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Inpatient Medicine | Other Rotations

Emergency Department

Approximately 90 percent of the Bigelow Service patients and 80 percent of the Ellison Service patients are admitted through the Emergency Department after initial evaluation and treatment. The Emergency Department is staffed by residents from the medical, surgical, and emergency departments. Medical residents spend 2-4 weeks in the Emergency Department during each year of residency. An Emergency Department attending physician is on site at all times for teaching and supervision. Medical residents are responsible for the evaluation and treatment of patients with minor complaints and major medical emergencies. Residents work in staggered shifts to accommodate the irregular flow of patients through the Emergency Department. Senior residents are responsible for providing teaching and supervision as well as triage decisions within the medical service. Seniors also provide urgent medical consultation to non-medical services in the Emergency Department. Emergency Department shifts usually run 8-12 hours.

Consultation

Residents provide general medicine consultation during the senior year. Each resident spends approximately two weeks as a general medical consultant, and performs medicine consults for non-medicine services (e.g., psychiatry, orthopedics, surgery, OB/GYN, etc). A group of general internists with expertise in medical consultation serve as attending physicians, and organize teaching rounds and a lecture series covering important aspects of medical consultation, including pre- and post- operative issues. In addition, all residents provide consultation with subspecialty units during elective rotations, working closely with supervising subspecialty fellows and attending physicians.

Oncology Service

The Oncology Service consists of two teams with each team consisting of a senior resident, two interns and up to 2 medical students. The Bone Marrow Transplant (BMT) /Leukemia Service is located on Lunder 10 and has 2 attending physicians, one for the BMT service and the other for the Leukemia Service. The team covers 18 patients. The Solid Tumor Service has a single attending of record for all 14 patients all geographically localized on Lunder 9. The two teams round in the morning on their respective floors and come together for teaching rounds on a core curriculum at 11 AM to 12 noon.

Composition of the Lunder 10 and 9 Teams respectively

Medical StudentsInterns (PGY-1)Seniors (PGY-3)Attending Physicians
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Interns on the Oncology Service do not take overnight call. The day intern admits until about 6 PM and follows his or her panel of patients with supervision from the senior medical resident and the attending of record. A PGY 2 nightfloat covers both teams overnight and admits. Overnight admissions are passed on to the day team under the direct supervision of the senior medical resident. The regionalized teams allow for multidisciplinary interactions with nurses, case managers, physical therapists and social workers involved in the care of this complex and critically ill patient population. Once every two weeks on Tuesdays there is a “Chiefs Rounds,” when challenging ethical cases are discussed with house staff, attendings, NP’s and nurses, with the presence of senior cancer center leadership.

Newton Wellesley Hospital Inpatient Rotation

Residents receive a robust community medicine experience at Newton Wellesley Hospital (NWH) located in a nearby suburb of Boston. This month-long rotation provides residents with a valuable perspective that complements their tertiary care experience at the MGH and often includes de novo presentations of common or even rare diseases. There are four NWH general medicine teams, each consisting of an MGH senior resident and two interns (one MGH medicine intern and one NWH preliminary intern). There is a nightfloat system staffed by MGH junior residents as well as NWH interns. MGH interns accept new admissions every other day until 6:00pm. Non-admitting interns can sign out to the admitting intern before 6:00PM or to the nightfloat NWH intern after 6:30PM. NWH has an experienced hospitalist service that covers the majority of medical admissions (over 95%).

There are three other rotations at NWH through which MGH residents can rotate. MGH junior residents spend part of their nightfloat rotation at NWH admitting new patients from 7:00pm to 5:00am. Some residents will also spend two weeks to one month in the NWH ICU staffed by two NWH preliminary interns, two MGH junior residents, and supervised by an MGH senior resident and an NWH attending intensivist. In the ICU, junior residents take call once every 4th night. Five MGH senior residents are selected to be the chief resident at NWH and spend 10-12 weeks of their senior year in this role. They run the daily didactic sessions to include morning report, intern report and medical student report.

At NWH, residents are able to view the MGH lunchtime core curriculum conference through November. For the rest of the year, lectures are given by NWH faculty or broadcast from MGH. In addition, residents also participate in a daily morning report, a weekly intern report, and bimonthly journal club and tumor board conferences.

For more information about other inpatient rotations, please click on the following page links below:



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