Overview
The adult medicine curriculum of the Memorial Hospital Family Medicine Residency consists of experiences in general internal medicine (inpatient medicine), cardiology, pulmonary medicine, gastroenterology and chief of the medicine service. During the inpatient medicine, cardiology, pulmonary medicine and medicine chief rotations, patients are regularly attended in the ICU/CCU setting.
First and second-year residents rotate on the inpatient medicine service, and the details of that rotation are contained in this document. The other adult medicine experiences have distinct curricula.
Goal
The inpatient medicine rotation shall provide the family medicine resident with the skills and knowledge to care for adult patients in the hospital setting.
Objectives
While caring for patients in the hospital, the resident:
PGY-1
- is able to perform a complete and accurate general history and physical exam. (PC)
- can present an appropriate and broad differential diagnosis for patients admitted to the hospital. (MK)
- can effectively manage uncomplicated adult patients in the inpatient setting with close supervision. (PC, MK)
- accurately shares medical information with patients and families and assesses the patient’s comprehension of the information. (ICS)
PGY-2
- demonstrates appropriate medical judgment to prioritize and efficiently perform a relevant and focused history and physical exam on a patient with a specific complaint. (PC)
- is able to recognize and manage less frequently encountered medical problems with minimal supervision. (MK)
- incorporates diverse sources of information into effective communication and relationship building with patients. (ICS)
- analyzes current medical literature related to patient care and is able to convey this information to peers and attendings. (PBLI)
There are no procedural requirements that must be completed specifically during the Internal Medicine rotation. However, there is a Procedures Curriculum, and residents gain experience meeting these requirements during this rotation. Procedures typically performed on this rotation include: Code Blue management, Endotracheal intubation, bladder catheterization, bedside ultrasound, joint/bursa injection/aspiration and lumbar puncture.
Implementation
Educational Methods
The inpatient rotation is a multifaceted educational experience. The core learning experience occurs with the supervised care of patients. Didactic teaching sessions also occur on a regular basis. Assigned readings are given to the residents to complement these other learning experiences.
Patient care on the inpatient service is provided by the PGY-1 and PGY-2 residents on the medicine service. This care is supervised by the chief of service and attending physicians board certified in Family Medicine or Internal Medicine. The duties of the medicine chief resident are outlined in a separate curriculum. Patients without physicians presenting themselves to Memorial Hospital are assigned to the service and identified as “staff patients.” Their care is assumed by a supervising attending physician and a first or second-year resident on assignment by the chief of service. Private patients from other physicians who admit to the service may also be assigned to the residents and will be followed by the resident along with the private physician. On average, a workload of at least 5 patients per day per resident is desirable.
Each morning, the medicine team meets in the resident conference room of the hospital for “morning rounds.” All new admissions to the service are presented to the group with appropriate laboratory reports and x-rays available for discussion. Medical history, physical examination and a review of the labs and x-rays with a differential diagnosis are a part of all presentations. Appropriate therapy, consultation and further diagnostic studies are to be considered by the team. All other staff patients previously admitted are discussed at morning rounds. Reference articles and text materials are presented by the residents or the supervising physicians as a part of the didactic training. Residents are also expected to discuss on a daily basis any private patient with the private attending physician.
Didactic education occurs in multiple settings. As a part of morning rounds, various topics which apply to current cases are presented by residents and supervising physicians. Monthly noon conferences are devoted to adult medicine. See the noon conference curriculum for details of the schedule. Medicine case conference (presentation of cases handled during the month by the residents) and specialty medicine topics are included. Other didactic sessions occur on a regular basis and are attended by the medicine team, including hospital sponsored CME events and ICU grand rounds. The supervising physicians also provide supplemental material to the residents relevant to the current patient responsibilities as needed.
Resident Responsibilities
The supervising physicians, chief of service and first and second-year residents assigned to the medicine rotation meet every morning for rounds at Memorial Hospital.
Attendance at morning rounds is mandatory for all residents assigned to inpatient medicine.
24-hour, in-house coverage is required by the medicine team. This coverage is divided into two shifts: day shift (7a- 7p) and night shift (7p-7a). The resident taking call responds to all hospital medical emergencies, including all “Code Blue” situations. Call changes and cross-coverage may be worked out by individual teams. A night coverage system for call enables residents to maximize their educational opportunities. Each resident must comply with the ACGME duty-hour requirements.
The medical records, including history and physical examination, progress notes, procedural notes and discharge summaries, are the responsibility of the assigned resident.
Each resident is required to write an “off-service” note on each patient being turned over at month’s end.
Residents from the prior block will present cases at the scheduled medicine case conference.
Resources
- UpToDate online access provided by Memorial Hospital
- Memorial Hospital Medical Library (Includes access to journal articles online)
Methods of Evaluation
Each supervising physician completes a rotation evaluation for each resident on the service. This evaluation is meant to be a summative evaluation of the direct observation of the performance of the resident during the rotation. Each resident will receive an evaluation from the attending physicians for each block of inpatient medicine.
Medical knowledge will be assessed annually on the Family Medicine in-training exam.
Each resident will be formally evaluated after each case conference presentation until the designated competencies are achieved.
