Daily Clinical Responsibilities & Taking Call

Daily Clinical Responsibilities (Wards/Consult service)

1. See your patient and perform a physical exam everyday. Ideally, you should be seeing at least two patients a day. Note any changes in condition from the previous day, better or worse.
2. Perform a focused physical exam. You are expected to focus your exam only after you have completed a total physical exam at the time of admission.
3. Collect relevant data from the chart, computer, and nurses.
   • Get the vitals, ins and outs, daily weight (if applicable), etc. from the chart. Read the nurse’s notes in the chart (or speak with the nurse) to find out what happened overnight. Read any consultant’s notes from the prior day.
   • If your patient has a cardiac monitor on, check the overnight telemetry readings!
   • Get the labs from the computer system as well as the results of any important radiologic studies or procedures. This may require you to go to radiology to get the preliminary read or have a radiologist read the study for you right.
4. You must write a daily note on each of your patients. The note should be titled: T3 Internal Medicine Progress Note [see Sample H&P/SOAP note]
5. Daily oral presentation on rounds
   • Anytime you see a patient and write a patient note, you should present this same patient on rounds. This does not mean reading off of your SOAP note. The information presented should be organized similar to the SOAP note (i.e. first the subjective, then objective, then assessment and plan).
   • The best presentations are done without notes and done in a fluid manner. Include all the relevant information but do not load it with extraneous info (this is the hardest part to learn, so don’t sweat it if you include some unnecessary stuff early on in the clerkship). Always attempt to discuss your patient with intern or resident during pre-rounds. However, interns, residents, or fellows should not repeatedly interrupt your presentations. If this becomes a problem, let the clerkship director know.
   • If your residents are not having Resident Rounds (a.k.a. pre-rounds), let Dr. Chakraborti know ASAP. This is a priority for the residency program! Your attendings expect that you have properly rounded with your resident before presenting to them.
6. Daily patient work
   • This is the stuff that needs to get done to advance the care of the patient. This is variable, but common tasks include ordering labs and studies, calling consultants, following up on labs or tests, speaking with social workers, and completing paperwork for discharge, nursing home placement, etc. Sometimes this stuff gets labeled as “scutwork”. It may be some of the less glamorous stuff, but it has to get done. Students are expected to help in these tasks, particularly for the patients you are following. Remember, these seemingly menial tasks are essential to getting the proper care for your patient. I promise you that the more you invest in this, the more your team will appreciate your help.
7. Switching services
   • Residents will switch services on Saturdays
   • Students (and attendings) change to the next service on Mondays, which means that you might have a weekend where you have new interns/residents, but the same attending (and the same patients).

Two weeks of outpatient clinic is a new addition to the IM Clerkship for the 2018-2019 academic year. Students will be assigned to one of 9 clinic schedules (Clinic Schedule A-I). For more details, please see the IM-Clinics page.