Inpatient Expectations

Clinical inpatient expectations vary based on clinical setting, specialty, attending, and context. This document outlines the expectations for each member of the inpatient hospital team. It is important for all team members to be aware of their roles and responsibilities in order to provide the best possible care for patients. 

Expectations by RIME Mneumonic

Reporter (Interns > Medical Students)

• Gathering clinical information: Reporters are responsible for gathering clinical information on each of their patients. This information may include the patient's medical history, physical exam findings, and diagnostic test results. Reporters should be able to gather this information accurately and reliably.

• Communicating clinical information: Reporters are also responsible for communicating clinical information clearly, both verbally and in writing. They should be able to communicate the information in a way that is understandable to other members of the healthcare team.

• Distinguishing important information from unimportant information: Reporters should be able to distinguish important information from unimportant information. They should focus their data collection and presentation on the central issues.

Interpreter (Interns/Sub-Interns > Medical Students)

• Identifying problems independently: Interpreters are responsible for identifying problems independently. They should be able to identify problems, including new problems, as they arise.

• Prioritizing problems: Interpreters should be able to prioritize problems. They should be able to decide which problems are the most important and need to be addressed first.

• Developing a differential diagnosis: Interpreters should be able to develop a differential diagnosis. This means that they should be able to come up with a list of possible diagnoses for a patient's condition.

• Making a case for and against each diagnosis: Interpreters should be able to make a case for and against each of the possible diagnoses for a patient's condition. This means that they should be able to explain the evidence for and against each diagnosis.

Manager (Attending and Senior Resident > Interns/Sub-Interns)

• Developing and defending a diagnostic and therapeutic plan: Managers are responsible for developing and defending a diagnostic and therapeutic plan for each of their patients' central problem(s). This means that they should be able to come up with a plan for how to diagnose and treat the patient's condition. They should also be able to defend their plan to other members of the healthcare team.

• Utilizing clinical judgment: Managers should be able to utilize their growing clinical judgment to decide when action needs to be taken. This means that they should be able to make decisions about the patient's care based on their knowledge, experience, and intuition.

• Analyzing the risk/benefit balance of specific diagnostic and therapeutic measures: Managers should be able to analyze the risk/benefit balance of specific diagnostic and therapeutic measures based on an individual patient's circumstances. This means that they should be able to weigh the potential risks and benefits of each treatment option before making a decision.

Educator (Attending > Senior Resident)

• Mastering the fundamental skills described above: Educators have mastered the fundamental skills described above. This means that they are able to gather clinical information, communicate clinical information, identify problems independently, prioritize problems, develop a differential diagnosis, make a case for and against each diagnosis, develop and defend a diagnostic and therapeutic plan, utilize clinical judgment, and analyze the risk/benefit balance of specific diagnostic and therapeutic measures.

• Defining important questions to research in more depth: Educators have the insight to define important questions to research in more depth. This means that they are able to identify areas where there is a lack of knowledge and to develop research questions that can help to fill that gap.

• Seeking out the evidence behind clinical practice: Educators have the drive to seek out the evidence behind clinical practice. This means that they are able to find and evaluate research studies that can help them to make informed decisions about patient care.

• Scrutinizing the quality of this evidence: Educators have the skills to scrutinize the quality of this evidence. This means that they are able to assess the validity, reliability, and relevance of research studies.

• Taking a share in educating the rest of the team: Educators take a share in educating the rest of the team. This means that they are able to teach other members of the healthcare team about clinical topics.

Expectations by Role

Quick note on staff vs non-staff: attendings, residents, nurses, and pharmacists are employees of the hospital. They are paid to perform their responsibilities and are expected to do perform their job functions while learning and improving. All other students and observers are primarily here to learn. They can assist the team in patient care with progressively increasing supervised responsibilities, but they are ultimately being evaluated on their progress as learners.

All Team Members

• Patient Saftey: anyone on the team is expected to speak up if a patient seems unstable or if they disagree with a course of action

• Teamwork: Ask for help if you can't get your job done on time, especially when it will affect other team members or patient care. Offer to help others when your job is complete

• Communication: try not to interrupt each other, update people on patients that they are assigned to, speak up when you're concerned

• Feedback: seek it midway through your rotation and at the end, if you plan on writing feedback that is less than positive consider

• Reminder: Every day is a fresh start. Keep trying to improve until you exceed the expectations of your role. Leave at a reasonable time!

Attending (RIME)

• The attending physician is responsible for the overall care of the patient. Things they say should be performed and documented

• Assigned patients: every patient on the list

• Needs: support in gathering all information needed to care for a patient

• Responsibilities: lead rounds, oversee all management, educate when time permits, attest notes, anticipate logistical issues

Senior Resident (RIME)

• Needs: feedback

• Assigned patients: every patient on the list

• Responsibilities: oversee all responsibilities of interns and medical students, communicate key information to attending, review all clinical documentation written by team, educate when time permits, documentation of discharge summaries, communicate with consultants, complete sign out for night team

• When your job is done: help teammates, educate team on common topics

Intern (RIME)

• Needs: specific feedback, progress to senior resident

• Assigned patients: between one third and one half of the patient list

• Responsibilities: pre-rounding on all assigned patients, present assigned-patients during rounds or support medical student, basic orders (electrolytes), AM labs, co-manage with senior and attending, documentation of H&Ps and progress notes.

• When your job is done: help teammates, aim to perform some functions of the senior resident if neeed

Sub-Intern/Observer (RIME)

The sub-intern or observer is a medical student who is rotating through the inpatient hospital service and aiming to function at or above the level of an intern but with direct oversight from the senior resident

• Needs: specific feedback, letters of recommendation

• Assigned patients: about 2 or 3 patients

• Responsibilities: know everything about the patients you are assigned to

• When your job is done: help teammates

Medical Student (RIME)

• Needs: specific feedback, letters of recommendation, direct supervision

• Assigned patients: about 2 or 3 patients

• Responsibilities: know everything about the patients you are assigned to

• When your job is done: help teammates

Pharmacy

• Needs: orders, communication

• Responsibilities: monitoring patient medications and possible side effects

Nursing

• Needs: orders, communication

• Responsibilities: administer medications, monitor vital signs, and provide patient education.

Patient

Believe it or not the patient is a member of the team! For patients with capacity, all medical decisions should be made in collaboration with patient. In addition to having an attending, senior resident, and nurse, every patient should be assigned an intern or sub-intern, and a medical student (if available)

• Needs: medical expertise, supervision of medical care

• Responsibilities: share symptoms and progress