Thomas Jefferson UniversitySidney Kimmel Medical College

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Resident Roles & Responsibilities
(last updated 7/2013)

Roles and Responsibilities pertain to all levels of resident training unless otherwise indicated:

Inpatient Internal Medicine Teaching Services

  • Perform an appropriately directed and thorough clinical history of patients on their service.
  • Perform an appropriately directed and thorough physical examination of patients.
  • Assess the condition of patients on their service.
  • Review laboratory data and results of other studies of patients on their service.
  • Communicate clinical findings effectively to other interns, residents, fellows and attending physicians.
  • Initiate management for the patient’s condition writing the appropriate orders in the patient’s chart having discussed the patient’s case with senior residents, fellows and attending physicians.
  • Following up on results of therapeutic interventions and diagnostic studies.
  • Documenting appropriately in the patient’s chart the initial History and Physical Exam, daily progress notes, event notes and procedure notes.
  • Completion of forms related to patient care including facility transfer forms, death certificates and outpatient prescriptions.
  • Pre-round on patients on the service prior to clinical rounds with the fellow and attending. Pre-rounding will include performing an appropriate clinical history, physical exam, reviewing laboratory and study results and developing an assessment of the patient’s condition and a diagnostic and therapeutic plan.
  • Perform procedures as seen appropriate on patients (approved procedures listed separately).

Ambulatory

  • Attend weekly continuity clinic where you evaluate and follow up on patients.
  • Rotate through multiple medical and surgical sub-specialty clinics on the Jefferson campus and satellite outpatient offices (including the VA).
  • Carry out an appropriate clinical history and physical examination for patients presenting to the outpatient office.
  • Assess severity of illness for patients presenting to the outpatient office.
  • Review laboratory data and results of other studies for patients presenting to the outpatient office.
  • Follow up on results of therapeutic interventions and diagnostic studies.
  • Develop an appropriate diagnostic and management plan under the supervision of an attending physician.
  • Communicate clinical findings effectively to supervising attending physicians and consulting physicians.
  • Document initial history and physical exam form and progress notes.
  • Perform outpatient procedures including but not limited to pelvic and breast examinations (approved procedures listed separately).

Jefferson MRICU/CCU rotation

  • Supervise Interns in the ICU.
  • Supervise/Perform Procedures (approved procedures listed separately).
  • Patient Management- responsible for patients in the ICU as well as ectopic patients in other ICUs.
  • Admissions- complete H&P, admission orders, review with attending/fellow.
  • Daily rounds with attending and fellows.
  • Facilitate patient transfer to the ICU from outside hospital or within Jefferson.
  • Write transfer note when patient is discharged from the ICU.

Jefferson Unit Float rotation (PGY2s & PGY3s)

  • Supervise the on-call intern with patient care and procedures.
  • Work up new admissions to his/her unit with the on-call intern, including H&P, admission orders, and review with attending/fellow.
  • Respond to codes.
  • Serve on the Rapid Response Team.
  • Assist Night Float or MARs as necessary.
  • Cover ectopic ICU/CCU patients overnight.
  • Facilitate patient admission and discharges from the ICU/CCU.

VA Hospital Wilmington Delaware

  • Perform all duties managing patients in the inpatient setting including the ICU (same as Jefferson inpatient responsibilities).
  • Assist in transferring patients to outside hospitals for diagnostic and therapeutic interventions not available at the VA.
  • Attend one ambulatory rotation (PGY 2 and 3 only).

Methodist Hospital

  • Perform all duties managing patients in the inpatient setting (same as Jefferson inpatient responsibilities).
  • Only manage patients on the teaching services.
  • Evaluate and admit patients to the ICU and teaching services.
  • Perform procedures as seen appropriate on patients (approved procedures listed separately).

Emergency Room (PGY1 only)

  • Understand and apply the basic principles of triage.
  • Assess severity of illness for patients presenting to the emergency department with appropriate supervision.
  • Carry out an appropriate clinical history and physical examination for patients presenting to the Emergency Department (ED)..
  • Develop an appropriate diagnostic and management plan under the supervision of the Emergency Department attending physician.
  • Emphasis on management is given to stabilization of the acutely ill patient.
  • Communicate clinical findings effectively to other interns, residents, fellows and attending physicians.
  • Present patients for admission.
  • Document initial history and physical exam form and progress notes.
  • Perform procedures specific to the ED under the supervision of ED attending or senior resident.

MAR (PGY2 and PGY3)

  • Cover outpatient calls from the Jefferson Hospital Ambulatory Practice (JHAP), triage and make recommendations.
  • Communicate all JHAP calls covered with the JHAP directors.
  • Triage patients in the ED presented by the ED staff for admission or consultation.
  • Assign patients to the appropriate medical service.
  • Triage patients directly admitted to the hospital and assign to the appropriate medical service.
  • Admit patients overnight to the medical services to be redistributed in the morning.
  • Serve as the supervising resident to the interns and night float (as House Chief).
  • Serve as backup to the Rapid Response Team.
  • Serve as backup to the unit residents.

NightFloat (PGY1 and PGY2)

  • Perform an appropriately directed and thorough clinical history and physical examination of hospitalized patients on their service requiring attention.
  • Learn about patients through evening signout and then communicate events taken place overnight to the primary team during morning signout.
  • Assess the condition of patients signed out from the primary teams.
  • Review laboratory data and results of other studies of patients signed out.
  • Communicate clinical findings effectively to other interns, residents, fellows and attending physicians.
  • Initiate management for the patient’s condition writing the appropriate orders in the patient’s chart having discussed the patient’s case with senior residents, fellows and attending physicians.
  • Follow up on results of therapeutic interventions and diagnostic studies.
  • Document appropriately in the patient’s chart progress notes, event notes and procedure notes.
  • Perform bedside procedures as needed.

PGY 1 additional role/responsibilities (Prelimary and Categorical interns)

  • Carry the service pager and write daily progress notes on up to 12 patients.
  • Teach and supervise 3rd year medical students.
  • Write off-service notes at the end of an inpatient rotation.
  • Attend morning report, noon conference, and dedicated intern reports.
  • Attend grand rounds and morbidity and mortality conferences.
  • Evaluate re-distributed patients first thing in the morning on weekends.
  • Prepare an intern case presentation.
  • Participate in the gynecological and prostate review course (categorical only).
  • Complete the Teaching Residents to Teach course (categorical only).

PGY 2 and 3 Resident additional roles/responsibilities

  • Supervise intern during daily workday.
  • Supervise on-call intern with admissions/procedures/patient care.
  • Admit up to 8 patients including H&P, orders, and review with attending/fellow,
  • Evaluate re-distributed patients first thing in the morning.
  • Participate in daily rounds with attending/fellow.
  • Dictate patients discharged from his/her primary service (Jefferson only).
  • Serve on the code team and back up to the Rapid Response Team.
  • Supervise 3rd /4th year medical students.
  • Write daily progress notes if inpatient service is in excess of 10 patients.
  • Attend noon conference daily on weekdays.
  • Attend grand rounds and morbidity and mortality conferences.
  • Prepare each of the following presentations at least once throughout residency:  inpatient case presentation, ambulatory case presentation, evidence based medicine, journal club, senior seminar, and ICU/CCU case presentations.
  • Complete the ECG and Chest X-ray competency evaluations.

Electives

  • Participate in outpatient and inpatient medical subspecialty electives.
  • Provide backup to inpatient services for residents who are unable to attend to their duties due to illness or personal issues (Pull system)
  • Participate in assigned research projects.

Medical Consultation (PGY3)

  • Cardiology pre-op clearance for surgery patients
  • General medicine managment of sub-specialty patients.

Geriatrics (PGY3)

  • Evaluate geriatric patients in the outpatient and nursing home settings.

PROCEDURES performed by PGY1s:

  • Use of handwashing and sterile aspectic techniques
  • Arterial Blood Gas sampling
  • Nasogatric Tube insertion
  • Peripheral IV access
  • Rectal and Prostate Examination
  • Breast Examination
  • Any procedure that a PGY2 or PGY3 does under proper supervision

PROCEDURES performed by PGY2s and PGY3s include the procedures by PGY1s and the following:

  • Perform bedside ultrasound guided procedure techniques
  • Lumbar Puncture
  • Central Venous Line Access
  • Paracentesis
  • Thoracentesis
  • Arthrocentesis
  • Arterial Line Access