All core inpatient rotations are completed at Englewood Hospital. These inpatient rotations are designed to successfully prepare residents for postgraduate experiences, caring for a broad variety of patients with diagnoses randing from “bread and butter” cases to those with more complex conditions. The structure of each rotation is designed to provide residents with increasing supervisory and teaching responsibility as they gain clinical experience and develop and hone different skills each year. During these rotations, the residents are exposed to patients with diverse cultural and socioeconomic backgrounds and pathologies. It is also here that residents learn the tenets of managing patients participating in our Bloodless Medicine program. All of our core inpatient rotations utilize a Night Float system to provide cross-coverage.
The Team A/B rotation forms the backbone of our inpatient rotations. Each team comprises one PGY2 and two interns under the supervision of a Hospitalist with a patient cap of 20 with the goal to maintain census closer to 16 to ensure and prioritize adequate time for discussion and teaching. The Hospitalist leads formal teaching rounds daily and offers real-time support in patient care, teaching and discharge planning. Each hospital floor is designed to take care of a specific subset of patients, affording residents exposure to a wide variety of clinical cases and pathology. A typical service might have patients with congestive heart failure and/or COPD exacerbations, acute stroke, GI bleeds, sepsis with underlying infections and patients with undefined illnesses such severe hypercalcemia requiring investigation.
Team Rh is a newer inpatient rotation that was developed out of feedback from our residents to transition to a Q3 (every 3rd day) call schedule. Each team comprises one PGY2 resident and one intern under the supervision of a Hospitalist. The team functions similarly to that of Team A/B, but with a patient cap of 14 and less total call coverage.
The Team O rotation is designed as a manager service and mirrors a traditional 7-on, 7-off Hospitalist schedule. Teams consist of one PGY3 and one PGY1 under the supervision of a Hospitalist. The PGY3’s role is that of a junior attending. Each team works seven 12-hours shifts and has the following 7 days off. During their inpatient weeks, they not only manage patients, but also act as the primary responders for the Emergency Code team during evening hours. The Emergency Code team responds to all rapid responses, stroke codes and code blues for the hospital.
During their days off (ADMIN shifts), residents participate in E-learning modules to help further develop and/or hone their clinical management. PGY1 residents participate in three different tracks: Wellness/Evidence-based Medicine, Transitions of Care, and Radiology/Bioskills. During these experiences, interns learn about well-being as a measure of professionalism, gain skills in formulating clinical questions and performing literature searches, review evidence-based models of care transition and quality discharge planning, and gain knowledge in radiographic image interpretation. PGY3 residents participate in our Patient Safety curriculum where they learn about the importance of recognizing, preventing and responding to medical errors and participate in root-cause analyses.
The Medical Consults or “MedCon” rotation is a 4-week rotation designed to give PGY3 residents an opportunity to hone their clinical skills around medical consultation, responding to changes in patient status and situations requiring urgent or emergent care, and triaging patients to determine need for transfer to higher level of care. The MedCon resident acts as the primary responder for the Emergency Code team during daytime hours. Residents can also work directly with an inpatient medicine subspecialty attending seeing initial and follow-up consults.
The Night Float team provides cross-coverage and admits all new patients and transfers for all inpatient services. All night float residents work Sunday-Friday, with 2 days off per week. The PGY1 residents provide cross-coverage for Teams A/B/Rh, the PGY2 resident does all admissions for Teams A/B/Rh, while the PGY3 resident admits and provides cross-coverage for Team O. PGY1 and PGY3 residents act as the primary responders for the Emergency Code team overnight. All Night Float residents are supervised by a Nocturnist and assisted with emergency codes by a Nurse Practitioner.