The inpatient Medicine service consists of a team of one Senior Resident and two PGY-1 Residents caring for up to 7 patients each under the supervision of a Pulmonology/Critical Care Attending. (We frequently have USF medical students rotating on our service as well). Each morning we pre-round on our assigned patients, then attend Morning Report at 8am, at which a teaching case is presented and the admissions from the previous night are discussed. Next we round as a team. At the bedside, the resident presents their patient to the Attending while we review the electronic health record for pertinent labs or images. The team sees the patient, and as a team we create our plan of care. This is very much a group effort; our Attendings allow us to make our own decisions as long as we first do no harm! After rounds we attend noon conference, then return to the hospital. Our afternoons are spent following up on the patients, their labs, imaging, tests and consults. The afternoons are also spent discharging patients, admitting new patients, and teaching. One afternoon per week, the Residents are excused from inpatient medicine responsibilities so that they can attend to their continuity patients in clinic.
During this block, we rotate with a community pediatrician in a private office. We see patients with the pediatrician, then discuss the treatment plan together. The practice is very busy, so we are exposed to a full spectrum of pediatric problems. Additionally, we receive a lot of training in patient and parent education during well child visits. We also become intimately familiar with the vaccination schedule! One half-day per week is spent at a local free clinic. This is always interesting; partly due to the frequent late presentation for care in these patients with limited resources, and partly due to the great personality of the pediatrician we work with! One day per week is also spent seeing sick children at the Turley Family Health Center.
Our in-patient pediatrics training is completed at Mease Countryside Hospital, a local affiliate hospital within the Morton Plant Mease - BayCare Health System. During this PGY-1 rotation, we work alongside the Pediatric Hospitalist and Pediatric specialists. There is only one Resident on this rotation at any given time, so it creates another excellent opportunity for individualized teaching and learning. There are no opposing Pediatric Residents rotating through this hospital. The structure is very similar to our adult medicine rotation, with a typical day consisting of pre-rounding alone, then presenting your patients to the Attending. A plan is then discussed and implemented. Afterwards, similar to our adult medicine rotation, the remainder of the day is spent following up on the patients, their labs, imaging and consults; as well as completing admissions and discharges. One afternoon per week, the residents are excused from inpatient responsibilities so that they can attend to their continuity patients in clinic. It is a busy rotation, but the teaching is excellent; at the end of your block, you will feel very comfortable admitting and caring for a pediatric patient.
During this PGY-1 rotation, the day begins by pre-rounding on patients we delivered on the previous day. We then meet with the OB/GYN or FP/OB Attending on call for a one-on-one lecture. Next we round with a Midwife on the post-partum patients. The remainder of the day is spent alongside the Midwife or Attending managing patients on the L&D, doing OB/GYN consults, and delivering babies. If all is quiet on L&D, we go to clinic at Turley to see patients with the Attending or Midwife in clinic.
This is one of our more unique PGY-1 rotations as every day is different. We work primarily with our faculty Behaviorist at Turley. We see patients together, and in the process become comfortable with the psychiatric office visit and the documentation of the psychiatric evaluation. We are also exposed to the many community resources available to our patients in terms of counseling, rehab programs, and classes. We also spend time with a Hospice Physician making house calls on terminally ill patients. We have several excellent lectures on common psychiatric problems and the medications used to treat them done jointly by our pharmacist and our Behaviorist. The rotation is concluded with a Resident presentation on a Behavioral Medicine topic of their choice. The presentation then becomes a part of the Turley library.
We complete one surgery rotation in the first year with the time on that rotation divided between the hospital surgical service/operating room and the outpatient surgery clinic. We may choose to emphasize either the inpatient or the outpatient experience, provided we first-assist on at least 25 major surgical cases, which is a graduation requirement. We are not expected to function as surgical Residents; rather, our focus is on learning about the procedures for which we will be referring our patients, including an understanding of the indications, benefits and risks. We are also expected to learn to recognize the common conditions that require urgent surgical referral.
During this rotation, we work shifts (some day, some night) with our ER Physicians. We have first contact with the patients, evaluate them, and order any appropriate labs and imaging. We then staff the patients with the ER Physician, and, after evaluating the test results, determine whether they require hospitalization or can be treated and discharged home. There are plenty of opportunities for critical care; you will likely intubate a patient, do a femoral stick, and start a central line (all closely supervised, of course). This rotation tends to be fast-paced and fun.
During this rotation, we spend two weeks in the Newborn Nursery and NICU working with a Pediatrician, Neonatologist and Neonatal Nurse Practitioners. Our mornings are initially spent pre-rounding and performing newborn physical exams. Next, we join our Pediatrician on rounds. There is just one Resident per Attending on this rotation, so it's a great opportunity for personalized teaching and learning. After regular newborn nursery rounds, we proceed to the NICU and work alongside their team caring for babies with problems such as premature lungs or infection. Our afternoons are largely spent in didactic sessions with the Attending. Along with this daily routine, whenever a high-risk delivery or c-section occurs, we have direct hands-on involvement in the initial triage of the baby.