All core inpatient rotations are completed at Englewood Hospital. These inpatient rotations are designed to successfully prepare residents for postgraduate experiences, caring for patients with “bread and butter” diagnoses to those with more complex conditions. The structure of each rotation is designed to provide a graduated experience to our residents such that they 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 soft patient cap of 16. 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 new inpatient rotation. Each team comprises one PGY2 or PGY3 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. 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 complete the Bioskills curriculum where they gain competence in understanding and performing procedures mandated by the American Board of Internal Medicine (ABIM) 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.
During the Medical Consults or “MedCon” rotation, is a 4-week rotation designed to give PGY3 residents inpatient subspecialty consult and House Doc experiences. Residents work directly with an inpatient medicine subspecialty attending seeing initial and follow-up consults. Residents can choose to work in up to 2 different subspecialties, each for 2-week intervals. To allow the Team O residents the opportunity to see their patients and participate in attending rounds, the MedCon resident also acts as the primary responder for the Emergency Code team Monday-Friday, 8A-1P.
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 given assistance with emergency codes by a nurse practitioner.
Critical Care Medicine/Intensive Care
The ICU rotation is one of the most popular among our residents. Residents rotate trough the ICU and each year have a graduated level of responsibility. On average, each resident will complete four 2-week blocks of ICU per year. We have now moved to a “day-team/night-team” model, which allows improved resident-patient continuity, nursing communication and transitions of care. During their ICU rotations, residents learn to manage cases requiring medical, cardiac, surgical and neurologic critical care. They will also perform various procedures such as central venous and arterial line placement, ventilator management, endotracheal intubation and diagnostic/therapeutic thoracentesis. During this rotation, residents work under the close supervision of an Intensivist. We currently have close to 24-hour Intensivist coverage, making the teaching experience for both the day and nights teams near identical.
All PGY3 residents complete 4 weeks of Emergency Medicine. Residents are supervised by Emergency Medicine attendings and learn the basic principles of Emergency Medicine including triage, procedural skills and transitions of care.