Baystate Medical Center is a large tertiary care center with 716 beds. For better work flow and to promote interdisciplinary teamwork as well as learning, our inpatient medical ward rotations are based on geographical rounding. Medical admissions to all of our medical teams are also based on geography to help ensure continuity of patient care.
PGY1: Learner Year
Patient caps: Each teaching team consists of 2-3 interns per floor who are supervised by a senior resident and an attending. During the first month of residency, interns will spend two weeks on the medicine wards carrying 4 patients. After orientation, their cap increases to 6 patients for the next two months. For the rest of the year, their cap is 7 patients.
Morning report: Interns on medicine wards rotations are not required to attend morning report, but it is encouraged if you have the time. On Mondays and Thursdays, we have traditional case-based presentations from residents. On Wednesdays, we have an abbreviated session prior to Internal Medicine Grand Rounds. On Fridays, we have Journal Club to discuss evidence-based medicine, led by a senior resident.
Weekends: Each intern works 6 days per week. Both interns work on the same day of the weekend and each intern covers their own patients. On the other weekend day, all patients are covered by the senior resident. Interns are expected to round and each do one admission on the weekend.
| 06:00 |
Arrive for sign out from the night float team, followed by pre-rounding. Pre-rounding involves seeing your patients, checking in with the nurses, reviewing overnight vitals, checking labs, and formulating your assessment and plan for the day. Your senior resident will be able to help with any urgent/emergent situation encountered by interns. |
| 08:30 |
Bedside rounds begin. Rounding teams consist of one attending, one PGY3 (teacher), and 2 PGY1s (learners). As one intern presents their patient to the senior resident, their co-intern helps place orders via computer-on-wheels. |
| 11:00 |
After rounds are finished, interns will verify orders, call consults, and work on daily progress notes. Senior residents can assist with this and are able to help with any questions. |
| 13:00 |
Once per week, interns will participate in simulation lab with an interactive mannequin. During intern year, the focus is on classic symptoms that you will encounter such as chest pain, shortness of breath, or altered mental status. Cases are 30 minutes with a 30 minute debriefing which also includes a teaching session. |
| 14:00 |
Each team receives one admission per day. Interns usually alternate admission days. Admissions are completed with the help of the senior resident and presented to the attending |
| 15:00 |
Finish up the day’s tasks, including afternoon re-assessments and notes. Complete a standardized, written sign out for the night float team for all patients. |
| 16:00 |
Sign out to night float team with standardized IPASS system. |
PGY2: Manager Year
Patient caps: Managers are expected to carry 8 patients on medicine wards. In addition, managers can have up to three “inter-care” or “step-down” patients on their list at a time.
Morning report: Managers on medicine wards rotations are expected to attend morning report, Grand Rounds, and Journal Club.
Weekends: Each manager works 6 days per week. One manager will come in on each weekend day and cover most of the team: managers cover 12 patients in the first half of the year and 14 in the second half, with attendings directly covering 2-4 patients. Managers do not do admissions on the weekends.
| 07:00 |
Receive sign out from night float team. |
| 07:30 |
Attend morning report, Grand Rounds, or Journal Club. |
| 08:30 |
Round on patients independently, making sure to involve family members, nurses, and other members of the team. After seeing all of their patients, managers will discuss their plans with the attending. |
| 12:00 |
Twice per week, managers meet with faculty members to check in, debrief difficult cases, and discuss topics such as goals of care discussions. Dr. Bryson also incorporates medical jeopardy at the end of each manager block during which a special lunch is provided. |
| 13:00 |
Once per week, managers will participate in simulation lab with an interactive mannequin. During manager year, the focus is on ACLS protocol and immediate, life-threatening situations such as unstable arrhythmias, acute respiratory failure, and others. Cases are 30 minutes followed by 30 minutes of debriefing with incorporated teaching sessions. |
| 14:00 |
Each manager receives one admission per day. Admissions are precepted directly with the attending physician. |
| 15:00 |
Finish up the day’s tasks, including afternoon re-assessments and notes. Complete a standardized, written sign out for the night float team for all patients. |
| 16:00 |
Sign out to night float team with standardized IPASS system. |
PGY3: Teacher Year
Patient caps: When supervising an intern team, teachers are expected to be responsible for up to 14 patients. When doing a Senior Wards rotation, patient caps and duties are the same as for managers.
Morning report: Teachers on medicine wards rotations are expected to attend morning report, Grand Rounds, and Journal Club.
Weekends: Each teacher works 6 days per week. Both interns come in on the same weekend day and each intern covers their own patients. On the other weekend day, all patients are covered by the senior resident.
| 07:00 |
Arrive at the hospital – can participate in sign out, or allow interns to take sign out on their own. Chart review and support interns as needed. |
| 07:30 |
Attend morning report, Grand Rounds, or Journal Club. |
| 08:30 |
Teachers are expected to lead teaching rounds. They will help prioritize which patients need to be seen first, and provide bedside teaching and immediate feedback to interns on their assessments and plans. The attending physician is present to support you, but you are in charge of leading the team. |
| 12:00 |
Once per week, teachers meet with faculty members to check in, debrief difficult cases, and discuss how to support and teach interns. |
| 13:00 |
Teachers are in charge of running simulation lab for their interns once per week. Teachers work with the chief residents to prepare a case and teaching points. |
| 14:00 |
Each team receives one admission per day, with interns usually alternating admission days. Senior residents are expected to develop an assessment and plan with their intern before the patient is presented to the attending. |
| 15:00 |
Finish up the day’s tasks, including afternoon re-assessments and notes. Review the interns’ written sign outs for the night float team. |
| 16:00 |
Supervise intern sign out to night float team with standardized IPASS system. |