Inpatient US Clinical Experience in Internal Medicine in New York

Information about this clinical experience:

You will be working with board-certified hospitalists who are core faculty members of an internal medicine residency program at Stony Brook University Southampton Hospital. You will join an inpatient team which includes the attending physician, a senior resident, a junior resident (PGY2), and 1-3 medical students. The attending physicians switch service every week which means that rotators can expect to work with four different attendings over the course of a four-week clinical experience.

Your day will be structured as follows:

Sign-Out

The day will begin when your resident receives sign-out from the night team. During sign-out, new admissions admitted overnight from the emergency department will be handed to your team, and updates will be provided on the status of established patients on your team’s service. You will then be assigned 1-2 patients to follow by the resident.

Pre-Rounds

Following sign-out, you will continue the day with pre-rounds. 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.

Attending Rounds

Once pre-rounds are completed, you will meet with your team for attending rounds to discuss patients on the service. 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. Visits to the bedside with the team will allow the team to finalize the day’s care plan and answer any questions patients may have.

Didactics

You will have the opportunity to attend didactic conferences, including Noon Conference and Grand Rounds, with the residents.

Task Completion/New Patient Admissions

The afternoons are a time to implement the plan of care from attending rounds and complete any patient care-related tasks (i.e., entering progress notes in EMR). On some days, the team will take new admissions from the Emergency Department. 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.

• Examining patients under supervision.

• Presenting  patients.

• Writing or entering progress notes (Cerner 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 first day of the rotation will be a three-hour orientation to the hospital and the department. As a result, your clinical work with the team will start on the second day of the rotation.