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Life of a resident at St. Michael’s exposed

Toronto, October 12, 2012

By Heather Brown

Dr. Christine McDonald (centre), a third-year resident, reviews a patient’s file with medical students Jonathan So (left), Kimia Honarmand (right of centre) and Cathryn Sibbald (right). Photo by Yuri Markarov, Medical Media
Dr. Christine McDonald (centre), a third-year resident, reviews a patient’s file with medical students Jonathan So (left), Kimia Honarmand (right of centre) and Cathryn Sibbald (right). Photo by Yuri Markarov, Medical Media

Life as a resident is hard work and no one knows this more intimately than Dr. Christine McDonald, a third-year resident at St. Michael’s.

Over the past three years of residency training, she has spent five months at St. Michael’s working on various medical services including infectious disease, endocrinology and respirology. Following those rotations she became the senior medical resident on Team D.

A senior resident has many responsibilities such as overseeing the care of the patients on her team, teaching and mentoring medical students and junior residents, assigning patients to the appropriate team members, verifying team members’ patient notes and formally reviewing and providing written assessments for each patient admitted during her shift.

When on-call, the senior resident on general internal medicine is also responsible for responding to requests from the Emergency Department to determine whether patients should be admitted for work-up or discharged home with followup. The senior resident also leads the code blue team for the hospital during the shift, managing cardiac and respiratory arrests.

“One of the most interesting aspects of being a resident on general internal medicine is having the opportunity to work on so many different patient cases both as a teacher and a learner,” said Dr. McDonald. “Working with the patients to identify what has brought them to hospital and ultimately gaining insight into their medical issues is very rewarding.”

Although every day is different in the life of a resident, Dr. McDonald shared a sample of one of her on-call rotations to help illustrate the diverse amount of work accomplished over 24 hours:

8 – 9 a.m.
Team briefing with attending physician. The group reviewed three newly admitted patients’ histories

9 – 9:30 a.m.
Bullet-rounds start. Allied health care team members, infection control and discharge planners at table to discuss patient cases

9:30 – 10 a.m.
On-call team and attending physician visited and assessed newly admitted patients and discussed their treatment

10 a.m. – noon
Divided patients among the medical students and residents and worked with discharge planners to ensure patients had their prescriptions and follow-up appointments

Noon – 1:40 p.m.
Reviewed blood work and other test results and continued inpatient rounding

1:40 – 3 p.m.
Called to Emergency Department for two patient consultations. Assessed ED patients and implemented initial management

3:45 – 4 p.m.
Returned to GIM unit and continued inpatient rounds and more family meetings

4 – 4:30 p.m.
Headed back to ED to assess the consultation patients. Entered preliminary admissions orders into the computer

5 – 5:30 p.m.
Transition/patient handover from day shift to on-call shift and received several new consultations in the ED

7 – 8 p.m.
Conducted new patient assessments, distributed consultations among students and residents

9:30 p.m.
Reviewed cases with medical students and residents

10 p.m.
Discharged patient following consultation with internal medicine staff

2 – 3 a.m.
Attended another patient consultation in the ED and reviewed more inpatient cases

4 a.m.
Reassessed acutely ill patient with junior resident

5 – 6 a.m.
Slept

6 – 7 a.m.
Checked blood work and other lab tests and reassessed patients. Prepared for 8 a.m. team briefing.

8 – 9 a.m.
Team briefing with attending physician, group reviewed newly admitted patients’ histories

9 – 9:30 a.m.
Bullet rounds. Allied health care team members, infection control and discharge planners discussed patient cases

9 – 10 a.m.
On-call team and attending physician visited and assessed newly admitted patients and discussed their treatment with them

10 a.m.
Shift over, left hospital to return at 8 a.m. the next day.