Residents and attendings from all disciplines attend morning report to review and discuss an interesting case.
A Day in the Life of an R1
7–8 a.m. — R1 pre-rounding
Each day, R1s will follow an average of five to eight patients. They use pre-rounding time to get sign-out from the R1 on-call the night before, discuss events with the nurses, review flow sheets, examine their patients and talk to families.
8–8:30 a.m. — Work rounds
The entire team meets in the team room to organize their work and patient care for the morning. The team consists of medical students, sub-interns, interns, senior residents, an attending, a care coordinator and team coordinator. This is also an opportunity for brief teaching sessions.
8:30–9 a.m. — Morning report
Residents and attendings from all disciplines attend morning report to review and discuss an interesting case. Morning report is run by the chief residents.
9–11:30 a.m. — Rounds
Ward teams meet and round after morning report. Teams “walk round” to each patient’s room. As a part of “family-centered rounds,” patients and their families, nurses and social workers join the medical team to plan care for the patient. The team coordinator facilitates rounds and performs administrative duties for the team throughout the morning. Bedside teaching by general medicine and subspecialty attendings occurs daily during this time.
11:30 a.m.–12 p.m. — Work rounds
The focus of this time is to help the post-call intern complete work, including sign-out, in preparation for getting everyone on the team to noon conference. This is also protected time to talk with consultants, touch base with primary care providers or perform other patient care prior to noon conference.
12:15–1 p.m. — Noon conference (Monday, Tuesday, Wednesday and Friday)
Faculty members from various disciplines present topics in a variety of formats. Lunch is provided. Evaluations are collected in order to improve the following year’s curriculum.
12:15–1 p.m. — Intern support group (Thursday)
Once weekly, senior residents take their interns’ pagers so that the R1s can participate in this session. The group is facilitated by a social worker, and the time is an opportunity for interns to confidentially share their experiences and partake in delicious snacks!
1–5 p.m. — General patient care
R1s follow up on issues or tests ordered on their patients. If on-call, they meet and admit new patients while being supervised by their senior resident. This is also a time when general medicine or subspecialty attendings teach on topics relevant to the team’s current patients. In addition to reviewing radiology images on our PACS system, residents also have the opportunity to review these films with a pediatric radiologist.
1–5 p.m. — Continuity clinic
Throughout the three years of training, residents follow a panel of patients at one of several community clinic sites. Continuity clinic is scheduled for one half day every week.
5 p.m.–7 a.m. — On-call
While on the wards, R1s are paired with a senior resident and take call every fourth night. On call, R1s will admit and work up new patients while also providing care to the remaining patients on their team until the following morning.
A night float system is in place to provide relief for admitting teams so that interns are protected from most new admissions after 11 p.m., allowing them to finish their work and usually get some sleep.