MUSC & VA Night Float

Educational Purpose:

The Night Float rotation is designed to give Medicine residents a broad-based experience in managing acutely ill patients spanning the entire domain of Internal Medicine. It is designed to develop the clinical skills necessary to diagnose and treat undifferentiated medical patients with a wide range of illnesses. The rotation provides each resident the opportunity to perform the initial history and physical on recently admitted patients as well as initiate directed therapy based on initial findings. The Night Float rotation is staffed with upper level residents (PGY 2 or higher). 

Goal:  Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. 

Residents are expected to:

PGY 1

PGY 2 and 3

1. To develop differential diagnoses and formulate a treatment plan on acutely ill patients.
2. To manage the inpatient illnesses which are commonly cared for by the general internist, cardiologist, gastroenterologist, nephrologists, hematologist/oncologist, and pulmonologist.
3. To understand appropriate pain control and the tenets of end of life care.

Medical Knowledge Goals and Objectives:

Goal:  Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care. 

Residents are expected to:

PGY 1

PGY 2 and 3

Practice-Based Learning and Improvement Goals and Objectives:

Goal: Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life long learning.

Residents are expected to develop skills and habits to be able to:

PGY 1

PGY 2 and 3

Systems Based Practice Goals and Objectives:

Goal: Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.

Residents are expected to:

PGY 1

PGY 2 and 3

1. To enhance the residents’ history taking and physical diagnosis skills.
2. To effectively lead an interdisciplinary team and to help teach other residents and students.
3. Supervise interns, medical students and help to formulate immediate care goals and facilitate long-term care plans.

Professionalism Goals and Objectives:

Goal: Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.

Residents are expected to demonstrate:

PGY 1

PGY 2 and 3

1. To understand the importance of transition of care and participate in meaningful patient hand-offs.

Interpersonal and Communication Skills Goals and Objectives:

Goal: Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates.

Residents are expected to:

PGY 1

PGY 2 and 3

1. To demonstrate interpersonal skills and to communicate effectively with patients and families.

Teaching Methods:

The majority of teaching on the Night Float rotation is case-based at the time of clinical encounters and during Morning Report. This teaching can include demonstration of history taking or examination skills, modeling communication or Socratic exploration of medical knowledge. The Chief Residents will also conduct didactic sessions on occasion during Morning Report and through General Medicine consults at the VA. Residents are expected to attend Morning Report three days per week and present cases admitted during the rotation, as well as Medical Grand Rounds, held once weekly.

Mix of Diseases and Pathological Material:

Residents care for patients with a wide variety of clinical syndromes including chest pain, coronary artery disease, CVAs, CHF, diabetes mellitus, DKA, pneumonia, COPD, asthma, pyelonephritis, acute and chronic renal insufficiency, SLE, vasculitis, dementia, and many others.

Patient Characteristics:

Residents care for a diverse patient population with respect to age, ethnicity, and gender. The majority of the patients are older adults, but there are significant numbers of adolescent and young adult patients in some sites.

Types of Clinical Encounters:

The Night Float rotation takes place in the Medical University Hospital and VA Hospital. Patients are admitted to MUH through 1W emergency rooms, from the outpatient clinics, transfers from other inpatient services, ICU transfer, and transfers from outside hospitals. Transfers are admitted to the VAH through Urgent Care, VA outpatient clinics, transfers from other inpatient services, and transfers from outside facilities.

Procedures and Services:

Residents often have the opportunity to perform many procedures on the Night Float rotation. Common procedures include central venous access placement, paracentesis, and thoracentesis, among others.  Residents are expected to interpret all EKGs and chest x-rays performed on their patients.

Supervision:

All procedures are appropriately supervised by a fellow or attending physician. 

Educational Resources to be Used and Reading Lists:

The residents have access to all major Internal Medicine textbooks, electronically and in print form. Additionally, the house staff is expected to pull journal articles appropriate to the care of their patients. Up-To-Date is available on any computer in the MUH and VAH in addition to eMedicine, MD Consult, etc.

Method of Evaluation of Resident Competence:

Residents are evaluated using the global evaluation form. Patient Care is assessed based on direct observation and complete review of all records. Medical Knowledge is assessed through direct questioning and observation. Interpersonal Skills and Communication is assessed by observation of interactions with patients and families. The attending and/or Chief Resident evaluates Professionalism through direct interaction and observation of the resident. Systems-Based Practice is evaluated based on interactions with the multidisciplinary team and based on the assessment of the discharge planners. Practice-Based Learning is evaluated based on the ability to consult the literature and to improve their performance throughout the rotation. Residents may receive evaluations throughout the rotation and at the close of the rotation. The residents evaluate the rotation and the attending physician through the E*Value system. The Chief Resident reviews all rotation evaluations and supplies a comprehensive evaluation of the resident based on performance over the month.