General Internal Medicine Consult Service

Medicine

Educational Purpose:

Internal Medicine is somewhat unique in that trainees must learn to function as primary caregivers and as consultants for other physicians. Interns (PGY 1) and upper level (PGY 2 and 3) residents rotate for a one month experience on the General Medicine Consult Service. This rotation will help the resident appreciate the role of the medical consultant and will provide experience in caring for the medical problems of patients admitted to other disciplines. Residents learn to interact with other specialties while serving as a consultant.

Goal: Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. 

Residents are expected to:

PGY 1

  1. To become familiar with perioperative management of diabetes mellitus, hypertension, electrolyte abnormalaties, and other common medical conditions.

  2. To learn to anticipate, recognize and treat alcohol withdrawal.

PGY 2 and 3

  1. To become familiar with perioperative management of diabetes mellitus, hypertension, electrolyte abnormalaties, and other common medical conditions.

  2. To learn to anticipate, recognize and treat alcohol withdrawal.

Medical Knowledge Goals and Objectives:

Goal: Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care.

Residents are expected to:

PGY 1

  1. To recognize the indications for antibiotic prophylaxis in the surgical patient.

  2. To understand the current recommendations for and methods of DVT prophylaxis in the surgical patient.

PGY 2 and 3

  1. To recognize the indications for antibiotic prophylaxis in the surgical patient.

  2. To understand the current recommendations for and methods of DVT prophylaxis in the surgical patient.

Practice-Based Learning and Improvement Goals and Objectives:

Goal: Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life long learning.

Residents are expected to develop skills and habits to be able to:

PGY 1

  1. To learn an “evidence-based” approach to each consult.

PGY 2 and 3

  1. To learn an “evidence-based” approach to each consult.

  2. To formulate short tem as well as long term plans of care and effectively communicate with consulting services.

Systems Based Practice Goals and Objectives:

Goal:  Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.

Residents are expected to:

PGY 1

  1. To learn the basic principles of effective medicinal consultation including appropriate communication.

  2. To recognize important preoperative risk factors for each organ system and to understand perioperative risk assessment including the cost effective use of lab and diagnostic testing.

  3. To appreciate the challenges of providing medical care to special populations including psychiatric and obstetric patients.

PGY 2 and 3

  1. To learn the basic principles of effective medicinal consultation including appropriate communication.

  2. To recognize important preoperative risk factors for each organ system and to understand perioperative risk assessment including the cost effective use of lab and diagnostic testing.

  3. To appreciate the challenges of providing medical care to special populations including psychiatric and obstetric patients.

  4. Supervise and facilitate education of interns and medical students rotating on the service.

Professionalism Goals and Objectives:

Goal: Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. 

Residents are expected to demonstrate:

PGY 1

PGY 2 and 3

Interpersonal and Communication Skills Goals and Objectives:

Goal: Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates. 

Residents are expected to:

PGY 1

PGY 2 and 3

Teaching Methods:

Residents on the GIM consult service will be responsible for answering all consults to General Internal Medicine in the Medical University Hospital, Ashley River Tower, and MUSC’s Institute of Psychiatry. Each patient will be carefully evaluated and presented to the GIM consult attending for discussion and further evaluation. The resident should peruse the current literature regarding the patient’s condition and should bring any pertinent articles to consult rounds. Further, the resident will be responsible for communicating any recommendations with the primary team and will follow the patient’s progress daily. The attending physician will hold regular didactic teaching sessions at least three days per week.

Mix of Diseases and Pathological Material:

The service is consulted from a number of other specialties, though surgical specialties (particularly Orthopedics) and Psychiatry are leading consultants. Common questions include preoperative assessment, DVT prophylaxis and management, hypertension management, diabetes management, electrolyte abnormalities, COPD management and alcohol withdrawal syndromes. 

Patient Characteristics:

Residents care for a diverse patient population with respect to age, ethnicity, and gender. The majority of the patients are older adults, but there are significant numbers of adolescent and young adult patients on some services.

Types of Clinical Encounters:

Clinical encounters include: preoperative assessment, DVT prophylaxis and management, hypertension management, diabetes management, electrolyte abnormalities, COPD management and alcohol withdrawal syndromes.

Procedures and Services:

Residents do not commonly perform procedures on this rotation, though they occasionally may perform arthrocentesis or central catheter placement under the supervision of the attending physician. Residents are expected to interpret all EKGs and other studies performed on their patients.

Supervision:

The GIM consult team consists of a PGY1, 2 or 3 resident and the attending physician. There is occasionally a fourth year student who is supervised by the resident. The attending physician directly supervises the resident and rounds with him or her daily.

Educational Resources to be Used and Reading Lists:

The overall curriculum for the rotation is available to the resident on the MUSC intranet. It consists of expectations and a reading list of pertinent articles regarding consultative medicine and management of specific conditions. Residents have access to all major Internal Medicine textbooks. Additionally, the house staff is expected to pull journal articles appropriate to the care of their patients. Up-To-Date is available in the resident’s library.

Method of Evaluation of Resident Competence:

The attending physician provides formative feedback at the halfway mark of the rotation. Residents are evaluated summatively using the global evaluation form. The Mini-CEX is often administered on this service as well. Patient Care is assessed based on direct observation and complete review of all records. Medical Knowledge is assessed through direct questioning and observation. Interpersonal Skills and Communication is assessed by observation of interactions with consulting physicians, patients, and families. The attending physician evaluates Professionalism through direct interaction and observation of the resident. Systems-Based Practice is evaluated based on interactions with the primary team and the ability to provide medical care in the consultative setting. Practice-Based Learning is evaluated based on the ability to consult the literature and to improve their performance throughout the rotation. The residents evaluate the rotation and the attending physician through the E*Value system. The consult attendings review the rotation evaluations and each attending anonymously receives his or her evaluations.