Educational Activities/Teaching Conferences
PGY1 Morning Report
Every Thursday morning, all first-year residents assigned to inpatient and ambulatory rotations meet for one hour to discuss one or two patients with the Ambulatory preceptor or the Program Director/Associate Program Director. Patients who are either recently admitted or recently seen in an ambulatory setting are presented by the resident who initially evaluated them. As the case unfolds, other residents comment on differential diagnosis, work-up, and management strategy.
Senior Resident Morning Report
Every morning, Monday through Friday, all second- and third-year residents on internal medicine inpatient rotations meet for an hour to discuss two recently admitted patients. Each case is presented by the admitting resident. As the case unfolds, other residents comment on differential diagnosis, work-up, and management strategy. Senior resident morning report is run by the inpatient Chief Resident. Also on hand is the program director or department chair as well as other faculty members.
Inpatient Attending Rounds
Attending rounds on all inpatient services at Oak Hill Hospital are combined teaching and management rounds. On the internal medicine teaching service, each team rounds daily with their hospitalist attending, seeing most patients at the bedside. History and physical findings are reviewed and a proposed management plan for each patient is presented by the residents for discussion with the attending. Teaching focuses on bedside skills and on basic science and clinical knowledge relevant to each patient's unique situation. Similar teaching/management rounds with appropriate subspecialty attending physicians are held daily on the inpatient hematology-oncology service and in the MICU and CCU.
Program Director's bedside teaching rounds (professor rounds) are a purely bedside experience. These rounds emphasize observational and physical exam skills.
Every Monday through Friday at 4 PM, residents on inpatient services gather to sign out their patients to the evening team before going home. During these sign-out rounds the residents will make a brief educational presentation on a topic related to a patient currently on service.
Subspecialty Bedside Rounds:
“Laennec Rounds”: Cardiologists follow teams and teach cardiac auscultation skills.
"Sherlock Holmes Rounds": Conducted by the Program Director. These rounds emphasize observational skills in clinical medicine.
Bugs and Drugs Rounds: Infectious Disease attendings discuss challenging infectious disease cases.
Noon conferences are held three days a week. The series begins with coverage of common medical emergencies. For the remainder of the year, the conference series covers core topics in ambulatory and inpatient internal medicine. Also included are the twice-monthly Journal Club, twice-monthly EKG Conference, and monthly Morbidity and Mortality Conference. On the first Friday of each month, the noon conference is a program business meeting when residents can discuss issues and concerns with the Chief Residents and Program Directors. Other Friday noon conferences (referred to as 'Fun Fridays') cover a wide range of entertaining, non-medical activities.
1. Categorical residents will be assigned to a single attending physician or clinic for the duration of their internal medicine residency.
2. Residents will attend their continuity clinic on 4 + 1 schedule. There will be one week of continuity clinic followed by four weeks of other rotations. There will be a ½ day clinic once or twice during these four weeks.
3. Residents will evaluate and manage patients assigned to them in the physician's office with supervision of the attending physician.
4. With supervision of the attending physician, each resident will provide all ongoing care to patients seen by him/her in the ambulatory clinic, including all follow-up of acute or chronic medical problems, preventative and maintenance healthcare, appropriate counseling of patients and families, and patient education.
5. Telephone messages, prescription refills, lab reports, and emergency or after-hours care of residents' patients will be handled by the residents if possible. Residents should routinely, within 48 hours of their clinic day, follow-up on patient labs and ancillary studies as available and call the patient. Inform the office nurse of your communications.
6. Each resident is evaluated bi-annually by their faculty preceptor in the ambulatory setting.
7. Per RRC mandate, each categorical resident must attend no less than 108 continuity clinics over three-year timeframe and may miss no more than one month of continuity clinics consecutively.
8. Absence from clinic will be permitted for vacations, educational leaves, illness or personal emergencies.
The 4:1 Schedule: A Novel Template for Internal Medicine Residencies
It is widely acknowledged that there is need for redesign of internal medicine training. Duty hour restrictions, an increasing focus on patient safety, the possibility of inadequate training in ambulatory care, and a growing shortage of primary care physicians are some factors that fuel this redesign movement. Read more from the Journal of Graduate Medical Education article provided courtesy of Accreditation Council for Graduate Medical Education.