A Day in the Life

Internal medicine residency at SLU is premised on the idea that medicine is best learned at the bedside with active reflection and feedback to hone performance.

Our residents have roughly two-thirds of their rotations at our main teaching hospital, SSM Health Saint Louis University Hospital, and one-third at VA Saint Louis Health Care System - John Cochran Division.

A typical day looks like this:

7 a.m.

Hand over (sign out) of existing patients. Held daily at 7 a.m. for existing patients and from 7- 7:30 a.m. for new patients with night medicine admitting team at SSM Health Saint Louis University Hospital in the eighth floor Fitch Conference Room; overnight teams transfer both patient care content and professional responsibility to receiving teams. This  involves face-to-face communication with an opportunity to ask questions, and read-back critical information and tasks that need to be done.

7 a.m.–8 a.m. Existing patient care team work rounds.
8 a.m.­–9 a.m. Attending-facilitated night medicine rounds.
9 a.m.–9:30 a.m. Attending-facilitated discharge rounds.
9:30 a.m.–11 a.m. Attending-facilitated teaching rounds.
10 a.m. – 10:30 a.m. Multidisciplinary rounds (team based rounds - geriatrics).
11 a.m. – 11:45 a.m. Attending-facilitated team work rounds and discharge planning.
Noon– 1 p.m. Medicine Noon Conference: Held Monday-Thursday, these seminars constitute the core didactic training experience for residents. They are designed to comprehensively cover the biologic basis of disease including the physiology, pathophysiology and molecular biology of disease. Complementary conferences that address moral, ethical, professional, societal and systematic (systems-based practice) issues are thoughtfully incorporated into this forum.

4 p.m.– 5 p.m. Resident report (combined). Held Monday through Thursday for students, interns and residents at SLUH from 4:00 p.m. to 5:00 p.m. (or 9:30 a.m. – 10:30 a.m. at JCVAH) these conferences provide an opportunity for learners to present and discuss, in-depth, a case from a previous clinical encounter.

7 p.m. – 7 a.m. Night medicine coverage.
 

SSM Health Saint Louis University Hospital

We have five resident teams on the medical services:

  • Two interns and one resident each. Each team has a cap of 16 patients.
  • Teams rotate call where they admit all general medicine patients from 7 a.m. to 7 p.m. every five days.
  • There are two “short-call” days where teams accept no more than four overnight admissions from the night medicine service with direct sign out in the presence of the attending during sign out rounds.

We also have an uncovered service staffed by academic hospitalists. There are also subspecialty rotations on hematology/oncology, cardiology, liver, GI and nephrology.

VA Saint Louis Health Care System - John Cochran Division

 
7:30 a.m.–9:30 a.m. Teaching attending rounds (except Friday).
9:30 a.m.–10:30 a.m. Resident morning report
12:00 p.m.–1 p.m. Medicine Noon Conference
 

 

Journal Club

Held bi-weekly, two to three articles from peer-reviewed medical journals are appraised. Journal Club evaluates hypothesis testing and statistical modeling while emphasizing the application of evidence-based medicine.

Rotating Thursday Conference

On Thursdays, a rotating schedule of conferences focused on patient safety, quality improvement and medical decision-making is held. These conferences are held in lieu of noon conference and are scheduled to coincide with senior resident four-week blocks:

  • Morbidity and Mortality
  • Resident Understanding of Decision-Making Conference 
  • RightCare rounds alternating with Schwartz rounds
  • House staff meeting
Grand Rounds

Internal Medicine Grand Rounds form the cornerstone of the department's educational programs. Held every Friday at 7:30 a.m. (or 12 p.m. at JCVAH on Wednesdays), these conferences highlight important advances in basic and clinical sciences as well as state-of-the-art reviews of core medicine topics.

Curriculum

Intern Year

The first year of residency – internship – is full of diverse patient care experiences with a smattering of electives.

Highlights include:

  • Rotations are month long.
  • Continuity clinic for interns is one afternoon a week (canceled for MICU).
  • Preliminary positions have the same schedule format.
  • Holiday schedule includes a dedicated five days off (in addition to vacation) during either Thanksgiving, Christmas, or New Years. 

Our preliminary positions have the same schedule format. Intern rotations are month-long.

Rotation Number of Months
 
MICU 1
Ambulatory 2
Electives 2
Inpatient Rotations 5-6
Night Medicine 1-2
 

Categorical Second and Third Years

The latter two years of categorical residency are broken into an innovative four-week block schedule, alternating “inpatient” months with “non-inpatient (mostly ambulatory)” months. In two years of residency, there are a total of 26 four-week blocks, thus a resident has 13 inpatient and 13 non-inpatient blocks.

Continuity clinic as an upper level is during the “non-inpatient block” and consists of two half-day sessions per week for a total of eight sessions in four weeks. There is no clinic during inpatient blocks, allowing you to focus on conducting inpatient care.

This schedule is tailored to provide you flexibility in tailoring a curriculum centered on your career interests, while providing breaks between busy inpatient rotations and outpatient rotations where you have weekends off, consistently.

The rough breakdown of the schedule over those two years is a follows:

Inpatient

Rotation Expected Number of Rotations as a Senior Minimum Total of Three Years of Residency Maximum Allowed Over Three Years of Residency
 
MICU 2 3 6
Night Medicine 2 2 4
Cardiology/CCU 2 2 4
Liver Service 1 1 2
Kidney Service 1 0 2
Oncology 1 0 2
General Floors (SLUH and VA) 3 2 5
 

Outpatient

Required Elective
 
Geriatrics/Endocrine

Clinical Elective 1

Emergency Room Clinical Elective 2 
Neurology  Clinical Elective 3
Medicine Consults  Elective 1
Infectious Disease Consults Elective 2
Long term care and team-based clinic (Jefferson Barracks)  
Ambulatory 1 (no vacation) SLU – Ambulatory ICU
    1. VAMC – Acute care
      1. Ambulatory 2 – VA Acute Care
      2. Palliative care
 
 

Scholarly Activities