Department of medicine

MUSC Gen Med Wards

Educational Purpose:

The General Medicine inpatient rotation at MUH is structured to give Internal Medicine residents a broad-based experience in managing acutely ill general medicine patients.  It is designed to develop the clinical skills necessary to diagnose and treat undifferentiated medical patients with a wide range of illnesses.  The rotation provides each resident with graduated autonomy combined with direct supervision by expert faculty.  There are four General Medicine Teams at MUH.

Goals and Objectives:

PGY-1:

1.  To enhance the resident’s history taking and physical diagnosis skills.

2.  To develop differential diagnoses and formulate a treatment plan on acutely ill patients.

3.  To manage the inpatient illnesses which are commonly cared for by the general internist.

4.  To understand the indications/need for appropriate subspecialty consultation.

5.  To demonstrate interpersonal skills and to communicate effectively with patients and families.

6.  To effectively lead an interdisciplinary team and to help teach other residents and students.

7.  To understand appropriate pain control and the tenets of end of life care.

PGY-2 and 3

1.  To enhance the resident’s history taking and physical diagnosis skills.

2.  To develop differential diagnoses and formulate a treatment plan on acutely ill patients.

3.  To manage the inpatient illnesses which are commonly cared for by the general internist.

4.  To understand the indications/need for appropriate subspecialty consultation.

5.  To demonstrate interpersonal skills and to communicate effectively with patients and families.

6.  To effectively lead an interdisciplinary team and to help teach other residents and students.

7.  To understand appropriate pain control and the tenets of end of life care

8.  To develop immediate and long term treatment goals of care

9.  To supervise the members of the team including medical students, medical interns, emergency medicine interns, neurology interns, as well as anesthesia interns.

10. To coordinate care using a multidisciplinary approach utilizing case managers, social workers, pharmacists, to facilitate optimization of patient care.

Teaching Methods:

The majority of teaching on the General Medicine service is case-based at the time of clinical encounters.  Inpatient rounds provide the best opportunities for education at the bedside.  This teaching can include demonstration of history taking or examination skills, modeling communication or exploration of medical knowledge, with an explicit focus on the published clinical evidence supporting clinical decision-making.  The attending physician also conducts didactic sessions on multiple occasions throughout the month.  Residents are expected to attend Morning Report three days per week and Noon Conference daily.

Mix of Diseases and Pathological Material:

Residents care for patients with a wide variety of clinical syndromes including chest pain, coronary artery disease, CVAs, CHF, diabetes mellitus, DKA, pneumonia, COPD, asthma, pyelonephritis, acute and chronic renal insufficiency, SLE, vasculitis, dementia, and many others. 

Patient Characteristics:

Residents care for a diverse patient population with respect to age, ethnicity, and gender.  The majority of the patients are older adults, but there are significant numbers of adolescent and young adult patients with acute and complicating chronic medical conditions needing inpatient care.

Types of Clinical Encounters:

The General Medicine rotation takes place in the Medical University Hospital.  Patients are admitted to the service through the 1W and CMH emergency rooms, from the outpatient clinics, transfers from other inpatient services, ICU transfers, and transfers from outside hospitals.  The PGY 1 residents are responsible for performing the initial H and P and writing all orders under the supervision of the PGY 2 or 3 resident.

Procedures and Services:

Residents have the opportunity to perform many procedures on the General Medicine Service.  Common procedures include central venous access placement, paracentesis, lumbar puncture and thoracentesis, among others.  All procedures are appropriately supervised by the upper level resident and the attending physician.  Interns and residents are expected to interpret all EKGs and chest x-rays performed on their patients.

Supervision:

The GEM team consists of a PGY 2 or 3 resident, two PGY 1 residents, a 4th year medical student, two 3rd year medical students, and the attending physician.  Nurse case managers and clinical pharmacists round with the team as well.  The upper level resident directly supervises the interns and the medical students.  The upper level resident leads rounds and helps formulate the care plan.  The interns perform the H and P, write progress notes, and write orders under the upper level resident’s supervision.  All patient care encounters are supervised by the attending physician.

Educational Resources to be Used and Reading Lists:

The residents have access to all major Internal Medicine textbooks, and a broad array of electronic resources (including Up-To-Date) through the MUSC library website.  Additionally, the house staff is expected to pull journal articles appropriate to the care of their patients.

Method of Evaluation of Resident Competence:

Residents are evaluated using the global evaluation form.  The Mini-CEX is often administered on this service as well.  Each resident evaluates his peers.  Patient Care is assessed based on direct observation and complete review of all records.  Medical Knowledge is assessed through direct questioning and observation.  Interpersonal Skills and Communication is assessed by observation of interactions with patients and families.  The attending physician evaluates Professionalism through direct interaction and observation of the resident.  Systems-Based Practice is evaluated based on interactions with the multidisciplinary team and on the assessment of the nurse case managers.  Practice-Based Learning is evaluated based on the ability to consult the literature and to improve their performance throughout the rotation.  Residents receive formative evaluation throughout the month.

The residents evaluate the rotation and the attending physician through the E*Value system.  The General Medicine Division reviews the rotation evaluations and each attending anonymously receives his or her evaluations.

 
 
 

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