Inpatient US Clinical Experience in Internal Medicine in Miami

Information about this clinical experience:

You will be working with a board-certified hospitalist who is a dedicated clinician and teacher. This preceptor is an attending in an internal medicine residency program and is actively involved in resident education. The physician has also taught medical students from Nova Southeastern University.

You will join an inpatient team which includes the attending physician, a senior resident (PGY3), a junior resident (PGY2) and two interns (PGY1). Your day will be structured as follows:

Before 8 AM: Pre-Rounds

Your day will begin with pre-rounds with the resident. The exact start time will depend upon how many patients you are following, the complexity of their cases, and the time required to complete the pre-rounding process. Pre-rounds involves gathering information from the overnight period, sorting through the information, organizing and synthesizing the data, and preparing it for presentation to the team during attending rounds. The necessary information will be collected through EMR chart reviews, discussions with nursing staff, and the patients themselves.

8 AM to 9 AM: Morning Report

Following pre-rounds, you will join the residents in morning report. During this highly educational conference, you will have the opportunity to hear and learn about interesting cases and topics.

9 AM to 12:30 PM: Computer/Bedside Rounds

Attending rounds with the team will initially be in front of the computer when the entire patient census is discussed in great detail. The junior most team member (i.e., student or intern) following the patient will be expected to present the case in a structured manner. Being able to organize and communicate relevant information to teammates will a crucial part of your role as a future resident; therefore, this will be excellent practice for what’s to come. Following this, the attending will engage the team in a discussion about salient points of the case and share clinical pearls. These discussions will also provide a means for you to hone your skills in developing differential diagnoses, synthesizing data, and formulating assessments and plans.

Following computer rounds, the team will begin bedside rounds where the patient’s status and plan of care will be confirmed. The emphasis will be on delivering patient-centered care to patients. You will be able to observe how personalized care is delivered at the bedside.

1 PM to 2 PM: Afternoon Conference

The residency program has a daily afternoon conference where important internal medicine topics are presented.

2 PM to End of Day: Finish Work and Admit Patients

The afternoons are a time to implement the plan of care from morning rounds and complete any patient care-related tasks (i.e., entering progress notes in EMR). On several days of the week, the team will take new admissions from the Emergency Department (3 to 7 PM). Seeing how patients are initially evaluated and managed in the ED and then admitted to the medicine service will give you insight into the processes related to new patient admissions. Being on the frontlines of working up new patients will allow you to exercise your diagnostic reasoning and problem-solving skills. You will have the opportunity to formulate an assessment and plan, share it with your team, and explain your reasoning.

During your experience, you will learn the following U.S. medical practices under the preceptor’s supervision:

• Taking patient histories.

• Presenting patients.

• Writing or entering progress notes (Meditech EMR)

• Have opportunities to research the literature to answer clinical questions at the point of care.

• Being involved in patient education.

• Working with other healthcare professionals to understand their roles and responsibilities.

Please note that the main attending physician is on a “one week on and one week off” schedule. During the attending’s week off, you will work with the attending physician’s colleague as well as the internal medicine residents.

Of note, a high percentage of patients are Spanish-speaking. The hospital has phone interpreter services available for employees and students who do not speak Spanish. Nearly all of the nursing staff speak Spanish and are more than willing to help team members who are not Spanish speakers.