Residency
Acute Internal Medicine Rotation
Preceptor:
Susanna Ku, PharmD
Kathryn Nighorn, PharmD
Site Description:
The internal medicine service at the University of Utah Hospital consists of four teams. Most teams consist of an attending, resident, two intern physicians and medical students. Each internal medicine team consists of up to 20 patients with a total census of up to 80 internal medicine patients throughout the hospital. The majority of internal medicine patients are located on one of two internal medicine units (AIMA or AIMB). Common reasons for admission include infection, coagulopathies, pulmonary dysfunction, liver dysfunction, and renal failure. Patients present with multiple disease states and complicated drug regimens.
Rotation Description:
The pharmacist functions as part of a multidisciplinary team. Primary responsibilities include daily review of medication profiles, patient education, reconciliation of home medications, and improving medication dosing and utilization in all patients.
Residents contribute to patient care by monitoring patients, making recommendations to the medical team to improve care, and by facilitating the delivery of medications. Residents will round with one of the internal medicine teams.
Presentations include daily patient presentations, bi-weekly topic discussion, weekly formal case presentations, one journal club, and one educational presentation/in-service.
RLS Goals:
R1.4 Demonstrate ownership of and responsibility for the welfare of the patient by performing all necessary aspects of the medication-use system.
R2.1 As appropriate, establish collaborative professional relationships with members of the health care team
R2.4 Collect and analyze patient information
R2.6 Design evidence-based therapeutic regimens
R2.7 Design evidence-based monitoring plans
R2.9 Implement regimens and monitoring plans
R5.1 Provide effective medication and practice-related education, training, or counseling to patients, caregivers, health care professionals, and the public.
E7.4 Manage time effectively to fulfill practice responsibilities. (Relates to all rotation activities.)
Activities Evaluated:
midterm and final
| Rotation Activity | RLS Goal | Teaching Method |
| Patient monitoring/data collection - Residents will be responsible for one of four internal medicine teams and will monitor and collect patient information for all patients on their team until the patient is discharged. The number of patients will vary daily, but each internal medicine team can have a maximum of 20 patients. | R1.4, R2.4, R2.7 | Modeling Coaching Facilitating |
| Formulate patient-specific therapeutic regimen -- Residents will learn to identify & resolve medication problems and formulate therapeutic regimen for all patients on their internal medicine team. Problem resolution must occur daily before leaving. | R2.4, R2.6, E7.4 | Coaching Facilitating |
| Rounds - Residents will round daily with the same internal medicine team for the duration of the rotation. Residents will round with their pharmacy preceptor the first week and then round independently for the remainder of the rotation. | R2.1, R2.4, R2.6, R2.9, R5.1 | Modeling Coaching Facilitating |
| Patient/case presentations - Residents will present patients to the preceptor daily with one formal case presentation weekly on Fridays. The formal case presentation will focus on a topic related to a specific patient's reason for admission and a formal handout will be required. | R2.4, R2.6, R2.9 | Coaching Facilitating |
| Topic presentations - Residents will present 1 to 2 formal topic discussions weekly to the preceptor. The presentations will include a formal handout. | R2.6, R2.9, R5.1 | Direct Facilitating |
| Patient education - Residents are expected to provide patient education to patients as appropriate. These include anticoagulation education or new medication education. | R5.1 | Coaching |
| Journal club - Residents will present one journal club presentation. The journal article must be current and published within the last 6 months. A formal handout will be required. | R2.6, R2.9, R5.1 | Coaching Facilitating |
| PowerPoint Presentation - Residents will present one PowerPoint presentation on a topic that is relevant to internal medicine. The presentation will include formal handouts. | R2.1, R5.1 | Coaching Facilitating |
Readings and prep work:
Core topics that will be covered with assigned readings prior to topic discussions include the following:
- Anticoagulation - ACCP Chest guidelines
- Diabetes Mellitus
- Fluid/Electrolyte Replacement & Management
- Hepatic Disorders - alcohol-induced, autoimmune, cholecystitis, ascites, cirrhosis
- Infectious Disease - pneumonia, UTI, cellulitis, opportunistic infections
- Pancreatitis
- Pharmacokinetics - vancomycin, aminoglycosides
- Pulmonary - COPD, asthma
- Renal Disorders - acute and chronic
****Residents are encouraged to request elective topics to be covered.
Project description:
1) Case presentation (weekly)
- Patient presentation in SOAP note format
- Topic presentation that focuses on a specific disease state relevant to a patient
- Formal hand-out and presentation
2) Journal Club (1)
- Topic must be related to internal medicine
- Article published within the last year
- Likely to impact patient care
- Formal hand-out and presentation
3) PowerPoint presentation (1)
- Examples of past topics have included: DVT prophylaxis, insulin review, bowel regimens, SC administration of drugs for palliative care patients, overview of CHF
- Formal presentation with hand-out
Typical Daily/Weekly/Monthly activities:
A typical day will be 0700-1530 but additional hours are usually necessary to complete projects, readings for topic discussions and journal club, and attend meetings. On post-call days, please prepare for an earlier day as rounds generally start at 0700 or earlier.
0700-0900 Round preparation- patient monitoring and med reconciliations
0900-1200 Internal medicine rounds
1300-1400 Patient presentations- identify and resolve follow-up issues with team
1400-1500 Topic discussions with preceptor
1500 + Additional time to work on projects, topic discussions, resolve any remaining follow-up issues with team
***Internal medicine grand rounds are Thursdays at 0745. Residents are encouraged to attend.
***Pharmacy grand rounds are every Wednesday at 1400. Residents are required to attend.
Evaluation:
The resident will receive feedback on progress each day as they discuss patients with the preceptor. The preceptor will provide formative feedback for the case presentations, journal clubs, and inservice. There will be a snapshot of their progress at 2 weeks for R2.4.1 and a summative evaluation of strengths and weaknesses. A formal final summative evaluation will occur on the last day of rotation.
