Inpatient US Clinical Experience in Internal Medicine in Houston

Information about this clinical experience:

You will be under the supervision of a board-certified internal medicine physician. This physician has extensive experience practicing as a hospitalist and teaching residents. Although the preceptor is no longer involved in teaching residents, the wealth of experience accumulated over years of teaching helps the attending create a learning experience that will prepare rotators for residency. The physician is on staff within the HCA Houston Healthcare System.

In the morning, your team will receive sign-out from the overnight hospitalist. Updates on established patients will be provided, and new admissions from the overnight period will be handed off to your attending. Then, from 10 to 11 AM, you will meet for multidisciplinary rounds. This is a meeting attended by your preceptor, nurses, pharmacist, and case manager. During these rounds, every patient, new or old, is discussed as a group. A summary will be provided of the patient’s reason for hospitalization, course of treatment, expected length of stay, plans for discharge, and follow-up care. Barriers to patient care and discharge will be raised and addressed. When you become a resident, you will be expected to attend these rounds; therefore, your exposure to these rounds now as a student will give you insight into their purpose, their structure, and your future role.

After multidisciplinary rounds, you will round with the preceptor, typically from 11 AM to 2 PM. As you accompany the physician from room to room, you will have the chance to see how an experienced hospitalist assesses patients, formulates the plan and explains it to the patient, and addresses any concerns or issues. Discussions during rounds 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 will allow you to understand how patient-centered care is delivered.

Following these rounds, the physician will show you how daily tasks of a hospitalist are completed. Please take note of how the attending physician attends to the daily responsibilities and activities in a highly detailed manner. For a hospitalist, meticulousness is a critical safety mechanism. Because they manage acutely ill patients with rapidly shifting conditions, a minor oversight can lead to severe adverse events. Strict attention to detail ensures diagnostic accuracy, prevents medication errors, and fosters safe care transitions.

One aspect of this attending physician’s style that is particularly notable is the collaborative approach that is taken. For example, studies have shown that cooperation between doctors and nurses (i.e., interdisciplinary cooperation) “contributes to quality of care by giving health professionals a better understanding of each other’s roles and ways of thinking and thereby, a shared understanding.” For best practices in communication between doctors and nurses, as well as other members of the medical team, please refer to the following article:

A Physician’s Guide to Communicating with Your Medical Team

Of note, once or twice per week, you will be on call with the attending. This will be a longer day when you will be in the hospital up until 9 PM. On call days, your team may receive up to six new admissions. 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.

During the clinical experience, although you will not be writing notes in the EMR, the preceptor is open to having you write simulated notes. These notes can be submitted to your preceptor for review and feedback. Over time, you will be able to refine your written documentation, an essential skill for your future work as a resident.

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

• Taking patient histories.

• Presenting patients.

• Writing notes (please note that these will be simulated notes for the doctor's review and will not be part of the medical chart)

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

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

Please note that the preceptor is on a “one week on one week off” hospitalist schedule (Monday – Sunday). On the preceptor’s off week, you will have the opportunity to work with the preceptor’s colleague.