Harborview Medial Center

General Medicine Service

Faculty Contact
Virginia Broudy, MD
Professor of Medicine
Chief of Medical Service, HMC

Address
Box 359782
325 9th Avenue
Seattle, WA 98104

Phone: (206) 744-8054
Email: vcbroudy@uw.edu

Overall Educational Purpose

To provide exposure to a broad range of acute medical problems in adults.

To enhance communication, problem solving, diagnostic, and treatment skills.

To foster independence, self-confidence, and dependability in a well-supervised academic environment.

Team Structure
1. Attending
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.

Didactics
Radiology Rounds: New films can be reviewed with an Attending Radiologist daily.
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.


Educational Content
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.

Patient Characteristics
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
Procedures most frequently performed during this rotation include thoracentesis, paracentesis, placement of central venous catheters, placement of nasogastric tubes, lumbar puncture (LP), and arthrocentesis.

Services
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 full
mix of surgical and subspecialty consultative services.

Principle Educational Materials Used
Recommended Readings
Residents have access to multiple full text articles, text books and on-line references in each team room via the web.

Pathologic materials


Methods Used in Evaluating Resident and Program Performance
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 competence).

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 daily.

 

Last Revised February 20, 2004 by Virginia Broudy, MD