Inpatient Medicine | NF

INTERN ROLE

• Primary clinician for all admitted patients. Tell your patient you are their doctor for the day. Discuss overnight events, lab results, and plan for the day. Answer questions, and explain care.

• Consult UL as needed for all admissions, help on orders, or on sick patients. UL is available any time, and there is not such thing as a stupid question.

• Carry the pager, returning all calls and admitting any new patients on mornings when you have hospital coverage in the afternoon. Wednesday mornings the pager is carried by the intern.

• In the afternoon, admit patients, ensure plans are being carried out, discuss cases with specialists, and ensure the list is updated prior to sign-out. Don't forget PM ICU notes (see ICU below).

• You are responsible for admitting patients until 45 minutes before scheduled sign out time. 

• Highlight questions you have about cases to your UL. These topics will get added into weekly teaching.

• Cap: 9 patients per intern

R2 ROLE

• Act as an independent hospitalist

• Assist and supervise medical student.

• Assist intern when they are overwhelmed.

• Provide teaching during rounds.

• Cap: 11 patients

  • If 11 very sick or active patients then this cap may be lowered

R3 ROLE

• Know all patients on service well. Review all labs and orders.

• Be support for intern. Check in with them before and after rounds to address any questions or concerns. 

• If intern/R2 are capped, see remaining patient overload.

• Otherwise, same as R2 second month

• See all new admissions from overnight, ICU patients, and sick/complicated patients daily. 

• Supervise new admissions and ICU/PCU transfers and write a brief UL H&P/sig event note within about 1 hour 

• Discuss all new admissions with attending physician. Review all admission orders.

Faculty Role

• NF teaching and feedback with R1.

• End of week feedback for all medicine team members.

• Support of UL in leadership of rounds.

  Rounding:

• FMC rounds start ~9:00-10:00. Check with your UL. ICU rounds are at 10:00am (see ICU below)

• Pre-round, see all patients, have notes done prior to rounds. 

• Call consults prior to rounds, if possible. Discuss with UL prior to consulting (especially in first month)

• Enter all orders for patients. Ensure the sign-out list is updated with daily plan prior to leaving for afternoon clinic and prior to afternoon sign out

• Discuss discharge needs with the transition care nurses - they have a lot to teach you!

ICU Patients:

• Discuss all orders with UL or attending, or review and place orders together. This helps us maintain our ICU privileges. 

• All ICU patients require an additional brief PM note - this is the responsibility of the daytime intern.

• ICU rounds are at 1000. Nurses present the patients. 

Pages:

• If it is about shortness of breath or chest pain, ALWAYS go see the patient. You can have nursing get vitals while you are on your way.

• When you are unsure what a nurse wants, ask if they are worried and would like you to come see the patient. If they say yes, go see the patient. 

• Write a brief "significant event" note whenever you see a patient after a page.

• If in doubt, call your UL.