Unit Orientation/Expectations for Residents
Upper level residents are expected to provide a supervisory role to interns and students. They should develop plans and provide guidance as well as ensure that appropriate medical decisions are being made on the patients on the service. The resident works directly with the attending to develop a plan of care, but the resident should serve as the initial decision maker and supervisor. The resident has a crucial role in the direct education of students and interns on the team.
Teaching
Evaluations
Daily Assignments on ACE Unit
Tips for Interns
Teaching
- An evidence-based approach will be used by the faculty to teach core topics in geriatric medicine, specifically relating to the care of acutely ill elders in the hospital setting.
- Please see list of core topics for curriculum outline.
- Presentations of specific topics are available on our web site (http://www.med.unc.edu/aging/ace/ed_present.htm).
- Residents and students also serve as role models and teachers for students on the rotation.
Evaluations
- Evaluations are important!
- Attendings are expected to do evaluations after their first week and at the end of the 2 week block. Evaluations at the 2-week mark will be included on the resident housestaff website for review by the residency director and inclusion in the resident’s record.
- Please remember to evaluate the attending and the service/rotation.
Daily Assignments on ACE Unit
7:00: Sign Out for all teams every morning, seven days per week, 3 Anderson conference room. All residents are required to attend. Interns are expected to preround during this time. Attendings are encouraged to attend.
7:30-9:00 : Work rounds; attendings may attend work rounds.
- Interns are expected to do pre-rounds
- The team should round together as this is most efficient!
10:00-11:00: Resident Report: A MUST DO unless there are emergencies on the service to deal with … Interns/students do work/discharges/labs/consults; attending available for questions/concerns
11:00-12:00: Attending rounds; rounds will consist of didactic sessions based upon clinical cases, reviews from students on team, CQI, and at least one session will review Morbidity and Mortality forms from the rotation;
We are all busy, but attendings AND residents AND interns are expected to meet DAILY for teaching purposes.
12:00-1:00: Daily lecture series on Mondays and Tuesdays. Grand Rounds on Thursdays. ; EBM conference on Fridays. Interns Conference on Wednesdays
3:00: Check out rounds for resident and attending: a MUST DO. Review events of day, updates, review labs/xrays/urine and other data, and PLAN for the next day’s discharges; includes interdisciplinary team rounds with SW, care coordinator, RT, pharmacy, NP, and nursing; plan for following day discharges, upcoming patient needs and plans.
Tips for Interns
1. Do expected discharge summaries and preparation THE NIGHT BEFORE!
2. Keep up with dictations or on line histories/discharge summaries
3. Work rounds should be driven by the resident, and should be fairly quick and efficient
4. Medicine A attendings will staff all patients on call nights and will see floats that come in during early hours of the morning that morning. The hospitalist service should not need to be involved in this.
5. Medicine A attendings prefer to be called with problems, questions, any concerns rather than hear about significant events the next day.
6. Contact primary providers when patients are admitted and discharged.
7. Use Resident Assistants as needed to help with work on service.
8. Discuss and record Advanced Directives (specific progress note to record conversation and directives available on Web CIS).
9. CALL PRIMARY PHYSICIANS.
10. Some things we are tracking on our service…
Discontinue any unneeded (most) foleys!!
Discontinue any restraints (think foleys, telemetry, iv lines, oxygen, scds, and any other “ropes” that keep patients tied to bed!!!)
Try to avoid benadryl as a sleep agent
Use antipsychotics with caution for patients with delirium:FDA concerns about atypical agents in patients withdementia and behavioral problems; View these as CHEMICAL RESTRAINTS
Use the TEAM to HELP:
Nurse practitioner is a GREAT asset!
Consider Recreation Therapy on all of our older adults (we have our own RT for our service!).
Think PT, OT and PMR (PMR can assist with more than discharge to acute rehab, they are available also for consults and for followup of frail elders!).
Elder Mistreatment/Neglect: Contact BEACON program
Last updated 10/4/2007.
