DOCSLIB.ORG

Primer to the Internal Medicine Subinternship

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Primer to the Internal Medicine Subinternship Primer to the Internal Medicine Subinternship A Guide Produced by the Clerkship Directors in Internal Medicine EDITOR: Heather E. Harrell, MD University of Florida College of Medicine ASSOCIATE EDITORS: Meenakshy K. Aiyer, MD University of Illinois College of Medicine at Peoria Joel L. Appel, DO Peter Gliatto, MD Wayne State University School of Medicine Mount Sinai School of Medicine Gurpreet Dhaliwal, MD Michelle Sweet, MD University of California, San Francisco Rush Medical College School of Medicine of Rush University INTRODUCTION Welcome to your internal medicine subinternship. We are delighted that you have joined us for this short period when you will have your first taste of what internship will be like and will experience more of what internal medicine has to offer. Regardless of your future career path, we wish you the most stimulating, rewarding, and transforming experience possible over the coming weeks. The information in this booklet has been produced through the collaboration and consensus of internal medicine subinternship directors across the country, most of whom have spent many years teaching, evaluating, and advising students. It should help fill in some common gaps in the formal medical curriculum as you begin your internship. A complimentary resource for your subinternship is the CDIM Internal Medicine Subinternship Curriculum and CDIM Internal Medicine Subinternship Training Problems, which cover more traditional medical topics commonly encountered during the internal medicine subinternship. It is available free of charge online at: www.im.org/Resources/Education/Students/Learning/CDIMsubinternshipCurriculum/Pages/defa ult.aspx Please note information provided by your subinternship director should take precedence over these suggestions. Disclaimer – Any reference to a product in this book does not imply any endorsement of the product by CDIM or the editor and authors. Product references are only included to provide examples of resources and are not meant to be exhaustive lists of available material. 1 Table of Contents INTRODUCTION.........................................................................................................................1 SECTION 1: MAKING THE MOST OF YOUR SUBINTERNSHIP.....................................4 SECTION 2: WORKING IN HEALTH CARE TEAMS.........................................................5 Chapter 1- Consultations.............................................................................................................5 Chapter 2- Effective Use of an Interpreter................................................................................9 Chapter 3- Answering a Nurse Page.........................................................................................11 Chapter 4- Tips for Triaging Cross-Cover...............................................................................13 SECTION 3: ADVANCED COMMUNICATION SKILLS...................................................14 Chapter 5- Negotiating Conflict................................................................................................14 Chapter 6- Delivering Bad News...............................................................................................17 Chapter 7- Discussing Adverse Events with Patients..............................................................19 Chapter 8- Decisional Capacity and Informed Consent.........................................................20 Chapter 9- Obtaining Advanced Directives and Documenting DNR....................................23 SECTION 4: TRANSITIONS OF CARE................................................................................27 Chapter 10- Cross Coverage.....................................................................................................27 Chapter 11- Transfer and Off-Service Notes..........................................................................32 Chapter 12- Discharge Planning, Counseling, and Summary...............................................34 SECTION 5: PRACTICAL NUTS AND BOLTS...................................................................41 Chapter 13- Essential Time Management and Organizational Skills...................................41 Chapter 14- Tips for Work/Life Balance.................................................................................44 2 Chapter 15- A Dozen Pearls to Keep Your Patients Safe.......................................................46 Chapter 16- What to Do When a Patient Dies.........................................................................47 Chapter 17- Tips for Dictating..................................................................................................49 Chapter 18- Documenting Procedures.....................................................................................51 Bibliography...............................................................................................................................52 3 SECTION 1: MAKING THE MOST OF YOUR SUBINTERNSHIP “It is a daring and transforming experience to attempt to heal another person.” — Edmund Pellegrino, MD For many of you, the subinternship will be your first real taste of autonomous patient care. Although you will of course be supervised, you are expected to be the first person evaluating your patients and generating assessments and action plans. You will be an integral part of the team, working directly with nurses, therapists, consultants, and other health care providers. Patients’ post-hospital care will be determined largely by how well you anticipate and facilitate their discharge needs. You will also be actively involved in the kinds of difficult discussions you may have only observed up to this point. With these increased responsibilities, efficiency will now be of paramount importance to your success. You will feel the potentially competing pressures of patient care, proper documentation, early discharges, and conferences. The tips and resources in this guide were developed to prepare you for many of the practical, day-to-day issues you will face when caring for hospitalized patients. They are intended to direct you to strategies that improve both the efficiency and quality of patient care. 4 SECTION 2: WORKING IN HEALTH CARE TEAMS Given the diversity of backgrounds and complexity of patients in the 21st century, medicine has become a team sport and no one appreciates that more than a busy intern. Facilitating communication among the increasingly large health care team is a critical skill that will help you care for your patients. A new intern quickly learns that one of the best resources is the nurse. If you have not yet asked a nurse, “What do we usually do in this situation?” chances are you will. Even with nursing shortages and increased nurse to patient ratios, the nurses still have the greatest opportunity to pick up subtle changes in your patients while also ensuring that the orders are carried out. Consultants also play a key role in the care of most patients, whether it is the physical therapist helping the patient walk or the transplant nephrologist managing a complex cocktail of immunosuppressants. Conveying complex data to patients and their families in a way that they understand while encouraging their participation in decisions about care is an essential duty for a physician. This section will provide strategies to maximize your communication with both the health care team and the patient. CHAPTER 1: CONSULTATIONS T. Robert Vu, MD Indiana University School of Medicine Physicians commonly request consultations to: Get expert advice on diagnosis. Get expert advice on management. Get assistance in scheduling or performing a procedure or test. Arrange follow-up. If you and your team already understand what is going on with a patient and are able to provide the care with your attending, there is little use in calling for a consult. Before calling, consider how the consultant may change your management. If a consultant would add to the case, then make sure you are very clear on what it is you and your team are asking the consultant to do before calling. “Curbsiding,” or asking consultants for an opinion without formally seeing the patient, may seem convenient but is discouraged. HOW TO MAXIMIZE YOUR CONSULT Perform the initial work up and have test results ready For most stable patients, obtain and wait for the results of relevant diagnostic tests before contacting the consultant. For example, a stable female patient with a chief complaint of abdominal pain will typically have a urinalysis, serum amylase/lipase, and serum or urine 5 pregnancy test performed; these test results should be available prior to contacting the consultant. For unstable patients or those with suspected unstable conditions (e.g., bleeding varices, dissecting aortic aneurysm, etc.), it is certainly indicated to contact the appropriate consultants before any definitive diagnostic tests have been performed. As for all patients, be sure that your upper level supervisors (i.e., senior resident or attending) are in agreement with your clinical impression and plans and are actively helping you manage the patient until definitive specialty help arrives. Call consults early in the day Most consult services have a resident or fellow see new consults first, and then round with the attending in the mid to late afternoon unless the problem is urgent. Therefore, it is most effective for patient care to call your consults early (as soon as you decide with your team a consult is needed,
Load more

Recommended publications
  • Role, Responsibility and Patient Care Activities for Trainees
    SUPERVISION POLICY Roles, Responsibilities and Patient Care Activities of Clinical Fellows Training Program in Clinical Cardiac Interventional Cardiology UWMC, HMC, VAMC, NWH Definitions Resident: A physician who is engaged in a graduate training program in medicine (which includes all specialties, e.g., internal medicine, surgery, psychiatry, radiology, nuclear medicine, etc.), and who participates in patient care under the direction of attending physicians (or licensed independent practitioners) as approved by each review committee. Note: The term “resident” includes all residents and fellows including individuals in their first year of training (PGY1), often referred to as “interns,” and individuals in approved subspecialty graduate medical education programs who historically have also been referred to as “fellows.” As part of their training program, residents are given graded and progressive responsibility according to the individual resident’s clinical experience, judgment, knowledge, and technical skill. Each resident must know the limits of his/her scope of authority and the circumstances under which he/she is permitted to act with conditional independence. Residents are responsible for asking for help from the supervising physician (or other appropriate licensed practitioner) for the service they are rotating on when they are uncertain of diagnosis, how to perform a diagnostic or therapeutic procedure, or how to implement an appropriate plan of care. Attending of Record (Attending): An identifiable, appropriately-credentialed and privileged attending physician who is ultimately responsible for the management of the individual patient and for the supervision of residents involved in the care of the patient. The attending delegates portions of care to residents based on the needs of the patient and the skills of the residents.
    [Show full text]
  • Attending Physician XII SC – Gastronenterology Clinical
    • COOK COUNTY-HEALTH Human Resources & HOSPITALS SYSTEM 750 S. Wolcott Room: G-50 Job Code: ------6547 Chicago, IL 60612 CC-HHS Grade: ------K FLSA: Exempt Standard Job Description Job Title Department Attending Physician XII-SC Gastroenterology-Clinical Job Summary The Attending Physician XII in the Department of Gastroenterology (GI) is responsible for patient care especially in relation to GI and Liver Disorders. Performs and supervises GI procedures. Participates in the education of Residents and Fellows. This position is exempt from Career Service under the CCHHS Personnel Rules. Typical Duties • Provides consultation and follow-up to patients with gastroenterological problems at Cook County Health & Hospitals System (CCHHS), including GI Clinics • Provides liver consultations to patients at Cook County Health & Hospitals System (CCHHS) • Educates and guides Residents and Fellows in appropriate management of gastroenterological problems • Performs emergency assignments, as needed • Provides services at Provident and/or Oak Forest, as needed • Provides on-call services Reporting Relationships Reports to the Medical Division Chair XII Minimum Qualifications • Doctor of Medicine (MD) or Doctor of Osteopathy Medicine (DO) from an accredited college or university • Licensed physician in the State of Illinois, or have the ability to obtain licensure prior to the start of employment • Successful completion of an Accreditation Council for Graduate Medical Education (ACGME) accredited in Gastroenterology • Successful completion of an Accreditation
    [Show full text]
  • Matrix for Health Care Provider Types*
    Matrix for health care provider types* Attending physician Authorize payment of Provide compensable Provide compensable Establish impairment status (primarily temporary disability medical services for medical services for findings responsible for and release the aggravation of injury initial injury or illness (permanent disability) treatment of a patient) patient to work or illness Type A attending physician Yes Yes Yes Yes Yes » Medical doctor » Doctor of osteopathic medicine » Oral and maxillofacial surgeon » Podiatric physician and surgeon Type B attending physician Yes, for a total of 60 consecutive Yes, unless the total of 60 Yes, 30 days from the date of No, unless the type B attending No, unless authorized by » Chiropractic physician days or 18 visits, from the date consecutive days or 18 visits from the first visit with any type B physician is a chiropractic attending physician and under a » Naturopathic physician of the initial visit on the initial the date of the initial visit on attending physician on the initial physician. written treatment plan. claim with any Type B attending the initial claim with any Type B claim, if within the specified 18 » Physician assistant (Note: Physician assistants are physician. attending physician has passed. visit period. not required to have a written Or, if authorized by an attending treatment plan.) physician and under a treatment plan. (Note: Physician assistants are not required to have a written treatment plan.) Emergency room physicians No, if the physician refers Yes An ER physician who is No, if the patient is referred to a Yes the patient to a primary care not authorized to serve as primary care physician.
    [Show full text]
  • Canadian Medical Association Code of Ethics 1965
    CANADIAN MEDICAL ASSOCIATION CODE OF ETHICS 1965 Transcribed from the original by A Keith W Brownell MD, FRCPC and Elizabeth “Libby” Brownell RN, BA April 2001 INTERNATIONAL CODE OF MEDICAL ETHICS OF THE WORLD MEDICAL ASSOCIATION Duties of Doctors in General 1. A DOCTOR MUST always maintain the highest standards of professional conduct. 2. A DOCTOR MUST NOT allow himself to be influenced merely by motives of profit. 3. THE FOLLOWING PRACTICES ARE DEEMED unethical: 4. a. Any self advertisement except such as is expressly authorized by the national code of medical ethics. 5. b. Taking part in any plan of medical care in which the doctor does not have professional independence. 6. c. To receive any money in connection with services rendered to a patient other than the acceptance of a proper professional fee, or to pay any money in the same circumstances without the knowledge of the patient. 7. UNDER NO CIRCUMSTANCES is a doctor permitted to do anything that would weaken the physical or mental resistance of a human being except from strictly therapeutic or prophylactic indications imposed in the interest of the patient. 8. A DOCTOR IS ADVISED to use great caution in publishing discoveries. The same applies to methods of treatment whose value is not recognized by the profession. 9. WHEN A DOCTOR IS CALLED UPON to give evidence or a certificate he should only state that which he can verify. Duties of Doctors to the Sick 10. A DOCTOR MUST always bear in mind the importance of preserving human life. 11. A DOCTOR OWES to his patient complete loyalty and all the resources of his science.
    [Show full text]
  • Resident Supervision Policy Supervision of the Medical House
    Medical House Staff Training Program Columbia University Medical Center NewYork-Presbyterian Hospital Resident Supervision Policy Supervision of the medical house staff in both inpatient and outpatient settings seeks to balance the need for appropriate attending physician supervision with the progressive responsibility and autonomy graduate medical residents must demonstrate by the conclusion of their training experience. Supervision of activities on the medical service falls under three broad categories depending upon the complexity of the clinical situation and/or training experience. For the purpose of defining the overall supervision policy, and based on HCFA and NYSDOH guidelines, supervision is defined as follows: 1) General Supervision: Supervision is furnished under the attending physician's overall direction and control, but the attending physician's presence is not required during the procedure or patient encounter. 2) Direct Supervision: Supervision is by an attending physician whose direct physical presence is either in the office suite or immediately available to furnish assistance and direction throughout the performance of a procedure or during a patient encounter. It does not mean that the attending physician must be present in the room when the procedure or encounter is taking place. 3) Personal Supervision: (also called Visual Supervision) Supervision by an attending physician who is in attendance in the room while the procedure or encounter is taking place. Patients admitted to the hospital fall under two broad designations, "private" and "service". Private patients have an attending of record who generally has had a long history of involvement with the specific patient and assumes professional responsibility for the care of the inpatient.
    [Show full text]
  • 123198 Attributes of Excellent Attending-Physician Role Models
    The New England Journal of Medicine Special Article ATTRIBUTES OF EXCELLENT ATTENDING-PHYSICIAN ROLE MODELS SCOTT M. WRIGHT, M.D., DAVID E. KERN, M.D., M.P.H., KEN KOLODNER, SC.D., DONNA M. HOWARD, DR.P.H., AND FREDERICK L. BRANCATI, M.D., M.H.S. ABSTRACT CENTURY ago, William Osler helped Background Although effective role models are create a new approach to medical educa- important in medical education, little is known about tion based largely on teaching by exam- the characteristics of physicians who serve as excel- ple. Osler himself is venerated as a para- lent clinical role models. We therefore conducted a gonA of clinical and pedagogic excellence, serving as case–control study to identify attributes that distin- an example for academic physicians to emulate. To- guish such physicians from their colleagues. day, role modeling is thought to be an integral com- Methods We asked members of the internal-med- ponent of medical education1-8 and an important icine house staff at four teaching hospitals to name factor in shaping the values, attitudes, behavior, and physicians whom they considered to be excellent ethics of medical trainees.7-10 Role models have a role models. A total of 165 physicians named by one or more house-staff members were classified as ex- strong influence on the career choices of medical 1,3-6,10-23 cellent role models (these served as the case physi- students. Since 1966, 25 articles have report- cians in our study). A questionnaire was sent to ed on various aspects of role modeling in medical them as well as to 246 physicians who had residen- education.1-25 Only two of these studies, however, cy-level teaching responsibilities but who were not have examined the actual attributes of excellent role named (controls).
    [Show full text]
  • Definitions: Fellow/Resident: a Physician Who Is Engaged in A
    Roles, Responsibilities and Patient Care Activities of Fellows ADOLESCENT MEDICINE FELLOWSHIP PROGRAM Definitions: Fellow/Resident: A physician who is engaged in a graduate training program in medicine (which includes all specialties) and who participates in patient care under the direction of attending physicians (or licensed independent practitioners) as approved by each review committee. Note: The term “resident” may also be used interchangeably with fellow for training and includes all residents and fellows including individuals in their first year of training (PGY1), often referred to as “interns,” and individuals in approved subspecialty graduate medical education programs who historically have also been referred to as “fellows.” As part of their training program, fellows are given graded and progressive responsibility according to the individual fellow’s clinical experience, judgment, knowledge, and technical skill. Each fellow must know the limits of his/her scope of authority and the circumstances under which he/she is permitted to act with conditional independence. Fellows are responsible for asking for help from the supervising physician (or other appropriate licensed practitioner) for the service they are rotating on when they are uncertain of diagnosis, how to perform a diagnostic or therapeutic procedure, or how to implement an appropriate plan of care. Attending of Record (Attending) An identifiable, appropriately-credentialed and privileged attending physician or licensed practitioner (as approved by each Review Committee) who is ultimately responsible for the management of the individual patient and for the supervision of the fellows involved in the care of the patient, The attending delegates portion of care to fellow based on the needs of the patient and the skills of the fellow.
    [Show full text]
  • Medical Students' Perceptions of the Elements of Effective Inpatient
    Medical Students’ Perceptions of the Elements of Effective Inpatient Teaching by Attending Physicians and Housestaff D. Michael Elnicki, MD, Amanda Cooper, MD Department of Medicine, University of Pittsburgh, Pittsburgh, Pa, USA. BACKGROUND: Most studies of effective inpatient teaching have fo- behaviors were responsible for improvement in student per- cused on teaching by attending physicians. formance over a clerkship, with house staff teaching account- 3 OBJECTIVE: To identify and compare medical students’ perceptions of ing for the majority of the variance. Students are more likely behaviors associated with teaching effectiveness of attending physi- to choose internal medicine as a career if their teaching resi- cians and housestaff (residents and interns). dents or attending physicians are excellent teachers.4 DESIGN AND PARTICIPANTS: Third-year students who spent 4 weeks Most of the studies that have assessed effective teaching on a general internal medicine inpatient service during academic year on inpatient services have focused on attending physicians. 2003–2004 completed surveys using a 5-point Likert-type scale. Stu- Elements of attending physician teaching that have been dents evaluated numerous teaching behaviors of attendings and shown to be important for student learning include using ac- housestaff and then evaluated their overall teaching effectiveness. tive and case-based learning, making thought processes MEASUREMENTS: Each behavior was correlated with the perceived transparent, and providing useful feedback. Excellent teach- teaching effectiveness in univariate and regression analyses. ers demonstrate sound clinical skills, are good role models, 5–8 RESULTS: Seventy-two students were taught by 23 attendings and 73 and encourage students’ professional growth. While occa- housestaff.
    [Show full text]
  • Strategies of Female Teaching Attending Physicians to Navigate Gender-Based Challenges: an Exploratory Qualitative Study
    ORIGINAL RESEARCH Strategies of Female Teaching Attending Physicians to Navigate Gender-Based Challenges: An Exploratory Qualitative Study Nathan Houchens, MD1,2*, Martha Quinn, MPH3, Molly Harrod, PhD4, Daniel T Cronin, MD1,2, Sarah Hartley, MD1,2, Sanjay Saint, MD, MPH1,2,4 1Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan; 2Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan; 3School of Public Health, University of Michigan, Ann Arbor, Michigan; 4VA Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan. BACKGROUND: Women in medicine experience with which to respond to these challenges were evaluated discrimination, hostility, and unconscious bias frequently through semistructured in-depth interviews, focus and with deleterious effects. While these gender-based group discussions, and direct observations of rounds. challenges are well described, strategies to navigate and Observations were documented using handwritten field respond to them are less understood. notes. Interviews and focus groups were audio recorded OBJECTIVE: To explore the lived experiences of female and transcribed. All transcripts and field note data were teaching attending physicians emphasizing strategies analyzed using a content analysis approach. they use to mitigate gender-based challenges in clinical MAIN OUTCOMES: Attending experience levels ranged environments. from 8 to 20 years (mean, 15.3 years). Attendings were DESIGN: Multisite exploratory, qualitative study. diverse in terms of race/ethnicity. Strategic approaches to gender-based challenges clustered around three themes: SETTING: Inpatient general medicine teaching rounds in female attendings (1) actively position themselves as six geographically diverse US academic hospitals between physician team leaders, (2) consciously work to manage April and August 2018.
    [Show full text]
  • 1904 Pediatric Sub-Internship
    1904 Pediatric Sub-Internship Course: Pediatric Sub-Internship Course Number: PED 1904 Department: Pediatrics Faculty Coordinator Ladan Agharokh, MD ([email protected] ) Assistant Faculty Coordinators: N/A UTSW Education Coordinator Contact: Anthony Lee ([email protected]) Hospital: (Location of rotation) Children’s Medical Center Periods Offered: Periods 1-12 Length: 4 weeks Max # of Students: 7 First Day Contact: Ladan Agharokh, MD First Contact Time: 8:00am First Day Location: Orientation via Zoom Prerequisites: PED 1801 Pediatric Core Clerkship Schedule Note: The sub-internship in Pediatrics extends through the last Sunday of the 4 week block; it does not end on Friday of the 4th week like many other MS4 electives. I. Course Description The student will be integrated as a functional member of a pediatric ward team. Students will be assigned to one of the inpatient pediatric teaching teams, general pediatrics or subspecialty. Students will take on primary responsibility for the patients they follow, similar to the level of an intern on the service. The student will assess patients, develop and implement patient care plans. Goals Objectives Assessment Methods Patient Care: Independently collect focused Senior resident and attending Patient care should be in a and comprehensive, physician review of electronic compassionate, appropriate and developmentally appropriate medical record (EMR) entries effective manner for treatment of health histories and perform thorough Skills evaluation from direct problems and promote continuity of physical examinations (1.01) observation. care. Create and maintain complete and accurate medical records including dictation summaries. (3.01) Manage the patient’s problem in the hospital, including writing orders under supervision.
    [Show full text]
  • Role, Responsibility and Patient Care Activities for Trainees
    Roles, Responsibilities and Patient Care Activities of Residents Cardiothoracic Surgery Traditional Two Year Residency University of Washington Harborview Medical Center Seattle Children’s Hospital Puget Sound VA Health Care System Definitions Resident: A physician who is engaged in a graduate training program in medicine (which includes all specialties, e.g., internal medicine, surgery, psychiatry, radiology, nuclear medicine, etc.), and who participates in patient care under the direction of attending physicians (or licensed independent practitioners) as approved by each review committee. Note: The term “resident” includes all residents and fellows including individuals in their first year of training (PGY1), often referred to as “interns,” and individuals in approved subspecialty graduate medical education programs who historically have also been referred to as “fellows.” As part of their training program, residents are given graded and progressive responsibility according to the individual resident’s clinical experience, judgment, knowledge, and technical skill. Each resident must know the limits of his/her scope of authority and the circumstances under which he/she is permitted to act with conditional independence. Residents are responsible for asking for help from the supervising physician (or other appropriate licensed practitioner) for the service they are rotating on when they are uncertain of diagnosis, how to perform a diagnostic or therapeutic procedure, or how to implement an appropriate plan of care. Attending of Record (Attending): An identifiable, appropriately-credentialed and privileged attending physician (or licensed independent practitioner as approved by each Review Committee) who is ultimately responsible for the management of the individual patient and for the supervision of residents involved in the care of the patient.
    [Show full text]
  • Hospitalist Perspective of Interactions with Medicine Subspecialty Consult Services
    ORIGINAL RESEARCH Hospitalist Perspective of Interactions with Medicine Subspecialty Consult Services Traci N. Adams, MD1*, Joanna Bonsall, MD2, Daniel Hunt, MD2, Alberto Puig, MD3, Jeremy B. Richards, MD4, Liyang Yu, MS5, Jakob I. McSparron, MD6, Nainesh Shah, MD7, Jonathan Weissler, MD1, Eli M. Miloslavsky, MD8 1Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; 2Department of Medicine, Emory University, Atlanta, Georgia; 3Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; 4Division of Pulmonary, Critical Care, and Sleep Medicine, Medical University of South Carolina, Charleston, South Carolina; 5Division of Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; 6Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Bos- ton, Massachusetts; 7Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; 8Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts. BACKGROUND: Medicine subspecialty consultation is that in-person communication occurred during less than becoming increasingly important in inpatient medicine. half of consultations, and 64.4% perceived pushback at OBJECTIVE: We conducted a survey study in which we least “sometimes” in their consult interactions. Participants examined hospitalist practices and attitudes regarding viewed consultation as an important learning experience, medicine subspecialty consultation. preferred direct communication with the consulting service, and were interested in more teaching during consultation. DESIGN AND SETTING: The survey instrument was The survey identified a number of barriers to and facilitating developed by the authors based on prior literature and factors of an effective hospitalist–consultant interaction, administered online anonymously to hospitalists at 4 which impacted both hospitalist learning and patient care.
    [Show full text]