Inpatient Training

Inpatient Rotations

A unique feature of our program is a 1:1 pairing of resident to intern on inpatient services throughout the three years. This affords interns the support needed for caring for very ill patients, while providing upper level residents the opportunity for more one on one teaching, including bedside, evidence based and on the fly teaching. Throughout the year the intern will gradually be expected to function more autonomously, while still receiving that valuable teaching provided by an upper level resident.

Ward Team Structure

C3A unique feature of our program is a 1:1 pairing of resident to intern on inpatient services throughout the three years. This affords interns the support needed for caring for very ill patients, while providing upper level residents the opportunity for more one-on-one teaching, including bedside, evidence-based and on-the-fly teaching. Throughout the year the intern will gradually be expected to function more autonomously, while still receiving that valuable teaching provided by an upper level resident.

Each service has a slightly different structure in terms of the number of teams, attendings, and the presence of fellows, as outlined below.

Geographic General Medicine Service

Six day teams consisting of:

  • One upper level resident
  • One intern
  • Four Attending physicians (one or two resident:intern pairs per attending)

Two night float teams consisting of:

  • One upper level resident
  • One intern
  • In-house night hospitalist (supervising both teams)

Q4 day call cycle

Day Call

  • Non call teams admit patients from 07:00 to 14:00 in drip system
  • Long call team admits new patients from 14:00 to 19:00
  • Non-call teams sign-out to the on-call team at 17:00
  • On-call team remains in-house for admissions & cross-cover until 20:00 (when NF team arrives)

Night Float

  • Team admits new patients from 19:00 to 07:00
  • Team cross-covers unit based general medicine service overnight
  • Residents present hold-overs to the day teams at 07:00
  • NF team leaves by 08:00-08:30 every day
  • Interns works 6 nights in a row for 3 three weeks during night float block by covering and admitting to the same service
  • Resident works 6 nights in a row for 3 weeks during night float block by covering and admitting to the same service in 1 week increments

Digestive Health Service

Four day teams consisting of:

  • One upper level resident
  • One intern
  • Hepatology Attending physician and Fellow
  • Luminal Attending physician and Fellow

One night float team consisting of:

  • One upper level resident (supervising Digestive Health and Heme/Onc night interns)
  • One intern

See below under Hematology-Oncology Service for call cycle

Hematology-Oncology Service

Four day teams consisting of:

  • One upper level resident
  • One intern
  • Hematology Attending and Fellow (supervising malignant hematology and bone marrow transplant patients)
  • Oncology Attending and Fellow (supervising solid tumor patients)

One night float team consisting of:

  • One upper level resident (supervising Digestive Health and Hem/Onc night interns)
  • One intern

Digestive Health Service & Hematology/Oncology Service (Q4 day call cycle)

Day Call

  • On call teams admits new patients from 07:00 to 19:00
  • Non-call teams sign-out to the on-call team at 17:00
  • On-call team remains in-house for admissions & cross-cover until 20:00 (when NF team arrives)

Night Float

  • One supervising resident plus one Hem/Onc intern and one Digestive Health intern make up Night Float team
  • Team admits new patients from 19:00 to 07:00
  • Team cross-covers on each service overnight
  • Intern and resident present holdovers to the day team at 07:00 for Hem/Onc and 08:00 for Digestive Health
  • NF team leaves by 09:00
  • Interns works 6 nights in a row for 3 three weeks during night float block by covering and admitting to the same service
  • Resident works 6 nights in a row for 3 weeks during night float block by covering and admitting to the same service in 1 week increments

Acute Cardiology Service

Four day teams consisting of:

  • One upper level resident
  • One intern
  • General Cardiology Attending and Fellow (supervising general cardiology patients)
  • Heart Failure Attending (supervising advanced heart failure patients)

Q4 day call cycle – resident overnight

Day Call

  • Team admits from 07:00 to 21:00
  • Non-call teams sign-out to the on-call team at 17:00
  • Intern leaves by 22:00
  • On-call resident remains in-house for cross-cover on acute cardiology service
  • Overnight admissions provided by CCU resident and intern
  • CCU intern and resident present holdovers to the day team at 07:00
  • Post call intern and resident round following holdovers with post call resident leaving by 10:00 and post call intern signs out to on call team at 17:00

Coronary Care Unit

Two day teams consisting of:

  • One upper level resident
  • One intern
  • One CCU Fellow
  • General Cardiology Attending (supervising general CCU patients)
  • Heart Failure Attending (supervising advanced heart failure patients)

One night float team consisting of:

  • One upper level resident
  • One intern

Q2 day call cycle

Day Call (Sunday-Friday)

  • Team admits new patients from 07:00 to 21:00
  • Non-call team sign-out to the on-call team as soon as work completed (approximately 14:00)
  • On-call team remains in-house for admissions & cross-cover until 21:00 (when NF team arrives)

Night Float (Sunday-Friday)

  • Night float resident/intern team admit 21:00 to 07:00
  • Night float team presents holdovers to Acute Cardiology and CCU starting at 07:00
  • Night float team leaves by 10:00

Weekend Coverage (Saturday)

  • Saturday night “CCU Night Float” is covered by a resident/intern pair that is currently on an outpatient/elective block
  • Night float team admits from 20:00 to 07:00 and cross covers the CCU
  • Night float team admits from 21:00-07:00 to acute cardiology service
  • NF intern and resident leave by 10:00

Medical Intensive Care Unit

Four day teams consisting of:

  • One upper level resident
  • One intern
  • Two Attending physicians and two Fellows (each supervising two resident teams)

One night float team consisting of:

  • One upper level resident
  • One intern

Q4 day overnight call cycle

Day Call

  • Team admits new patients from 07:00 to 20:00
  • Non-call team sign-out to the on-call team at 17:00
  • On-call resident remains in-house to cross-cover overnight
  • On-call intern leaves by 22:00
  • All teams round at 08:00 and post-call resident leaves by 10:00
  • Post call intern signs out to on call team at 17:00

Night Float (Continuous)

  • Night float intern/resident team admit new patients 20:00-07:00
  • Night float intern is responsible for cross cover with the help of the overnight call resident
  • Night float team present overnight admissions on morning rounds
  • Night float team leave by 10:00
  • Each team does 5 days of night float at a time

Typical Weekly Schedule

Monday

Tuesday

Wednesday

Thursday

Friday

07:00-08:00

Holdover Rounds presented to the Day Teams by the Night Float Team

08:00-09:00

Resident and Intern Bedside Rounds and Work Rounds

09:00-10:30

Attending Rounds with Team – Residents, Interns, Students

11:30-12:30

Morning Report (Jul-Nov)
CMC/CPC Conference (Nov-Feb)
Board Review Series (Feb-Jun)

Morning Report followed by Evidence-Based Medicine or Morbidity & Mortality

Department of Medicine Grand Rounds

ICU Morning Report (Jul-Nov)
CMC/CPC Conference (Nov-Feb)
Board Review Series (Feb-Jun)

Internal Medicine Residency Program Weekly Meeting

14:00-15:00

Afternoon Teaching including Intern Report and Subspeciality Service Lectures