Inpatient Ward

Seattle, Washington - PEDS 665 P

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

This memo will explain details of your role and responsibilities on the INPATIENT teams at Seattle Children’s

  1. New patient evaluations (H&Ps); patient load:
    1. Perform full H&Ps on at least 10 inpatients, preferably at time of admission or transfer.
    2. Follow 2-3 patients at any given time.
  2. Oral case presentations:
    1. Present full (but brief – <5 minute) oral case presentation on all newly admitted patients the morning after they are admitted.
    2. Present follow-up oral case presentation (~2 minutes) on daily work rounds for current inpatients.
    3. Oral case presentations should include your assessment and plan for the patient.
  3. New patient H&P write-ups:
    1. Write-ups should be entered into the electronic record as soon as possible (no later than the next morning).
    2. 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.
    3. 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)
    4. Turn in one write-up each week for feedback (3 total for the clerkship). Send each write-up to your ward attending and also to the clerkship director assigned to you for feedback (indicated on the personal calendar/schedule you received at orientation). Write-ups are due no later than 5pm on the last day of the week. You may copy the write-up from the electronic record and paste into a word processing document to email for feedback. Requirements include:
      1. The document sent for feedback must be fully de-identified. Change all patient/family names to initials only. Do not copy the medical record number, account number, or any other Protected Health Information.
      2. Carefully review any information that has been automatically inserted into the document by the electronic system. You are responsible for the document’s accuracy (as you are for the version submitted to the electronic record).
      3. The write-up must be your own work, not a copied version from the resident or attending.
    5. All new patient H&P write-ups entered into the electronic record must be signed promptly and forwarded to your direct supervisor (either senior resident or primary attending) for their review and electronic signature.
  4. Daily progress notes and orders:
    1. Write daily progress notes on all current inpatients. All daily progress notes entered into the electronic record must be signed promptly and forwarded to your direct supervisor (either senior resident or primary attending) for their review and electronic signature.
    2. Go over your notes with your intern or your primary attending. You will work with your residents/interns/attending to enter orders electronically on your patients.
  5. Daily Activities on the Ward:
    1. 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 number, contact consultants etc. to facilitate their care.
    2. Pre-rounding means: Arrive early to gather data 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
    3. Write your daily progress notes.
    4. Present your patients on daily team rounds
  6. Call: Call occurs with your team members. 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. The main purpose of call is for you to have the opportunity to admit patients and practice pediatric history and physical examination skills. You should have at least 5 call shifts.
    Team 1*Team 2*Team 3Team 4Team 5Hospitalist
    Mon and Weds Tues and Thurs Coordinate with senior resident Coordinate with senior resident Coordinate with senior resident Coordinate with attending
    *These two teams share overnight call; coordinate so that only one medical student is on call on any given evening.

    If you have admitted multiple patients that day before the evening shift you may arrange with your supervisor (residents or attending) to go home early to work on your write-ups. READ about your patients when you go home after call!

  7. 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 you a chance to improve in recommended areas. Ask for feedback from your intern, resident and attending. Ask for specific areas of improvement.
  8. Supervision:
    1. Resident-based teams: 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 picking 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.
    2. Attending-based teams (Hospitalist): You will work directly with the attending Medical Hospitalist, who will be the primarily involved in your teaching, rather than an intern or resident (see above). Since there are usually not residents on the Hospitalist team, all the educational duties noted above belong to the attending. The chief residents remain available for support and discussion.

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 Sign-out6:30A UnitUnit
Morning Report8-8:30A M, W, FRC.3.905
Intern/Medical Student PREP8:30-9:30A M, T, W, F Unit
Walk Rounds 9:30-11:30A M, T, W, F Unit
Resident/Student Conference 12:30P M, T, W, F RC.3.905 (M, T, F) Wright Aud (W)
Inpatient Student Conference3-4P M, W & ThSee orient. materials for location
Grand Rounds8:00A ThWright Auditorium
Clerkship Lectures3-4P TSee orient. materials for location
Call night Sign-out6:00P (Call night ONLY)Unit
ExpectationsWork 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 your intern or resident co-signs.

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