Unit Orientation/Expectations for Medical Students

General Orientation
Daily Assignments on ACE Unit
Call
Team Schedule
Expectations
Write-ups
Presentation
Professionalism

General Orientation: Most of our patients are located on 8 bedtower. Our goal is to admit frail older patients with acute medical problems who require short-term acute medical care. In order to care for complicated older patients with multiple medical problems and often complicated social situations, we utilize a team-based approach. The team consists of 1 to 2 medical students, 2 interns, 1 resident, an attending who is faculty within the Division of Geriatric Medicine, a nurse practitioner with expertise in hospice care and geriatric medicine, a care coordinator, a social worker, a nutritionist, and a dedicated recreational therapist.

Medical students should pick up several patients during each call night, work them up wiht a complete history and physical exam, and be ready to prresent them the next day to the team. They should follow the patient closely and should work on developing differential diagnoses as well as plans of care. Medical students are closely supervised in all care by interns, residents, and attendings and can only write orders or perform procedures with direct observation.

Daily Assignments on ACE Unit
7:30 - 9:00 - Work Rounds. you and the interns are expected to preround on your patients prior to the beginning of work rounds. Attendings will occasionally be present on work rounds.

10:00 - 1:00: Resident's Report. The upper level resident will need to attend this. Report is open to students and interns as well. Most will use this time period, though, to complete work such as notes, consult calls, follow-up on labs and other data, talking with families, planning for discharges, etc. Touch base with your intern!!

11:00 - 12:00: Attending Rounds. This will usually consist of didactic teaching sessions specifically related to clinical questions that arise on the service. You are expected to attend and to be prompt.

12:00 - 1:00: Lecture Series for residents and students Mondays, Tuesdays, Thursdays: Intern's conference on Wednesdays; EBM conference for students and residents on Fridays.

Please try to schedule some afternoon time (2 - 4 range) to meet for 30 minutes with the attending apart from the rest of the team. This time is graet to use to work on formal presentations and to do individual bedside teaching for physical exams.

3:00: Some time in the afternoon your attending will do check-out rounds with the residient. This will include a brieif interdisciplinary team meeting to review the plans for the morning, discharge toals, and upcoming needs on the service.

Call
Currently, the interns are not taking overnight call. There will be a night resident assigned to the team. Please touch base with the resident on your team to work out call hours and schedule

Team Schedule: We are on call every other day. Each interna is on call every fourth day. The intern on call and the team resident will take admissions until 7 PM, and then the night residient for the team will begin taking admissions. The team can take 2 "floats" from the night before on their call day, and then can take up to 5 new admissions until 11 PM on the call night.

Expectations
You will pickup and follow patients closely. The more responsibility you take the more you will learn. Your intern, resident, and attending should and will be complete back up for you. Please keep everyone informed of any new data you learn! Ideally, you should follow all of the patients that your intern has. In the beginning of the year this may not be possible, but try to follow as many patients as you feel you can. We expect you to see and do a full history, physical and write up on at least 2 of the admissions each admitting cycle (call is every fourth day). In addition, you should keep in close touch with your intern and resident throughout the call day and try to at least see and examine as many of the other patients as you can. The more patients you see and examine the better a clinician you will become!

We would like the students on the service to cover ALL the patients. Even if you do not do a full admission/workup, each patient should be picked up and followed by a student.

Write-ups: Please have complete history and physical exams done by the next day on your new patients. In addition, we require you to do full "write-ups," formally written notes as outlined in your medicine orientation. We would like to see a discussion at the end. Please base the discussion upon a specific patient question that arises from the case. We do not want to see a rehash of UpToDate. A short but well thought out discussion based upon a very specific question that requires you to do a literature search is much better! For example, you admit an older woman with recurrent aspiration pneumonia. A discussion based upon a review of the literature aimed at answering the question "Do gastrostomy tubes prevent aspiration pneumonia in older patients?" would be much, much better than 3 pages of a review of pneumonia based upon your reading of UpToDate!!!

Preround on your patients and follow them closely. You will need to be very assertive in order to keep up to date on all of the newest news on your patients!

Offer to help. Touch base frequently with your intern and your resident. We work better as a team.

You will need to touch base with the resident at the beginning of the rotation to get a monthly schedule. You will have days off, usually when your intern is off. Please let us know early in the month if you need any specific weekend days off. You are off for the standard student holidays as well.

Presentation: We would like for you to do a presentation based upon a clinical question that arose during the course of caring for one of your patients. Ideally this would deal wiht a review of a common problem that relates specifically to the geriatric patient. For example, how might the work up of anemia be different in an elderly patient? How would the differential or the management change based upon the patient's age?

Professionalism: You should be on time for conferences and rounds. you should dress comfortably but neatly. Rounds should include edside interactions, and you should be professional and courteous to patients and families. Address patients by proper names, including patients who are demented or who appear unaware of their surroundsing - assume they can hear you and understand you. You canoot have coffee/beverages/food with you during work rounds.

Last updated 10/4/2007.