Medicine Consult

I. Goals and Objectives:

The third year rotation on the General Internal Medicine Consultation Service is designed to provide residents with broad experience in the practice of consultative medicine. To this end, third year residents will spend 4 weeks supervised by a medical attending as the medical consultant to the non-medical services. The goal of the experience is to provide training in the pathophysiology, diagnosis and management of medical problems particular to patients being cared for primarily by other services – particularly surgery, psychiatry, neurology, and OB/GYN. Residents shall gain experience in such care in a variety of settings, including intensive care units, pre- and post-operative settings, inpatient wards, and outpatient preoperative clinics. An additional goal of the rotation is to enhance residents’ effectiveness and communication skills with patients as well as consulting physicians.


Goals by Relevant Competency (all for 3rd year level residents only):

    • Patient Care: Learn to interview and examine preoperative and nonmedical patients in an effective, efficient, and sensitive manner; gain experience in culling information through chart review and discussions with primary providers; formulate thorough differential diagnoses and plans; appropriately tailor recommendations to a patient’s particular medical problems and reason for hospitalization.
    • Medical Knowledge: Use literature and reference sources to increase knowledge base relevant to the care of patients with medical illness on non-medical services; increase knowledge of pre-procedural risk-assessment; enhance knowledge of medical problems affecting pregnancy and post-partum states; broaden understanding of medical problems arising post-operatively; understand the underlying pathophysiology of conditions faced in consultative medicine; broaden knowledge of indications and interpretation of chest and abdominal X-rays, electrocardiograms, and pulmonary function tests.
    • Professionalism: Establish trust with patients, staff, and physicians requesting consultation; exhibit honesty, reliability and responsibility in patient care; demonstrate respect for patients, staff and other non-medical services; work with team to fulfill the needs of patients; lead health care team in patient care; understand limitations and ask supervisors for help when indicated; accept assignments graciously; attend conferences.
    • Interpersonal Skills: Write understandable and legible notes; more fully develop ability to listen to patients and staff and communicate verbally with the physician requesting the consultation; work effectively as a member of the health care team.
    • Practice Based Learning and Improvement: Understand limitation of knowledge of medical illness in patients on non-medical services and patients being evaluated for preoperative medical risk; use references and literature to improve practice patterns; accept feedback and change behavior; ask for help when needed; learn from the outcomes of patients under your care and alter practice patterns to improve outcomes in the future.
    • Systems Based Practice: Advocate for patients; develop a sophisticated understanding about the health care system/structure and develop a relationship with the requesting service to ensure that the patient’s medical needs are met and coordinated with the care delivered by the primary service; utilize ancillary services to benefit patients; facilitate the delivery of care by assisting with scheduling tests; consider cost-effectiveness in diagnostics and management plans; facilitate the involvement of medical subspecialists or transfer to a medical service when appropriate.


II. DISCIPLINES COVERED DURING ROTATION

Cardiovascular

    • Goals and objectives: understanding the assessment and management of perioperative cardiac risk associated with surgery; understanding the prevention, diagnosis and management of post-operative cardiac complications and cardiac complications of pregnancy; understanding when a subspecialty consultation is appropriate
      • Principles, physiology and basic science
      • Practice skills unique to Cardiology
        • Specific tests and procedures: use and interpretation, eg. ECG, stress testing, echocardiography, cardiac catheterization
        • Preventive care and perioperative cardiovascular risk reduction
        • Patient education (attitudes/values)
      • Approach to presenting complaints/problems
      • Specific diagnoses in Cardiology (CAD, Valvular disease, Hypertension)
      • Emergencies
      • Treatment modalities
      • Technical skills


Endocrinology

    • Goals and objectives: understanding the diagnosis and management of diabetes in patients hospitalized for nonmedical reasons and perioperative glycemic control; understanding the prevention, diagnosis and management of perioperative complications of corticosteroid use; understanding the effect of pregnancy and post-partum states on chronic medical problems as well as medical issues particular to pregnancy; understanding when a subspecialty consultation is appropriate
      • Principles, physiology and basic science
      • Practice skills unique to Endocrinology
        • Specific tests and procedures: use and interpretation
        • Preventive care
        • Patient education (attitudes/values)
      • Approach to presenting complaints/problems
      • Apecific diagnoses in Endocrinology (Diabetes mellitus, Adrenal insufficiency)
      • Emergencies
      • Treatment modalities
      • Technical skills


Hematology

  • Goals and objectives: understanding the diagnosis and management of hematologic complications in patients hospitalized for nonmedical reasons and hematologic complications of pregnancy; understanding the assessment for bleeding risk and hypercoagulable states; understanding the principles of perioperative anticoagulation management; understanding the indications and regimens for DVT prophylaxis in surgery; understanding when a subspecialty consultation is appropriate
    • Principles, physiology and basic science
    • Practice skills unique to Hematology
      • Specific tests and procedures: use and interpretation
      • Preventive care
      • Patient education (attitudes/values)
    • Approach to presenting complaints/problems
    • Specific diagnoses in Hematology (Thrombophilic states, Hypercoagulable states, DVT and PE)
    • Emergencies
    • Treatment modalities
    • Technical skills


Infectious Diseases

  • Goals and objectives: understanding the diagnosis and management of infectious complications in patients hospitalized for nonmedical reasons and perioperative infection control; understanding the indications and regimens for antimicrobial prophylaxis in surgery; understanding when a subspecialty consultation is appropriate
    • Principles, physiology and basic science
    • Practice skills unique to I.D.
      • Specific tests and procedures: use and interpretation
      • Preventive care
      • Patient education (attitudes/values)
    • Approach to presenting complaints/problems
    • Specific diagnoses in I.D.
    • Emergencies
    • Treatment modalities
    • Technical skills


Pulmonary

  • Goals and objectives: understanding the preoperative evaluation and management of patients with pulmonary disease; understanding the prevention, diagnosis and management of post-operative pulmonary complications and pulmonary disease in patients hospitalized for non-medical reasons; understanding when a subspecialty consultation is appropriate
    • Principles, physiology and basic science
    • Practice skills unique to Pulmonary
      • Specific tests and procedures: use and interpretation, e.g. PFTs, CXR, ABG
      • Preventive care
      • Patient education (attitudes/values)
    • Approach to presenting complaints/problems
    • Specific diagnoses in Pulmonary (Pneumonia, COPD, Asthma, Respiratory failure, Atelectasis)
    • Emergencies
    • Treatment modalities
    • Technical skills


Toxicology

  • Goals and objectives: understanding the prevention, diagnosis and management of alcohol, sedative, and cocaine intoxication and withdrawal in patients hospitalized for non-medical reasons; understanding when a subspecialty consultation is appropriate
    • Principles, physiology and basic science
    • Practice skills unique to Toxicology
      • Specific tests and procedures: use and interpretation
      • Preventive care
      • Patient education (attitudes/values)
    • Approach to presenting complaints/problems
    • Specific diagnoses in Toxicology
    • Emergencies
    • Treatment modalities
    • Technical skills


III. ROUNDS AND CONFERENCES

Medicine Consult Rounds:

    • Participants: PGY3s on team, consult attending
    • Objective: direct patient management, direct didactic and interactive learning (journal club, case conferences, MKSAP questions)
    • Time: Mon-Fri 9:00AM-11:AM

Medical Grand Rounds:

    • Participants: PGY1-3, MS III, IV, attending staff
    • Objective: didactic learning
    • Time: Th 12:15PM- 1:15PM


Preoperative Clinic Didactic Session

    • Participants: PGY3s, preoperative clinic attending
    • Objective: didactic learning about preoperative medical evaluation
    • Time: Wed, Th 1:00PM - 4:30PM