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Rotations

Medicine Wards

  • There are 8 teams in our wards system divided into
    • 1 Intermediate Care Unit (IMC) team
    • 1 hematology/oncology team
    • 1 cardiology team
    • 5 general wards
  • On all wards teams house staff care for patients belonging to their “teaching” attending as well as private attendings with typically 1/3 of the patients on the team census under the care of the “teaching” attending. Rounds with the teaching attending typically occur sometime between 9-11AM and last 1-1.5 hours.
  • The intermediate care unit (IMC) team, analogous to a “step-down” team, cares for all patients in the 14 bed intermediate care. The IMC team typically admits 2-6 patients daily (1-3 per intern), has a high turn-over and cares for patients who require more care (eg BiPAP) or higher levels of monitoring, but do not require intensive care unit (ICU) level care.
  • The hematology/oncology team includes a hematology/oncology fellow and admits daily.
  • The cardiology team admits daily.
  • The 5 general wards teams care for medicine patients on the wards and calls on these teams are on a q5 day schedule.
  • We adhere to the ACGME rules for interns, including a 16 hour cap on intern calls. The residents and interns on the ward teams do not take overnight call. Night float admitting residents admit patients overnight for the team on the day of their night call (as well as patients that come overnight for teams that admit daily) and the team signs in to receive those patients, if any, on their post-call day.
  • Team cap for all teams is set at 20 patients with exception of the IMC team, which has at most 14 patients. General wards teams can admit at most 10 patients on their call days (max 5/intern), with no intern carrying more than 10 patients at any specific time.
  • Night float covers all patients on the house staff service overnight with sign out on weekdays starting at 4PM and at 11AM on weekends or holidays. Sign-in occurs no later than 7AM on all days. 
  • All residents and interns have four days off averaged over a four week period.
  • The rotation includes daily noon conferences (replaced by grand rounds on Wednesdays), morning report once a week for interns and three times for residents, chairman’s conference, journal club once a month, and once a week outpatient continuity clinic in the afternoon for the categorical interns and residents (that are scheduled so they don’t conflict with call or post-call days).
  • We are currently evaluating a possible move to a daily admission system for all teams.

Medical ICU

  • Our medical ICU is a closed unit and is among the busiest in the region consisting of 19 beds.
  • ICU team consists of five PGY-2/3 and five interns. Medical students (acting interns) may also be part of the team
  • Rounds are from 8:30AM to 12:00PM daily (patients admitted overnight are presented first) with extensive bedside/didactic teaching, supplemented by MICU conferences on weekdays from 12:30PM to 1:30PM and a MICU textbook containing study material/articles for the rotation and board review.
  • There is a critical care fellow in the MICU 24/7 to discuss cases and assist with procedures. Each resident and intern will have one week of MICU night float during the rotation. Otherwise resident & intern schedules consist of a repeating four day cycle with at least four days off per four-week block.
  • Interns in the MICU are on a 4 day cycle (admitting, work, call and extra OR day off).
  • Residents in the MICU are on a 4 day cycle (Work/admitting, call/post-call, and extra OR day off).
  • Both interns and residents do one week of MICU night float during the rotation. 

CCU

  • Our CCU is a closed unit and is among the busiest in the region consisting of 14 beds.
  • The CCU team consists of four PGY-2/3 residents and four interns.
  • Rounds are from 8:30AM to 12:00PM daily with extensive bedside/didactic teaching, supplemented by cardiology conferences on weekdays from 12:30PM to 1:30PM and a CCU textbook containing study material/articles for the rotation and board review.
  • There is a cardiology fellow in the CCU 24/7 to discuss cases and assist with procedures.
  • Resident & intern schedules consist of a repeating four day cycle with at least four days off per four-week block.

Night Float

  • The night float team consists of at least 2 PGY-2/3 residents AND 2 other interns OR 2 other PGY-2/3 residents.
  • Night float duties include cross cover, triage, and admitting. 
  • Residents attend morning report from 7:30AM to 8:30 AM on Monday, Tuesday, & Thursday mornings after shifts to get continued didactic training during night float rotations.
  • Residents are expected to do two 2-week rotations and one 1-week rotation for a total of 5 weeks each year.
  • Interns are expected to do two weeks of night float with duties alternating between cross-cover and admitting responsibilities. It is designed to be an educational experience, with residents present throughout their shifts to supervise them.

Continuity Clinic

  • Categorical interns and residents are assigned to a weekly, half-day afternoon continuity clinic except during their ICU, CCU and night float rotations.
  • Before every clinic there is mandatory ambulatory care conference on important outpatient medicine topics from 1PM to 1:30 pm.
  • The Ambulatory Care Center uses an electronic medical record. 
  • Registered nurses triage phone calls and take messages for resident physicians when they are not in the clinic.
  • Residents work with the same designated faculty member to care for a panel of patients throughout their training. 

Ambulatory

  • Categorical residents complete a total of four blocks of ambulatory medicine during their three years of training, 2 blocks during the PGY-1 year and one block each during their PGY-2 and PGY-3 years.
  • Ambulatory medicine includes urgent and pre-operative clinic rotations. Also, residents have the opportunity to rotate through different non-internal medicine subspecialties (e.g. ob/gyn, orthopedics, podiatry, dermatology, psychiatry, ophthalmology, vascular surgery, urology, etc.), private primary care practices, adolescent clinics, occupational-health and free city clinics.
  • The rotation includes specific outpatient morning reports and evidence based outpatient medicine case analysis.

Medicine Consultation

  • Categorical residents complete one block of medicine consultation during their three years of training, which takes place during the PGY-3 year.
  • Medicine residents are responsible for pre-operative evaluations (both elective and emergent), as well as co-management of patients with chronic medical problems on non-internal medicine services.

Emergency Medicine

  • Categorical residents complete one emergency medicine rotation during their PGY-2 year.
  • The MedStar Washington Hospital Center Emergency Room (ER) is the busiest in Washington, D.C., with over 80,000 ED visits per year.
  • Patients often have serious medical conditions and a relatively high proportion of patients get admitted.  The most serious trauma cases are seen at MedStar Washington.
  • Residents work one-on-one with the ER attending, shifts are 8 hours long with an extra 1 hour at the end of the shift for sign out to the incoming team.

Geriatrics

  • Categorical residents complete one block of geriatric medicine during their three years of training (either the PGY-2 or PGY-3 year) at MedStar Washington or the VA Medical Center. 
  • Residents participate in inpatient consultations, home care visits, and a geriatric assessment program.