Inpatient US Clinical Experience in Internal Medicine in Miami

Information about this clinical experience:

You will be working with an attending physician who is a board-certified hospitalist. As a core faculty member in an internal medicine residency program, this physician has considerable experience educating residents and students.

You will join an inpatient team which includes the attending physician and several residents. Your day will be structured as follows:

Before 9:30: 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, reviewing notes/vitals/labs/imaging/medication orders in the EMR, and visiting the patient to assess their condition. Following your collection of this patient data, you will organize and synthesize the information and formulate the assessment and plan. The final steps in the pre-rounding process are discussing your case with the resident and preparing to present the case to the team during attending bedside rounds.

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.

9:30 AM to Noon: Bedside Rounds

This attending prefers to round at the bedside. Just outside the patient’s room, 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 your oral case presentation, you will visit the patient with the team so that the attending physician can confirm the patient’s status and plan of care and answer any questions the patient may have.

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). Please note that the tasks to complete will be related to both established and newly admitted patients. On several days of the week, the team will take new admissions from the Emergency Department from either 6 AM  to11 AM or 11 AM to 3 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.

• Performing physical exams under the physician’s supervision.

• 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.

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.