Assignment of patients and records

When you begin on an inpatient rotation at the University of Virginia Hospital, you will be assigned up to three of the patients currently followed by your resident.  You should write a brief on-service note summarizing each patient's problems and course in the hospital chart.  Thereafter, you should follow these patients as though you had performed the initial workup.

Each week you are on the service, you will do a complete history and physical examination on at least three new patients.  When your upper-level resident is on call, you will work up at least one of the patients admitted that day.  You should perform a complete history and physical examination and participate in all aspects of the acute care of the patient.  In order to work up enough patients you will have to work up two patients on some call days.

The student write-up must be placed in the chart within 24 hours of the patient's admission.  The write-up should include a formulation of the patient's problems but no lengthy discussion.  It should include considerations of differential diagnosis, initial plans for workup, and a plan of management. Extensive reading of the current medical literature is not a prerequisite to writing the formulation.  The PGY2 or PGY3 on the service will review the write-up and discuss it with you within 48 hours of its being placed in the chart.  You may be asked by your attending or resident to prepare an in depth discussion on one or more patients selected by them during the course of your rotation.

Follow-up of Assigned Patients 

You should see each patient daily prior to morning rounds (which generally begin at 0730 hours).  You should check each patient's progress and perform an appropriate examination.  The extent of your follow-up examination will depend on the patient's status, but attention always should be directed to vital signs, dietary and fluid intake, bowel function, urine output, and medications.  You may obtain unreported laboratory results by calling the appropriate laboratory.    With this information in hand, you will be able to inform the resident of the patient's progress and needs at the time of morning rounds.  If you believe that a particular course of action is indicated immediately, you should notify the house staff so that the entire team is alerted, and an appropriate course of action can be planned.

You should write progress notes on each of your assigned patients and give a concise account of progress or change.  For patients with rapidly changing illnesses, you may need to write multiple progress notes over the course of a single day.  Every note should include date, time of day, and signature.  Please do not leave blank spaces for pending lab results.  Note that labs are pending and write a second note later in the day indicating and discussing appropriate lab results.  Unfortunately, the attending cannot refer to your note, and the resident must write one as well.  Your note, however, may still contain very important information.

Diagnostic and Laboratory Procedures

Routine laboratory work will be carried out by the central laboratory, but you are encouraged, for purposes of your education, to examine personally the blood smears, Gram stains, urine sediments, etc., if observation of these will help you understand the patient's illness.  A medical technologist, Mrs. Louise Perrin, is available part-time in the Physicians' Work Room to assist in the preparation and interpretation of various specimens.  You should introduce yourself to Mrs. Perrin during your rotation and learn how to prepare and examine blood smears, urinalysis, Gram stains, and appropriate analysis of other specimens.   

You can help fulfill your responsibilities as a member of the medical team by anticipating the need for laboratory tests (e.g. serial fecal blood and serial hematocrits in follow-up of a patient with active gastrointestinal bleeding).  For patients with changing patterns of disease or changing laboratory values, a flow sheet readily reveals the time and sequence of serial determinations and observations.  In addition, all blood smears and stains, whether routine or otherwise, should be labeled and preserved.

Radiological results may be obtained by calling PACS to get medical access. 

Residents' Library:  The Hook Internal Medicine Residents Library is located just outside 3 Central.  The combination can be obtained from your resident.  Students are invited to use the library, noting the following regulations:  No books are to be removed from the library at any time, for any reason.  No backpacks or coats can be stored in the library.  Please do not leave valuables such as diagnostic equipment or PDAs in the library.  Thefts remain a problem. The computers are to be used only for medically related searches.  They should not be used for email, gaming, etc.  Our presence in this library is by invitation and is a privilege rather than a right.

Rotation Schedule (Important)

Because of the new ACGME requirements for work hours, the Internal Medicine housestaff will be utilizing a schedule in which teams serve on a Night Float rotation some of the time.  The plan requires that housestaff teams will substitute for one another on a schedule which is out of phase with those of the students.  This unfortunately means that your housestaff team may change with somewhat greater frequency than it did in previous years.  You should stay with your attending physician for his or her entire rotation, no matter how your housestaff team changes.  We will ask you by email for the names of your housestaff with whom you rotated; it is extremely important that you respond in order for us to obtain evaluations. 

You will be on call when your upper level resident is on call.  Thus you will work no more than 80 hours/week or 30 hours continuously.  This is a requirement of the Liaison Committee on Medical Education.

Students who are absent because of illness lasting more than two days should be evaluated at Student Health and notify the Office of Student Affairs.  The appropriate instructors will then be informed.  Students with clinical responsibilities should also notify an appropriate member of the resident or attending staff as soon as possible so that their responsibilities can be assumed by someone else.  Anticipated absences for personal reasons should be arranged with the director of the clerkship.  Absences of longer than two days and recurrent absences should be discussed with the Sr. Associate Dean for Education, Dr. Richard D. Pearson (8/2000)