Internal Medicine: Inpatient Rotations

Inpatient Services: The inpatient services allow for a wide exposure to care for hospitalized patients. A broad spectrum of pathology is encountered. Carefully selected senior staff rounders are assigned to each house officer team. Residents have the majority of responsibility for patient care. Rounders are responsible for overall supervision of patient care and teaching for the rotation. Teaching rounds are conducted daily. Complete ancillary services ensure that residents obtain a focused medical education and experience.

General Medicine Floors (B1/B2/F1) & Subspecialty Floors: On the inpatient medical floors, house officers encounter a variety of medical conditions and take a primary role in patient management. Subspecialty floor offers house officers more in-depth exposure to subspecialty based conditions. Senior staff rounders are sub specialists with advanced expertise. The house officer generally sees patients between 6:30-8a.m. Rounds with the senior staff are 8-11a.m. Patient management and bedside instruction are emphasized. Didactic and patient focused teaching rounds are held most afternoons. Overnight calls are every fourth night; Monday through Thursday.

F2 (Pulmonary): Patients with cardio respiratory problems and DVT are the most frequent. Clinical care pathways have been generated for these management problems. The attending physician is a Pulmonary specialist. Common diagnoses: pneumonia, asthma, COPD, pulmonary embolism/DVT, pulmonary hypertension, and lung transplant.

P2 (Hematology/Oncology): Commonly encountered conditions include: oncology emergencies, cord compression, febrile neutropenia, leukemia/lymphoma, solid tumors, bone marrow transplant and infections in an immunocompromised patient. The attending physician is a hematology/oncology specialist.

H2 (Nephrology): Commonly encountered conditions include acute and chronic renal failure, malignant hypertension, and complications of ESRD (End Stage Renal Disease), dialysis, and kidney transplant. The attending physician is a Nephrology specialist.

F6 (Infectious Diseases/General Medicine): Commonly encountered conditions include: Endocarditis, Meningitis, HIV disease and tuberculosis. The attending physician is an Infectious Disease specialist.

H5 (Cardiology Telemetry Floor): Commonly encountered conditions include acute coronary syndrome, congestive heart failure, syncope, arrhythmias, and valvular disease. The attending physician is a cardiology specialist.

Night Float: A Night Float (NF) system to cover patients admitted at night allows the inpatient teams to have much less overnight call. Call is 8p.m. to 9a.m. Monday through Thursday, with one 24 hour call per week (7am-7am Sunday to Monday) with 48 consecutive hours off duty each week (Friday to Sunday morning). The NF team has daily morning teaching rounds utilizing case presentations, discussions and bedside teaching with the floor team. This rotation is for second and third year residents.

Coronary Intensive Care Unit (CICU)-16 Beds: Overnight calls every fourth night. Commonly encountered conditions: acute myocardial infarction, cardiogenic shock, invasive hemodynamic monitoring, complicated heart failure and post-interventional care. Patient management rounds with the attending cardiologist occur daily. Teaching rounds follow a didactic or case presentation for 1 hour 3 times/week. Morbidity-Mortality review each Monday from 8-9a.m. and topics review each Friday from 8-9a.m.

Medical Intensive Care Unit (MICU)-44 Beds: Overnight call is every fourth night. Commonly encountered conditions: Septic shock, ARDS, ventilator-supported patients, multi-organ failure. Patient management rounds occur daily for 2 to 3 hours. Didactic teaching sessions fill the second half of rounds with specific topics covered monthly. This is a great opportunity to develop skills in procedures (central lines, airway management, arterial lines, etc.).