Inpatient Service Structure
When on a general medicine team, the team assignment consists of an upper level resident, two interns, an attending and one to two medical students. During an inpatient wards month, each team member will attend clinic at Myers Park approximately twice during the month. We believe that our call cycle and hybrid nightfloat schedule creates an optimal environment for learning while maximizing patient safety, continuity of care, and resident satisfaction.
Our house officers care for a vast variety of medical illnesses; including not only the diagnostic dilemmas, but a large amount of “bread and butter” medicine. It is rare that you would have a patient admitted with the diagnosis already made. Our inpatient services are all generalist admitting teams, and we have no subspecialty inpatient admitting services. Thus, when on an inpatient service, you will admit an exciting variety of neurology patients, cardiology patients, heme-onc patients, etc. all on the same night. It is up to your team to decide if you want a subspecialty consultant to assist you with patient management.
For our inpatient General Medicine services, our five (5) day call cycle works as follows:
- Short Call:
- Monday-Friday, 7 a.m. – 1:30 p.m.
- Cap of six (6) new admissions for two interns, i.e., max three (3) admissions per intern
- The upper level resident and both interns on the team are present for short call
- Rounding / Clinic Day:
- The morning is spent rounding on the team’s inpatients.
- Either the upper level or the interns may be scheduled for clinic in the afternoon (each team member has clinic approximately twice during the month).
- The team has no admitting duties unless there is patient overflow to the team. One of the house staff may have the day off.
- Long Call Day:
- Long call Part 1: [consists of one of the two interns on the inpatient team and the team upper level resident]
- Monday-Friday, 1:30 p.m. – 7 p.m. / Saturday-Sunday, 7 a.m. – 7 p.m.
- Cap of five (5) new admissions for one intern
- Long call Part 2: [admitting done by the other of the two interns on the inpatient team and the "night float" admitting resident – both arrive at 7 p.m.]
- Monday-Sunday, 7 p.m. - 7 a.m., Cap of five (5) new admissions
- "Post" call day
- Entire team meets to discuss the overnight admissions.
- Afterward, the overnight intern and night float resident leave by 9 a.m.
- The other intern and the team resident will round with the attending and complete any needed patient care throughout the day.
- Rounding / Clinic Day
- Similar to the other rounding / clinic day.
Intern Night Float
- All “cross coverage” of patients is done by a separate night float intern from 5 p.m. – 7 a.m. The night float intern does not admit patients, but solely handles cross-cover issues and assists with codes and other overnight emergencies.
- On average, CMC internal medicine categorical residency interns will have two 2-week blocks (Sunday-Thursday) of this night float "cross-coverage" in the first year, plus and additional two weekends / year of night float responsibility. Preliminary interns are not scheduled for a night float rotation but are scheduled for approximately 4 weekends / year of night float duties. In addition, all interns will typically work approximately five overnight shifts during their month in the Medical ICU.
Resident Night Float
- On average, upper level residents will have two weeks (Sunday - Thursday) of night float responsibilities plus an additional two weekends of night float responsibility. The night float rotation during the PGY-2 and 3 years consists mainly of supervising an intern as he/she admits patients from the emergency department.
- Upper level residents also typically will work seven to eight overnight shifts during their month in the Medical ICU.
- The Coronary Care Unit has no overnight duties.