Senior Resident

Hospital Service Senior Resident
Each third-year resident completes two months as senior resident on the inpatient family medicine service at Methodist. Responsibilities include supervision and teaching of the first year interns and coordination with the weekly rounding faculty.

Family Medicine Inpatient Rotation Teaching Module

Rotational Goal
Residents will gain an understanding of the broad range of medical conditions which present in a general family medicine practice and are managed in the hospital by family physicians.

Rotational Objectives
By the end of their rotations on the family medicine service, residents will be able to demonstrate mastery in the diagnosis and treatment of common inpatient conditions as follows: 

(A) Patient Care
Through patient care experience gained as part of the family medicine inpatient rotation, when further presented with patients in the inpatient setting, residents will be able to:

• Accurately obtain a complete medical history to include assessment of exposures, living situation, baseline functional level, and history of current illness, along with co-morbidities
• Perform an appropriate physical exam to guide decisions regarding patient management, especially with regards to fluid management, cardiac and respiratory status, and mental status
• Formulate appropriate management plans for patients, with complete but cost-effective use of laboratory and radiologic testing and consultants
• Effectively arrange for patient disposition and coordination of care after discharge
• Facilitate discussions, when appropriate, about end of life decisions
• Perform newborn circumcisions

(B) Medical Knowledge
At the completion of the family medicine rotations, residents will be able to demonstrate medical knowledge of common inpatient conditions and “best practice treatment plans” suitable for the family physician to include being able to:

• Describe the pathophysiology, presentation, differential diagnoses, and management of common inpatient conditions relating to cardiac, pulmonary, GI, neurologic, infectious, and post-surgical etiologies
• List the steps to take in holding an effective family conference
• Identify the common in-patient diagnoses for children and describe their management
• Describe appropriate post-partum and newborn management, including information to give parents regarding circumcisions

(C) Practice-based Learning and Improvement
At the completion of the family medicine rotations, and subsequently in the inpatient setting, residents will be able to:

• Critically evaluate evidence basis for diagnosis and treatment of acute medical conditions requiring hospitalization
• Interpret and apply treatment guidelines; see www.guideline.gov/
• Modify patient treatment plans on an ongoing basis based on patient response to therapy.

(D) Interpersonal and Communication Skills
At the completion of the family medicine rotations, and subsequently in the inpatient setting, residents will be able to:

• Obtain a full medical history using effective communication skills with hospitalized patients and their families/care takers
• Provide appropriate patient education and information on diagnosis, treatment, and prognosis to patients and their families/care takers
• Coordinate care with patient and other team members; consult specialists as needed, providing clear information about the reason for the consultation request and the urgency of the need

(E) Professionalism
During the family medicine rotations, residents will exhibit characteristics of a professional health care provider by:

• Dressing appropriately based upon standards present for attending physicians in the clinic and/or inpatient setting associated with the family medicine rotation
• Demonstrate sensitivity and responsiveness to hospitalized patients’ perception of illness, and include these perceptions and patient preferences in formulation of management plan
• Substantively contributing to the learning community in the clinic/hospital, by attending and actively participating in presentations associated with the rotation

(F) Systems-based Practice
At the completion of the family medicine rotations, residents will be able to:

• Coordinate care for hospitalized patients, with specialists, rehab services, social workers, chaplains, and other care team members as needed
• Understand the available resources for care of the patient in the hospital and after discharge
• Will understand cost significance of selection of medication and care plans for the patient, based upon insurance coverage (or lack of coverage)

Hospital Rounding Schedule
See G3 and intern duties listed below.

Conferences/Case Presentations
The senior and interns on the family medicine rotation coordinate one to two noon “Inpatient Conferences” during the month, usually around a case presentation/problem work-up from the inpatient census. 

Reading List

• Texts and journal articles relevant to inpatient problems addressed
• Practice Management topic ideas are located in the file drawer in the senior call room  (3^rd years)

Procedural Skills to Be Acquired
See the evaluation sheet for this rotation

Formal Teaching Schedule

• Attend daily noon didactic educational conferences.
• The rounding faculty physician and/or the senior resident will review topics/journal articles related to patient problems as time allows when having group rounds. Most faculty members will have teaching rounds with the residents at 11:00 a.m.
• Arrange a time to meet with rounding faculty to discuss a mutually agreed upon practice management topic (3^rd years)

G3 Duties at Methodist Hospital

• Assume primary responsibility for managing the family medicine inpatient service.
• Communicate regularly with the rounding faculty during the day.
• Senior residents will be responsible to coordinate care of the inpatient service.
• Round daily
• Help with progress notes, H&Ps, and discharge summaries

Faulty physicians who deliver their own OB patients are encouraged to sign out post-partum visits, newborn care, circumcisions, and discharging to the senior resident.

• The senior resident may consult with the rounding faculty and decline when the service is unusually busy.
• Call the patient’s primary physician when a patient is admitted.
• Coordinate the follow-up care plan with that physician.
• Address psychosocial issues for every patient

The primary resident physician will be informed of the admission of his/her patient but the G-3. Except for while on away rotations, the primary resident will visit his/her hospitalized patient’s to write progress notes and orders, and communicate back to the G3 by 9 AM each weekday. The G3 coordinates care so that tests are followed up during the day and the rounding faculty physician can be updated. The rounding team will conduct weekend and holiday rounds on all the patients. Sign out daily to the clinic on-call G2/G3 physician person-to-person, particularly ICU/CCU/3E patients. You may delegate signs-outs to the G1. Coordinate weekend rounds with the faculty preceptor, intern, and resident on-call. Coordinate clinic follow-up care. May delegate to G1 if G1 primarily followed the patient. Make the clinic appointment for the patient. Speak with the physician who will follow-up the patient, or leave a voice mail. Write instructions on Discharge Instruction Sheet, and ask the patient to bring this sheet to the clinic appointment.

• Round one day every weekend, usually the opposite day that the intern rounds
• You make take one weekend off per month, as can the intern.
• Round both weekend days when G1 has “golden weekend”.
• Plan this at the beginning of each month
• Communicate with the faculty preceptor well in advance
• Call all consultants directly
• Tell the consultant what you want done and when it needs to be done
• You may delegate this to the intern after educating them on the process
• Coordinate daily teaching sessions for the G1
• Allow the intern to “do the talking” with the patients.
• Encourage him/her to make decisions in the patient’s management
• Resist the temptation to “take over”
• Complete a discharge summary on all hospitalized patients, or delegate to the G1 if G1 primarily followed the patient.

Medical student responsibilities:

• Help supervise medical students on this rotation
• Medical students may write notes in charts, however a resident must also write a complete note. 

G3 Duties in the Emergency Room
See all Creekside admissions with the G1, 7:00 a.m.–5:00 p.m. Monday through Friday (When you are in clinic, the rounding faculty will see patients with the G1). If you or the G1 see one of our patients in the ER who is not admitted, discuss the situation with the faculty physician. This patient may need to be seen by the faculty physician, who makes appropriate documentation and then helps determine billing level/codes. The G3 submits these charges to Creekside.

G3 Responsibilities at Park Nicollet Clinic-Creekside

• See patients in clinic up to four afternoons per week, 3:00–5:00 p.m.
• No afternoon clinic when the G1 is post-call (and leaves early) or is on vacation.