© 2019 Mercy IMR Medicine Chiefs

General Medicine Curriculum 

GMF Expectations 2019-2020
  • 4 teams consisting of two resident, two interns, +/- sub-I, and medical student(s)

  • Overnight: Two nightfloat admitting residents, one cross-cover intern

  • The key word is team, not sides. Every resident is expected to know every patient on the team, not sides. This includes phone calls about management and disposition. This will be enforced this year.

CAPS/General Rules:
  • Day team interns will have an admitting cap of 3 total patients (any combination of holdovers, transfers and new patients). New admissions will be from 1-4 pm. 

  • However, If you do get an admission after 4 pm, (which should not occur and if it does, inform the chiefs) please ADMIT THE PATIENT IF YOU HAVE NOT HIT YOUR DAY CAPS OR TEAM CAPS

  • Interns have a cap of 8 patients.

  • Residents have a cap of 16 patients

  • Night float can admit up to 15 patients total. 

  • Night float residents are the cross-cover intern’s senior, and any management decisions should be discussed between nightfloat and each team the next morning. 

  • Night Float: Will admit from 5pm to 6am. 

TRANSFERS FROM ICU/CCU:
  • Patients who were previously on a housestaff team should return to their original housestaff team (Bounce backs). If the patient was admitted directly to the ICU, they can be distributed to any general medicine service.

  • Bounce backs from the ICU do not count towards your admission caps of the day. I.E you will still be responsible for 3 new admissions.

  • New Patients from the ICU do count towards your caps.

WORKFLOW BY DAY:
  • 6:00 am:

    • day interns, and sub-I arrive for signout from Night float cross-cover and night float admitting.  

    • Interns are responsible, with supervision of senior resident for all presentations starting July 1st, 2019. 

    • Interns are expected to write at least 5 notes on July 1st, 2019 and progress to writing 8 notes by end of July.

  • 8:30 am – 11 am: 

    • Attending Rounds with time to be determined based on new admissions, etc.

  • 12 pm- 1 pm:

    •  Lectures during this time (does not include Cath conference)

    • Tardiness/absent to lecture will not be tolerated, especially while on GMF (except for dealing with unstable patients, important family meetings, etc)

  • 1 pm - 4 pm: 

    • New admissions

    • Complete Departs for potential discharges of the following day.

    • 2 PM: IDPR rounds

  • 5 pm:

    • Signout to cross-cover intern - Please do not put off work to your night float intern that can be completed during the day.

  • 5 pm to 6 am: 

    • Night Float will admit up to cap of 15 (and alternate with IPC). 

    • If IPC is capped, then night team admits all patients until they either hit Teams Cap of 64 or night cap of 15.

    • NF will admit until 6 am. (If paged from 5- 6 am, may hold for morning teams to admit the patient)

Overall:

PGY1 residents have primary responsibility for patients they are assigned and are the first point of contact for patient care issues. They are responsible for writing daily progress notes, placing orders for their patients, arranging and following up on results of diagnostic studies, interacting with consultants, writing prescriptions, ensuring appropriate follow-up at the time of discharge. Furthermore, the PGY1 is responsible for communicating the admission and final diagnostic and therapeutic plan to the outpatient physician. Interns will be supervised by a senior resident at all times. 

PGY2/PGY3 (senior) residents are the resident team leaders and are responsible for supervising PGY1 residents in the above activities.  They are responsible for evaluating all new admissions and doing history and physical that includes a summary of the presentation, differential, and plan of care.  

The attending physician is ultimately responsible for the education and supervision of residents on the team and ensure safe, cost-effective and quality care of the patients admitted to their team. To ensure appropriate levels of supervision, attendings will round daily in-person and will be available 24/7 by phone to the team and individuals covering the team.

Decisions regarding readiness for progression to independent practice are made by the Clinical Competence Committee.

 

General Medicine Curriculum

Acute Renal Failure

Management of Acute Renal Failure

Alcoholic

Alcoholic Hepatitis

Alcohol Withdrawal

Atrial Fibrillation

ACC Guidelines Atrial Fibrillation

Atrial Fibrillation New Guidelines and Procedures

Cellulitis and Soft Tissue Infections

Cellulitis and Soft Tissue Infections

Distinguishing Cellulitis From Its Mimics

Chronic Obstructive Pulmonary Disease/Asthma

Contemporary Management of Chronic Obstructive Pulmonary Disease

Emergency Treatment of Asthma

Cirrhosis

Management of Adult Patients with Ascities Due to Cirrhosis

Delirium

In the Clinic: Delirium

The Treatment and Management of Delirium Among Older Person

Electrolyte Overview

Review of Electrolytes

Heart Failure

Systolic Heart Failure

Treatment of Advance Heart Failure

Syncope

New Concepts in the Assessment of Syncope

Diagnosis and Treatment of Syncope

Urinary Tract Infections

Uncomplicated Urinary Tract Infections

Venous Thromboembolism

Oral Rivaroxaban