This experience on the wards will have many similar components to your home institution and some different ones. In order to make the transition easier, here is a list of your expectations and responsibilities as a resident while here. The goal is for you and your interns to work together, learn, and take care of this amazing patient population.
Pre-Rounding / Rounds
Chart check all the patients on your service. Before rounds, every day, look through their vitals, labs, imaging, and consultations.
See the new and the sick. Before rounds, at least see and examine all of the new and sick patients on your team.
RTL. Run the list with your interns before rounds briefly to make sure that there is a plan for each patient and that your interns are understanding and prioritizing the right problems. You might have to spend a little more time on some patients and breeze through others, and that is okay! Just make sure you are supporting your interns before rounds.
Be the leader on rounds. Rounds usually start at 8:30-9am depending on your attendings preference with the goal is to finish rounds by 11:30am. You are the one that decides the order of patients to be rounded on, usually the new or sickest first followed by known discharges.
You are expected to direct rounds and guide the team with management plans and teaching.
Make sure your interns understand the plans and creating to-do lists for each patient, prioritizing the important things i.e. put the stat antibiotics order in before calling the consults; calling the consult before writing the progress note, etc.
These are required and it is expected that you log-on promptly at noon (when rounds are finished). Links to the noon conferences are in the Calendar.
Help get things done. Your interns are the ones primarily responsible for completing tasks on the patients, but it is a team effort. Help by placing an order while they call a consult or update sign out while they finish progress notes!
Communicate with the nurses. Especially with the pandemic, bedside rounds have become more difficult. You should run the list with the charge nurse daily. If you need something to happen stat (get a CT scan, start a heparin drip, stat dose antibiotics), let the nurse know! While your intern is placing the order, you should call the nurse to get things done. You can either call the floor or vocera the charge nurse i.e. “Call 4C Charge Nurse.”
Update families frequently. Especially because of the pandemic and the decreased visitors to the hospital, family members are frequently very worried and at a loss of what to do. Try and update a family member (if the patient agrees) every couple days.
On that note, take care of your patients as if they were a loved one.
You are expected to oversee and supervise all new patient admissions. You and your intern should both see the new admissions and discuss the plan together.
New admissions need to be seen by a physician within 1 hour of the call.
Use your judgement about admissions during the morning or during rounds. The interns are presenting the old patients, so one option is for the residents to break off of rounds and see the new patient. The other option is to have one intern present all their patients while the other intern starts the new admission. Both have pros and cons, so use your judgement wisely.
Step-downs from the ICU overall follow the same process as admissions, however you have 15 minutes to see the patient and accept them to your service. If you have any concerns about the patient, discuss with your attending who can escalate it to the ICU attending.
Oversee the AIs. The fourth year medical students aka the acting interns are your responsibility. You oversee their patients – for example if you have 16 people on your team; 6 can go to each intern and your AI will carry 4. For these four patients you should see them and addend your AI's progress note with a physical exam and an assessment/plan.
Flex your teaching muscles. Chalk talks, case-presentations, every patient encounter is an opportunity for learning and you are the leader of that education for your team.
General medical student expectations. MS3 Medical students are oriented by Drs. Logan and Ringwala and MS4s by Dr. Haney, but you should be aware:
• MS3s generally see patients that interns follow while AIs see patients with residents.
• Medical students should write progress notes daily.
• Noon lectures 12-1pm are mandatory for medical students and are watched in separate areas for some to decompress how many people are eating in the same space (i.e. the Medical Conference Room).
• Students should aim to carry 2-3 patients.
• Can I send the medical students home?
Students are expected to stay at least until your team runs the list with your attending (~3pm)
On call days, medical students are expected to stay until 6pm.
Medical student evaluations. For MS3s from GW, we are responsible for evaluations; typically this was done in person but with COVID we are doing it virtually. Please use QR code to the right to get to the evaluation form.
Part of your role as the wards resident is to run the rapid response team when you are on call. Click here to see the full rapid response orientation.