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Cardiology Inpatient Teaching Service Expectations

General expectations for ALL students

I. Organizational structure:

  • First day of service report at 8 am to 4042 RCP (Cardiology Teaching Team Room)
  • Provide residents and faculty with your contact information
  •  Introduce yourself to the 4RCE and 4RCW clerks on the first day
  •  Day off:  core students Sunday; subinterns either Saturday or Sunday
    • Core students:  Sundays; Clerkship directors must approve any other day off in advance
    • Subinterns:  either Saturday or Sunday to coincide with senior residents day off
  • Daily Admissions:   8:00 AM to 5:30 PM or until a team cap of 12
  • Night call is not expected.    For the subinterns only, ONE night call may be taken during your General IM rotation on 6RC
  • Make every effort to learn as much as possible during this rotation and demonstrate your interest in learning to the team

II. Patient care:

  • Round daily in the morning with the Cardiology teaching team
    • Present patients in SOAP format on daily care rounds
  • Work up at least one new patient daily and present to the Cardiology attending
  • Stay up-to-date with normal and abnormal test results
  • Always make sure your patients are aware of the plan

III. Educational responsibilities:

  • Each week identify at least 3 skills you would like to work on while on this service, share them with the team and work to achieve your educational goals
  •  As early as possible, let your attending know  of specific cardiac procedures or tests that you wish to observe
  • Attend  educational sessions:
    • Clerkship specific teaching sessions
    • Resident Core Conferences
    • Internal Medicine Grand Rounds
    • Cardiology Teaching sessions (work room and daily rounds)
    • Cardiology Fellow Conferences (optional)

IV. Communication:

  • Documentation:
    • Write admission notes and daily progress notes in electronic medical record
    • Write/pend orders and immediately notify the senior resident of availability to sign in EPIC
    • Contribute to discharge summaries (work with 4RC nurse navigators,  social workers, pharmacists, interns, and residents on discharge planning)
  • Write and practice patient hand-off
  • Attendance/observation at one goals of care discussion is strongly recommended

Student expectations based on level of training

Core Clerkship Students (M2/M3)

Advanced Clerkship/Subinterns (M3/M4)

1. Supervision 1. Supervision
Function under supervision of the team (interns, residents and cardiology attending) Function semi-independently with a level of responsibility and supervision similar to a first year resident.   Supervision is by cardiology attending and senior residents
Learn through a process of observation and controlled participation in patient care. Admit patients in the presence of your team members. Independently interview and examine patients, formulate clinical reasoning, differential diagnosis, and share your final assessment and plan with your senior resident and cardiology attending.
Interns and senior residents remain the primary point of contact for all your patients.

As soon as you admit the patient, put your name and a pager number in EPIC  as ‘Primary contact person’, so that floor clerks and nurses can communicate with your directly:

-- click on ‘Attending’ name >> ‘Open Treatment Team’ >> ‘Add me’, chose relationship ‘1st Contact or Resident >> Accept.

Let the subinternship program director know if you are not being directly contacted by the nursing staff regarding your patient matters despite your efforts to improve such communication.
Learn as much as you can from every patient you come across. Learn as much as you can from every patient you come across. It is strongly recommended that you engage yourself in any interesting patient cases or clinical concepts, review literature and share it with the team.
2. Number of patients 2. Number of patients
Follow 1 or 2 patients  Follow at least 2 or 3 patients.  Discuss a total number of patients that you wish to manage beyond this expectation with your team
3. Communication 3. Communication
Observe and practice doctor-patient communication skills with all patients Practice doctor-patient communication skills, using the PEEER Model and complete self-evaluation for at least 2 patients
Make every effort to attend weekly clinical case presentations by during ‘tea time’ (6RC) and actively participate in small group discussions. Once during your subinternship, during a ‘tea time’ (6RC) you will be required to present one of your patients for students, interns, residents , chief residents and staff.
4.  Patient notes 4.  Patient notes

Final sign your note in EPIC (no cosign)

Request verbal feedback on each Admission and Progress note from staff and residents

Final sign your note in EPIC (no cosign)

Each week, print at least one Admission Note and at least one Progress Note to allow for verbal feedback from residents and staff.  Also use a rubric self-assessment tool downloaded from ICON/Canvas  each week to document progress in effective note-writing skills
5.  Evaluations 5.  Evaluations
At the end of the 1week, initiate evaluations to Interns, senior residents and cardiology attending At the end of the 2 weeks, initiate evaluations to cardiology attending and senior residents.

Expectations for Cardiology Faculty and Internal Medicine Residents

  • Review expectations with student as well as Goals and Objectives  on first day
  • Serve as a role model [research studies have shown that clinical skills, personality and teaching abilities were the most important characteristics making physicians excellent role models in the eyes of their students; Wright S. et al, The impact of Role Models on Medical Students. J Gen Intern Med 1997;12:53.
  • Encourage student participation on rounds and highlight aspects of patient care from all patients on the service
    Note, clerkship students and subinterns are currently not ACLS certified
  • Emphasize student’s clinical decision-making skills and development of management plans
  • Highlight aspects of the evaluation and management of the patient with cardiovascular disease.
    Make sure that students, especially subinterns, are exposed to a variety of different cases during their rotation. The following are common cardiac conditions that students should be exposed to: chest pain with high probablility for ACS, non-cardiac chest pain, pericarditis, atrial arrhythmias, systolic heart falure, diastolic heart failure, valvular heart disease, hypertensive emergency, and many others.
  • Focus part of teaching to level of student;  spend time each day reviewing a topic with the student
  • Give verbal feedback to students on both written documentation and oral presentations
  • Be supportive of students’ educational venues 
  • Encourage students, especially subinterns, to review the literature relevant to aspects of patient care and share with the team.  Consider mentoring student to present interesting cases at local ACP Chapter Clinical Vignette competition
  • Provide opportunity for students to observe goals of care discussion
  • At the end of the rotation, students will send you an e-mail with a link to electronic Evaluation. Complete the online evaluation within one week as  any delay in completion of your evaluations will lead to delays in final grade completion and may require Dean’s approval (refer to the attached evaluation anchors). Comments regarding student’s skills as well as specific examples of the student’s contributions to patient care should be provided, including mini-literature searches and leading discussions.


  • The emphasis on this service will be on learning to:
    •  take a good cardiac history
    • perform a good cardiovascular exam
    • order and interpret appropriate imaging/testing in the patient with cardiovascular disease
  • Core topics required on inpatient internal medicine core clerkship relevant to cardiology include:
    • Acute coronary syndrome
    • EKG interpretation
    • Telemetry skills and interpretation
  • Additional topics
    • Assessment of the patient with heart failure
    • Severe aortic stenosis
    • Appropriate management of atrial fibrillation and atrial flutter
    • EPIC rounding tips: rounding reports