Internal Medicine - 3rd Year

Expectations

Welcome to your third year medicine rotation at Lankenau Hospital.  Our goal is to provide you with a true general medicine experience and help you develop the clinical skills and confidence to become an outstanding house officer.  Your duties will include but are not limited to:

1. Performing full detailed histories and physical exams
2. Developing assessments, differential diagnoses, and treatment plans
3. Daily detailed progress notes
4. Attending various medical lectures and conferences
5. Presenting on daily rounds to your attending and residents
6. Carry 2 to 3 patients at one time
7. Enter orders for your patients with supervision by your resident
8. Discuss and present your patient to consultants

The most important thing is that you know your patients extremely well (better than anyone on the team) and provide excellent patient care.  You will also learn the organizational skills that it takes to manage multiple patients at one time.  You should actively read about your patients’ disease processes and always ask questions when you are not sure of something.   

Team Set-Up

Our system here at Lankenau Hospital consists of 8 geographically-based medical services.  You will each be assigned to a floor-based team consisting of one resident, one intern, and possibly one fourth year medical student or another third year student.  You will have one attending on your service that is responsible for your teaching and evaluations; they are the “team leaders”.  Each team may have patients who are assigned to private attendings, thus the “team leader” attending is not responsible for their care.  You occasionally may have a patient of a private attending, especially if it is a good learning case, but this is very rare.  While it is important to recognize you are part of a team you will be working mostly with your senior resident.  They should be supervising your work and helping you place any orders that you write.

Daily Schedule and Call

You will be expected to arrive to the hospital at 6:30 a.m. to start your day.  Upon arrival you will go to the 1 southwest conference room to pick up your sign out from the night float intern as well as any new admissions from the night float resident.  You should round on your patients and write your progress notes between 7-9:45 a.m.  Each team will have case management rounds between 9:45 and 10:00am.  Bedside teaching rounds will take place between 10:00 a.m.-12 p.m.  There will be daily noon conference taking place between 12-1pm in the Annenberg building.  You should be excused from rounds to attend these as well as all other teaching conferences.  During the afternoon you will be responsible for following up on studies and consults your patient may have had, as well as new admissions which may come in after 12pm.  On regular days you will be available to take admissions until 3:30pm.  You will take “long call” every fourth day along with your senior resident and admit new patients until 8 p.m.  You are expected to take call on one Saturday and one Sunday during your rotation, again following the call schedule of your senior resident.  You do not have to come in on your post-call day on the weekends.  You must sign out your patients every day to either the on call intern (during regular days) or the night float intern (during long call days).

Conferences and Rounds

Morning Reports
Resident morning report takes place every morning at 7:45 or 8am in the Figueroa Conference Room in the Annenberg Building.  This conference is optional, however attendance is encouraged as your floor work load allows.  You should attend Intern Report every Wednesday afternoon at 12:00pm in the McLean conference room in the Annenberg building. 

Grand Rounds and M & M
Grand rounds are held in the hospital auditorium at 8am every Friday morning.  You should attend the post grand round conference at 9:30AM in the McLean Conference room each Friday (you are excused from the beginning of rounds).  Morbidity and Mortality conferences are held every second Wednesday of the month in the hospital auditorium (except July and August). 

3rd Year Report
Each student will be assigned a day to bring a case they have been following on the floors for a group discussion.  A senior resident on a teaching elective plus one member of the faculty will guide you through the case including differential diagnoses, diagnostic evaluations, and recommended treatments.  These conferences take place every Tuesday at 1 p.m. and Thursday at 2 p.m. in the Figueroa conference room.

Core Lecture Series
You also have a series of core lectures that you are required to attend as part of your curriculum through your medical school.  These may be held at 12 p.m. in lieu of your attendance at noon conference.  You are excused from your floor duties for all lectures.

Evaluations

You will be evaluated during this rotation by an attending and a senior resident.  You have the option of having multiple attendings evaluate you if you work with more than one.  You also have the option of having your intern fill out an evaluation on your behalf.  You should be receiving feedback throughout your rotation, and more specifically should ask for a mid-rotation feedback session with your evaluators.  Please turn in all evaluations to Ellen Hughes in Annenberg G-10 prior to your last day.

Contact Information

Jonathan Doroshow (Associate Program Director for the Internal Medicine Residency and 3rd year Clerkship Director)

Office:  Annenberg G-10
Email:  doroshowj@mlhs.org

Amy Valentino (Program Coordinator for the Internal Medicine Residency)

Office:  Annenberg G-10
valentinoa@mlhs.org