» Family Medicine Residency

For Prospective Residents

PGYI Junior on Family Medicine Inpatient Services
Santa Monica-UCLA Medical Center

Goals

The purpose of this rotation is to provide residents with the knowledge and skills necessary to care for patients admitted to a community hospital with common medical problems. The resident will learn about the diagnosis and management of specific disease processes and will also become familiar with the social, economic, and ethical issues unique to the practice of inpatient medicine. In addition, the resident will gain the experience necessary to determine appropriate disposition for patients discharged from the hospital

Objectives

Patient Care and Medical Knowledge

Residents will:

  1. Be able to perform a history and physical examination on all patients
  2. Be able to develop a problem list, assessment and plan for all patients
  3. Be able to order and interpret appropriate studies for each patient
  4. Be able to assess and provide care for the wide scope of inpatient medicine seen on the Family Medicine Inpatient Service
    1. Adult medical patients
    2. Obstetrical patients
    3. Pediatric patients
    4. Surgical patients
    5. Critically ill patients
    6. Newborn patients
    7. Psychiatric patients
    8. Geriatric patients
  5. Be able to perform basic Family Medicine procedures
    1. Intubations
    2. Central line placement
    3. Transcutaneous pacemaker placement
    4. Cardiac defibrillation
    5. Arterial line placement
    6. Arterial blood gas
    7. Lumbar puncture
  6. Be able to discuss with patients end of life care
    1. Decision making by patient or designee
    2. Code status
    3. Medical futility
  7. Be able to coordinate care of patients using other members of the healthcare team
    1. Social workers
    2. Discharge planners
    3. Physical and occupational therapists
    4. Case manager
    5. Home health
    6. Palliative care
    7. Appropriate consultants
  8. Recognize and treat psychiatric issues in hospitalized patients
  9. Obtain appropriate consultations from specialists and maintain clear communication with consultants
  10. Be able to utilize the skills and expertise obtained from outside rotations to provide exemplary medical care to the Family Medicine patient
  11. Be able to discern proper disposition of patients, with appropriate medication and follow-up

Practice-Based Learning and Improvement

  1. Integrate the medical aspect of disease into the context of each individual patient taking multiple factors into account
    1. Socio-economic
    2. Emotional
    3. Ethical
    4. Religious
    5. Occupational
    6. Environmental
    7. Medico-legal
    8. Behavioral
  2. Be able to use the Internet to access current literature about diseases encountered on the Family Medicine Inpatient Service
  3. Be able to critically evaluate literature about current medical treatment of diseases experienced on the Family Medicine Inpatient Service
  4. Be able to work well in the context of the Family Medicine Inpatient Team
  5. Be able to be an active participant during rounds
  6. Be able to work with residents, fellows and attending physicians in all areas of practice
  7. Be able to implement changes in patient care based on new information obtained from Attending rounds, clinical experience, review of literature and other sources

Interpersonal Communication Skills

  1. Communicate effectively with patients
    1. Able to communicate in a manner in which the patient and the family of a patient with a medical condition requiring hospitalization can understand
      1. Acute problem that hospitalized the patient
      2. Chronic medical conditions the patient may have
      3. Treatment plan
      4. Prognosis
    2. Able to listen to and address the concerns of patients and their families
  2. Communicate effectively with colleagues
    1. Able to work efficiently in the context of a medical team in a community hospital
    2. Able to clearly communicate patient sign-out, both when giving and receiving sign-out
    3. Able to work efficiently with the support staff in the care of the hospitalized adult medical patient

Professionalism

  1. Demonstrate cultural competency
  2. Demonstrate the ability to act in the best interests of the patients
    1. Respect for confidentiality
    2. Respect for patient autonomy
  3. Be professional in all aspects of patient care
    1. Accepts personal responsibility for patients
    2. Accepts feedback in all aspects of care, including the six core competencies
    3. Timeliness
    4. Appropriate attire

Systems-Based Practice

  1. Demonstrate understanding of the care of the variety of patients seen on a Family Medicine Team in the context of the current healthcare system in a community hospital
  2. Coordinate care with ancillary services to improve the healthcare of the patient
  3. Assist patients in dealing with their acute illness and any underlying chronic diseases they may have
  4. Understand and be able to utilize the alternatives to acute hospitalization
    1. Home infusion therapy
    2. Subacute nursing facility
    3. Acute rehabilitation facility
    4. Chronic care facility
    5. Hospice
      1. Inpatient
      2. Outpatient, including home hospice

From working with fellows and attending physicians in all areas of practice, residents are expected to learn to integrate the medical aspects of disease with the socio-economic, emotional, ethical, religious, occupational, environmental, medico-legal, and behavioral aspects of disease and disease prevention.

On a personal level, the resident will learn the boundaries of personal responsibility, the skills needed to function effectively as a member of a healthcare team and to incorporate quality improvement, risk management, and cost effectiveness into the decision-making process. The resident is strongly encouraged to observe the fellows and attending physicians for the qualities that make for effective leadership.

Begin the road to becoming an educator. Residents and interns have significant responsibilities for teaching medical students while on service. Many months sub-interns are also on services. Teaching is a major component of these months.

Logistics

Contacts

Denise Sur, MD
Residency Program Director
(310) 319-4709 #1
p19691

Chief Resident

Babak Ettekal, MD p22367
Keyvan Hariri, MD p22370
Gus Kalioundji, MD p22371
Gideon Kwok, MD p22372
(310) 319-4709 #1

Additional Information

If you have any questions or concerns about your duties or responsibilities, please discuss this with your Senior Resident. If there are still issues, please contact your Chief Resident.

Location: Santa Monica - UCLA Medical Center

*** Page the Senior Resident (name is listed on the monthly assignment sheet) to determine the reporting time and location for the first day of the rotation. You should also receive the name of the Junior Resident from whom you will receive your patient sign-out.

Continuity Clinic: 8 clinics / rotation

Call Schedule: q4

Educational Half Day: You are expected to attend as much of EHD as possible each week. You are excused from patient care responsibilities.

Schedule

Weekdays

0630 - 0730 Seniors/Juniors receive sign-out from post-call residents.
Prerounds get nursing input and take care of urgent patient issues.
0730 - 0815 Educational rounds with community attending (case presentations, lectures, etc). Community attendings will be present 3-4 days per week. This time will also include psycho-social rounds, community CME lectures, and possibly radiology rounds.
0815 - 0830 Card flip with Senior Resident. Discuss urgent issues and potential DC's.
0830 - 1000 Time to work. Call community attendings to review plan, take care of discharges, etc.
1000 - 1030 IPS rounds: Present case and run board with Senior and IPS Attending.
1030 - 1200 Work
1200 - 1300 Sign-out to on-call team if going to afternoon clinic or post-call.
1900 Senior NF arrives, gets sign-out from Day Senior.

ER-SM R1 holds a code pager when in house

Weekends/Holidays

0800 Juniors and Seniors sign out together. Informal resident rounds.
TBA Informal attending rounds with on-call team; time determined by individual attendings.

* Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities.

* At least 1 in 7 days will be off.

* There must be at least 10 hours off for each resident between shifts.

Phone Numbers and Pagers

R1 call room (2105 H): x94601 ER-R1 numeric pager: 310-737-5325

R2 call room (2105 G): x94466 IPS Jr numeric pager: 310-737-5393

R3 call room (2105 F): x94352 IPS Sr numeric pager: 310-737-5310

Lounge (2105 B): x94565 3rd floor conference room 3

Duty Descriptions

Summary of Duties

Attending on IPS Service

  1. Provide teaching and serve as a resource for all Service patients
  2. Round daily with the IPS team, either in person or by phone, to review patient treatment plans
  3. Be available by pager or phone 24 hours daily for urgent issues or admissions

Residents on IPS Service

  1. Overall goal is for Senior to be supervisory, called whenever things get too busy for Junior
  2. Teamwork is key, at the first sign of a problem, let the Chief Resident know
  3. When in doubt, patient care comes first
  4. Your second priority is education

Specific Duties

Post-call Junior

  1. Finish work and sign-out to On-call Junior before 30 hour work limit
  2. No new patients may be accepted after 24 hours of call
  3. Residents may remain on duty for up to six additional hours to participate in didactic activities, transfer care of patients

Post-Post-Call Junior

  1. Help the Post-call Junior so they can leave by 1PM
  2. Help team round on weekends
  3. Finish work on own patients
  4. Assist in any other duties that need to be done and sign-out to On-call Junior with Senior's knowledge
  5. Continuity clinic in afternoon

Pre-Call Junior

  1. Help the other juniors
  2. Help team round on weekends
  3. Finish work on own patients
  4. May be in afternoon clinic or have the day off

IPS Junior On Call

  1. Patient Care
    1. Call starts at same time every day so that there is an On-call Junior in house at all times who is able to take admissions
    2. Admissions
      1. Les Kelley, including scheduled surgery patients who had pre-op at LKC
      2. Community
        1. Politely decline community admits if cap filled
        2. Provide a list with attendings' names to Senior so that an apology letter can be sent
      3. Peds admits after 5PM M-F, after Peds intern leaves on Saturday or for continuity clinic, all day Sunday
        1. Peds admits before 5 will be taken by the intern on SM-Peds rotation (can be called in from Dr. Sachs' office if admit before 4:30pm)
      4. Cap
        1. Rough guideline is 5 admits per 24 hour shift
        2. No strict cap on admits because no limit on LKC and Peds admits
        3. On-call Senior to determine cap based on other activity in house
    3. Codes blues
      1. With Senior
      2. Do procedures
      3. May run code at discretion of On-call Senior
    4. Obstetrics
      1. LKC OB's
        1. Antenatal testing (NST, AFI, BPP)
        2. L&D triage
        3. Admissions
        4. Labor management
        5. Call primary resident and notify FP attending and OB backup attending.
          1. PMD expected to come in and manage patient unless not permitted by schedule
      2. Panel OB's (pt's w/out primary OB): Check monthly OB calendar for the specific days we are covering Panel OB - generally first half of the month
        1. L&D triage
        2. Precipitous delivery
        3. Admission
        4. Labor management
        5. Call On-call Senior, and OB backup attending
      3. C-Section assists
      4. Standby deliveries (until comm attending arrives)
    5. Cross-cover
      1. IPS cross-cover issues
        1. Make sure to write brief SOAP note
        2. Update sign-out
      2. Urgent cross-cover issue for non-IPS patients
        1. When ER resident not in house
        2. Includes falls, CP, SOB, tele events, transfers
        3. Make sure to write brief cross-cover note
        4. Notify PMD if actions are taken
        5. PMD expected to follow up on tests ordered or to come in and manage patient if issue needs prolonged attention
    6. Death Pronouncements
      1. Brief note required
      2. Ask nurses to notify PMD and family
    7. Transport pts to WW
      1. Only if there are more than 2 residents around
      2. Pt must be stable for transport
    8. Procedures
      1. Teaching service procedures (lines, intubations, etc.)
    9. Following requests are optional but please do if possible:
      1. Placement of Dobhoffs
      2. D/C central lines (unless pt is decompensating)
      3. CXR reads (refer to UCLA night hawk - beeper 97612 inpt, 93580 ER)
  2. Administrative
    1. Dictations
      1. All H/P's and D/C summaries must be dictated within 24 hours
      2. Electronic copy must be sent to the attending
    2. Sign-out
      1. Must be done in person - not over the phone or by leaving paper sign-out
      2. Updated daily and given to On-call Junior
      3. Please save on Junior call room computer as a Word document so that all the residents can access this sign-out
      4. Please give copy also to On-call Senior