The purpose of the night float rotation at Washington Regional Medical Center is to provide PGYI residents with a focused experience in the evaluation and care of a broad range of patients commonly encountered in all aspects of the hospital setting at night including critical care, medical/surgical units, pediatrics, nursery and emergency medicine.

Goal I: Establish a working knowledge of ER, critical care, medical/surgical units, pediatrics, and nursery.

Goal II: Build and expand upon skills in the ER and the Inpatient Service.

Goal III: Become familiar with the differential diagnosis and treatment of common ER visits, critical care, medical/surgical units, pediatrics, and nursery.

The resident is expected to:

• Report Monday through Friday 5:00pm to 7:00am

• Take phone calls after hours from continuity patients of both outpatient clinics.

• 
  Work with the upper level resident to provide quality patient care

•  Check out all admissions to the faculty attending on call during the night

• Contact the upper level resident on the Family Medicine Service for an update on patient care issues that need to be addressed during sign off rounds at 5:00pm

• Required to attend ½ day of clinic on Monday afternoon each week
  

Specific duties:

• Sign out to on-coming service residents between 6:00 a.m. and 7:00 a.m.
  

• Cover the ER with supervision
  

• Inpatient consults

Goal

Patient Care: Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. The Family Medicine Resident is expected to:

• Demonstrate caring and respectful behaviors in patient care.

•  Establish a foundation of skills in interviewing, informed decision-making, and the development of treatment plans.

• Counsel and educate families, perform physical exams and procedures, and perform preventative healthcare.

Goal

Medical Knowledge: Residents must demonstrate knowledge of established and evolving biomedical, clinical epidemiological and social-behavioral sciences as well as the application of this knowledge to patient care. The Family Medicine Resident should have knowledge of:

• Basic sciences in the principles of history taking.
  

• Principles of problem solving.
  

• Technique of basic and advanced cardiopulmonary resuscitation.
  

• Indications for and method of diagnostic procedures including venipuncture, lumbar puncture, pulse oximetry, and nasogastric intubation.
  

• Indications for subspecialty referral and consultation.
  

• Pathology, physiology, diagnosis, and management of common problems.

Goal

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life long learning.  Residents are expected to develop skills and habits to be able to :

Competencies

• Identify and perform appropriate learning activities

• The residents will identify strengths and limits of knowledge by progressive increases in their knowledge base

• Use information technology to optimize learning

Objectives

• The resident becomes competent in the use of UpToDate, DynaMed, and journal searches.  The resident will learn to utilize a variety of knowledge sources

• The resident will become competent in the use of EMR to track patients, recover lab data and medical reports

• The resident will become competent to use the PDA with Epocrates and 5-Minute Medical Consult

Goal

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.  Residents are expected to:

Competencies

• Work in interprofessional teams to enhance patient safety and improve patient care quality

Objectives

The resident will:

• Understand the interaction of ER follow-up and urgent patient issues

• Promote timely notification of referring physicians

• Strive to insure good patient flow while preserving high quality of care

• Practice cost–effective care and advocate for patients within the system

• Work to control health care costs and allocate resources to provide high quality care

Goal

Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.  Residents are expected to demonstrate:

Competencies

• Compassion, integrity, and respect for others

Objectives

The resident will:

• Receive mentoring by the faculty to teach the understanding of compassion, integrity, and respect in care of the adult with acute and chronic problems

• Demonstrate a commitment to carrying out his/her professional responsibilities

• Demonstrate respect, compassion and integrity and respond to the needs of patients

• Demonstrate adherence to ethical principles

• Respect and maintain confidentiality of patient information

• Show sensitivity and respect to diverse patient populations

• Know when to seek consultation from other appropriate specialists to either manage or co-manage a patient for optimal care

• Respond to pages and other consultations in a timely manner

• Dictate comprehensive history and physical exams in a timely manner

• Develop respectful, altruistic, ethically sound practice which is sensitive to culture, age, gender, disability issues

Goal

Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates.  Residents are expected to:

Competencies

• Communicate effectively with physicians, other health professionals, and health related agencies

• Recognize the impact of social, cultural and environmental factors that will affect the health and well being of patients and their families

• Demonstrate an awareness of the importance of physician and patient working as partners to promote optimal health

• Demonstrate interpersonal and communication skills that result in effective information exchange with patients, families and colleagues

• Work effectively with others as a member of a healthcare team

• Create therapeutic relationships with patients and the development of listening skills

Objectives

The resident will learn appropriate consultation, timely transfers, and other options of care for acute and chronic problems.  This will be monitored at daily report and on rounds.

At the conclusion of each resident rotation, the residency coordinator sends a formative-type, rotation-specific performance evaluation form to the rotations' supervising physician.  When the completed evaluation is returned, the resident physician and the resident's faculty advisor review the evaluation and attest to reviewing it by signing/initialing the form.  Next, the program director reviews and attests to the document.  Once all three have reviewed and attested the evaluation, it is included in the resident's permanent file.

Resident will evaluate the faculty supervising the rotation anonymously via New Innovations.

References available at the AHEC Library:

 Bennet JC, Goldman L. Cecil textbook of medicine. 21^st ed. Philadelphia, Saunders, 2000 2v.

 Fauci A, et al. Harrison's principles of internal medicine. 14^th ed. New York, McGraw-Hill, 1997.

 Rakel, RE. Saunders manual of medical practice. 2^nd ed. Philadelphia, Saunders, 2000.

 Pfenninger, JL, Fowler GC. Procedures for primary care physicians. St. Louis, MO, Mosby, 1994.

 Behrman RE, et al. Nelson textbook of pediatrics. 16^th ed. Philadelphia, Saunders, 2000.

 Sieberry GK. The Harriet Lane handbook: a manual for pediatric house officers. 15^th ed. Mosby, 2000.

 Tintinalli JE. Emergency medicine: a comprehensive study guide. 5^th ed. New York. McGraw-Hill, 2000.

On Line Resources:

UpToDate and DynaMed