Revised March 3, 2008
Goals and Objectives
Hospitalist Medicine Rotation
Rotation Coordinator:
Iyad Houshan, MD
Chief, Division of Hospital Medicine
Assistant Professor of Medicine
Department of Internal Medicine
University of Nevada School of Medicine
Suite 300, 2040 W. Charleston Blvd.
(702) 671-2345
Educational Purpose:
- Expose resident to a non- resident driven inpatient system.
-
Further develop clinical skills in assessment, treatment and discharge
planning.
-
Coordinate care plans across other physician co- workers.
-
Medical economics.
Teaching Methods
The Senior PGY-2 or -3 resident will be working closely with the attending
providing daily progress notes and follow-up recommendations for the care of each
patient. Daily rounds will occur with the attending physician at which time instruction in
the unique aspects of the consultative process will be provided. Residents will be
required to continue their regular Morning report and Noon conference core curriculum.
The resident and attending will review and discuss each required reading.
Mix of Diseases
The patients seen will represent a very wide spectrum of medical problems encountered
in an inpatient setting. Most of the patients are admitted through the Emergency
Department and display either an initial presentation of an acute problem or an
exacerbation of a chronic condition. There are very few elective admissions or tertiary
referrals. On occasion, a patient will be accepted in transfer from the Air Force Hospital
at Nellis AFB, the VA ambulatory clinic, or an outside hospital.
Patient Characteristics
A diverse patient population, male and female, of all ages from adolescent to geriatric,
representing most ethnic and racial backgrounds, from all social and economic strata. The
hospital serves primarily the indigent population of Clark County but any patient,
presenting to UMC who requires admission, without a primary physician in Clark County
or one who does not admit to UMC, is admitted to the resident service.
Types of Clinical Encounters
In all instances, residents will have first contact with the patients and will be supervised
by the attending physician. The patient encounters are consistent with what is typically
seen on an inpatient service. Patients will be followed from admission (largely through
the emergency department) through their hospitalization to discharge. The residents are
the primary physicians for each patient on the hematology/oncology service (cross
cover). For each patient under their care, they will conduct and dictate or write an
admission history and physical examination, and formulate a diagnostic and therapeutic
plan. The residents will examine each patient daily and write daily progress notes. The
resident is also responsible for dictating the discharge summary on each patient. The
history, physical examination and subsequent orders and progress notes will be reviewed
by the attending physician. The resident is expected to evaluate every patient under
his/her care on a daily basis. The resident is to confer with the attending physician if
there are any questions about the diagnostic or therapeutic plan on any patient. The
resident will review the patient record, obtain a patient history and perform a physical
examination. The resident will review all available laboratory and imaging data and then
formulate a differential diagnosis and recommendations for continued evaluation and
treatment. The resident will also discuss the patient with the attending physician.
Patients are also accepted in transfer from both the ICU and CCU. The resident will
interview and examine each patient and write a transfer-accept note.
Close interaction with various other healthcare team members including care managers,
discharge planners, home health agencies, inpatient nurses, respiratory therapists,
physical therapists, and patient care technicians occurs daily.
Resident Supervision
Residents have constant on-site supervision by an attending physician as well as daily
personal supervision in their patient care.
Procedures and Services
Abdominal Paracentesis
Thoracentesis
Central Venous Line Placement (internal jugular; subclavian, femoral)
Lumbar Puncture
Breast Examination
Pelvic Examination
Rectal Examination
Methods of Instruction
Responsibility: Faculty will provide a minimum of two medical literature articles per
week per team for resident review and discussion on teaching rounds.
Bedside rounding will occur daily. Bedside rounding will focus on history taking,
physical examination skills, chart review, and review of medical records.
The Attending Physician will be responsible for rounds starting and stopping on t ime so
that:
1) Work-hour restrictions are met.
2) Resident can attend Morning Report and Noon conferences
(exceptions may be made for post-call days and emergencies)
3) 4 ½ hours of teaching rounds occur each week.
4) Approval of all days off at the beginning of the month.
Days off during the week are strongly discouraged.
5) Be available or arrange coverage during all attending days to
Respond to resident calls and evaluate seriously ill patients if
needed.
Didactic Teaching
Morning Report
Residents are required to maintain greater than 60 % attendance at morning
report. Morning Report begins at 8 a.m. on Monday through Thursday and at
8:30 a.m. on Friday.
Noon Conference
Residents are required to maintain greater than 60 % attendance at noon
conference. Noon conference occurs daily, Monday through Friday. These
sessions cover the basic core curriculum, and other curriculum topics such as
ethical issues, geriatrics, computer systems and informatics, health care systems,
occupational and environmental health issues, and other topics of concern.
Educational Resources
Work rounds with resident and/or attending physician (daily)
Attending physician management and/or teaching rounds (daily)
Morning Report daily
Department Noon Conference Series (daily)
Intern Report (Friday 8:30 a.m.)
UMC Grand Rounds (Friday 7:30 a.m.)
Department M & M Conference (monthly)
Journal Club (quarterly)
Department of Medicine Reference Library
UMC Library (hard copy and on-line references)
Hours: Monday - Friday, 7:30 am – 4:00 pm
UNSOM Savitt Medical Library (on-line)
Reading List
Harrison’s Principle’s of Internal Medicine, Kasper DL (editor), 16th ed., McGraw
Hill
The Washington Manual of Medical Therapeutics, 32nd ed.
Cardinal Manifestations of Disease, pp. 53-360.
Oncology and Hematology, pp. 493-730.
Infectious Diseases, pp. 749-1206.
Disorders of the Cardiovascular System, pp. 1229-1345.
Disorders of the Respiratory System, pp. 1407-1419.
Disorders of the Kidney and Urinary Tract, pp. 1495-1574.
Disorders of the Gastrointestinal System, pp. 1579-1737.
Disorders of the Immune System, Connective Tissue, and Joints, pp. 1753-1928.
Endocrinology and Metabolism, pp. 1965-2214.
Neurologic Disorders, pp. 2277-2503.
Ancillary Educational Materials
Subspecialty Texts of Neurology, Pulmonary Medicine, Nephrology,
Endocrinology, Infectious Diseases, Rheumatology as well as General Medical
References (Harrison’s Principles of Internal Medicine, Cecil’s Textbook of
Medicine) are available 24 hours a day, seven days a week in the resident lounge.
Savitt Medical Library On-Line
Residents have access to the on-line services of Savitt Library (the main library of
the University of Nevada - Reno) via their computer in the resident room, Suite
300 of the 2040 W. Charleston Building. Access to this room is available 24
hours a day, seven days a week.
Full text is available for many peer-review journals including, but no limited to:
ACP Journal Club
Annals of Internal Medicine
British Medical Journal
Cancer
Circulation
Journal of the American College of Cardiology
The Lancet
New England Journal of Medicine
Stroke
Also available on-line:
Harrison’s Principle’s of Internal Medicine, 14th ed.
Merck Manual, 17th ed.
Guide to Clinical Preventive Services, 2nd ed.
The Cochrane Library
Medline and Grateful Med Databases
Pathological Material and Other Educational Resources
Residents are encouraged to review the pathological reports on patients for whom they
have cared. If a patient for whom the resident has cared should die and have an autopsy,
the resident is encouraged to attend the post-mortem session.
Training Sites
University Medical Center
All of the inpatient general ward service experience occurs at University Medical
Center (UMC).
Resident Schedule
Day resident:
Monday through Friday 7AM to 7 PM for 2 weeks.
Can keep their clinic schedule once a week
Night resident:
Monday through Friday 7 PM to 7 AM for 2 weeks. When resident has a
clinic, they will have the night before off which will be made up by
working on Saturday night of that week. Total 5 nights in a week.
Competency-based Goals and Objectives
Hospitalist Rotation
Learning Venues
Evaluation Methods
1. Direct patient care
A. Attending evaluation
2. Attending Rounds
B. Direct Observation
3. Residency core lecture series
C. Nurse evaluations
4. Self study
D. Written Examination
5. Morning Reports
E. Resident/Self Evaluation
F. Patient Evaluation
Competency: Patient Care
Obtain an accurate history including
history of present illness
Perform an accurate physical exam
Obtain old records including, but not
limited to, discharge summaries,
operative reports, results of relevant prior
evaluations, and procedure and operative
reports if applicable
Generate a differential diagnosis, define
and initiate therapeutic plan, and modify
therapy, as needed.
Appropriately initiate pharmacological
Level Specificity
This rotation will
occur during
either PGY-2 or -3
level, with
no difference in
expectations or
standards for each
year
Learning
Venues
1,2
Evaluation
Methods
A, B, E
Level
1, 2
1, 2
A, B, E
A, E
NA
NA
1, 2, 3, 4, 5
A, B, D, E
NA
1, 2, 3, 4, 5
A, B, C, D, E
NA
NA
treatment, modify dosing based on
clinical scenario, and manage adverse
effects.
Monitor patient progress, respond to
change in patient condition during
medical treatment and postoperative
period.
Identify and initiate corrective action for
common laboratory abnormalities and
procedure complications.
1, 2
A, B, C, E
NA
1, 2, 3, 5
A, B, C, D, E
NA
Provide care for a service of 10 patients
independently
Competency : Medical Knowledge
1
A,B
NA
Learning
Venues
Evaluation
Methods
Understand the principles of inpatient
medical care
Recognize the need for and timing of
appropriate subspecialty involvement in
complex cases.
Understand appropriate antibiotic
treatment and complications of infectious
diseases
Understand principles of management of
patients with common medical problems,
including cardiac, endocrine,
gastrointestinal, pulmonary, renal, and
rheumatologic conditions
Understand conditions necessitating
transfer of a patient to a higher level of
care (i.e., ICU)
Understand conditions necessitating
consideration of surgery.
Competencies: Interpersonal and
Communication Skills
1, 2, 3, 4, 5
A, B, D, E
NA
1, 2, 3, 4
A, B, D, E
NA
1, 2, 3, 4
A, B, D, E
NA
1, 2, 3, 4
A, B, D, E
NA
1, 2, 3, 4
A, B, D, E
NA
1, 2, 3, 4
A, B, D, E
NA
Learning
Venues
Evaluation
Methods
Interact in an effective way with
physicians, residents, nurses and medical
support staff.
Demonstrate understanding of patient
preferences in diagnostic evaluation and
management .
Maintain accurate medical records.
Serve as a patient advocate.
Ensure adequate transfer of information
1, 2
A, B, C
NA
1, 2
A, B, C, D, E, F
NA
1, 2
1, 2
1, 2
A, B, C
A, B, C, E, F
A, B, C, E
NA
NA
NA
Level
Level
when transferring patient to care of
another physician.
Communicate efficiently and effectively
with referring physician, regarding
diagnosis, treatment and follow-up.
Provide effective and efficient sign-out.
1, 2
A, B, C, E
NA
1,2
A, B, C, E
NA
Competency: Professionalism
Learning
Venues
Evaluation
Methods
Treat team members, primary caregivers,
and patients with respect and empathy.
Understand, practice and adhere to a code
of medical ethics.
Participate actively in consultations and
during rounds.
Attend and participate in all scheduled
conferences.
1, 2
A, B, C, E, F
NA
1, 2
A, B, C, E
NA
1, 2
A, B, C
NA
3, 5
Attendance, A
NA
A, B, C, E, F
NA
Demonstrate compassion and empathy in 1,2
family conferences and end-of-life
discussions
Competency: Practice-Based Learning Learning
Venuses
Incorporate case studies with relevant
1, 2, 4, 5
research outcomes and report those
findings during clinical rounds.
Review the outcomes of patient care in
1, 2, 4, 5
order to reflect on the approach taken in
the delivery of care.
Utilize established practice guidelines for 1, 2, 4, 5
individual diseases to devise care
strategies.
Identify limitations of one’s medical
1, 2, 4, 5
knowledge in evaluation and
management of patients and use medical
literature (primary and reference) to
address these gaps in medical knowledge.
Identify and apply hospital system and
1, 2, 4, 5
clinical guidelines in the diagnosis and
management of patients.
Use information technology to manage
1, 2, 4, 5
patient specific information.
Competency: System-Based Practice
Learning
Venues
Gain familiarity in the billing process for 1, 2, 3, 4
Evaluation
Methods
A, E
Level
Level
NA
A, E
NA
A, E
NA
A, E
NA
A, E
NA
A, E
NA
Evaluation
Methods
A, E
Level
NA
inpatient admission, daily care and
discharges.
Coordinate care amongst specialty
providers, nurse practitioners, physician
assistants, social workers and care
coordinators.
Demonstrate and understanding of the
complexity of directing effective patientcentered care in a hospital setting.
Direct discharge planning to maximize
the patient safety and well being in the
transition to the out patient setting
including appropriate correspondence
with out patient providers, social work
and home health.
Demonstrate basic understanding of
medical economics.
Understand the value of the hospitalist as
a leader participating in the hospital
committees to make changes to policies
and bylaws.
1, 2
A, B, C, E
NA
1, 2, 3, 4
A, B, C, E
NA
1, 2
A, B, C, E
NA
1, 2, 3, 4, 5
A, D, E
NA
1, 2, 3, 4, 5
A, E
NA
EVALUATION
A. Of Residents
At the completion of each rotation, all clinical faculty are required to complete the
standard ABIM resident evaluation form. All clinical faculty are required to
provide face-to-face feedback with the residents. In addition, residents may
receive interim feedback utilizing the ABIM’s Praise and Early Warning cards.
B. Of Rotation and Preceptor
All residents are strongly encouraged to evaluate the rotation, and the clinical
faculty member, at the completion of the rotation. These evaluations are then
converted to type and shared anonymously with the clinical faculty quarterly.
The program director also discusses the rotation with the residents to ensure
rotation quality and satisfaction. This will be done at the form completion
monthly meeting or separately.
Hospitalist Rotation Resident Check List
1. Evaluation reviewed at mid-month and end of rotation by the supervising
faculty member and resident.
2. Completed assigned readings.
3. Attended all assigned clinical activities (excluding scheduled time away, required
clinics and emergencies).
4. Completed required case report abstracts and/or posters assigned by the supervising
faculty member.
5. Demonstrated understanding of the basic principals of hospital management.
6. Received verbal feedback at end of rotation.
Intern/Resident Signature___________________________ Date_________________
Supervising Faculty_______________________________ Date_________________
All items must be completed for rotation credit and checklist returned to the
Department of Medicine by the month’s end.