Faculty Chair:
John Andazola, MD
Contacts:
- John Andazola, MD
- Dolores Gomez, MD
- Kathleen Hales, MD
- Stephanie Benson, MD
Required Experiences:
Memorial Medical Center
Optional Experience:
None
Weekly Schedule PGY1:
| Sunday | Monday | Tuesday | Wed | Thursday | Friday | Saturday |
| Off | Off | Off | Off | Off | Off | Off |
| Float | Float | Float | Float | Float | Float | Off |
Weekly Schedule PGY2 or 3:
| Sunday | Monday | Tuesday | Wed | Thursday | Friday | Saturday |
| Off | Off | Off | Off | Off | Off | Off |
| Float | Float | Float | Float | Float | Float | Off |
Requirements:
AOA
No specific requirements
ACGME
No specific requirements
Description of Rotation or Educational Experience:
The night float (NF) rotation was developed in order to maximize the learning and teaching experience of the resident, to maintain the well being of the resident, and lastly to maintain appropriate duty hours as required by the ACGME. Each resident is assigned to night float twice in the first year, once in their second, and once in the third year. There are many benefits to this structure which allows the residents to maintain appropriate duty hours and:
- Residents are not post-call during the week including Fridays which allows the seniors to attend all assigned conferences.
- Senior resident are on 24 hour call only on Saturdays which is shared between 12 residents.
- The PGY1 residents only take a 12 night call on Saturday when not on service which rotates between 4 residents.
- There is always a senior on night float with an intern, which maximizes supervision.
- Having a consistent NF resident “on call” every night improves continuity of care for our inpatient and OB services at night.
Expectations:
PGY1
The NF PGY 1 resident is the physician with the primary responsibility of the care of the FMS patients. Thus they must know all conditions, treatments, labs, medications allergies, etc. of each of their patients. The PGY1 is required to:
- Carry the FP Service phone and answers admission and cross-cover calls
- The PGY 1 assigned to the phone will respond to all rapid responses or Codes
- Call the supervising resident when there is a new admission or question.
- Discuss all admissions with the senior resident.
- See each admission first, unless the patient is seriously ill
- Discuss with the supervising senior resident what his/her needs and expectations are.
- Contact the attending to discuss the treatment plan of any complicated patient or to inform the attending of any significant changes in a patient’s status
PGY2
The NF PGY2 will review and discuss the patient care of EVERY admission with the intern on night float. This will maximize intern supervision and patient safety. He/she will also write an abbreviated Senior Resident Admit Note on each admission. The NF resident’s primary responsibility is to cover L&D and to oversee each ER admission. One major role is to be a resource to the intern on night float for any questions or patient issues. The night float must be present during morning report. The NF residents will not have continuity clinic and will not be required to attend didactic conference every Friday afternoon.
FM Faculty
Every night there is a faculty member assigned to call. The faculty member is available by telephone to answer any question that the residents have. The Faculty must be present for every delivery, every critical care admission, and for every procedure performed by the residents. The residents are encouraged to call the attending for any questions or concerns with patient management.
FMS OB Attending
is the OB faculty member. His role is that of consultant/teacher, as well as attending with direct patient care responsibility. He will go over all admissions and laboring patients, under his care, with the residents, and is expected to round daily on the patients and discuss management issues with the primary Resident involved. He should also be available to act as a liaison for conflict resolution between the ward team and private attendings and Midwives. He is available for consultation on high risk OB patients and for those who may need surgical intervention. Before any formal consults are made or if management of care changes are planed the FMS attending must be notified. The only exception is in an emergent situation where patient safety is an issue.
1st Step Midwife
is a major educator on the NF rotations. Her role is that of consultant/teacher, as well as direct patient care responsibility. She will go over all admissions and laboring patients, under her care, with the residents, and is expected to round daily on the patients and discuss management issues with the primary Resident involved.
1st Step OB Attending
is the supervising obstetrician for 1st Step. His role is that of consultant/teacher, as well as attending with direct patient care responsibility. He/she will go over all admissions and laboring patients, under his care, with the residents, and is expected to round daily on the patients and discuss management issues with the primary Resident involved. He should also be available to act as a liaison for conflict resolution between the ward team and private attendings and Midwives. He is available for consultation on high risk OB patients and for those who may need surgical intervention. Before any formal consults are made or if management of care changes are made the 1st Step Midwife must be notified. The only exception is in an emergent situation where patient safety is an issue
Call
The NF residents will cover as supervising senior resident from 6pm to 6am each night Sunday thru Friday. The rotation is 4 weeks long and there is not other call responsibility.
Patient Care
Goal
Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health in the call setting. Special attention to the obstetric and inpatient urgencies and emergencies that commonly present at night.
Competencies
[Insert specialty specific requirements]
Objectives
The PGY1 demonstrates the ability to:
- Perform and report developmentally, age, and setting appropriate history and physical examination as measured by global assessment.
- Generate an appropriate differential diagnosis as measured by global assessment.
- Make informed decisions about diagnostic and therapeutic interventions based on patient information, patient preferences, up-to-date scientific evidence, and clinical judgment as measured by global assessment.
- Develop and carry out patient management plans as measured by global assessment.
- Use information technology to support patient care decisions and patient education as measured by global assessment
- Collaborate with health care professionals, including those from other disciplines, to provide patient-focused care as measured by global assessment.
Objectives
The PGY2 demonstrates the ability to:
- Obtain and report appropriate obstetric and medical history
- Perform and report appropriate physical examination on labor and delivery, in the ER and on the wards
- Generate an appropriate differential diagnosis
- Interpret Fetal heart rate strips (NSTs) using Dr. C. BRAVADO
- Interpret BPP and AFI
- Evaluate SROM in triage
- Evaluate suspected labor in triage
- Evaluated and treats preterm labor
- Evaluate and preeclampsia in triage and L&D
- List the indications for and performs labor augmentation and/or induction
- Evaluate and treating postpartum hemorrhage using the “4 T’s” of the ALSO course
- Recognize and indications for appropriate use of operative vaginal delivery
- Identify and manage fetal distress
- Manage gestational diabetes in labor
- Perform, document and report a newborn examination
- Make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment
- Develop and carry out patient management plans
- Use information technology to support patient care decisions and patient education
- Perform appropriate procedures while on supervising on the inpatient service, with attention to consent, technique, patient comfort and follow-up
- thoracentesis
- paracentesis
- lumbar puncture
- central venous line
- Obtain, document and report an accurate cervical exam
- Perform, document and report a routine vaginal delivery
- Repair 1st and 2nd degree lacerations
- First assist in C-sections
- Collaborate with health care professionals, including those from other disciplines, to provide patient-focused care
Medical Knowledge
Goal
Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care. Special attention to the obstetric and inpatient urgencies and emergencies that commonly present at night.
Competencies
[Insert specialty specific requirements]
Objectives
The resident:
- Demonstrates an investigatory and analytic thinking approach to clinical situations
- Knows and applies basic and clinical knowledge in specified areas/diagnoses:
- Acute respiratory distress
- Acute atrial fibrillation
- Acute chest pain/ACS
- New onset tachycardia
- Alcohol withdrawal
- Acute altered mental status
- Nausea/vomiting/diarrhea
- Sepsis
- Hypotension
- Hypertension
- Hyperglycemia/hypoglycemia
- Electrolyte abnormalities
- Normal Labor (PGY2)
- Preeclampsia (PGY2)
- Preterm Labor (PGY2)
- Labor dystocia (PGY2)
Practice Based Learning and Improvement
Goal
Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life long learning. A key aspect of this rotation is the development of supervising and teaching skills. The residents are expected to develop skills and habits to be able to supervise and teach junior residents and interns.
Competencies
- Identify strengths, deficiencies and limits in one’s knowledge and expertise
- Identify and perform appropriate learning activities
- Locate, appraise and assimilate evidence from scientific studies related to their patients’ health problems
- Provide bedside teaching and guidance to interns and students
Objectives
The resident:
- Recognizes his/her own strengths and limitations
- Asks questions as an engaged, critical learner
- Uses information technology to manage information, access on-line medical information, and support their own education and to aid in the teaching of junior learners.
- Facilitates the learning of students and interns
System Based Practice
Goal
Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.
Competencies
- Work effectively in various health care delivery settings and systems relevant to their clinical specialty
- Coordinate patient care within the health care system relevant to their clinical specialty
- Incorporate considerations of cost awareness and risk-benefit analysis in patient care
- Advocate for quality patient care and optimal patient care systems
- Work in interprofessional teams to enhance patient safety and improve patient care quality
- Participate in identifying systems errors and in implementing potential systems solutions
Objectives
The resident:
- Practices cost-effective health care and resource allocation that does not compromise quality of care
- Advocates for quality patient care and assist patients in dealing with system complexities to minimize discomfort or confusion
- Recognizes that the patient is part of a greater system and provides care in a manner that supports continuity
- Knows how to partner with health care managers and health care providers to assess, coordinate, and improve health care and know how these activities can affect system performance
Professionalism
Goal
Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.
Competencies
The list below reflects competencies that fall under Professionalism. Which of the following competencies are relevant for the rotation or educational experience you have chosen?
- Compassion, integrity, and respect for others
- Responsiveness to patient needs that supersedes self-interest
- Respect for patient privacy and autonomy
Objectives
The resident:
- Accepts responsibility for patient care
- Never misrepresents patient care information
- Consistently performs in a punctual, reliable and collegial manner
- Demonstrates dress, hygiene and manner of speech that consistently reflect appropriate standards
- Demonstrates a commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, patient privacy, informed consent, and business practices
- Demonstrates sensitivity and responsiveness towards patients’, colleagues’ and team members’ gender, age, culture, disabilities, ethnicity and sexual orientation
Interpersonal and Communication Skills
Goal
Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates. Residents are expected to: Communicate well with patients, interns, midwives, and attending FM, OB and ER physicians.
Competencies
- Communicate effectively with patients and families across a broad range of socioeconomic and cultural backgrounds
- Communicate effectively with physicians, other health professionals, and health related agencies
Objectives
The resident:
- makes organized and effective oral presentations
- creates and sustains a therapeutic and ethically sound relationship with patients and families
- Communicates effectively and respectfully with others as a member, leader or teacher of a health care team
Teaching Methods
Residents will provide medical care to patients under the direct supervision of the attending physician or midwife. They will be directly supervised on all procedures performed in the hospital. Residents will be assigned specific reading topics to be completed by the end of their last month on the Night Float rotation.
Assessment Method (residents)
A 360 global assessment tool, procedure check lists and the REDI assessment tool will be used in assessment of the resident during their experience. All procedures will be recorded on New Innovations.
Assessment Method (Program Evaluation)
Residents will be provided with an evaluation of the rotation experiences and of the attending physicians as well and given the opportunity to provide feedback of the longitudinal rotation during their quarterly IEP assessments.
Level of Supervision
The resident is directly supervised by the attending physician and Midwives during all procedures performed in the hospital. The attending will see all patients on the service each day and will document their involvement in the patient’s care. An Attending will be available 24 hours a day.
Educational Resources
Readings:
PGY1
PGY2
PGY3
Videos
Books
Williams VW, Flanders SA, Whitcomb WF, Cohn SL, Michota FA, Holman R, Gross R, Merli GJ. Comprehensive Hospital Medicine An Evidence-Based Approach. Philadelphia, Pa: Saunders, Elsevier, 2007.
Marino, PL. The ICU Book 2nd ed. Baltimore, Maryland: Williams and Wilkins, 1998.
Organizations/Web Resources
American Academy of Family Physicians: http://www.aafp.org
American College of Radiology: http://acr.org
Society of Teachers of Family Medicine: http://www.stfm.org
UpToDate: UpToDate, Inc.: http://utdol.com
SNMFMRP Curriculum 