Inpatient Information

Scheduling Details

Note that all schedules are subject to change, depending on faculty and team needs. Times listed here are approximate. All students begin the day on the wards at approximately 7:00 a.m. for pre-rounds and work rounds (until 9:00 a.m.).

Keep these important points in mind when following your inpatient master schedule:

• Buddy up with an intern. This will provide you with a consistent contact point for both learning and patient management.
• Add your call nights to the schedule (see the responsibilities section for more details). You must take 4 calls during your inpatient time - and one must be a weekend call (ends at 11:00PM).

At the end of the day - even conference days - all students return to the wards to check on any patients they may have. You will either join sign out or receive sign out from the on-call intern.

Responsibilities

Patient Load: Each student should have 2-3 inpatients at all times. If you have fewer patients, you need to ask the resident for additional patients to keep up your clinical load.

On Call: Students will take call every fourth night and on those nights they should pick up at least one admission. Make every effort to take call with the same intern. They should take the history and do the physical exam in the presence of the intern (and the resident, if the resident so desires).Try to have the intern let you do at least part of the history and part of the PE in an uninterrupted flow - so you can practice and receive feedback on these skills. Be persistent in this request - if need be - show this handout to the houseofficer. If there are no admissions by 10:00 p.m., the student should check the ER for any admissions waiting to come up. Make your call schedule with the resident on the first day of the clerkship. Night call on the wards ends at 11:00 P.M. Weekend call starts with work rounds at 8:00 AM and lasts until 11:00 P.M. Student should have taken 3 weekday and one weekend call by the end of the rotation. During the call, the student should cover all of the other students' patients and respond to any problems that arise. Other on call responsibilities include:

• Evaluating any problems that arise on any patient
• Assisting the intern with any task related to patient care issues
• Writing notes on all patients followed by the other students on your team
• Covering all of the other student's patients

Other Responsibilities:

1) Examine your patient at least twice a day (once first thing in the morning and once before you leave for home at the end of the day).

2) In addition to a required morning note on all your patients, you must return to the wards at 5:00 p.m. to check on your patients and write any addenda regarding daytime developments. Speak to the on-call intern and consult the chart for details.

3) All notes should be reviewed and critiqued by the intern or teaching resident and co-signed by that person.

4) You are also responsible for presenting your patients on all rounds. For formats of notes and presentations, please see the Pediatric Clerkship packet. (LINK)

Admission Write Ups: Follow the format in the overall packet. Hand in a total of two write ups to the teaching attending to be critiqued. See your schedule for turn-in dates for write-ups. If these are late or not handed in at all you will miss important feedback and the resident will evaluate your performance accordingly. Make a second copy and hand in on the due date to Dr. Miller (Give it to Jakki who will date the receipt of the write up and place in your folder - BH5N-517).

Daily Presentations and Write ups: Use the formats described in the Pediatrics Clerkship packet (Link). Remember to carry your level of involvement beyond what is minimally expected by trying to formulate decision points and making some recommendations about what decision you feel is the best. Remember to back up your statements with literature and pathophysiology and not with anecdotes that you heard.

Activity Details

Pre - Rounds: (7:00 a.m.- 7:30 a.m.) During this time, check on how each of your patients did overnight and examine all your patients in a focused manner to assess their current health status. Try to write your progress notes at this time and prepare your work round presentations. At the beginning of the rotation, you should leave about 30 minutes per patient until you figure out how long it takes you to pre-round.

Work Rounds: (7:30 a.m. - 9:00 a.m.) Residents run these rounds for the purpose of setting the day's agenda for each patient. Present all your patients in a focused manner - following the SOAP - by systems format - as per the house staff. Be prepared to present in bullet form if time is short. Examples of good and bad presentations can be found here.

Work Time: (9:00 a.m. - 10:00 a.m.) You and the interns should take a deep breath and prioritize what needs to be done. This will help you develop clinical judgment. Use this time to finish your notes, speak with families, do necessary procedures and arrange tests and consults.

Attending Rounds: (10:00 a.m. - 11:00 a.m.) Be prepared to discuss and present your patients during this time. Discussions should reflect your preparation and knowledge of the literature regarding your patient's problems. They should also reflect that you have thought about your patients and made some judgments regarding their problems.

Conferences and Lectures: The remainder of the day will usually have a variety of conferences that will pull you off the wards and other responsibilities that may pull you off the wards. If you are leaving, you must sign out any work that needs to be done to a fellow student. Let the intern of that patient know this as well.

Radiology Rounds: (2:00 p.m. - 2:30 p.m.) Present your patients to the radiologists succinctly; that is, using a one sentence summary that implies the reason the x-ray was obtained. The time of this conference is subject to change, so follow the house staff's lead on this issue.

Sign Out Rounds: (late afternoon) The time for this activity fluctuates so you will again have to follow the house staff's lead on this issue. Your role here will also depend on the individual house officers involved. Clarify this with them early in the clerkship.