Residents spend around 2 months per year on the General Medicine, with time split between the Integrated Teaching Unit (ITU) and the General Medicine Service (GMS). Both services care for a diverse range of patients including underserved patients from the Boston area and patients transferred from around New England for tertiary or quaternary care. The services make use of a twilight system, in which a resident-intern pair come to the hospital in evening to help take over patient care responsibilities from the day team.
Brigham medicine services also have regionalized care, with at least 80% of each team’s patients all on the same unit. The benefit is that this allows residents, nurses and the rest of the interdisciplinary team to work together closely to provide optimal care for our patients. The services both place a large emphasis on teaching and have dedicated time each afternoon for didactics.
The Integrated Teaching Unit (formerly Intensive Teaching Unit) is a core general medicine rotation for all housestaff that was the result of an innovative research project in medical education. The service is uniquely designed to provide more time for teaching by creating a team structure that allows for more clinicians to care for each patient. The team is comprised of two attendings (one generalist and one specialist), two residents, three interns and two medical students; the teams have the same cap as the GMS teams, which results in fewer patients for each intern and more time to be present on rounds. The team is led by one the residents, with the other resident focusing on the more mundane tasks enabling the interns to focus more on their presentations and learning from the attendings and teaching resident; the resident alternate roles each day.
One of the incredible strengths of the ITU is the ability to learn from multiple senior clinicians discuss patient care approaches, and teach about physical exam findings, cost-effective medicine and clinical reasoning on many patients. Additionally, having a specialist on the services allows for a unique insight into that specialty’s approach to patients and consults. Finally, the Chief Residents also rotate as attendings on this service.
The General Medicine Service is the more traditional medicine service with one attending, one resident and two interns per team. Similar to ITU, the interns present all the patients and are responsible for all patient care orders and consults. The resident functions as the leader and teacher of the team both on rounds and at the afternoon sessions, with the attending functioning to help teach and provide clinical insight. A typical census for the team is around 16-18 patients (8-9 per intern) with the average length of stay of 3 days.
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