Inpatient Consult Service

Overview

• Fellows spend 7 months of their first year on Consult Service at URMC.
• There are always two fellows concurrently on the Consult service. In addition there is a dedicated inpatient GI APP on the team who assists with select consults and post-procedure admissions. 
• First-year fellows are encouraged to participate in the endoscopy on patients for whom they provided a consult, unless it is an advanced therapeutic procedure to be performed by a third year fellow.  
• Consult rotation fellows see all consults called between 8 AM and 5 PM, Monday through Friday. This will also include “hold over” consults called overnight but not seen by the on-call fellow.
• During the first few months of the academic year, first-year fellows are expected to run all cases by a senior fellow or attending for a quick triage
• The consults are presented by the fellows (and/or any medical residents/students rotating on the GI Consult Service) to the Attending during teaching rounds at a pre-arranged time.
• The fellows will participate in the selection of educationally appropriate consultations for the medical residents and students.
• Fellows will be required to “pre-round” on selected active inpatients, maintain an up-to-date list of active consultations including a written sign-out, carry the consult pager, provide telephone triage and communication to the primary teams, and follow through on all relevant GI clinical care on their patients. Any patient’s who are “signed-off” must have a clear follow-up plan outlined if applicable.
• There is a small “GI Service” for IBD flare and post-procedure admissions which will be admitted under the primary consult attending with assistance of a hospital APP. Fellows and the inpatient GI APP will also be responsible for the clinical care of these patients under direct attending supervision.
• Fellows will work closely with the endoscopy unit charge nurse to facilitate inpatient endoscopic procedures. There is a full compliment of ancillary staff available to assist with setup and performance of the procedures.

Principal Teaching/Learning Activities

Teaching rounds:

• Pertinent bedside history and physical examination teaching
• Discussion of differential diagnoses and the clinical data used to support them
• Discussion of recommendations and plans and review of pertinent medical literature to support such recommendations
• Review of pertinent Radiologic studies
• Review of Pathology may be deferred to the combined GI-Pathology conference unless an urgent review by the Consult team will affect patient management.

Problem Mix/Patient Characteristics/Types of Encounters

• Consultations from all over the hospital (URMC)
  • Emergency room
  • Acute care clinics
  • Various Strong Memorial Hospital Intensive Care Units, surgical floors, OB/GYN floors, general medical floors, Wilmot Cancer Center units, psychiatric floors, and to some extent from the Pediatric floors (teenagers).  
• Exposure to a wide variety of consultative questions 
  • Fully embrace the complete lists of clinical disorders and clinical problems as contained in the outline of the ACGME Specific Program Content within Program Requirements for Residency Education in Gastroenterology. 
  • Patients may be critically ill, in need of urgent stabilization, post-operative, acutely ill, convalescing, or ambulatory.
• Exposure to Hepatology
  • General Hepatology during Inpatient Consult rotations, all attending’s clinics, and own Fellow’s Longitudinal Clinic
  • Eight months of rotations though outpatient and inpatient Transplant Hepatology