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To gain experience providing care for patients admitted in non-critical beds and further understand the relationship between practice-based medicine and systems-based practice.

Admissions

All admissions should be seen with resident and presented to Attending on call within 1 hour of initial notification.

In addition to typical components of a History and Physical, admission notes MUST document complete outpatient medical record (or lack thereof), comprehensive ROS, and all available diagnostic studies at the time of admission.

Teaching Rounds

Begin at 10:30 am (unless otherwise stated) and should be orchestrated by the resident on service.  All new patients will be seen and examined as a team and patients potentially being discharged should be at least aware of this possibility.  Although the largest portion of the rounds will be at the bedside, a portion of the time on rounds will be didactic (see presentations).

Presentations

All team members are expected to present at least one topic, preferably relating to a patient on service.  Such presentations can be self-assigned (with attending approval) and/or prompted from team discussions.

Progress Notes

Residents are expected to see ALL patients (including private) and form and execute care plans before teaching rounds each morning.  As the formal teaching service, residents are expected to complete progress notes on H-team patients before private patients.  Patients anticipated to have progress notes completed after rounds should have brief note documented in chart indicating as such, ie. "Patient seen and examined, ______ orders entered, full progress note to follow at ______ am/pm" to ensure adequate patient coverage.

Progress notes should be comprehensive and should always include an Problem List with active problems further explored in the assessment and plan.  See examples...

Discharge Summaries (See template)

Housestaff are responsible to dictate discharged patients with last names beginning with A-L.  Before dictating discharge summary, the physician should have in her mind "what is important for the primary care physician to know about this admission?"  Incomplete discharge summaries can result in a lower final evaluation than expected, see Evaluations.

Evaluations

Earning of HONORS is multi-factorial but absolutely contingent upon:

1. Performance as member of the team
2. Completion of all assigned discharge summaries within 7 days of completion of service
3. Quality of team documentation of patient encounters
4. Level of participation during clinical/didactic rounds
5. Regular attendance of conferences

Role of the Housestaff

At minimum:

MS-III: Apply medical knowledge to gain experience in the care of specific disease processes

MS-IV: Gather, summarize, and present all available information

PGY-1: Gather, summarize, and present all available information efficiently

PGY-2: PGY-1 + interpretation of history, physical exam, and diagnostic studies in the formulation of an individualized plan of management

PGY-3: PGY-2 very efficiently + fine-tuning the "art of medicine" + role modeling for other team members

"Art of Medicine"=

Weekend Coverage

The H-Team is covered by one Attending Physician (see call schedule) on the weekends.  Formal teaching rounds are limited to "work rounds" to facilitate efficiency and maintaining the integrity of the "80-hour work week" for housestaff.  Admissions are assigned by the AO and redistributed on Monday mornings if large discrepancies exist between the services.