Teaching Practices
Inpatient medicine experience for residents includes rotations with two inpatient teaching practices. One is located at Strong Memorial Hospital and focuses on general medicine and hematology/oncology. The other, with a focus on general medicine, is at nearby Highland Hospital.
The teaching practices are centered on an unusual concept in residency training: small, two-person teams that care for eight to 12 patients in a floor rotation. This efficient and flexible arrangement gives the intern frequent one-on-one exposure to the senior resident who is the other half of the team. And the senior resident gets more time to read, research, and teach.
Strong Memorial Hospital Inpatient Teaching Practices
The resident teams at Strong are divided into two teaching practices. The general medicine teaching practice includes five PGY-2/PGY-1 resident teams, each working with a full-time general medicine hospitalist. The hematology/oncology teaching practice includes one PGY3, two PGY-2s, and two PGY-1s. As a team, they care for patients of full-time hematology/oncology faculty.
General medicine teaching practice: The hospitalist is the attending physician of record for most of the team's patients, and makes daily teaching and management rounds with the team. Admissions are assigned every day based on a team point system. Established patients get one point, and new admissions get two points. Teams have an absolute cap of 12 points. So, a team with 10 established patients could not receive more than one new admission. No team ever receives more than three new admissions in a single day.
Each weekday, four of the five teams receive no new admissions after 3 p.m., and are free to go home around 5 p.m., after sign-out rounds are completed. The fifth team receives no new admissions after 7 p.m., and goes home around 9 p.m., after signing out to staff doing "night-floats."
In addition to the five PGY-2/PGY-1 teams, three PGY-3s play supervisory and teaching roles for the resident teams. These third-year residents also assist nurse practitioners and physician assistants, and perform general medicine consultations on patients on non-medical services.
Hematology/oncology teaching practice: One PGY-3, two PGY-2s, and two PGY-1s work as a team caring for the patients of full-time hematology/oncology faculty. The residents do daily teaching and management rounds with two on-service attending physicians, one from the soild tumor service and one from the leukemia/lymphoma service. The PGY-3 and PGY-1s work days only. One PGY-2 works days and the other nights; they switch roles halfway through the four-week block. Admissions to this practice are distributed daily among the residents to assure a balanced case load. Total resident census is capped at 16 patients. A hematology/oncology nurse practitioner covers any additional patients.
Highland Hospital Inpatient Teaching Practice
Three internal medicine resident teams and one family medicine resident team care for the patients of general internists, geriatricians, and subspecialists. The teams get daily interactions with the attending physicians of record for each patient. They also do teaching rounds three times a week. This involves bedside presentation and detailed discussions of each patient. Teams have an absolute cap of 12 patients, and no new admissions are assigned after 7 p.m.
One of the four teams is on "long call" every day, and accepts up to five new admissions. The team goes home around 9 p.m., after signing out with night-float personnel. The other three teams go home around 5 p.m., after sign-out rounds.
