Inpatient Medicine | Bigelow Service
The hallmark of the Department of Medicine’s teaching service, the Bigelow Service is comprised of five teams responsible for the care of general medicine units. Resident and students participate in the management of the patients under the supervision of one or two attending physicians. The team works together collaboratively during work rounds and attending rounds learning and caring for all patients. Teaching is done by all members of the teams in the various settings with attending presence, teaching and supervision every day. There is an emphasis on bedside teaching and direct observation of clinical skills. The junior resident takes on the meaningful role of team leader and manager with guidance from the teaching attending. The junior resident acts as the leader of the multidisciplinary team with an opportunity to learn from the role.
Composition of a Bigelow Team
|Medical Students||Interns (PGY-1)||Juniors (PGY-2)||Attending Physicians
On the Bigelow in 2012-2013, there are 5 interns and 1-2 juniors who oversee the care of 20-24 patients. Overnight, the interns are supervised by a senior resident who manages 2 teams. Four interns rotate on an every 4th night rotation while the 5th intern plays a "bridge" role. The bridge works 7 AM to 7 PM Monday through Thursday and also works Saturday 9 PM to 12 noon the following day. Three interns work from 7 AM until 7 PM helping admit and care for the patients on the team. The overnight intern admits and covers the floor with the supervision of a senior resident, the Bigelow teaching senior resident overnight. The admitting intern presents the new admissions to the team between 8 and 10 AM the following morning on attending rounds.
The junior resident supervises the care provided by the team and leads discussion in work rounds. The team works as a collaborative group that discusses and exchanges ideas and comes up with a plan for the day for all patients. The team based approach allows optimization of patient care with input from many members allowing for optimal education. Attending rounds are focused on optimal patient care and education. The team system fosters a sense of camaraderie among team members and allows interns to be exposed to the care of new patients every day and the care of all patients on the team rather than being limited to just the patients whom they admitted. Because the interns have familiarity and responsibility for all patients, cross coverage at night is improved.
Selected cases from the Bigelow are discussed at Resident’s Report, where a senior physician and chief residents help foster an interactive educational session every day at 4.30 PM. The junior residents also meet with the chief residents every day to review cases. The junior resident gets to present at Noon Conference on their experiences and highlights of the cases from the team on the Bigelow called “Cases from the Bigelow”.
View the Resident Call Cycle at MGH For Inpatient Care
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