MDU-MDL v1

Med U/L General Medicine teaching services

Med U (MDU, Burnett Service) is one of three (U/L/W) General Medicine teaching services at UNC Medical Center. It is staffed solely by Division of Hospital Medicine faculty and has the unique privilege of Eric Allman, ACNP who works within the team structure. It is named in honor of Charles H. Burnett who came to Carolina in 1951 as the first chair of the Department of Medicine in the newly expanded four-year medical school. 8 bedtower is the geographic home unit for MDU.

Med L (MDL) is our newest General Medicine service, started in 2018 as Med BEST (Bondurant-Ehringhaus Service for Teaching) at the Hillsborough Campus. The service was named honoring Dr. Stuart Bondurant, Dean of UNC SOM from 1979-1994, and his wife Susan Ehringhaus. The service moved to the Medical Center in 2020 during the COVID-19 pandemic. MDL is staffed by Division of Hospital Medicine faculty, alternating with the Chief Residents. 6 bedtower is the geographic home unit for MDL.

Expectations and Responsibilities:

Teaching is an expectation and one of our three core missions. We encourage use of clinical “pearls” during daily bedside rounds AND 10-20 minute “white board” talks minimum of 3x/week. Typically these talks are focused on medical students but participation of interns and resident is welcomed. Pearl: Eric Allman ACNP offers many unique teaching pearls and topics and is a tremendous resource. Pearl: Consider checking in with Attendings who rotate before and after you to coordinate teaching topics and avoid repetition. Be clear about Expectations at the beginning of your rotation and as each new team member rotates onto the service. Provide a written list of your expectations and priorities. i. Pearl: Review Christina Kahl’s guidance on setting expectations. Feedback is a key educational tool. The DHM uses Feedback Fridays to meet individually with each team member to provide feedback and set goals.

Feedback and Evaluations MedHub is the DOM residency evaluation tool for Attendings to provide evaluations of residents you have worked with >/= 4 days. Julie Golding is the admin person who sends the links. Pearl: In order to ensure the opportunity to provide feedback to the interns and residents, you might need to specifically request a link from either the residents or Julie. Attendings receive anonymous evaluations once annually from the residency program. Pearl: In order to ensure you receive evaluations from the residents, consider directly asking for them or including this request in your expectations.

The attending should see every patient every day, independent of the team when necessary. Attendings must be available to see or staff patients in the ED or in other emergent situations. Attendings must assign themselves as the “Attending Provider” in Epic on the first day of service and for all new patients. The attendings should be signed into the team attending pager for the duration of time on service. The attending should provide 24/7 availability to the team, active involvement with team, patients and families. Responsibilities to patients and team take priority over other non-clinical duties. At time of discharge, the attending should ensure that accurate, problem-based summaries have been completed, follow-up appointments scheduled within 14 days, and “warm handoffs” provided to outpatient providers. Pearl: Eric Allman ACNP often performs the patient discharges, which is a great help to the interns.

Mobility: We still have rehab aides on 8bedtower. Strategies to be sure we are utilizing them to maximum benefit of patients: Make sure every patient has the most liberal appropriate activity order in place on admission. Early PT/OT orders if indicated. It is highly beneficial overall for the MD team to encourage, stress the importance of, and set expectation for patient mobilization during hospitalization. Communicate this regularly to the patient and family.

Typical Schedule:

Prior to 8:45 am: Independently review new admission H&Ps and updates on current patients. Independently see patients that are scheduled for morning discharge. 8:45 – 9:00 am: 8BT CAPP rounds Resident or Eric responsibility, however Attending must ensure someone attends. 8:45 am - 10:30 am: Team Bedside Rounds on selection of patients, prioritizing most ill, stepdown, new patients, and patients who present good learning opportunities for team. Rounding is a significant teaching opportunity for clinical pearls. Ideal for a team member to touch base with CM/SW when rounding and before leaving each floor (when patients non-regionalized to 8BT) Pearl: 8:45 – 9:00 interval (while resident is at CAPP rounds) can be used to see a few 8BT patients or “table round” on a few patients w/ interns Pearl: Eric is an excellent resource for relaying CAPP info on non-8BT patients 10:30 am – 11:00 pm: “Table Round” on rest of patients not seen during Bedside Rounds. i. Pearl: Cover ALL of Intern A patients first, then Intern B patients, allowing uninterrupted work time for other intern. 11:00 am – 12:00 pm: Attending alone (or with Resident) rounds on patients not seen during rounds with team and in-depth assessments of specific patients. 12:00 pm - 1:15 pm: Resident report/noon conference. Grand Rounds on Thursdays (except summer months). Afternoons: Teaching sessions for team Staff new admissions Help with patient and family meetings More in-depth assessments of any particular patients Run list with resident before departing for the day Coding and Documentation update with Specialist i. Pearl: Eric typically attends this but Attending should ensure attendance if Eric is unavailable

Resources

Eric Allman ACNP Service Line Leader: Christina Kahl MD 8BT Nurse Manager: Nikia Smith RN Toshia Swinson – CM SiZhuo (Susan) Li – CM Rose Peifer – SW Erica Potter - SW