A Day in the Life

We talk with a pair of our residents, Akul Yajnik and Anne Arnason, about a normal day on one of our inpatient medicine teams.

Anne: Thanks for talking with us! We start off every day by getting signout from the overnight team in our resident lounge, just before 7 am. We hear about events that happened during night shift from our colleagues, as well as about new admissions that may have been admitted to our team overnight.

Akul: We have a geographic bed system, so we expect to hear about a few patients each morning that we can then assume care for in our assigned rooms. After getting signout, we head up to the team room and start reviewing the charts for each of our patients.

Anne: Often at this point we will start discussing any patients we are concerned about with our senior resident and might also start reviewing the plan with the senior resident or with a medical student, if they will be following the patient. We then go pre-round on each of our patients, making sure that we have a chance to see each of them individually before rounding with the rest of the team.

Akul: We start work rounds with the whole team a little after 9am. Most of the time, it’s led by our resident, with our attending joining for rounds one weekday per week. On the weekends, the attending leads rounds on the resident’s day off.

Anne: The structure of resident-led rounds was something unique about UPMC that really impressed me when I was interviewing. As an intern, I appreciate the flexibility of presenting to my senior resident most days of the week, and look forward to the additional leadership I’ll get to take as a resident next year leading rounds. Attendings are still incredibly available, but having resident-led rounds gives each level of trainee the chance to take on a greater degree of graded responsibility.

Akul opining about whether a patient’s shortness of breath is related to the moderate sized pleural effusion seen on the admission chest x-ray.

Anne: Rounds end in the late morning, and then we take care of some of the follow up items for each of our patients. This often includes placing any orders that weren’t placed during rounds, calling consultants, and starting to take care of a few notes.

Akul: We then go to noon conference, where we have lunch catered every day.

Anne: Today’s conference was about clinical reasoning! One of our faculty members was given a case she hadn’t seen before and worked through it as more information from the case was revealed.

Some of our residents enjoying one of our educational noon conferences.

Akul: After noon conference hour, we get back to the team room and finish up the rest of our work. This includes finishing up our notes, following up on labs or imaging, going back to the bedside to evaluate patients, and calling families to provide updates.

Anne: We’ll also hear about new patients and admit them as they make it up to the medicine floor. The senior resident and attending are always around to discuss patients and help us with the admissions.

Akul: We have dedicated teaching from our attendings in the afternoons too. The topics are myriad but are almost always customized to the clinical interests of the medical students, interns, and residents on the team.

The team hard at work, following up on a few things in the afternoon before their attending comes by for teaching rounds.

Anne: It’s been a full day, so later on in the afternoon we make sure to start working on our signout document for the night team. We want to be thorough and considerate in terms of what the night team should know about everyone we’re caring for.

Akul: We go back to the lounge around 6pm and let our colleagues on night float know about our patients and anybody we are particularly concerned about, and what we are concerned for. And that’s it! A day in the life.