagnose and treat common inpatient conditions. Identify and develop a preliminary management plan for complex, undifferentiated and emergent conditions, including conditions that require intensive care
Order and interpret common medical investigations judiciously
Develop a comprehensive admission management plan with differential diagnoses, which prioritize issues beyond those of disease acuity, incorporating function, social support, and family and community context
Communicator:
Communicate effectively and professionally with patients, their families, allied health and physicians
Counsel patients about risks and benefits of tests, procedures and treatment alternatives
Engage patients / advocates in shared decision-making for difficult, ambiguous or controversial situations
Participate and demonstrate effective communication skills in family meetings, with supervision
Demonstrate effective communication during transitions of care and especially end of life care
Use problem-based charting to effectively follow patients with multiple medical issues
Develop discharge summaries that communicate relevant information for patients and outpatient providers.
Collaborator:
Collaborate with interdisciplinary team members and subspecialists to manage common and complex medical conditions.
Engage and collaborate with the Antibiotic Stewardship Committee member during Antimicrobial Stewardship rounds
Identify the variety of community resources including rehabilitation, long term care, LHIN services
Demonstrate appropriate and timely referral to outpatient services e.g. Geriatric Outreach, Geriatric Psychiatry, Heart Function Clinic, COPD Clinic.
Considers and access appropriate health care professional and community resources to optimize patients functioning and discharge planning as well as reduce risk of readmission.
Professionalism:
Display awareness of the core values of the profession and actively and independently takes steps for professional development
Respect patients’ dignity and autonomy.
Demonstrate honesty, reliability, compassionate attitude and maintain appropriate boundaries.
Recognize and manage conflict when patient values and personal values differ.
Advocate for appropriate allocation of limited health care resources.
Advocate for patients within the healthcare system, demonstrating sensitivity and responsiveness to patients’ culture, age, gender, sexual orientation and disabilities.
Appreciate biopsychosocial factors which may impact discharge/disposition at the time of admission.
Scholar:
Incorporate evidence into clinical decision making, integrate learning from prior clinical exposure, identify gaps in clinical knowledge/attitudes/skills and take steps to address this.
Use appropriate resources based on clinical question.
Independently appraise clinical guideline recommendations for bias and cost-benefit considerations.
Reflect on personal experience and feedback.
Participate in formal learning sessions on the floor, attend Department of Medicine Grand Rounds
Use information technology to manage patient-specific information and work effectively within the hospital system.
Manager and Health Advocate:
Promotes the health of individual patients within inpatient setting.
Demonstrate efficient time management by setting priorities to manage multiple inpatients during the day
Incorporated of cost-awareness in complex clinical situations.
Identify health needs for individual patients and advocate appropriately. Identify gaps in available services and address them.
Demonstrate an understanding of the complexity of directing effective patient-centered care in a community hospital.
Avoid treatment and procedures which are not supported by evidence and/or potentially may cause harm to the patient as per CWC (Choosing Wisely Canada).
Cardiology: ACS, CHF, Atrial fibrillation, Valvular heart disease, HTN, Chest pain, PVD
Respirology: Pneumonia, COPD, Asthma, TB, Pleural effusion, Lung cancer
Gastroenterology: GI Bleeding, Diarrhea, Constipation, Nausea/Vomiting, Abdominal Pain, IBD, Pancreatitis, Diverticulitis, Cholecystitis, CBD obstruction, Cirrhosis, Ascites
Geriatrics: Falls, Dementia, Delirium, FTC, Polypharmacy
Hematology: Anemia, Thrombocytopenia, Transfusion medicine, DVT/PE, Myeloma
Nephrology: AKI, CKD, Acid-base disturbances, Hypo/hypernatremia, Hypo/hyperkalemia
Neurology: TIA, CVA, Back pain/radiculopathy, Seizures, PD, Syncope, Dizziness, Headache
Rheumatology: Crystal arthritis, GCA/PMR, OA, OP, Lupus, RA
Infectious Disease: UTI, Cellulitis, Osteomyelitis, Diabetic foot infection, Sepsis NYD, Endocarditis, Meningitis, Encephalitis, Fever in the returning traveller, Fever of unknown origin
Endocrinology: DM, DKA/HHS, Hypo/Hyperthyroidism, Hypo/hypercalcemia, Dyslipidemia
Urology: Urinary retention, Hematuria
Palliative Care: Symptom management, End of life care, Goals of care
Other: Chronic non-cancer pain, Allergic reactions, Drug overdose, Alcohol intoxication/withdrawal, Hypo-/Hyper-phosphatemia, Hypomagnesemia, Malnutrition, Re-feeding syndrome
Common Medical Investigations: Bloodwork, ECG, CXR, CT Head, ABG, Spirometry/PFT, Urinalysis, Fluid analysis (Peritoneal, Pleural, Joints, CSF)
Final evaluations will be done in POWER by the hospitalist who supervised the resident most of the time. Residents should also arrange to meet with their supervisor for mid-rotation feedback.