Schedules and Rotations
How it looks: 4+2+2
Our resident schedule is built around clinical and educational continuity to optimize learning and patient care delivery. It takes time to adjust to a new rotation and to come together as a team, both of which are critical to resident learning and patient care. Given this, medicine ward and critical care rotations are both four consecutive weeks long. All other rotations are two weeks long.
Key Rotations
Medicine Floors and ICU rotations are scheduled with intern, resident, and attending in the same four-week block to maximize education and team continuity.
Co-Management: At NWH all admitted surgical patients are co-managed by a medicine team. Third year residents will manage this service with a supervising attending. The residents will also cover consults for non-surgical services.
Observation Unit: The observation rotation will staffed by one PGY2 and one PGY1 will work on this service, like a floor rotation, under the supervision of a hospitalist attending. This rotation is structured to allow housestaff to have more opportunities to “admit” and manage patients of lower acuity.
Ambulatory: Ambulatory, including continuity clinic, will be scheduled such that residents will have continuity clinic two consecutive weeks out of each 8-week block (6+2 model), for a total of 12 weeks per year. Addiction medicine is covered during this rotation.
Subspecialties/Electives: Will be scheduled based on the interest or perceived needs of the resident. Time spent in an outpatient setting varies from 25% to 75%. Available electives include Cardiology, Gastroenterology, Endocrinology, Hematology/Oncology, Infectious Diseases, Nephrology, Pulmonary, Rheumatology, Palliative Care, Neurology, and Research.
Typical Day on inpatient in the first year:
7:00 AM – Night float signs out to day team with Nocturnist oversight. Night float goes home.
8:00 AM – Teaching attending checks in with intern about patients – just like a senior resident would do
9:00-10:30 AM – Walk/bedside rounds with Attending and two interns that make up the team
11:30 – 12:30 – Interdisciplinary rounds with entire care team
1:30 - 2:15 PM (Monday & Thursday) – Afternoon Report
1:00 - 4:00 PM (Wednesdays) – Academic half day – Attendings cover patient care while interns learn
4:30 - 5:00 PM – Sign out to cross-cover team and then go home if not cross-cover team – Attending oversight
5:00 - 8:30 PM – Cross-cover intern manages resident floor patients – Call attending is in house support
8:30 - 9:00 PM – Sign out to Night Float – finish any remaining work and go home. Attending oversight
8:30 PM – 7:00 AM – Night float covers admitted teaching patients. Can help with admits if time allows, but primarily an Attending function.
How we cover “call” and nights
Making sure our residents’ patients have continuous coverage by a resident is important for quality patient care and for quality education. It is also important that we minimize the number of times a resident that isn’t familiar with the patient steps into deliver care. Both of these need to be achieved while being mindful of the number of hours a resident works.
Our solution to this in our 2 inpatient floor team system, where each team has 1 resident and 2 interns, is to create a buddy resident for each team. The buddy gives us the ability to have q4 cross-coverage from 5:00-9:00 PM with consistent resident/intern pairs with a senior that knows the patient, better than a random resident on elective. This also means the non-cross-coverage residents and interns get to go home sooner. The cross-coverage team signs out to night float and then goes home.
All the while having at least two on call or nocturnist faculty in the building at all times. Even in our first year as a program, we will have ample in house support. Instead of calling a second year resident for guidance, you get an attending to answer your questions on the spot.
Night Float is two weeks long, 6 days/week, with one intern and one resident. Intern manages already admitted patients and the resident works through admissions.
Rotation Weeks by Program Year
PGY-1:
Wards: 12 weeks
Critical Care: 4 weeks
Night Float: 6 weeks
Observation Unit: 4 weeks
Ambulatory: 12 weeks
Subspecialty/Elective: 10 weeks
Vacation: 4 weeks
PGY-2:
Wards: 8weeks
Critical Care: 4 weeks
Night Float: 6 weeks
Observation Unit: 4 weeks
Ambulatory: 12 weeks
Subspecialty/Elective: 12 weeks
Palliative Care: 2 weeks
Vacation: 4 weeks
PGY-3:
Wards: 8 weeks
Critical Care: 4 weeks
Night Float: 4 weeks
Emergency Department: 4 weeks
Ambulatory: 12 weeks
Subspecialty/Elective: 12 weeks
Co-Management: 4 weeks
Vacation: 4 weeks