During the third year of residency, all residents experience a two or four week rotation on the medical consult service either at BMC or the West Roxbury VA. Residents have the opportunity to work with other disciplines in the hospital, including surgery, neurology, obstetrics/gynecology (BMC), rehabilitation medicine, and psychiatry (VA). In addition, we co-manage all hip fracture patients with the orthopedic service. This experience ensures that residents develop expertise in the clinical and interpersonal skills essential to internal medicine. There is also a significant outpatient experience in the preoperative clinics both at BMC and the VA, where emphasis is placed on optimization of cardiac and other medical risk factors in the time surrounding surgery. Residents assess preoperative patients in the Internal Medicine Preoperative Assessment Clinic (IMPAC) at BMC or Cardiac Risk Assessment Clinic (CRAC) at the VA.
Working closely with a core group of General Internal Medicine faculty, residents will learn the general principles of preoperative risk evaluation and management. They will evaluate the patient’s known medical problems, assess the associated surgical risk, address previously unrecognized medical problems and optimize treatment of all medical problems prior to surgery. Other core topics that residents will learn during this rotation:
- The preoperative evaluation and use of laboratory testing
- Perioperative medication management including the treatment of the hyperglycemic patient and the patient on anticoagulation
- Cardiac risk stratification and risk reduction before noncardiac surgery
- Identifying and reducing risks for pulmonary complications
- Minimizing perioperative complications in patients with renal insufficiency
In addition to learning the management of the above issues, the resident will also learn how to appropriately provide a consult and demonstrate an investigative and analytical approach to consults.