Overview
Residents act as chief of service in PGY-3. A small number of residents may act as chief of service in the last block of PGY-2. The other adult medicine experiences have distinct curricula.
Goal
The chief of adult medicine service rotation shall provide the advanced-level resident with the opportunity to broaden his/her skills in caring for the hospitalized patient by adding the responsibilities of supervision, leadership and teaching to the usual patient care.
Objectives
While serving as the chief of service, the resident:
- effectively leads a team of caregivers providing excellent care to patients admitted to the hospital, including critically ill patients. ( SBP)
- is able to analyze current medical literature as it relates to a specific patient and present this information to less experienced residents in a manner that is relevant to patient care. (PBLI)
- supervises residents and medical students in a manner that allows for learning and excellent patient care. (PC, SBP)
- manages the flow of information between patients, families and other medical team members in a manner that optimizes patient care. (ICS)
- recognizes the necessity of appropriate consultation and involves specialists in the care of patients effectively. (SBP)
Implementation
Educational Methods
The chief of service rotation is a unique opportunity for residents who are experienced at caring for hospitalized patients to learn to supervise and teach others. By supervising other residents, it is expected that the resident will learn valuable skills for future practice, including the ability to supervise non-physician providers and medical teams. Additional exposure to inpatient medicine late in training also allows the resident to master advanced skills in delivering care to the hospitalized patient. The learning process of the chief of service rotation is mostly experiential.
The chief is directly supervised by board certified attending physicians in Family Medicine and/or Internal Medicine. While PGY-1 and PGY-2 residents on the inpatient rotation are the primary physician for patients admitted to the medicine service, the chief is directly involved in the care of the patients and the supervision of the residents providing care. This allows the chief to obtain advanced experience in caring for patients and experience in supervising other providers. Details of the medicine service are outlined in the inpatient medicine curriculum.
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. The chief of service leads rounds, which are attended by the supervising attending physicians. Medical history, physical examination and a review of the laboratory studies and radiographs with a differential diagnosis are a part of all presentations. Appropriate therapy, consultation and further diagnostic studies are considered by the team. All other patients previously admitted to the medicine service 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. This is coordinated by the chief of service.
Didactic education occurs in multiple settings. The chief prepares and gives several small lectures. Supervising physicians also present information related to patient care. 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 coordinated by the chief of service) 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.
Resident Responsibilities
The chief of service responsibilities include:
- Attending and leading morning rounds daily
- Coordinating the call schedule for residents and supervising attendings
- Assigning patients to residents at the beginning of the rotation and as they are admitted to the hospital
- Reviewing each new patient with the admitting resident at the time of admission to the hospital
- Scheduling and providing educational sessions related to current patient concerns and commonly encountered inpatient adult medical problems
- Supervising the care of each patient on the staff medicine service
- Documenting the experiences of the medicine team to ensure that an appropriate volume of patients are being seen on the service
- Understanding and complying with the ACGME work hour restriction
- Monitoring compliance of the residents of the inpatient medicine rotation with the ACGME work hour rules
- Providing direct patient care when it is not feasible for the assigned resident to do so
- Reviewing medical records of the residents on the service to make sure that they are accurate, timely and complete
- Coordinating the “turnover” of patients to the new team at the completion of a rotation block
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 chief of 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 an average of two attending physicians for each ½ block of inpatient medicine.
Medical knowledge is assessed annually on the Family Medicine in-training exam and longitudinally by supervising attending physicians.
