| PROVISIONS |
The internship is designed to provide the R1 resident with many
patients primary to care for. The patients through their own illness
will give the intern
the experience needed to begin his/her development into a skilled physician.
Patient Care Duties:
In-patient
- Assume primary care for each assigned patient within 30 minutes of receiving
the patient.
- Assess patient's clinical status, recognizing a patient in critical
or unstable condition and call for the resident
- Begin work-up and treatment as deemed necessary by clinical status.
- Obtain a complete history, including review of all available old records
and record the history in a well-organized and legible format.
- Perform a complete
physical exam and record the exam in a well-organized and legible
format.
- Develop a comprehensive, organized differential diagnoses.
- Order appropriate laboratory and radiological evaluation, with the help
of the resident, to further diagnose the patient’s illness.
- Interpret
the laboratory and radiological data with the help of the resident
and record it in the History and Physical.
- Develop and implement, with the help of the resident, a treatment plan.
- Work with nursing, social work and other members of the health care team,
implement the patient’s care and prepare for a timely discharge.
- Interview and examine the patient daily in a problem-focused manor. Record
daily progress notes using SOAP format.
- Write daily orders as needed. Notes should reflect: change in patient status
by history as well as by physical exam, new lab or radiological
information, an assessment of each problem the patient has in order of priority,
a plan for
each problem. This should be discussed with the resident daily.
- Dictate a comprehensive discharge summary in a timely fashion, with the
help of the resident if necessary, sending a copy to the attending and all
consultants.
Out-patient
- Assume primary responsibility for all outpatients assigned to you.
- Obtain a complete history on new patients, including reviewing all available
old records, and record the history in a well-organized and legible format.
- Perform a complete physical exam on all new patients and record the exam
in a well-organized, comprehensive format.
- Form a differential diagnosis and after discussion with the attending,
order laboratory tests and/or radiological tests to best determine the diagnosis.
- Interpret the results of the tests with the help of the attending and formulate
a treatment plan.
- Working with the attending, develop an appropriate scheduled follow-up
for each patient.
- Develop and implement a preventive health plan for each patient and record
it in a well-organized form in the medical record.
- Develop a process for following up on tests that you order for your patients.
- Return patients phone calls in a timely manner, and if there is any question
regarding management, discuss with the attending.
Medical Knowledge:
In-patient
- Initial management of the following emergencies: Coma, seizure, stroke, stable
and unstable angina, myocardial infarction, dyspnea, sever asthma, pulmonary
edema, hypotension, hypertension, gastrointestinal bleeding, arrhythmias, cardiac
or pulmonary arrest, DKA, hyperkalemia, hyponatremia, hypernatremia, delirium,
sepsis syndrome.
- Use of evidence based medicine available on-line, in textbooks and
journals, to understand the pathophysiology, clinical presentation, and
medical management of diseases presenting in the assigned patients. As
an intern, one is expected to build a knowledge foundation by seeing
many patients and reading about their problems. The medical knowledge
will be wide ranged but rather shallow. The Intern should be using textbooks
as the primary source of their information.
Out-patient
- The Intern should gain knowledge in the pathophysiology, clinical presentation,
and management of common medical conditions seen in the clinic;
hypertension, diabetes mellitus, Chronic obstructive pulmonary disease,
congestive heart failure, coronary artery disease, hyperlipidemia, osteoporosis,
arthritis, depression, gastroesophageal reflux disease,chronic
renal
failure.
- The Intern should know the primary and secondary preventive guidelines
and practice them.
Interprsonal and Communication Skills: The intern is expected to treat
peers, members of the allied health care team, attending physicians,
and above all patients with respect, interacting in a cooperative manor
to work toward excellence in patient care. Anything less will not be
tolerated. The intern should develop skills of communicating effectively
with fellow residents, attendings, and consultants regarding patient’s
disease states.
Practice Based Learning: The intern is expected to use each patient as
an opportunity to learn. He/she should identify the areas of knowledge
deficit and using the textbooks, on-line resources or journals, correct
the knowledge deficit. The Intern should develop the skill of identifying
his/her strengths and weaknesses and work to improve the areas of weakness.
The resident and attending will work with the Intern on this area.
Professionalism: The intern is expected to know and to practice medical
professionalism as outlined in The Physician Charter published by ACP
and ABIM. See attached document.
System-based Practice: The intern is expected to develop an understanding
of the patient care systems at work in the Presbyterian environment
and the method by which he/she can access the needed services for his/her
patients. For example: when to consult social work, when to consult
home health care, when to consult pharmacy for teaching, when to consult
risk management, when to consult sub-specialty physicians, when to
consult rehabilitation services, etc. The intern should become familiar
with the resources available to his/her patient in the community.
Duties and Responsibilities of the R1: Please refer to the Policy on
Duties and Responsibilities. This policy outlines in detail the clinical
and didactic experiences provided for the R1. It defines lines of authority.
It defines work hours.
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