Basic Expectations of the R1 on Medicine Services

revised June, 2007

Being an effective clinician involves much thought and communication. This list of basic expectations is meant as a starting guide to help you develop skills in organization and clinical responsibilities. If you cannot fulfill any of the expectations listed below, call your senior residents as soon as possible to tell them and to ask for help.

Pre-Rounds

  • Pick up your sign-out sheet to find out what has happened overnight.
  • Talk to and examine each of your patients.
  • Review vital signs, ins and outs, weights.
  • Read chart for new notes from nurses, attendings, consults, studies, cross-cover.
  • For ICU/CCU patients, review ventilator settings, latest ABG, Swan numbers, any other important parameters that the team is following.
  • Organize your thoughts for rounds; update the problem list for each patient.

Work Rounds

  • Give SOAP note presentations using data gathered in pre-rounds.
  • Give post-call abbreviated H&P (3-5 minutes) for new patients.
  • Keep a running "To Do" list during work rounds.
  • Discuss with your team how to best integrate order writing or phone calls during work rounds to best balance efficiency, patient care, and education.

Daily Work

  • Prioritize the "To Do" list that you made during work rounds.
  • Make things happen as soon as work rounds are over: call consults, write orders, order studies for all of your patients.
  • Find out test results for tests as they occur throughout the day.
  • Return to take more time to talk to patients about test results, changes in plan, and for any longer discussions about issues that could not be fully addressed in pre-rounds or rounds.
  • Update family members, senior residents, attendings if the status of a patient changes dramatically.
  • It is usually best to write notes last after all orders, phone calls, procedures are done on all patients.
  • Above all, daily notes should capture significant clinical events, any procedures or important tests occurring during the day, and your clinical reasoning and decision-making.  Daily notes should provide enough information for consultants to address relevant clinical issues and allow cross-covering physicians to quickly understand and treat your patients in emergencies.  Daily med lists, complete problem lists, code status are all helpful on daily notes.
  • Ask your senior residents or attendings about documentation requirements on your service.

Data Management

  • Have a system for recording patient data (H&P, daily labs, study results, problem list and plan).
  • Early in the year, ask colleagues and senior residents for suggestions regarding organization.

Leaving for the Day

  • Sign out to cross-cover; anticipate potential issues on each patient and suggest a plan.  Regulations regarding work hours place a premium on communicating information to other members of the care team sufficient to assume complete care of your patients.
  • If you have finished your work and other team members are still working, offer to help them finish before you leave.
  • Clinic Days: You must go to clinic on time, so plan ahead on clinic days and start earlier if necessary. With careful planning and coordination with your senior resident, usually you will not need to return to the ward site after clinic. Ideally, other team members will help with a few notes and phone calls. Sign out with your senior resident and cross-cover intern before you leave for clinic.
  • Clarify with your senior residents if they want you to check out with them at the end of your shift.
  • Please be aware of the following rules regarding work hours:  call shifts are limited to 24 consecutive hours, plus up to 6 additional hours if needed to effectively transition care to other physicians (“30-hour rule”); housestaff may not work more than 80 hours in a 7-day period (“80-hour rule”); there must be at least 10 hours between consecutive shifts (“10-hour rule”); and housestaff will have an average of 1 day off per week during a given month.  The University of Washington Medicine Residency and the Department of Medicine fully support these regulations governing work hours.

If you don't know, say so.
If you are unable to do what is expected, ask for help early.