Orientation for Systems Based Practice (SBP) Rotation

Welcome to the SBP rotation which includes: general medicine consultation, extra clinic, patient communication, informed consent, nurse-share time, and procedures.

General Medicine Consultation

The consult service provides you with the opportunity to think about and deal with issues that do not frequently present themselves on the Firms. You will have the chance to learn how to be an effective consultant, perform pre-operative evaluations, recommend DVT prophylaxis, care for patients with anticoagulation needs, and answer a variety of questions from some very grateful departments.

The consultation service activities start around 9am (please discuss with the attending and fellow) daily at which time you will meet with the fellow or attending to begin rounding on the “old” patients. After rounds, all the new consults will be divided by the fellow/attending among the team members. The intern is then expected to attend noonconference followed by a 2PM (approximate) session with the consult attending to review a pertinent consultative medicine topic at least 3 times per week. The interns and fellow will then present to the attending all of the new patients. The day ends after all of the new consults for the day are seen by the team unless you are told otherwise by the consult attending or fellow.

We have many instances this year where there is no fellow on the team. That means you (the interns) are running the team. You will hold the gen med consult pager, round on the “old” patients with the attending, and see all of the new consults. You will also have tosign-out to the overnight covering fellow. Signing out includes both verbal and written (emailed sign-out) communication. The schedule for overnight coverage is attached to this email.

If you are unsure who the attending or fellow is, please call Lisa Williams at 7-3631.

Internet Learning- http://www.jhcme.com

SBP is a great time to get some reading done. You MUST complete 5 (http://www.jhcme.com) consult modules in the next two weeks. When you complete a module, please let Steve Sisson (ssisson@jhmi.edu) know by emailing him the CME certificate.

Communication Skills

On one Monday morning, each intern will participate in an assessment of interpersonal and communication skills. You will have many opportunities during this rotation to observe different styles and challenges in physician-patient communication, and the program feels this is an opportune time to reflect on your skill-building in this important competence. Please meet in the JHOC Sim Center at 8:00 am for a brief orientation to the exercise. The Sim Center is located on the 8th floor of JHOC; if you take the elevators by the coffee shop, it is immediately on your right as you exit the elevators. You should allow approximately 1.5 -2 hours for the exercise.  There will be some down time, but you will have access to a workstation while there. Pat Thomas (pathomas@jhmi.edu)   will e-mail you prior to the exercise with more information.

On the other Monday morning of the rotation, you will have a lecture by Mark Hughes on informed consent. Please contact Dr. Hughes via pagerbox or by e-mail (mthughes@jhmi.edu) if you do not know the exact date and time of the lecture. The lectures will generally be located on the 7^th floor of JHOC.

Nurse “Share Time” (NST)

All too often we place the discharge order and just expect the patient to disappear. We would like you to spend an afternoon (4pm-7pm) with a nurse to experience what happens after you enter that order. This will give you a greater appreciation for the complexities of the discharge process. You will also develop a better understanding as to why discharge is a transfer of care fraught with patient safety issues. Contact your home floor nurse manager (Thayer- Osler 4, Janeway- Nelson 3, Barker- Halsted 8, Longcope- Osler 4) to schedule a time. The nurse manager will connect you with the appropriate floor nurse.

Procedures

Johns Hopkins is dedicated to patient safety. The procedure portion of this course will give you the opportunity to practice procedures under the watchful eye of our local physician assistant procedure expert, David Lichtman. David runs the procedure service for the hospitalist service. He will review the best practices for each procedure (central line placement, paracentesis, thoracentesis, lumbar puncture (if time permits). One of the consult interns will be “on-call” for procedures each day of the rotation. David will page you when a procedure is about to take place. As long as you are not presenting on rounds, attending a teaching session, or evaluating a consult patient, you are encouraged to perform the procedure under David’s supervision. Please contact David to let him know that you are available to perform procedures, especially if the consult service is quiet. David can be found on pagerbox (3-2076).

Consultation Medicine Component: Residents will…

Medical Knowledge:

1.  understand how to assess a patient to determine DVT prophylaxis needs
2. learn the importance of preoperative risk assessment
3. evaluate glycemic control techniques in the hospitalized patient
4. contemplate blood pressure control in hospitalized patients
5. review common medical problems that can complicate the perioperative time period
6. learn the role of the medical consultant

Patient Care

1. make DVT prophylaxis recommendations
2. manage blood pressure and blood glucose of patients in the perioperative time period
3. evaluate and manage patients with medical perioperative complications
4. evaluate and manage patients with medical problems on non-surgical services
5. provide preoperative risk assessment to surgical services

Practice-Based Learning and Improvement

1. locate, appraise, and assimilate evidence from scientific studies related to the medical problems of patient’s on non-medical services
2. utilize EBCP to care for patients on non-medical services
3. obtain and use information about patients on non-medical services and the larger population from which these patients are drawn
4. apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness as related to patient’s on non-medical services
5. use information technology to manage information, access on-line medical information; and support their own education
6. facilitate the learning of students and other health care professionals

Interpersonal and Communication Skills

1. provide information using effective nonverbal, explanatory, questioning, and writing skills to patients, family members, and physicians on non-medical services
2. work effectively with others as a member of the comprehensive general medicine consult service

Professionalism

1. demonstrate a commitment to excellence and on-going professional development
2. demonstrate sensitivity and responsiveness to patients’ culture, age, gender, and disabilities

Systems-based Practice

1. know how types of medical practice and delivery systems differ on non-medical service
2. practice cost-effective health care and resource allocation that does not compromise quality of care for patients on non-medical services
3. advocate for quality patient care and assist patients in dealing with system complexities
4. experience work flow thorough the eyes of a medicine nurse.

Revised, June 2009