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  1. 1. RESIDENT, FELLOW AND STUDENT RESPONSIBILITIES SECTION OF ENDOCRINOLOGY DEPARTMENT OF MEDICINE JOAN C. EDWARDS SCHOOL OF MEDICINE MARSHALL UNIVERSITY The overall goal of our training program is to train fellows, residents, and students in the specialty of endocrinology so at the successful completion of their training they will be competent to provide comprehensive, specialized medical care based on a high standard of demonstrated knowledge and skills appropriate to their level of training. The following document defines the responsibilities of the rotating resident, fellow and medical student. I. Responsibilities of the Rotating Resident A. The resident will work with the attending physician and the clinical fellow assigned to the inpatient consultation service. New consults should be seen by the resident and the attending within 24 hours. This may require that the resident evaluate the patient the first thing in the morning or in the evening in order to present the patient to the attending physician with 24 hours of notice of the consult. The resident and student should make early morning rounds on the patients prior to the rounds with the attending physician. If rounds are not possible, the most current information on the patient should be available to the attending physician. The schedule for attending rounds will be determined by the attending physician and dictated by the attending physician's schedule. His/her expected duties include: 1. A complete history and physical examination or in certain cases a limited evaluation. If you are not sure as to the extent of your examination, ask the attending physician what he would like done. 2. A problem list and assessment and initial plan for each patient at the time of consultation. 3. A discussion of that plan with the fellow and the attending physician upon completion of the initial assessment. He/she will be responsible for presenting a thorough history and physical and the results of current laboratory data to the attending physician. The resident must review the current literature pertaining to diagnosis and management of his patients. In-depth case study methods are essential for good care and the learning process. 4. Communication and supervision of therapeutic and diagnostic recommendations. The resident will be responsible for making sure that the appropriate tests are ordered and performed properly by the teaching service resident. The resident will perform special procedures or tests under the supervision of the Fellow or Endocrine Attending. He will be responsible for making sure samples are collected and labeled properly and sent or delivered to the proper laboratories. 5. Daily problem-oriented progress notes should be legible and “soaped” and contain elements consistent with E & M codes for the visit. The final progress note should document the date of admission, date of discharge or signing off of consultation, admission and discharge diagnosis, problems which were outlined 1
  2. 2. while the patient was hospitalized, and medications the patient is to receive at discharge. It also indicates the disposition of the patient and assigns follow-up care. An order should be written for a copy of the note to be sent to the attending endocrinologist. 6. The resident maintains an endocrine flow sheet, indicating all pertinent laboratory data and therapeutic interventions in chronological order; especially important is a record of routine or special laboratory data which does not appear on any computerized laboratory forms. This is particularly important in the diagnostic testing of syndromes of glucocorticoid excess, the management of diabetic control, DKA, SIADH, and hypercalcemia. 7. The resident notifies the attending Endocrinologist of the patient's discharge and arranges follow-up care. B. Call Responsibilities The rotating resident will not be on call after hours or on weekends. C. Clinic Responsibilities The resident will be assigned to clinics at UPIM. All clinics start promptly, and residents are expected to be there promptly. An additional clinic is held the second Friday of the month at 1:00 PM at St. Mary's Hospital. His/her function in the clinic will be determined by the attending physician in the clinic and may vary depending on the patient's problem and the patient's previous interaction and dependency on the attending physician. The UPIM Clinics have the following timings: Monday 1:00-5:00 PM, Wednesday 1:00- 5:00 PM, Thursday 8:00-12:00 Noon, and Friday 8:00-12:00 Noon. D. Teaching Responsibilities If a student is assigned to the service, the resident will also be responsible for teaching the student the basic skills and bedside behavior and appropriate interaction with the patient. The resident should rotate workups with the student. However, the resident will be responsible for a brief note in the chart of the patient that the student has evaluated. E. Conferences 1. Core Curriculum Conference twice monthly on 2nd and 4th Tuesdays 12 Noon-2:00 PM (Residents conference room, UPIM). 2. Research Conference once monthly on 3rd Tuesday) 12:30 PM (Conference room, Research Building, VAMC) 3. Endocrine Clinical Case Conference each Tuesday 9:00 AM after medical grand rounds 4. Journal club once monthly (1st Tuesday after medical grand rounds at 9:00 AM) Residents and students are expected to participate in the clinical conferences. The research conference is optional but we encourage the residents and students to attend. 2
  3. 3. II. Responsibilities of Fellows A. In the absence of a rotating resident on the service, the fellow assumes the rotating resident's responsibilities. Otherwise, a brief, positive and pertinent negative history and physical examination must be completed on every patient admitted to the service; this write-up amends and corrects any errors in the rotating resident work-up. B. The research fellow at the VA will take consults at the VA and be responsible for the care of all patents, unless otherwise directed by the attending endocrinologist. C. Supervises, assists and directs the rotating resident in patient care, chart tending and procedures. D. Organizes and directs rounds. E. Organizes and performs thyroid aspirations, bone biopsies, suppression tests, provocative tests and follow-ups. Keeps records of procedures and has attending physician sign off. F. Has responsibility for supervision of medical students; reviews their history and physical examinations to aid them in formulating their problem lists, and discusses their formulations and approach to these problems. G. The on-call schedule will be provided to the fellows before the start of each month. H. Clinic Responsibilities The clinical fellow will be assigned to 3 half day clinics each week. These clinics will be held at UPIM and VAMC facilities. The fellow on research rotation will have one half day clinic. Fellow will be responsible for continuity of care including follow-up of test results and plans. Fellow must arrange for coverage of clinics when he/she is on leave. The schedule for the assigned clinics will be made available to the fellow at the start of each rotation. I. Conferences Fellows will be responsible for organizing the weekly clinical case conferences and will be assigned to these on rotating basis. Fellows are expected to assume a leadership role in preparation and presentation of clinical material in these conferences. Research conference is held on the 3rd Tuesdays of each month. Fellows present both their basic or clinical research projects at these conferences. In communicating their research, fellows should be prepared to discuss their hypothesis, methods, experimental design and analysis, interpretation and basis for the conclusions. Fellows actively participate in the journal club held on the 3rd Tuesdays of each month. Fellows also deliver lectures to their fellow colleagues and internal medicine residents at the assigned noon conferences. 3
  4. 4. III. Responsibilities of Medical Students A. Work-up endocrine patients both in inpatient and clinic settings and present to the attending physician. B. Make daily inpatient work rounds with the resident and fellow. C. Attends assigned clinics and conferences. D. Performs procedures under the guidance of the resident and fellow if needed. Revised September 2007 4