Harborview Medial Center
General Medicine Service
Virginia Broudy, MD
Professor of Medicine
Chief of Medical Service, HMC
325 9th Avenue
Seattle, WA 98104
Phone: (206) 744-8054
Overall Educational Purpose
To provide exposure to a broad range of acute medical problems in adults.
To enhance communication, problem solving, diagnostic, and treatment
To foster independence, self-confidence, and dependability in a well-supervised
2. R2 or R3 (occasionally FP R2)
3. Two R1s
4. One Sub-Intern
5. One-Two MSIII
Principle Teaching Methods
Case discussion and review
This occurs in four settings: Daily work rounds, Morning Report
(four days per week), Intern Report (once a week) and Attending rounds
(at least four and one half hours per week).
During monthly orientation materials sent to attendings, the Chief of
Service requests that teaching occur at the bedside whenever possible.
Radiology Rounds: New films can be reviewed with an Attending Radiologist
Chief of Medicine Rounds: Weekly conference for discussion of patients
on inpatient and outpatient services. Pathologic material, including autopsy
findings, are presented whenever available.
Didactic lectures: These occur three times weekly and cover a broad range
of inpatient and outpatient general medicine topics.
Mix of Diseases
Patient present to the Harborview inpatient ward with the full variety
of acute medical problems seen in adults. Harborview provides primary
hospital care for patients followed in Harborview-based and satellite
clinics (Madison, Pioneer Square, etc.). Harborview also receives referrals
from King County institutions for patients who require inpatient treatment
(King County Jail, Detox center, Bailey Boushay House, Public Health,
TB Conference, and Western State Hospital). In addition Harborview receives
emergent referrals through the EMS-Medic One system. Harborview receives
tertiary referrals for patients with traumas, burns, infections or pulmonary
disorders from all over the WAMI region.
Patients admitted to Harborview inpatient Medicine wards generally are
from disadvantaged socioeconomic backgrounds (Medicaid 47%, Medicare 20%,
Managed Care 5%, Self pay 7%, Workmen's Comp 5%, Commercial Insurance
16%). Ethnic minorities constitute a considerable proportion of patients
on the inpatient medical service.
Types of Clinical Encounters
All patients seen during the rotation are inpatients receiving care for
acute medical problems. Clinical encounters include Emergency Room evaluation
at the time of admission, full history and physical at the time of admission,
morning rounds and daily evaluations by individual team members. Interns
are exposed to patients under the care of their peers during work rounds
and beside visits during intern report.
Procedures most frequently performed during this rotation include thoracentesis,
paracentesis, placement of central venous catheters, placement of nasogastric
tubes, lumbar puncture (LP), and arthrocentesis.
Harborview Medical Center has a full range of services available
for participation in patient care. There is a full service intensive care
unit, an emergency room staffed 24 hours by attending physicians, and
mix of surgical and subspecialty consultative services.
Principle Educational Materials Used
Residents have access to multiple full text articles, text books and on-line
references in each team room via the web.
Methods Used in Evaluating Resident and
At the end of the rotation, the resident is evaluated in writing and their
performance reviewed with them verbally by every attending and fellow
he or she has interacted with for a significant amount of time. The evaluator
rates the resident on a nine-point scale in each component of clinical
competence (i.e. patient care, medical knowledge, practice based learning
improvement, interpersonal and communication skills, professionalism,
system based learning, educational attitudes, leadership, overall clinical
The resident is given the opportunity to evaluate in writing the quality
of the curriculum and the extent to which the educational goals and objectives
of the rotation have been met. The resident also evaluates the teaching
competence of each attending and fellow with whom s/he has interacted
for a significant amount of time.
Explicit Lines of Responsibility for Care
of Patients on this Service
Direct Supervision of Patient Care
The attending physician provides supervision to all members of the team
(senior and junior residents and medical students). The senior resident
provides supervision to junior residents and students. Attending and resident
team members provide supervision to medical students.
Trainees rotating on the inpatient ward at Harborview are expected to
assume full responsibility for the evaluation and management of the patients
seen on this service. In order to ensure optimal patient care, residents
are provided with 24-hour access to their supervising residents, attending
physician, and consultants. Interns take call with their supervising resident.
Residents covering the Intensive Care Unit, Neurology, and Surgical Specialties
are always in hospital and available for emergent consultation. The attending
physician is available through paging, and speaks regularly with the senior
resident during on-call periods. Fellows and attending physicians are
available, usually within 30 minutes, for assistance with patient evaluation
and for performance of emergency procedures. Attending physicians must
document their involvement in the evaluation and management of patients
Last Revised February 20, 2004 by Virginia Broudy, MD