The general Inpatient Medicine rotations at UConn John Dempsey Hospital, Hartford Hospital and Saint Francis Hospital and Medical Center have similar team structures. Teams generally consist of a one resident/one intern pair as well as a third or fourth-year medical student. One attending is typically assigned to each team.
All of the ACGME duty hour regulations are strictly enforced. Interns work less than 80-hours per week when averaged over four weeks and get one day off in seven, including an entire weekend on each of their ward call rotations. Intern caps are set at no more than 10 patients. Interns may admit no more than five new patients on any call night. All of our hospitals have hospitalists who act as ward attendings and all sites have an active off-service policy.
The interns have primary responsibility for patient care including daily progress notes, developing a management plan, and interacting with patients, families, and attending physicians. Interns and residents are also given the responsibility to perform all procedures on their patients with appropriate supervision. Residents are responsible for supervising interns and students on inpatient services. Residents enjoy considerable autonomy in their decision-making but always have appropriate guidance and support from faculty attendings. All housestaff have access to medical subspecialty services or non-medical subspecialties for consultation purposes.
All sites have patient populations ranging from adolescents to the elderly. Patients with a wide variety of problems, from common general internal medicine problems to unusual problems cared for by subspecialty services, are admitted to the General Medicine service. Some patients are admitted with acute, catastrophic illnesses; others with exacerbations of chronic illnesses. All socioeconomic groups are represented. Patients are admitted from the General Medicine and specialty clinics, Emergency Department, and private offices. About 60% of the patients on the teaching service are covered by private insurance while the other 40% are a mixture of uninsured and Medicaid patients.
The educational curriculum at each site includes a full schedule of daily conferences including residents' morning report, bedside attending rounds, Grand Rounds, professor rounds, morbidity and mortality conference, autopsy conferences and advanced physical diagnosis rounds. Each site also holds a weekly morning report specifically for the interns to help them become independent in developing diagnostic and management plans.
Topics from the core curriculum are covered in our innovative web-based noon conference curriculum. During the summer months, the series of noon conferences at each site focuses on acute medical emergencies that interns are likely to encounter while on call. These problem-based conferences are presented by upper level residents and focus on the acute management of common medical emergencies.