Inpatient Ward

Seattle, Washington - PEDS 665 P

Expectations for Medical Students on the Inpatient Ward Teams at Seattle Children’s

This memo is to help sort out the details and roles for medical students on the INPATIENT teams at Seattle Children’s
  1. History and physicals:
    • Perform full H&P’s on at least 10 inpatients; follow 2-4 patients at any given time
  2. Oral presentations:
    • Present brief (3-5 minute) oral case presentation on all newly admitted patients the morning after they are admitted.
    • Present patient progress (1-2 minutes) on daily work rounds for current inpatients. Both of these presentations will include your plans. Additional formal presentations at the discretion of the inpatient team.
    • One formal topic PowerPoint presentation at third Tuesday 3pm clerkship conference is required, including a slide listing your references.
  3. Case write-ups: Write-ups are due on the charts the next morning.
    • For newly admitted patients: On the majority of patients you will write up a complete H&P including a differential diagnosis, discussion of problems and assessment and plan. See the sample H&P in this manual for specific elements that should appear in the pediatric history and physical.
    • For transferred patients/patients already hospitalized: Summary of HPI, relevant PMH/FH/SH and presenting PE followed by a review of hospital course by systems (e.g. Respiratory problems, GI problems, etc)
    • You will turn in 3 write-ups for feedback. Turn in 1 H&P/weekly. Week one: house attending; week two: Sherilyn Smith; week three: house attending.
    • Give copies of your H&Ps to the senior resident and ask for feedback about the content and presentation.
  4. Progress notes and orders: Write daily progress notes on all current inpatients. Have them ready to sign early in the day. Go over your notes with your intern. You will work with your residents/interns to enter orders electronically on your patients.
  5. Daily Activities on the Ward: You are expected to pre-round on all your patients. You should view yourself as the primary care giver for these patients, with supervision!! Give people your pager #, contact consultants etc. to facilitate their care.
    • Pre-rounding means: Arrive early to gather numbers and check on your patients. Important data to gather:
      1. Vital signs over the last 24 hrs, Total fluid Ins (cc/kg/day or cal/kg/hr) and Outs (cc/kg/hr) (I/O)
      2. Medication changes (i.e. Nebulizer frequency Q3, Q4, etc…..),
      3. Overnight events... Fever spikes, seizures, and any important changes in status, results from consults/tests
      4. Brief, pertinent, physical exam
      5. AM lab results
    • Write your daily SOAP notes.
    • Present your patients on daily team rounds (including on Thursday mornings, before the Student Conferences except if you are post call).
  6. Call: The purpose of evening inpatient call is to ensure that you are carrying an adequate number of patients. You should plan on taking evening call 4-5 times over the course of your three weeks on inpatient. The schedule is below and can be modified by your senior resident but should not result in fewer than 4 call evenings during your inpatient rotation. You are expected to be present for evening sign-out on the Unit at approximately 6:30P and to stay until 10 to 11 on weeknights. If you have admitted multiple patients that day, you may arrange with your residents to go home early to work on your write-ups. READ about your patients when you go home after call!
    Remember, this schedule is always open to change depending on the team’s volume. Your senior resident will decide any changes. The student on the Hospitalist team should work out their schedule directly with the attendings.
  7. Team 1 Team 2 Team 3 Team 4 Team 5
    Weeks 1-3 Mon and Weds Tues and Thurs Mon and Weds Tues and Thurs Any evening

  8. Feedback: Because of the short time frame that medical students are on the wards, it is important to give and get prompt feedback. Feedback regarding clinical performance should occur at least twice during the rotation (and possibly three times - i.e. weekly) to give students a chance to improve in recommended areas. Ask for feedback from your intern, resident and attending. Ask for specific areas of improvement. Also, give feedback to your intern, residents, and attending. They will appreciate this and your experience will improve as a result.
  9. Supervision: In general, you will work with the interns for learning how the wards work, physical exam pearls, etc. The intern is responsible for reviewing and cosigning progress notes. The senior residents are in charge of reviewing admission notes, helping you with and providing feedback of your oral case presentations, and in general helping you during your pediatric rotation. If you find yourself needing more direction, whether it is how you can help out the team or pick a topic to learn more about, ask your senior resident. The chief residents are also available if you need to discuss issues regarding your team and overall educational experience.
  10. Please let us know when things are not going as you expect. It is your education and we want to make it the best possible experience we can! If we know early in the rotation, we can clarify and rectify problems.

    Usual Schedule Staggered Sign-out 7:00-8:00A M-F Unit
    Morning Report 8:30-9:00A M, W, F RC.3.905
    Intern/Medical Student PREP 9:00-9:30A M, T, W, F Unit
    Planning Time/Practice Rounds 9:30-10:15A M, T, W, F Unit
    Walk Rounds 10:15A-12:15P Unit
    Resident/Student Conference 12:30P M, T, W, F RC.3.905 (M, T, F)
    Wright Aud (W)
    Student Conference Afternoons M, T, W See orient. materials for location and time
    Grand Rounds 8:00A Th Wright Auditorium
    Student Lectures 9:45A Th See orient. materials for location
    Cluster Rounds 4:30-5:30P M-F Unit
    Call night Sign-out 6:30P (Call night ONLY) Unit
    Expectations Work up and admit 1-2 patients when you are on call. Follow at least 2-3 patients at any given time (present on work rounds, write daily progress notes, function as primary provider). If you write orders, please be sure intern or resident co-signs.

    Where is…?
    Cafeteria__ 7th Floor Ocean section B
    ER__ 1st Floor Forest
    GME Office__ 7th Floor Ocean section C, OC.7.830