As you gain competence in our Learner-Manager-Teacher Model, you will progress from a high degree of supervision to an increasing amount of autonomy.
PG1: Learner Year
PG2: Manager Year
PG3: Teacher Year
07:25
|
I arrive at High Street Health Center with my cup of coffee that I picked up from Starbucks down the road, and park in the employee parking (not the patients parking!) |
| 07:30 |
I attend ambulatory morning report where one of the senior residents is presenting the (SPRINT) trial. My ambulatory chief resident and a faculty member are there to facilitate the discussion. |
| 08:00 |
I head to my team pod to check my inbox, meet my precepting attending, team nurse, and MA and start my morning clinic session. |
| 12:00 |
My morning session is over, I sit at my desk to finish my notes. I check my inbox messages and see that a patient is asking for his amlodipine to be refilled. I quickly confirm his dose in the system and send refills for him. |
12:15
|
Back to the conference room for lunch and to catch up with my co-residents. |
| 13:00 |
Everyone is back to their pod, however I head to the subspecialty pod as I have a PM&R session with one of our attendings. My first patient is Spanish-speaking. I don’t speak much Spanish, but I don’t panic—I go to the interpreters pod to ask one of the certified medical interpreters to join me. |
| 16:00 |
I’m done seeing patients and back at my desk to finish my notes and check my inbox messages one more time. Once I’m done I head to the gym for a quick workout. |
| 18:30 |
I meet my friends for dinner and we plan a trip to Boston for the upcoming weekend. |
| 20:30 |
Back home, I review my patients for tomorrow’s session. I quickly read about migraine treatment as I’m seeing a patient tomorrow for follow up after she was started on topiramate. |
| 21:00 |
I watch the latest episode of Ted Lasso before someone spoils it for me the next day at work. |
| 22:00 |
Bed time |
Manager year is very exciting, its a year of independence and a great growth. During manager year, you and your colleague are managing a team of 8 patients each and working directly with an attending. On weekends, you will cover four patients from your colleagues list while they are off for a total of 12 patients. Manager wards are located on two main units, one of which is our intermediate care unit (step down unit from ICU). Managers will do an admission every other day.
Managers will attend simulation lab Monday for one hour running codes and peri-codes each week. While on manager wards, residents are expected to attending morning report, grand rounds, journal club, and Interdisciplinary Plan of Care rounds (IPOC).
| 06:00 |
Arrive at the hospital, take sign out from night team and start chart reviewing. |
| 07:30 |
Attend morning report, journal club, and grand rounds. |
| 08:30 |
Attend IPOC rounds with nurses and case manager for daily updates on overnight events and discharge planning. |
| 09:30 |
For manager wards, the start of rounds is a little more flexible since we are required to attend morning report and IPOC rounds. We work together to find a time we are both ready for rounds. Rounds are split, my colleague will run their list while I work on my notes and vice versa. On manager wards, we typically have 1-2 four year sub-I medical students who will cover 2-3 patients and present those to the attending during rounds. |
12:00
|
Lunch time! I typically grab lunch and hang out in the resident library and catch up with my colleagues.
|
| 13:00-15:00 |
Now time to complete my notes, discharges, and do my admit. I update families, reassess patients and finish up the day’s tasks before preparing sign out for the night team. |
| 15:30 |
Check in with attending to run the list again for updates and potential discharges for the next day. |
| 16:00 |
Sign out to night float team. The day can be busy depending on acuity of patients, sometimes I am signing out around 17:00 or 18:00. Go home to my dog, eat some dinner, go for a walk, or watch some trashy TV. |
Teacher year is very exciting, full of educational opportunities! It has two different types of wards: teacher wards (TW) (3 blocks of 2 weeks each) and senior wards (SW) (3 blocks of 2 weeks each). During senior wards, the two weeks are split into a rounding week and a less busy week with independent study time and admissions, to reflect a "hospitalist" rotation and provide us with the experience of managing a higher work flow.
The rest of the year consists of ambulatory, elective, ICU (3 blocks of 2 weeks each), consults and board review blocks. Below is a description of my normal day on teacher wards and senior wards.
Patient caps: As a teacher, supervising an intern I am responsible for 12-14 patients carried by my two interns. Senior wards rounding week, I am carrying my own 13 patients from Mon to Sun. Senior wards "easy" week, I come in on Tuesday to do 6 admissions but have the rest of the week of to rest and do self-study.
Morning report: Teachers on TW rotations are expected to attend morning report, Grand Rounds, and Journal Club.
Teacher Wards 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.
On Teacher Wards
| 07:00 |
Arrive at the hospital – as a teacher, 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 |
Attend team huddle with case managers to identify discharges for the day |
| 09:00 |
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 me, but I am in charge of leading the team |
| 12:00 |
Once per week on TW, teachers meet with faculty members to check in, debrief difficult cases, and discuss how to support and teach interns.
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| 13:00 |
Teachers are in charge of running simulation lab for their interns once per week on TW. Teachers work with the chief residents to prepare a case and teaching points. |
| 14:00 |
Each team receives one admission per day on TW, with interns usually alternating admission days. I am expected to develop an assessment and plan with my 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.
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16:00
|
Supervise intern sign out to night float team with standardized IPASS system. I head home and finish up my data collection for a research project I am working on. I spend the rest of the evening with my family with a quick stop to get some ice cream!
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On Senior Wards
| 06:45 |
Arrive at the hospital, take sign out and start chart reviewing. |
| 08:30 |
Attend morning huddle till 9 and then start seeing patients. |
| 10:00 |
As a senior, I can decide and coordinate with the attending when I want to round. We do table rounds with the attending |
| 10:30 |
For the rounding week, I am responsible for 14 patients. After rounds, I start doing my discharges and simultaneously work on orders and consults for my patients. I also start working on notes for my other patients. For the admitting week, I work on Tuesday and do 6 admissions.
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| 15:00 |
On rounding week, finish up the day’s tasks, including afternoon re-assessments and notes. Prepare sign out for the night team. |
| 16:00 |
Sign out to night float team with standardized IPASS system. Rounding week can be busy depending on acuity of patients, sometimes I am signing out around 17:00 or 18:00. |