Internship is 15 rotations spread out over the first 16 months of residency. Intern rotations provide the basic skills in medical knowledge, procedures, organization, and management that provide the foundation for practicing medicine. We ensure all residents rotate through any service as an intern that they will have to manage as a senior in the future. Senior rotations provide increasing opportunities for autonomy and working in a supervisory role with interns and medical students. Review our rotation schedule here.
Ambulatory training occurs both in the Ambulatory Care Clinics, located on site at MMC, and in community-based practice sites. The combined Internal Medicine-Pediatric Resident Continuity Clinic is conveniently located in the hospital across from the Pediatric Clinic and one floor above the Internal Medicine Clinic. Radiology, laboratory and other support services are also close by. In addition to learning from their clinical experience, residents build primary care knowledge through our established outpatient curriculum with teaching sessions prior to clinic sessions. Many of the resident QI projects during residency focus on areas related to their own patient panels and they are given time during ambulatory rotations to move their PDSAs forward. Our clinic faculty, APP, nurses, social work, dietician, case managers and administrative staff are phenomenal and the clinic is a home base for the residents even when they are not scheduled for continuity clinic.
The MMC continuity clinic patients include an ethnically diverse group of patients who have immigrated to Portland and many others whose families hail from Maine for many decades. Residents receive standardized patient/interpreter training to develop their communication skills working with interpreters in-person, by phone, and telemedicine given that English is not the primary language for many of our patients.
Residents have continuity clinic half-day sessions during all pediatric rotations and non-inpatient rotations on internal medicine. This modified scheduling parallels the internal medicine program’s X+Y scheduling. Residents cross-cover inboxes during vacations, night teams and for urgent clinic questions.
Community Med-Peds & Rural Rotation
One of our unique components of ambulatory training here at MMC includes 2 outpatient rotations located in more rural settings outside of Portland. Residents are matched with Med-Peds physicians to give them an opportunity for immersion into what it is like to practice in a community away from the specialty environment of Maine Medical Center and experience different practices with Med-Peds physicians. Sites include Windham (all residents do 1 month there with 4 Med-Peds faculty), Norway, Damariscotta, Brunswick and Ft. Kent (housing is provided if not within reasonable daily driving distance). We also have a hospitalist elective in Bar Harbor (Acadia National Park) to provide inpatient experience in a rural community. Residents enjoy the opportunity to take advantage of some other parts of Maine’s beautiful outdoor activities in the more remote settings.
Personal Learning Block (PLB)
Up to 16 weeks of individualized elective time spaced out over 4 years of residency. PLBs occur during transitions between categorical programs in 2 week blocks (i.e. Medicine to Pediatrics or Pediatrics to Medicine). Residents have an opportunity to create a specialized curriculum that suits their particular interests/education requirements.
Examples the elective time include:
- Patient Quality and Safety week (required for interns)
- Ultrasound elective (scheduled for interns)
- Step 3 prep and exam time
- M&M week (capstone to Patient Safety education – required for PGY4)
- Scholarly activity block: writing a case for publication, completing a poster, continued work on quality improvement projects
- Practice of procedural/technical skills
- Continuity clinic
- Extension of International Health electives
International Health Elective
Residents have ample exposure to a diverse population in Portland due to a large refugee/immigrant population but for those who are interested in expanding global health education outside of the country there is opportunity for elective rotations. Residents have completed rotations in Haiti, Belize, Dominican Republic, Guatemala, El Salvador, Zambia, Uganda, Malawi, Lesotho, and Cambodia.
Faculty have been working to establish a mechanism (and funding) to support any resident or fellow who wishes to do an international rotation. Faculty in multiple departments (including Dr. Diamond-Falk for Med-Peds) have been going to a teaching hospital in Rwanda for several years and have begun taking trainees and do some teaching virtually. For those residents looking for other opportunities, faculty are available to help find established sites to participate in global health experiences.
Pediatric Inpatient Unit
More than 2,000 patients per year are cared for on the inpatient unit of the Barbara Bush Children's Hospital (BBCH). Pediatric diagnoses range from common respiratory and gastrointestinal disorders to congenital heart disease, metabolic disorders, and end-stage renal disease. The attending faculty at the BBCH includes a Pediatric Hospitalist group and a full range of sub-specialists involved in medical and surgical specialties. In addition, community pediatricians admit their private patients to the inpatient unit and follow these patients with residents and medical students.
Pediatric Intensive Care
Med-Peds residents rotate for one block in our 10-bed PICU during their second year before doing their first Pediatric Supervisory block. Here, residents are the primary caretakers for critically ill children under the direction of our PICU staff and Pediatric sub-specialists. The patient population in the PICU is varied, so residents care for children with a myriad of diagnoses including, but not limited to, status epilepticus, respiratory failure, diabetic ketoacidosis, and sepsis. Unique to this program is the opportunity to care for children with both non-surgical and surgical cardiac disease in both the pre- and post-operative periods. Residents are also members of the Pediatric Critical Care Transport Program. This is a ground-based system that transports critically ill children from Maine and New Hampshire hospitals to the Barbara Bush Children's Hospital.
Neonatal Intensive Care Unit
The neonatal intensive care unit experience occurs in our Women and Infants - Coulombe Family Tower, a state-of-the-art 50-bed NICU and Step Down unit as well as a new Labor and Delivery suite that opened in September 2008. The Barbara Bush Children's Hospital sees 2,500 deliveries per year. The NICU has an average of 700 admissions per year, of which 150 are transports from outlying hospitals. Residents are supervised by board certified neonatologists with a wealth of experience caring for premature infants as well as educating residents. Residents gain valuable delivery room experience, manage premature infants with complex needs, and learn assessment skills to quickly triage those infants requiring intensive care from the delivery room. A team of experienced neonatal nurse practitioners complement the neonatology service and are involved in many aspects of the hands-on training in the NICU.
Medicine Inpatient Rotations
The Department of Medicine has an average daily census of more than 280 patients. Patient care at Maine Medical Center ranges from primary care to a full spectrum of tertiary care issues, ensuring a superb patient population for residency training. Tertiary care is provided through programs such as invasive cardiology, ERCP, advanced critical care, neurosurgery, infectious disease consultation, renal and bone marrow transplantation, and cardiovascular surgery. The department is staffed by over 150 board-certified internists, two-thirds of whom have subspecialty certifications. The attending faculty includes an Adult Hospitalist group, subspecialists as well as community internists. Residents complete inpatient rotations in general medicine, cardiology (including cardiac ICU), renal transplant and hematology/oncology. In addition many residents choose elective on the inpatient subspecialty consult services.
Medical Intensive Care Unit
Residents spend 2-3 blocks in the 45-bed intensive care unit. The ICU is staffed by board-certified combined pulmonologists/intensivists (including a Med-Peds trained attending) with approximately 2,000 admissions per year. A thriving pulmonary and critical care fellowship program fosters a vibrant learning and research environment. Med-Peds residents find that they are exposed to a challenging mix of patients, providing both ample procedural and medical experience with critically ill adult patients. In addition to the time in the Medical ICU, residents are exposed to the Cardiac Intensive Care Unit during their subspecialty cardiology rotations.
As mentioned in the Med-Peds Continuity Clinic and Community Med-Peds & Rural Rotation, ambulatory experiences take place in many locations. For the Pediatric ambulatory care rotations, the Pediatric Ambulatory Clinic is based here at MMC. During the Pediatric Ambulatory Care blocks, residents rotate onto the Newborn Nursery Teaching Service under the supervision of the dedicated Newborn nursery faculty. These experiences allow residents to learn first-hand about general pediatric practice. Residents will also work in the Teen, Dermatology and International Clinic while on pediatric ambulatory rotations. In the setting of COVID-19, residents are spending time at the Respiratory Assessment Center where any patients with symptoms concerning for COVID-19 are seen at a separate clinic a brief distance from the hospital with all providers in PPE (PAPR/N95+face shield) to ensure trainees continue to get exposure to patients with acute respiratory illness.
Internal Medicine ambulatory care rotations allow residents to participate in a variety of specialty clinics such as dermatology, international/travel clinic, homeless health, Preble Street Learning Collaborative, STD clinic, sports medicine, and women's health. Residents complete an IM subspecialty rotation at the VA which includes time with GI, Rheumatology, Pulmonology, Nephrology and Cardiology.
Three blocks are spent in the ED. Residents care for children and adults who present to the ED including those with major or minor trauma, orthopedic injuries, poisonings, ingestions, and lacerations. Interns are expected to see both Pediatric and Adult patients during their first block in the ED. The MMC ED serves approximately 80,000 patients per year. This level one trauma site provides residents the opportunity to manage adult and pediatric patients that present with critical medical and surgical problems.
The second and third blocks are Pediatric ED supervisory blocks in the Pediatric Emergency Department. The newly dedicated pediatric emergency department was opened in summer 2009 with 10 beds dedicated to pediatric patients. It is geographically distinct from the rest of the department and is open 13 hours a day. This experience is supervised by board-certified emergency medicine physicians. Residents have the opportunity to supervise the learning of pediatric and emergency medicine interns in the care of pediatric patients in the ED. Residents also spend time at the Northern New England Poison Control Center during this time and gain valuable knowledge about toxicology during this month.
Adolescent medicine training includes a block in the second year where residents work side by side with faculty in school-based health clinics, eating disorders clinic, adolescent psychiatry clinic, sports medicine clinic, STD clinic, and other venues where care is directed toward teens. This experience also includes the weekly Teen Clinic which takes place at the MMC Pediatric Clinic during afternoon-evening hours
Developmental and Behavioral Pediatrics
This is an intern year rotation where residents work with board-certified developmental pediatricians (one of whom is Med-Peds trained) and a neuropsychologist caring for children with behavior issues, autistic spectrum disorders, ADHD, and learning disabilities. The bulk of this rotation occurs in the outpatient developmental-behavioral pediatric clinic. Time is also spent in pediatric neurology clinic, spina bifida clinic, child abuse clinic, and developmental team clinic. The rotation involves interactions with a diversity of experts in child development, learning disabilities, neurology, and child psychiatry.
During this rotation, residents are able to get a flavor of both the inpatient and outpatient care of geriatric patients. Residents will work in the ACE unit (Acute Care for the Elderly) and with HELP (Hospital Elder Life Program) during the days they are in the hospital. In addition, they do geriatric and palliative care consults on inpatients. For their outpatient experience, residents work with Hospice of Southern Maine and also go to the Geriatric Center. Scheduled educational sessions include a weekly morning conference and a talk by a geriatric fellow. Geriatric Grand Rounds and Journal Club occur once a month.
Five blocks of Internal Medicine and six blocks of Pediatric subspecialty/electives are set-aside over the four years of training. All of the major subspecialty areas are represented in our program. 4 blocks of “required” subspecialty rotations are required on both IM and Pediatrics. Residents have additional electives in both programs that may come from the list below or may be a more individualized experience.
Electives may be chosen from the following areas in Pediatrics: Advocacy, Allergy/Immunology, Anesthesiology, Cardiology, Child Abuse, Child Psychiatry, Endocrinology, Gastroenterology, Genetics, Global Health, Hematology/Oncology, Hospitalist Medicine, Infectious Diseases, Nephrology, Neurology, Ophthalmology, Orthopedics, Parenting, Pulmonology, Research Experience, Rheumatology and Sports Medicine.
Medicine Electives include: Addiction Medicine, Cardiology Consults, Endocrinology, Gastroenterology, Global Health, Hospitalist Medicine, Infectious Disease, Neurology, Pharmacology, Psychiatry Consults, Pulmonology, Rehabilitation Medicine, Research Elective, Rheumatology and Sports Medicine.
A Day in the Life
We asked some of our interns to describe in detail what a 'Day in the Life' was like as a resident.
Pediatric Senior Resident
5:00 AM: Wake up and get ready for the day. I live near MMC and can walk or bike to the hospital in 10minutes. A nice way to get some fresh air and exercise before starting the day.
6:00: Arrive at MMC! I typically grab a coffee before heading up stairs. Before sign out with the overnight senior, I review the list and notes on the computer and try to pick a few teaching topics for the day based on our patient list as well as try to anticipate some of the main plans for the day.
6:30AM: Grab sign out from the overnight team. There are consistently 3 seniors on each rotation month with two day teams and a night senior. The camaraderie among my colleagues formed during these months is some of the best during residency. A few of those minutes in the morning are spent chatting and joking with fellow senior residents. One of us takes the admitting pager for the day. All ED, outside hospital and clinic calls go through us for admission. We take all the information and make a general plan for admission then update the attending or get them conferenced into calls if there are questions. This can be challenging on busy days (we have a teaching senior who takes the pages 6+ months of the year during rounds) but is an incredible chance to assist rural pediatricians, ED doctors around the state and triage admissions.
6:45-7:45AM: After sign-out, I check in with my interns and medical students. I work directly with fourth year medical students, who are participating in acting internships. At MMC, we allow our 4th year students a lot of autonomy. They write and I sign their orders and help edit their notes before the attending cosigns them. This is great prep for them for their intern year. I try to allow the interns to captain the ship with their 3rd year medical students. I will then go pre-round on any new patients, check in on any “sick” ones and see AI patients (often with them to help them review exam skills).
7:45-8:30AM: Head down to morning report (M, T, W, F). Most mornings we have an interesting case from the inpatient unit or the clinic, but we will occasionally have resident presentations from elective months or a specialist lecture (child abuse, dermatology, etc.)
8:30-11AM: I meet with my team (one senior resident, one to two interns, two to four medical students and a pediatric pharmacist), and we begin rounding with our attendings. There are no fellows, which means we’re running the show. The senior is in charge of identifying acute patients, offering quick teaching points, and moving rounds along to keep efficient. On the Pediatric unit, we do a lot of family centered rounds. Nurses are also present for all our rounds. Our Pediatric Attendings are wonderful at pointing out physical exam findings and incorporating teaching into our daily rounds. Our pharmacists are a wealth of knowledge. I like to bring a computer on rounds to help with orders and bring up images.
11:00 - Mid afternoon: Get to work! And lunch… ALWAYS EAT, no excuses! Help interns and med students facilitate plans for the day, finish notes, update discharge summaries and sign outs.
On Wednesday and Friday 11:30-12:00PM we have Rad Rounds where we look at images on our patients with a pediatric radiologist.
Mini-SIM sessions on Friday 1:00-2:00PM are set up to participate in code practice at our SIM lab here in the hospital. These are interdisciplinary and often include our nurses, pharmacists, respiratory therapists and pediatric hospitalists. It is a great opportunity to practice extra code scenarios given they are less common on Peds.
1:00 PM: Residents attend their half-day continuity clinic while on pediatric service. This is important to factor in when rounding to allow sufficient time to complete work before you or one of your interns leaves for clinic in the afternoon.
2:00 PM: Interdisciplinary Rounds: The senior residents attend these with our ancillary staff to help with discharge planning.
Admissions: The two seniors on the floor alternate days carrying the admission pager and the afternoons are often filled with new admissions and fielding calls from outside hospitals and primary care physicians regarding patient transfers to our facility. Working with the interns and medical students, we do our admissions and try to get everyone “tucked in” for the night team. Sometimes, if the afternoon is slow, one of the senior residents or an attending may give a “chalk talk” or senior residents can work with students to practice starting IVs or other procedures.
5:00PM: We sign out to the night team, which is made up of one senior and one intern (and often a medical student). The seniors work Sunday through Thursday nights when on the night team (2 weeks during 2 of the 3 senior Peds inpatient rotations). Most days it’s very reasonable for me to be home by 5:45PM.
5:00AM: My alarm goes off. I eat breakfast, take my pups for a walk, and am out the door by 6:00AM. My wife and I decided to buy a house when I matched here, so my commute is about a 12 minute drive. Most residents live within walking or biking distance of the hospital.
6:15AM: I arrive at the parking garage and hop on the shuttle for the short ride to the hospital. During the warmer months, the garage is a nice short walk to the hospital. I grab a coffee on my way through the lobby and head up to the pediatric inpatient unit.
6:30AM: Sign out. The day teams (usually comprising a senior resident, two interns, one M4, and one or two M3s) meet the night team in the conference room to run the list and learn about new admissions. After sign out, I touch base with the 3rd year medical students and find out which patients they are interested in seeing for the day and try to arrange a time to practice their presentations before rounds. I try to speak with the overnight nurses before they sign out at 7:00AM. The nurses are fabulous, easily accessible, and great at sharing information from overnight. If kids are sleeping, we let them sleep and examine them on rounds. Otherwise, I examine my patients and talk to parents before rounds. I update the treatment board with who the medical team is for the day so the patient’s family knows who to expect on morning rounds.
7:45AM: Morning report! Most days the topic is an interesting case from the floor, but resident or attending presentations from various specialists are often in the mix as well. On Thursdays we attend a Grand Rounds at 9:00AM and two didactic sessions from 10 to 12 instead of morning report. On Thursdays rounds will be quicker to ensure everyone has a plan prior to Grand Rounds. Journal club on pertinent Peds articles occurs monthly after didactics.
8:30-11:00: Rounds with the attendings, trainee team, nurses, and one of our incredible pediatric pharmacists! There are two teams on the floor each month. One team has hospitalist and pulmonology patients while the other team has hospitalist and hematology/oncology patients. Additionally, both teams share low-census subspecialist patients (cardiology, neurology, gastroenterology, endocrinology, nephrology, etc.). After rounding with the hospitalist and oncologist (or pulmonologist), we contact any additional subspecialists whose patients we may be caring for. Rounds is a great time for learning. We primarily do bedside rounds, but occasionally do table rounds (Thursdays). As an intern we carry anywhere from 2-10 patients depending on the census. Pediatric volumes can be variable by season and often even day-to-day!
11:30AM: On Wednesday and Friday we head off to radiology rounds where any new images on our patients are pulled up on the screen for discussion with a pediatric radiologist. This is a great opportunity for sharpening our image reading skills and asking questions to advance patient care!
1:00PM: I finish up remaining notes, call consults, work on discharging patients, and take admissions from the emergency department, clinic, and outside hospitals. Sometimes we have a lecture from an attending and/or senior resident in the afternoon. I also take this time to touch base with our wonderful social workers, nutritionists, physical and occupational therapists and other ancillary staff on certain patients. Sometimes in the afternoon we will attend family meetings on our complex patients. Nearly all of our patients are on our 30 bed inpatient pediatric unit or are intermediate level care in the PICU, but on our service if they do not require PICU management (occasionally an older adolescent or young adult on pediatric team will be in another unit). This makes it easy to catch the interdisciplinary providers on the unit and connect with nurses and attendings in-person throughout the day.
5:00PM: Time to sign out to the night team. The overnight intern works one week of night float (Sunday through Friday night) at a time during their inpatient pediatrics block with an overseeing senior resident.
Internal Medicine Senior Resident
5:00-5:30AM: Alarm goes off. I check Epic on my phone to see if there are new patients on the list. This determines how leisurely I go through my morning. I do a little yoga and make/eat my breakfast at home. I usually text my intern and medical students the new patient assignments, so that they can prep charts.
6:00-6:15AM: I’m out the door, on the way to MMC. If you live close enough to walk or bike, do it! I live outside of Portland in Falmouth, so I drive with a 7-10 min commute depending on “traffic”. At that time in the morning, many traffic lights are just blinking. I park in the new parking garage, where there is no difficulty finding a spot then I hop on the shuttle, about a 3 min ride to the hospital. Once there, I head to the Med-Peds resident room to get ready. I print a patient list, do some quick chart checks and head up to the work room.
6:30-6:45AM: Sign-Out . This place is abuzz from about 6:30-7am with attending physicians, residents and interns signing out. Each of the four medicine teams breaks off one at a time to hear about what happened overnight, who behaved, who didn’t, big events and a brief H&P on any new patients.
I pull the team back together to make a general plan for the day, and quickly “run the list” to make sure we prioritize active/sick patients, new admissions, time-sensitive tasks and discharges. I try to see a few patients and get what I can in motion before heading to morning report; depending on the day, that can be anywhere from 1-4 people.
7:30-8:30AM: Morning Report! Pre-COVID, it took place in the Dana Center, where the coffee is provided. Sometimes folks would pick up breakfast in the cafeteria and eat it there. Post-COVID we have Morning Report via Zoom. All of the hospital computers have Zoom, so you can pull it up anywhere.
Our medicine chiefs run morning report and usually we start and/or end with board questions related to a selected topic, followed by a case presentation to further illustrate key teaching points. We are fortunate that our specialists are consistently present to help facilitate these didactics and offer a wealth of experience and wisdom around key educational concepts, evaluation, diagnosis, management, etc. without overpowering the residents’ input.
8:30AM: Head back to your team’s floor to attend interdisciplinary care rounds (IDCR) – a meeting of all nurses, ancillary staff and physicians (either you or your attending will go) to review and discuss specific patient issues, clarify care plans and anticipated discharges, etc. for each patient on the floor. The attending is usually the only one who attends these, but you are welcome to go as the senior as well. I use this time to check in on my team, address any questions/active issues, work on notes, look up teaching topics, and check orders.
9:00AM: ROUNDS! I always start with a review of our individual and team goals that I ask folks to come up with on the first or second day. I also try to ask everyone about something non-medical that happened to them in the last 24 hours. Rounding style is determined by the senior resident with some input from the attending. Bedside rounding is a priority and we see any new/active patients or people with good exam findings. Many of our patient’s rooms are double rooms, so we work to balance keeping everyone involved without increasing risk of exposure in small rooms. I round with a wheeled computer so we can check data, review imaging, and put in all the orders as we go. If patients are going to be discharged, we review the medication reconciliation, patient instructions, and follow up plans with the patients in the room, so that they can be discharged as early as their rides arrive. For the remainder of patients we don't see together, we talk through on table rounds. There is a specific non-resident admissions team, so we are protected from admissions during rounds.
11:00AM: Ok, 11:00 may be a bit idealistic- so I’ll say we finish rounds between 11am -12pm. Then I do a quick recap with the team and reprioritize tasks, make sure everyone grabs something to eat, and get to work! We prioritize calling our consults, updating families, then finishing notes, and following up on action plans.
Thursdays I hold pagers for interns so that they can attend an intern-specific conference from 12-1.
Fridays from 1:00-3:30PM are our protected medicine teaching block; the attending physician holds our pagers during this time so we can focus on didactics, currently via Zoom. This is a good time to grab milkshakes (they call them “frappe” here) for the team, often bought by attendings from our Pavilion Grill, with delicious flavors from vanilla to coffee Oreo.
2:00PM-3:00PM: Will meet up to “run the list” usually with the attending. If time allows we may also do a “chalk talk” or go to pathology or radiology to review our patient’s results. Often this is when we get admissions.
4:30PM: All teams that are not on long call stop taking admissions. We re-group again and review labs, update sign out tabs for the night team and think about who might be discharged the next day.
5:30PM: Sign out to the night team. Every fourth day your team is on "long call." In addition to being the hospital’s Code Team, the long call team continues to work on admissions one by one until relieved by the overnight team. This provides coverage during the sign out hour to minimize interruptions for the other teams. The long call team usually signs out between 6 and 6:30pm.
I then drop my stuff off in the Med-Peds room, often running into other Med-Peds folks for a quick chat. In the warmer months, I walk down the hill to the parking garage rather than take the shuttle, enjoying that last little bit of sun (unless it’s after October, because then it will be dark). Then it’s home, (+/-workout), dinner, and call it a night.
Internal Medicine Intern
wake me again at 5:30 which is when I actually get out of bed. My commute to work is only about 3 minutes by bike from door to door. I usually brave it and make the trek (pun intended) without a raincoat since it is so short. That was only a bad idea one time. Many of the other interns live within walking distance or a short 10 minute drive to the hospital. The time before heading into the hospital is also a great time to log into Epic (the hospital EMR) briefly at home to see how many new patients the team picked up overnight and gives a good idea for how the morning will go.
6:15 -6:20AM: Arrive at Maine Medical Center. The time of arrival varies slightly for me based on number of new admissions, as these take a bit more time to review. First thing I do is print out my patient list and begin pre-rounding on my patients through Epic. I usually bring in my headphones and have a good mix of jams to help me start the day and focus. I generally try to get all the information I need from chart checking and start my daily notes before sign out so I will only need to see my patients afterward. Once you get a good system to follow for checking information this can generally go pretty quick, especially when paired with a hot cup of coffee and a little classic rock. It’s great if you can get as much done as possible before sign out so that you can ask the night team meaningful questions.
6:30-7:30AM (9 if needed): Meet with the overnight team for sign-out, discuss new patients with senior resident, and then finish pre-rounding.
7:30-8:30AM: Morning report. A senior resident presents a patient with an interesting diagnosis or a complex problem and hospital course. After the presentation the resident, chief resident and/or an attending from the relevant subspecialty will give teaching points on a topic relevant to the case. Interns may prioritize patient care activities during morning report if needed. It’s not expected for interns to make it to morning report and sometimes it is next to impossible depending on the daily workload.
9/9:30-11:30AM: Time for rounds with the team! Depending on your service this can include the attending, the senior resident, a co-intern or MS4, one or two MS3s, and a pharmacist. Rounds take different forms depending on attending and senior resident preference, but typically we do bedside rounds for any patients admitted overnight, “sick” patients and any potential discharges. We then do “table rounds” in which we sit together in a conference room to discuss the remaining patients on the service. The senior resident or occasionally an intern will use a computer on wheels (COW) during rounds to put in new orders as plans for the day are finalized and look up laboratory data and significant imaging for the team to review. Friendly tip, never let a patient hear you saying you have the COW, they inevitably think you are talking about them, its udder nonsense.
11:30AM: Rounds end, and I meet with the senior resident, co-intern, and med students to run through the list and prioritize clinical tasks to be completed before any daily conferences. Typically, discharges and calling necessary consults for patients are at the top of the task list.
12:00PM: On Thursdays we have intern report, a 1 hour didactic session run by the chief residents designed to address floor topics commonly encountered by interns. At the beginning of the year, this includes Epic tips and tricks and refreshers on basic topics to get us all on the same page. As the year goes on and interns become more proficient and efficient, the topics get more nuanced and interns have the opportunity to present to their peers, in the style of a morning report. This is an awesome directed learning opportunity, and a great chance to catch up with your class!
1:00PM: On Fridays we have didactic teaching sessions from 1-3:30PM covering important topics in in-patient medicine with the chief residents and an attending or pharmacist. On other afternoons I finish my notes, update sign out tabs, call any remaining pending consults and follow up on any test results that come in throughout the day. As time permits, I will check in with my patients and discuss plan changes with them and their families. I also work on new admissions that come in to the teams during this time. The teams will often reconvene in the late afternoon (3-4PM) to go over some relevant teaching points related to one of the patients on the service with the attending or senior resident. "Chalk talks" are great and in my experience all of the attendings have a few excellent ones. The other benefit is that there is no "pimping" culture here so attendings and seniors will ask you questions but in an educational manner. Fur coats are optional at chalk talks.
4:30PM: All teams that are not on long call stop taking admissions. Every 4th day, the team takes “long call.” The long call team is responsible for all admissions from 4:30PM until they are relieved by the night team after the other teams have finished signing out, usually by about 6:00PM. You also carry the code pagers, and respond to any “Code Blue” events, or clinical emergencies, throughout the hospital. As an intern, this is great exposure and gives you the opportunity to watch your fellow senior residents at work “running” codes. Other than the extra 1-2 hours of admitting time, long call is just like any other day.
5:30PM: Time to sign out to the night team! We generally print copies of the updated sign out sheet for the day to give to the night team and update them on any pending tests or lab values and contingency planning for the patients on the service. I find they love it if you have time to doodle a fun little drawing on the corner.
6-6:30PM: Finish sign out. On long call days and days with a particularly heavy work load I will spend some extra time at the hospital finishing up notes for the day and tucking in new admissions. In general I get home by 6 or 6:30 PM so I can eat dinner, do something physical, and get plenty of sleep for the next exciting day on the wards!