|
|
|
|
Rotation Information (back to top) Faculty: Mike Tuggy, MD Resident Chairperson (2002-2003): Kim Dovin, MD
R-2 ICU Rotation (back to top) Objectives
Assignment Each second year resident will spend one 4-week block on the Medicine/ICU/CCU service at Swedish at Providence Medical Center. On night call, the second year resident will: 1) supervise two R-1s and work with the attending physician and consultants on admissions to the medical floor, ICU, and CCU and, 2) care for those patients followed by the resident’s team as well as those of its cross-coverage team. On short day call, the second year resident will supervise two R-1s in the care of redistributed patients admitted by the Night Float. In addition to the responsibilities at Swedish at Providence Medical Center, the second year resident will continue to have continuity clinic at his/her respective site one half day a week. Duty Hours The medical service will set duty hours. Please contact Sandy Petit (320-2553) for more details regarding specific expected times of attendance. Call Responsibilities Night Call: The night call schedule will be every fourth night and alternate between 8:00am – 8:00am admissions and 8:00am – midnight admissions. The second year resident will act primarily as the supervisor for two R1s. The current admission maximum or "cap" is 5 patients per R1. This call schedule is adjusted for weekend coverage as outlined in the Duty Hours. During the shorter night call, the second year resident will be co-admitting as the supervising resident with the senior Internal Medicine resident. During these night calls, the Internal Medicine resident will attempt to have the second year resident supervise the ICU/CCU admissions. There will be an in-house senior Internal Medicine resident acting as the Night Float. S/he will be available for consultation on patient management or procedures from 8:00pm – 8:00am. If patient management consultation is required prior to the arrival of the night float, a senior Internal Medicine resident will be available by phone. If procedure consultation is required prior to arrival of the night float, the inpatient hospitalist, ICU attending, or emergency room attending will be available. Remember, patient care is of utmost importance. If there are any questions or concerns regarding patient care, please do not hesitate to contact the above-mentioned resources. Short/Day Call: Two days after the longer night call ("post post-call day"), the second year resident will supervise two R1s in the care of those patients admitted the previous night by the Night Float. The critically ill patients that were admitted by the Night Float will generally go to the Night Call team and not the Short/Day Call team. Faculty Dr. Robert Schoene – University of Washington and Swedish at Providence. Dr. Michael Tuggy – Director of Family Medicine, Swedish at First Hill. Chief Medical Resident at Swedish at Providence Colleague - University of Washington Internal Medicine R2 or R3 Colleague – Swedish at Providence Family Medicine R2
Conferences Medicine conferences as directed by the curriculum for the senior resident while at Swedish at Providence. Family Medicine didactics are scheduled every Tuesday afternoon. Care Pathways Clinical care pathways should be followed where applicable. Codes The second year resident will carry code beepers while on the longer night call and should be prepared to "run" the code. Vacation No vacation is allowed during the Medicine/ICU/CCU rotation at Swedish at Providence. Priorities
Common Medical Diagnoses The study and practice of internal medicine involves the application of a comprehensive review of the medical records, a thorough medical history, and a complete physical examination as the basic intellectual materials to determine diagnosis and treatment. The primary educational process of the specialty comes from forming a differential diagnosis and discussing with others the strategies for care and treatment. For each patient, the second year resident is expected to compare the patient’s history, physical findings, and laboratory findings in comparison to ordinary or "classic" presentations of the disease process suspected. Afterwards, consideration should be made to obtain additional laboratory or imaging studies to confirm the diagnosis. Treatment alternatives and the expected hospital course and potential complications should be discussed with the other colleagues and the attending. Common medical diagnoses likely to be encountered in the ICU/CCU setting include:
Procedures The following are procedures for which there is usually an opportunity to learn when on the ICU/CCU ward. Remember, understanding the indication for each procedure is as important as learning how to do it.
Further Learning Objectives and Recommended Reading
The Cardiology/CCU rotation Each R3 will complete a four-week cardiology/CCU rotation with a cardiologist able to provide an adequately intensive experience. Currently, the available cardiologists that the R3 will work with will be Dr. John Olsen (primary contact, office number: 292-7990) and his associates. The experience will include cardiology clinic time with the preceptor, inpatient consults, telemetry/CCU admissions, assisting in the cath lab, and EKG interpretation. Residents will gain knowledge and confidence with the spectrum of acute and chronic cardiovascular conditions. Emphasis should be on diagnosis and management of artherosclerotic diseases of the coronary arteries, EKG interpretation, hypertension management, congestive heart failure, valvular disease, and outpatient management of angina and arrhythmias. Each resident will be expected to provide care under the supervision of the preceptor in the ICU, CCU, and telemetry unit as well as the general medical units. The resident should be able to assist in the cath lab between the hours of 0800 and 2200 on weekdays and should participate in the administration of treadmill stress tests. The R3 will spend about one half day to one day of continuity clinic each week. If the R3 is referring his/her patient to cardiology during the CCU rotation, every scheduling effort should be made to attend this referral. During Tuesday afternoon didactics, priority for the CCU resident should be:
No vacation time is allowed during the CCU rotation unless discussed with Chief Residents and approved by the cardiologist. Medicine Conference Lecture Topics Cardiovascular
Dermatology
Endocrinology
Gastroenterology Nephrology
Hematology Infectious Disease
Rheumatic Disorders Respiratory
Neurology
EKG Series (13 lectures)
Frequently Used Medicine Consultants
The 3rd year medicine requirements and electives: During the third year, the internal medicine curriculum consists of required structured clinical experiences in dermatology and neurology. For both of these rotations, learning objectives and recommended reading will be available on the Swedish Family Medicine intra-net website. The R3 is responsible in providing these learning objectives to the specialist so that teaching/learning can be structured. If learning objectives are not met while working with the specialist, the R3 is responsible in using other resources to fulfill these requirements. This can include additional reading, the Internet, or using materials from The Learning Center. Below is a list of contact dermatologists and neurologists as well as their expectations/requirements when working with them. Please try to contact these individuals at least one month prior to starting the rotation to optimize scheduling. Electives in other internal medicine disciplines are also available including rheumatology, endocrinology, pulmonary medicine, hematology/oncology, rehabilitation medicine, allergy, and substance abuse rehabilitation. Before beginning a rotation in these other medicine electives, the R3 is responsible in preparing his/her proposed learning objectives and to review these with his/her advisor or other Family Medicine faculty member. Below is a current list of those specialists that have received recommendations from previous residents. While on any third year medicine elective, the R3 will still need to fulfill his/her continuity clinic duties as directed by the Clinic Chief. For any elective internal medicine rotations, the continuity clinic duties should be discussed as soon as possible with the Clinic Chief so that the R3 can make the most of his/her learning experience. Finally, the R3 should make every attempt to participate in the specialty care of the continuity patient if s/he is in that particular rotation. For example, if the R3 is on dermatology for the month and has a continuity patient being referred to dermatology, a scheduling effort should be made to try to attend that dermatology referral. Dermatology
Neurology
Rheumatology
|
