The General Medicine Ward rotation provides house staff with the opportunity to care for the Bronx’s diverse patient population and become skilled and confident in the diagnosis and management of a breadth of pathology. The structure of the medical wards allows interns and residents to develop as independent thinkers within a team-based patient care setting.
Medicine Ward Structure
The Moses and Einstein Campus medicine teaching services are broken up into 8 and 6 house staff teams, respectively. Each team is geographically located on a hospital floor and cares for either 8 or 14 patients. The teams are composed of a dedicated teaching attending physician, a 2nd or 3rd year resident, and either 1 or 2 interns. Sub Interns and third year medical students from the Albert Einstein College of Medicine are part of most teams throughout the year. In addition, each team has an overnight intern who cares for its patients and admits any new admissions to that team. This intern covers the same patient panel each night providing continuity of care. To provide additional support at night 3-4 senior residents oversee two teams each and admit with the overnight interns, providing not only teaching but also assistance with any questions that may arise.
Daily Schedule
A typical work day starts at 7:00am with house staff led resident rounds. This is followed by attending Rounds and multidisciplinary IDT Rounds. The noontime hour is protected house staff education time which includes a variety of conferences. The day residents and interns from each team stay every other day till either 6:00pm or 8:00pm. The remainder of the day is devoted to patient care during which house staff write their notes, perform any patient related work and admit any patients to their team. One member of each team, whether it is an intern or resident, will stay till 8:00pm to sign out the team’s patients to the night intern and resident. These night interns and residents will help finish any work that still needs to be accomplished for the teams patients and will also do any admission to the team overnight. Since each geographically located team cares for either 8 or 14 patients a team is given an admission whenever they discharge a patient and their census falls below these cutoffs.
Sample Daily Schedule
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Monday
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Tuesday
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Wednesday
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Thursday
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Friday
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Saturday
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Sunday
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Day Team
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7:00-8:30am
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Resident
Rounds
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Resident
Rounds
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Resident
Rounds
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Resident
Rounds
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Resident
Rounds
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Resident
Rounds
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Resident
Rounds
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8:30-10:30am
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Attending
Rounds
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Attending
Rounds
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Attending
Rounds
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Attending
Rounds
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Attending
Rounds
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Attending
Rounds
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Attending
Rounds
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10:30-11:00am
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IDT Rounds
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IDT Rounds
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IDT Rounds
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IDT Rounds
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IDT Rounds
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Patient Care
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Patient Care
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11:00-12:00am
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Patient Care
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Patient Care
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Patient Care
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Patient Care
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Patient Care
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12:00-1:00pm
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Intern/ Resident
Reports
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Intern/ Resident
Reports
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Chief of
Service
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Grand Rounds
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Clinical
Reasoning Seminar
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1:00-6:00pm
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Patient Care
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Patient Care
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Patient Care
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Patient Care
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Patient Care
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6:00-8:00pm
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Night Team
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8:00pm-7:00am
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Patient Care
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Patient Care
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Patient Care
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Patient Care
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Patient Care
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Patient Care
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Patient Care
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7:00-8:30am
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Resident
Rounds
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Resident
Rounds
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Resident
Rounds
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Resident
Rounds
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Resident
Rounds
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Resident
Rounds
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Resident
Rounds
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8:30-10:00am
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Attending
Rounds
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Attending
Rounds
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Attending
Rounds
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Attending
Rounds
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Attending
Rounds
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Attending
Rounds
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Attending
Rounds
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Resident Rounds: From 7:00am-8:30am each resident leads their team’s day and night intern on walk style rounds reviewing with them overnight events and active issues in preparation for Attending Rounds. This allows the residents and interns to formulate each patient’s daily plan.
Attending Rounds: From 8:30am-10:30am a dedicated teaching Attending, who is responsible for all the patients on the service, discusses each patient with the teams senior resident, both the day and night interns, and the night resident. These resident driven rounds are an opportunity to incorporate the most recent evidence-based approaches into patient care.
IDT Rounds: Each team’s second or third year resident attends a 30 minute multidisciplinary meeting with the floor’s social worker, nurse manager and nursing staff to review disposition planning and barriers to discharge.
Noontime Conference: From 12:00pm-1:00pm each day are protected resident and intern conferences.
- Intern and Resident Reports: Residents and Interns break into their respective groups in these two conferences which usually take place on Mondays and Tuesdays of each week. An Intern or Resident will present a current case that is on the Wards in an Attending-led group discussion centered around the case’s key teaching points.
- Department of Medicine Grand Rounds: Every Thursday this weekly state-of-the-art lecture features a prominent leader in Medicine.
- Clinical Reasoning Seminar: Each Friday this hour long seminar centers around a challenging case which is used to illustrate the core principles of clinical reasoning. This is accomplished by separating the house staff into smaller groups that use both biologic and probabilistic reasoning to arrive at a correct diagnosis.
- Morbidity and Mortality Seminars: Two times per month the medical service meets to examine a case where a patient morbidity or mortality occurred. An Attending physician facilitates the group’s examination of the case and explores ways in which a different outcome or improvement in care could have been provided.
- Chief of Service: Every Wednesday a challenging or interesting case from the Wards is presented to a chief of one of the medical services. He or she uses this time to lead a group discussion on the important teaching points.
- Autopsy Rounds: This monthly conference takes place in the Morgue and is led by the Pathology department. An autopsy from a medicine patient is reviewed allowing the house staff to hear a patient’s history and see the post mortem findings from the case.
- Journal Club: Three to four times per month the residents on the wards meet to discuss, analyze and critically appraise the most recent literature.