CONSULT/PROCEDURE ROTATION

Contact: David Tierney or Michael Ornes - page or contact through AHS (612-863-7450) or the Medical Education Office

Staffed by Hospitalist: There will be a single point attending. There will be lectures/tutorials that cover consultative medicine, perioperative care, and procedures. A staff will perform the end of the rotation evaluation and give verbal, face-to-face feedback.

Subspecialty clinic: none
Resident continuity clinic: Wednesday PM, a three week minimum notice, given to Anne, is required if you are planning on taking vacation time.

Conference: May attend AHS case conference if no resident conference (see schedule in Hospitalists’ area)
Performance Expectations: Individuals from the Abbott Northwestern Hospitalist Service will select appropriate internal medicine consult patients and call the resident on the service to see these patients and plan when, later that day, to staff the patients. Staff covering the procedure team will contact the resident to coordinate performance of procedures.

Educational Goals and Objectives:

	Educational objectives	Assessment method
Patient Care	1) Hospital consults and follow up visits will be performed, staffed, and documented in Excellian with appropriate language 2) Understand the role of an internal medicine consultant in the hospital setting including communication with the attending, communication with other care providers, and timing and appropriateness of signing off 3) Demonstrate competency at performing the core procedures noted below with initial skills practice and competency demonstrated at the ANW Simulator Center and then with qualified staff on the procedure team 4) Procedure notes will be entered into Excellian immediately after the procedure with the appropriate language	1) Global faculty assessment 2) Direct faculty bedside observation 3) Initial demonstration of competency in procedure skills on simulators 4) Direct feedback from procedure staff
Medical Knowledge	1) Review core topics noted below using patient care and didactic opportunities and supplement with independent reading 2) Participate in tutorials on internal medicine consultation and perioperative medical care	1) Global faculty assessment 2) Procedure test
Practice-Based Learning and Improvement	1) Demonstrate insight into knowledge deficiencies and limitations 2) Use information technology to answer clinical questions	Global faculty assessment
Interpersonal and Communication Skills	1) Refine the skills necessary to present patients and topics informally and formally to another physician or group	Global faculty assessment
Professionalism	1) The resident is expected to manage their daily workload with a goal of about 6 patient encounters including consults, procedures, and follow up notes 2) The workday is expected to start by 8AM with no new work assumed after 4PM 3) The resident will record the procedures performed competently (as per the supervising staff in the cosigned procedure note) in their procedure log in e-value	Global faculty assessment
Systems-Based Practice	1) Understand systems unique to this subspecialty	Global faculty assessment

Core topics to be covered by patient care, didactic lectures, or independent reading include general principles of consultative work, procedures, and topics common to consultative internal medicine hospital practice.

Procedures that require demonstration of safe performance and competency:

Venous blood draw

Arterial blood draw

Peripheral IV catheterization

(Performance of ACLS and Pap smear and cervical culture will not be covered in this rotation)

Procedures that require knowledge of indications and contraindications, recognition and management of complications, pain management, and sterile techniques and in some of the procedures knowledge of specimen handling, interpretation of results, and knowledge of the requirements and enough knowledge of the procedure itself to obtain informed consent (in addition to the procedures listed above) include:

Abdominal paracentesis

Arthrocentesis

Central Venous line placement

Incision and drainage of abscess

Lumbar puncture

Nasogastric intubation

Pulmonary artery catheter placement

Thoracentesis

Topics common to consultative medicine included but not limited to:

Perioperative management including preoperative risk assessment, pain management, and cardiac, pulmonary, and other complications

DM management in the hospital

Thrombosis and bleeding