Inpatient rotations take place in a wide variety of hospitals:
The University Hospital (UH)
The Ross Heart Hospital (RHH)
The Arthur James Comprehensive Cancer Center (JCC)
The Ohio State University East Hospital (OSUE)
UH, RHH and JCC are all located on the campus of The Ohio State University. Front and center facility-wise, is the new James Cancer Hospital and Critical Care Tower, which will open during December 2014. The OSUE Hospital is located approximately 6 miles away in downtown Columbus. These four hospitals provide a terrific spectrum of patient acuity and pathology. At the end of three years, our residents are proficient in caring for inpatients and ICU patients in both community and tertiary settings.
Ohio State University is one of the few residency programs to offer an inpatient subspecialty ward system. During their three years (or four for Med Peds!), residents rotate through a variety of general internal medicine and subspecialty inpatient services (see table below). Residents learn to care for patients from experts in their field. Our residents are passionate about this service structure. They find that it is easier to learn when the clinical and educational experiences are concentrated in a given field for a month at a time.
PGY 2 and 3 residents are the team leaders and have a significant amount of autonomy in the daily evaluation and management of patients. We strongly believe in resident led work rounds, allowing for the initial patient assessment and management plan to be developed by the house officer. The attending physicians participate with residents, interns and medical students on daily teaching rounds and have been repeatedly recognized for their support and dedication.
Our MICU rotation is one of the most popular rotations for all of our residents, even those not planning a career in critical care medicine. Our 25 bed ICU is covered by a team of interns and residents each month. In this busy environment, the residents care for critically ill patients under the guidance of fellow and faculty physicians who consistently win teaching awards. All residents are coached in proper procedural technique and get many opportunities to insert venous and arterial lines, and manage airways. By the end of their residency, all residents should be competent to independently place central venous catheters and insert radial arterial lines.
Historically, most of our teams consisted of one faculty member, one intern and one supervisory resident, along with several students. In recent years some newer structures have been added - 2 resident/2 intern teams, 1 resident/2 intern teams, and services with 2 senior residents without interns (heart failure, pulmonary). This variety in team structure provides residents a wider range of team experiences in which to develop their decision making and leadership skills. Regardless of the team structure, all teams include an attending physician and usually have third and/or fourth year medical students.
One resident with One Intern covering up to 10 patients, has proven quite manageable given our team design. The one resident and one intern team allows close relationships to develop between our residents. Every patient on the team belongs to the entire team. Residents and interns share note writing and care planning responsibilities. Both interns and residents admit and staff patients with the faculty attending and thus get the opportunity to get direct teaching and feedback about their clinical diagnostic skills.
Two Residents covering up to 16 patients. In this structure, the residents will have an opportunity to mature their decision making skills and efficiency without the responsibility of overseeing an intern. The residents will still have teaching responsibilities with the medical students on the service. In this model, the residents will work closely with the attending physicians and be able to include practice management education specific to the advanced level the residents are practicing.
One resident and Two Interns covering up to 18 patients. In this model, the residents take on a more supervisory role while allowing the interns to develop relationships with their own patients. This structure allows interns to develop clinical decision making and a sense of autonomy early on. The resident and attending provide a strong support network for the interns as they develop these skills.
Two residents and Two Interns cover up to 20 patients. The nature of this services means there is always ample patient care experience and back-up/support to go around. Intern and Resident pairs divide into Scarlet and Grey sub-teams, in recognition of OSU pride.
Our call structure is designed to provide outstanding patient care and give residents the rest they need to stay sharp and focused on their important work and to continue to read about their patients, while adhering to the new ACGME work hour restrictions. We have a call structure with interns and residents not taking overnight call on any service. Interns and residents rotate on a night team that works from 6pm to 7am, Sunday through Thursday. We have interns and residents on consults and clinic blocks who work one weekend of night float on Friday and Saturday nights. Interns and residents on inpatient services still take call on the weekends, but instead work from 7am to 6pm, when the night team arrives.
|Acute Coronary Service||Hematology|
|Congestive Heart Failure||Hepatology|
|General Cardiology||Medical Intensive Care Unit|
|General Medicine-Nephrology (OSU East)||Night Team|
|General Medicine-Pulmonary||Transplant Medicine|