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 had extensive experience practicing medicine as a hospitalist. Facilities where this preceptor has staff privileges include hospitals within the Memorial Hermann Health System as well institutions within 60-90 miles of Houston. You will see patients with the preceptor in the hospital from 7 AM to 7 PM. The typical patient census averages approximately 18 patients per day. Patients will be seen in the following areas:

• Medicine ward

• ICU

• Emergency Department

Your morning will begin a review of the patient list with the attending physician. After you receive your patient assignments, you will start with prerounds. During prerounds, you will check in with nursing staff to inquire about any new developments or events that have occurred overnight. These discussions will also inform you of any nursing perspectives or concerns that will need to be shared with the medical team. 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

After the pertinent data has been gathered, you will meet with the preceptor at approximately 9 AM to begin hospital rounds. As you move from one patient to another, you will have the opportunity to present your findings to the attending. 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. 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. Of note, due to hospital policies, you will not be able to independently take histories and perform exams.

Following attending rounds, you will accompany the preceptor to interdisciplinary rounds. This is a meeting attended by your preceptor, nurses, and the 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. Your role will be to contribute to these rounds as everyone’s input is valued. With your preceptor’s permission, you may be able to present your cases to the interdisciplinary group. This will be an excellent opportunity to further grow your communication skills. An example of the type of presentation you may give during these rounds:

Mr. ____ is admitted for…Plan is for…We expect to discharge patient in ____ days to home/SNF/ALF/etc…we will need the following: Home Health, Physical Therapy…

Based on the example above, you can see that an effective presentation during interdisciplinary rounds will include the reason for hospitalization, a brief update on major clinical issues, goals that need to be met before discharge can take place, expected discharge date, discharge location, and any anticipated home health needs.

After rounds are completed, you will accompany the preceptor to implement the day’s plans. Once or twice per week, your attending will be on call. 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.

Although you will not be able to enter 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.