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Hospitalist Rotation

Educational Purpose:

The Hospitalist Elective at MUH is structured to give Internal Medicine residents a broad-based experience in managing acutely ill general medicine patients, consulting on surgical co-management patients, triaging ED and outside hospital admissions, and conducting preoperative evaluations. It is designed to develop the clinical skills necessary to diagnose and treat undifferentiated medical patients with a wide range of illnesses. The rotation provides each resident with graduated autonomy combined with direct supervision by expert faculty.

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:

To enhance their history taking and physical diagnosis skills.
To develop differential diagnoses and formulate a treatment plan on acutely ill patients.
To manage the inpatient illnesses which are commonly cared for by the hospitalist.
To learn how to medically optimize and risk assess surgical patients.
To co-manage surgical patients with acute and chronic medical illnesses.
To perform the role of admitting officer of the day, triage admissions, and provide safe handoff.

Medical Knowledge Goals and Objectives:

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

Residents are expected to:

To develop differential diagnoses and formulate a treatment plan on acutely ill patients.
To understand the indications/need for appropriate subspecialty consultation.
To develop immediate and long term treatment goals of care.
To understand appropriate billing and coding for patient encounters.
To learn medication management, risk assessment, and stress testing indications.
To understand the role of a hospitalist in providing improved patient care and quality care metrics.

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:

To develop skills and habits to continue life-long learning.

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 develop the ability to call effectively on other resources in the system to provide optimal health care.

Residents are expected to:

To effectively lead an interdisciplinary team.
To coordinate care using a multidisciplinary approach.
To triage patients to the appropriate teams and hospitals where they can get the procedures and consults necessary for their care.
To refer patients for stress testing, cardiac evaluation, and to request records to expedite preoperative evaluation.

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:

To demonstrate interpersonal skills and effective communication with patients, families, and consulting teams.

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:

To enhance their history taking and physical diagnosis skills.
To demonstrate interpersonal skills and effective communication with patients, families, and consulting services.
To effectively lead an interdisciplinary team.
To provide timely responses for admission requests.
To provide safe handoffs, communicate pertinent medical illnesses, and diagnostic testings to admitting teams.

Teaching Methods:

The majority of teaching on the Hospitalist elective is case-based at the time of clinical encounters, however this will be supplemented with a comprehensive reading list which is aimed at preparing the resident for a career in hospital medicine. The resident will have significant autonomy and therefore will need to practice healthy life-long learning habits by researching a clinical question and presenting it to the hospitalist attending. The attending hospitalist will provide bedside teaching when possible which can include demonstration of history taking, examination skills, modeling communication or exploration of medical knowledge. The hospitalist attending will focus on published clinical evidence supporting clinical decision-making. Residents will also receive didactic sessions on multiple occasions throughout the month on topics such as triaging, preoperative evaluation, preoperative medication management, coding, and billing. Residents are expected to attend Morning Report and academic half day when feasible.

Mix of Diseases and Pathological Material:

Residents care for patients with a wide variety of clinical syndromes including chest pain, coronary artery disease, CVAs, CHF, diabetes mellitus, DKA, pneumonia, COPD, asthma, pyelonephritis, acute and chronic renal insufficiency, SLE, vasculitis, dementia, and many others.

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 with acute and complicating chronic medical conditions needing inpatient care, surgical co-management, and preoperative evaluation.

Types of Clinical Encounters:

The Hospitalist elective takes place in the Medical University Hospital. Patients are admitted to the hospitalist service through emergency rooms, from the outpatient clinics, transfers from other inpatient services, ICU transfers, and transfers from outside hospitals. This is similar for surgical co-management patients however the majority of preoperative evaluations will occur in the outpatient preoperative clinic. Residents will be responsible for performing the initial H&P or consult note, and writing all orders under the supervision the attending physician.

Procedures and Services:

Residents have the opportunity to perform procedures on the Hospitalist Elective and all are appropriately supervised by the attending physician. Residents are expected to interpret all EKGs and chest x-rays performed on their patients.

Educational Resources to be Used and Reading Lists:

The residents have access to all major Internal Medicine textbooks and a broad array of electronic resources (including Up-To-Date) through the MUSC library website. Additionally, the house staff is expected to pull journal articles appropriate to the care of their patients.

Below is the required reading list for the hospitalist elective:

Zero to 50,000 — The 20th Anniversary of the Hospitalist (NEJM)
Who Consults Us and Why? An Evaluation of Medicine Consults/Co-management Services at Academic Medical Centers (Journal of Hospital Medicine)
Hospitalists as Triagists: Description of the Triagist Role across Academic Medical Centers (Journal of Hospital Medicine)
Management of diabetes and hyperglycaemia in the hospital (The Lancet)
Evolution of Co-management (Society of Hospital Medicine)
Integrated Fragility Hip Fracture Program: A Model for High Quality Care (Journal of Hospital Medicine)
Preoperative Medicine Overview (Dr Srikanth’s powerpoint)
Preoperative Medication Management (Dr. Srikanth’s powerpoint)

Method of Evaluation of Resident Competence:

Residents are evaluated using the global evaluation form. 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 patients, families, consultants, and interdisciplinary team members. The attending physician evaluates Professionalism through direct interaction and observation of the resident. Systems-Based Practice is evaluated based on interactions with the multidisciplinary team and on the assessment of the nurse case managers. Practice-Based Learning is evaluated based on the ability to consult the literature and to improve performance throughout the rotation. Residents receive formative evaluation throughout the month. Residents evaluate the rotation and the attending physician through the E*Value system. The Hospitalist Division reviews the rotation evaluations, and each attending anonymously receives his or her evaluations.