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.
- 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.
- 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.
- 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
- Update family members, senior residents,
attendings if the status of a patient changes
- 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.
- 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
- 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
- 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.