Harborview Medical Center

Medicine Consult

Faculty Contact
Rachel E. Thompson, M.D.
Director, Medical Consult Service, Department of Medicine
Harborview Medical Center
Phone: (206) 744-3680
Email: rethomps@uw.edu

Address
Harborview Medical Center
325 Ninth Avenue
Box 359780
Seattle, WA 98104

Overall Educational Purpose
Medicine Consults
1. To learn to evaluate and offer assistance in the care of patients on non-medical services with particular attention to the workup, diagnosis, or management of symptoms/diseases including, but not limited to:
· Diabetes mellitus
· Venous thromboembolism
· Hypertension
· Pneumonia
· Skin and soft tissue infection
· Acute and chronic renal failure
· Fever
· Shortness of breath
· Chest pain
· Supraventricular arrhythmias

2. To learn to evaluate and preoperatively assess patients who are undergoing non-cardiac surgery with particular attention to issues including, but not limited to:
· Cardiac risk assessment
· Pulmonary risk assessment

Team Structure
2 Attendings
1 R2/R3
1 Intern

Principle Teaching Materials
Case discussion and review
The attendings on the medicine consult service discuss the patients that are seen by the intern and resident.

Rounds
Each afternoon the residents will have bedside rounds with the attending on the consult service. New patients are presented first and follow up on prior consults second.

Didactics
At least three times per week the consult attending will give a lecture on topics pertinent to medicine consultation. This will usually happen prior to rounds.

Educational Content
Mix of Diseases
On the medicine consult service common diseases treated include:
· Preoperative evaluation
· Diabetes mellitus
· Hypertension
· Atrial fibrillation
· Chest pain
· Acute renal insufficiency
· Undiagnosed fever
· Venous thromboembolism

Patient Characteristics
The patient population is a mix of races and comes from a broad range of socioeconomic backgrounds. About 1/3 of the population do not have insurance, 1/3 have Medicaid or Medicare, and the last 1/3 are private or self pay. Harborview serves a large homeless population, a significant intravenous drug using population, and operates as the regional care center for HIV infected individuals in the greater Seattle area.

Types of Clinical Encounters
Every patient seen by the residents on this service are inpatients. The night float team will not care for patients in the intensive care units, but when serving as the medical consultants they will often follow surgical patients with ICU needs. 100% of the patients that are admitted by the night float team come through the emergency department.

Procedures

Rotation Specific Schedule
Monday
8AM – Consult resident picks up consult pager from night float resident and receives sign out on patients requiring consultation overnight
8:15 a.m. – 2PM – Resident is seeing new and old consults and preparing for rounds
10AM-11AM – Morning report
12:30-1:30 p.m. – Lunchtime conference
2PM – 5PM – Resident rounds with attending on patients and attending gives didactic lecture.
Intern has the day off

Tuesday
8AM – Consult resident picks up consult pager from night float resident and receives sign out on patients requiring consultation overnight
8:15 a.m. – 2PM – Intern and resident see new and old consults and preparing for rounds
10AM-11AM – Morning report
12:30-1:30 p.m. – Lunchtime conference
2PM – 5PM – Resident rounds with attending on patients and attending gives didactic lecture.

Wednesday
8AM – Consult resident picks up consult pager from night float resident and receives sign out on patients requiring consultation overnight
8:15 a.m. – 2PM – Intern and resident see new and old consults and preparing for rounds
10AM-11AM – Morning report
12:30-1:30 p.m. – Lunchtime conference
2PM – 5PM – Resident rounds with attending on patients and attending gives didactic lecture.

Thursday
8AM – Grand rounds
9:15AM-10:15AM – Resident teaching conference
11AM – Consult resident picks up consult pager from night float resident and receives sign out on patients requiring consultation overnight
11 a.m. – 2PM – Intern and resident see new and old consults and preparing for rounds
12:30-1:30 p.m. – Lunchtime conference
2PM – 5PM – Resident rounds with attending on patients and attending gives didactic lecture.

Friday
8AM – Consult intern picks up consult pager from night float resident and receives sign out on patients requiring consultation overnight
8:15 a.m. – 2PM – Intern sees new and old consults and preparing for rounds
10AM-11AM – Morning report
12:30-1:30 p.m. – Lunchtime conference
2PM – 5PM – Intern rounds with attending on patients and attending gives didactic lecture.
Resident has day off

Saturday/Sunday
Not operational on weekends (covered by the on call teams). Both resident and intern have the days off.

Principle Educational Materials Used
Recommended Readings
The consult attendings have assembled a notebook full of pertinent articles related to medicine consultation which is provided to each of the residents at the start of the rotation.

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

Each patient seen on the consult service is the responsibility of the attending staff physician. That faculty physician sees, examines, and discusses all new patients with the resident or intern.

Ongoing care will be provided by the resident and intern with discussion with the attending on the consult service. All major changes in status will have documented involvement by the attending faculty member.

 

Last Revised February 24, 2004 by Rachel Thompson, MD & Colin Cooke, MD