Balanced Approach
First-rate Training Without Service Sacrifices
We have taken great pains to assure a humane, balanced residency experience as well as adequate reading and sleep time. Program designs include:
- Afternoon crossover float
- Night float resident
- No call floor teams (no overnight call)
- Dedicated critical care teams (on call every 4th night)
- Dedicated floor teams (on call every 5th night)
- Friday/Saturday Night Resident Float Coverage
- Subinterns and medical students from Boston University and University of New England on housestaff teams
- Limited patient load
- Limits on the number of admissions per 24 hour period
- 12 months of elective time during the three-year training period
- Physician Assistants in the Critical Care areas
Admission Rotation
Plan Nothing undermines excellence more than multiple simultaneous admissions. It doesn't happen in the real world of medicine and it shouldn't happen during a training experience.
By rotating successive admissions among seven eligible housestaff teams, we spare any one of the teams an overload situation, protecting housestaff morale and improving patient care. Residents have time to thoroughly and appropriately evaluate each patient before the next admission is directed to them. That assures time to take an adequate history, round up old records, speak to the referring physician, discuss an assessment and plan, write complete documentation and orders, and even teach a little on the case.
This "many team" concept also allows the "Long Call" team (who are out of the cycle until late afternoon) to be spared any admissions until they have tended to their prior inpatients, many of who are acutely ill and require detailed attention.
This small refinement demonstrates how we dovetail educational concerns with service requirements so the resident opportunity is maximized.
The average patient load per General Medical Service intern averages 6-7 patients. On average, an ICU house officer will carry approximately 2 unit patients and 2-3 maxi-care patients. In the CCU, the patient load is greater (there are many short stay "rule out MI" patients) and averages about 5-7 patients per house officer.
Intern Admission Caps: No intern shall be responsible for more than 5 new admissions in a 24-hour period and not more than 8 new patients in any 48-hour period. These limits are not invariably reached. An intern's average patient load is 6 to 7 and never exceeds a total of 12.
Resident Admission Caps: On the general medical floors, residents cap at 12 admissions. The first five admissions stay on their service, and all other admissions get distributed the next morning to the short-call teams. There is night float coverage every night that comes in at 9 p.m. and does admissions until 8 a.m.
