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Attending Expectations

Department of Medicine Teaching Service Attending Expectations

These are expectations created by the Department of Medicine for teaching attendings acrossservices. Beth Ann Brubaker Jen McEntee are available for any additional questions or concerns. - Inpatient attendings are chosen selectively. It is a privilege and an honor to serve as an inpatient attending. Division leadershipmaintain the right to selectively include or exclude individuals from attending if they fail to meet established department-wide expectations and/or receive negative resident evaluations. Serving as an inpatient attending is a full-time job and any accompanying responsibilities must be prioritized over all other professional duties while on service. - Attendings maintain the highest level of availability. - Attendings remain available 24/7 during rotations. - Outpatient clinics and procedures limited as much as possible. - Each attending commits to seeing patients independent of the team when necessary. - Before and after work rounds, attendings remain available to the MAO to discuss pending admissions when requested. - Attendings are available to see or staff patients in the ED or in other emergent situations. - Each service is expected to admit daily.

  • Attendings serve a minimum of 1 month per year on an inpatient service. In order to remain familiar with and expectations, a minimum of 1 month per year will be expected of all participating attendings. Rare exceptions may be made.
  • Attendings prioritize continuity of patient care and education.
  • . There may be exceptional circumstances, which will require the approval of the Chair.

  • The outgoing attending initiate a verbal “sign-out” (ideally, face-to-face) with the incoming attending. Within reason, the outgoing attending remain available to the incoming attending for further communication and follow-up questions.

  • Attendings remain flexible to any given team’s educational format. Based upon the daily responsibilities and needs of each service, attendings approach the education of any team with a commitment to react and adapt on a daily basis. If the service is exceptionally busy, the attending and the team prioritize completion of rounds and allocate time outside of rounds to provide educational opportunities (presentations, lectures, etc.). Attendings provide daily feedback to night float residents prior to the next night’s shift.

  • Attendings adhere to an established schedule of rounds; they will begin by 8:40AM and end by 11:00AM. Bedside rounding is the expectation for appropriate patients for all services. (Please see Ideal Day for Inpatient Preceptors below) Attendings, independent of the house staff, establish familiarity with and knowledge of each patient on the service prior to making rounds with the team. Barring unforeseeable emergencies or incidents, prior knowledge of each case is necessary as attendings will no longer receive exhaustive presentations on patients while making rounds. Time to receive and provide feedback on in-depth presentations should be scheduled outside of work rounds. Completion of rounds relies on the expectation that attendings will see patients with or without a resident outside of rounds. This includes patients in the ED.
  • The order/format of rounds will be prioritized as follows:
  • Unstable Patients
  • Transfers/Admissions
  • Discharges
  • Stable Patients Within these guidelines, attendings work with the resident/intern to flexibly determine the exact order of rounds based on the needs of the day. Attendings are responsible for patients already admitted to the service remain in the ED awaiting an open floor bed. During this interim period, the attending is expected to prioritize the care of these incoming patients. At the time of discharge, attendings ensure that discharge summaries have been completed, follow-up appointments have been scheduled within 14 days, and outpatient providers have received a “warm handoff” of the patient.
  • Participation in CAPP Meetings. Physician participation is expected by either a resident or attending. However, current knowledge of dispositions is the responsibility of all providers on the team.

IDEAL Day for Inpatient Attendings on Teaching Services:

We appreciate all of the work that you do We look forward to continuing to collaborate with you in creating this new workflow and making it work for all parties involved.

7:45- 8:30 (M,W, F) – Attend morning report in 133 MacNider

Prior to 8:30 – please review H&P, daily changes on current patients, and see patients who are going to be discharged that day (patients discussed day prior during afternoon DC rounds and additional discharges that have been identified by your senior resident)

8:301– Round with team (discuss with Resident to identify order of patients to be seen: most ill, stepdown patients, good teaching patients).

  • 12:00 – Independently see patients that were not seen on rounds (may be patients who are in the hospital primarily for disposition with no active issues)

12:00 - 13:00 – Attend conference

13:00 - 17:30 – Continue working, participate in family discussions, staff admissions, arrange teaching times AND TEACH