General Medicine

Weekday Structure

• 7:00-7:30 AM: Night interns hand off old patients to Day interns. Day interns should ask for any overnight events as well as the outcome of Action plans that they handed off the night before.

  • Residents and interns must sign in to their team(s) on EPIC when they arrive and sign off when they leave hospital

• 7:30-8:00 AM: Night residents hand off new admissions to day residents. 

• 7:30-8:30 AM: Intern Bedside Rounds. Start with sick and new patients.

  • Print a team list with a blank column for notes - this will be your lifeline throughout the day.

  • After bedside rounding, chart round to note significant results and make a note of any labs that haven’t been drawn yet

  • Start your notes (if you have time)

  • if you need help, contact the resident 

• 8:00-8:30 AM: Residents attend Morning Report (all weekdays except first and last day of block)

• 8:30-9:00 AM: Resident and Intern meet to discuss urgent issues before rounds

• 9:00-10:45 AM: Resident Bedside Rounds (resident leads bedside rounds for their team on all patients)

  • Attending accompanies Early Resident team. Intern/students present to resident, who leads rounds

  • Resident budgets time as appropriate to keep on schedule. Intern and Student are expected to present efficiently using standard format and summarizing available data (eg vitals, imaging, imaging) as appropriate

  • Chart round via Haiku or COW during walk rounds. 

  • Make plans before moving on to the next patient; enter urgent orders and consults during rounds.

  • See sick patients first → off-floor patients → floor-patients (so that you are on the floor for your slot in IDT rounds). 

  • If bedside rounding still not finished by 10:45, the Attending will detatch to round with their second team while the resident continues to lead rounds on any remaining patients.

• 9:45-10:00 AM: IDT rounds (time depends on team/floor)

  • Interns should enter orders and call consults during this time

  • Attending should be present if they only have one team

• 10:45-11:45 AM: Late Resident Team Table Rounds with Attending (can start earlier if Walk Rounds end early)

  • Resident teams present to Attendings their well-developed assessments and plans based on bedside rounds, lab results, and IDT rounds. Residents are expected to facilitate efficient rounds by helping their teams present succinctly, and to budget time as appropriate to keep on schedule. 

  • Confirm plans, enter orders and consults during rounds

• 12:00-1:00 PM: Noon Didactics

  • M/Tu/Th: Noon Conference mandatory for all residents and interns

  • W: Intern Report mandatory for all ward interns (residents hold intern pagers)

  • F: 12:00-1:30 PM: Clinical Reasoning Conference (CRS)/Chopped mandatory attendance for everyone

• Afternoon Didactics

  • MW 3:00-4:00 PM: Resident/Attending Teaching Rounds 

    • Monday session is led by the Attending, Wednesday discussion is led by the Senior residents and their teams

    • Attendings with only one team should combine with another Attending’s team so that two teams are included in each Teaching round session

    • first Monday is expected to include review of expectations

  • Th 3:00-4:00 PM: Resident Report mandatory for all PGY2s and PGY3s

  • F: Feedback Friday as appropriate on first Friday, mandatory on second Friday

• 4:00-4:30 PM: Reassessment Rounds: 

  • Early Resident, Intern, and Attending meet to review outstanding To Do items, status of their plans. 

  • Early Resident hands off to sister team Resident (If two teams are supervised by one attending, then the intern on call is supervised by the resident of the other team).

• 4:30-7:30 PM

  • Early residents/interns can leave after Reassessment Rounds 

  • Late intern is supervised by the late resident of their sister team. This includes questions/problems that come up as well as late admissions (between 2-5:30 PM).

• Admission Cut-Offs

  • Day Teams

    • 2 PM for Early Resident, 5:30 PM for Late Resident

    • 5:30 PM – 7 PM: Floor senior or sister senior will triage, speak with ED staff, and enter orders as needed. Full admission completed by the Night team.

  • Night Teams

    • 5:30 AM - Last full Admission 

    • 5:30 AM – 7:30 AM: Night Teams will triage, speak with ED staff, and enter orders as needed.

• 7:00-7:30 PM: Handoffs to Night Teams

  • Handoff document is updated daily by resident (see Handoffs)

  • Verbal hand-off must be supervised by the Resident of their sister team, who then hands off their team.

  • Sick patients should be added to “Overnight Hot Spot” list to facilitate closer monitoring at night