Resident Responsibilities

There are no private patients and no private attendings at Mayo Clinic Rochester. Hospitalized patients are assigned to an individual resident physician who is responsible for that patient's care in the hospital and, when appropriate, for follow-up care in the resident's outpatient clinic.

While on a hospital team, residents receive appropriate supervision and daily teaching from a single faculty assigned to the team. The faculty acts as both the attending-of-record and the teaching attending for the service. Selection of faculty for teaching assignments is based in large part on resident teaching evaluations. Second and third-year residents are responsible for teaching, leadership, and supervision of intern teams. All residents receive formal instruction in these three key resident roles.

Evaluation
Performance in the six ACGME competencies (medical knowledge, patient care, professionalism, interpersonal communication, practice-based learning, and systems-based practice) is monitored carefully throughout the internal medicine residency in order to ensure that residents acquire adequate knowledge and develop appropriate technical skills. Supervising faculty members and resident peers provide feedback and formally evaluate residents after each clinical rotation. Each resident has an electronic portfolio that can be freely accessed to review evaluations. This portfolio is also a repository for evidence of ongoing learning from presentations, projects, and publications. Each resident is assigned a personal faculty advisor to provide regular feedback and guidance. During an annual review session with the program director or an associate program director, the resident's progress is reviewed. In addition, residents regularly evaluate the faculty, each rotation and the program to ensure that the educational needs of the resident are being met.

Ambulatory Clinics
Over one-third of the three-year program is spent in outpatient assignments. Experience includes general medicine continuity clinics, subspecialty consultation clinics, and the emergency room. Residents will learn to practice high-quality, cost-effective outpatient medicine during their ambulatory care experiences. Residents uniformly cite these ambulatory clinic experiences as an invaluable part of their training.

Continuity Clinic
Residents follow their own patients each week in the ambulatory care center as part of a continuity clinic firm. Mayo Clinic's primary care clinics have the following unique characteristics:

• The clinic "panel" includes new ambulatory patients as well as post-hospital visits.
• Residents are responsible for both the initial evaluation, as well as all follow-up care for the patients in their panel.
• Residents gain experience with a broad spectrum of outpatient problems, thereby enhancing their primary care skills.
• Residents work in the same "firm" of 24 residents with a group of eight supervising physicians for three years.
• A Resident Procedure Clinic provides a learning experience for a variety of ambulatory procedures.
• Patient appointments, test scheduling, chart availability, and secretarial and nursing support are all provided in a modern ambulatory care center where residents dictate their notes.
• During continuity clinic, supervising faculty are free from other responsibilities in order to focus on the learning needs of residents.

Procedures
Ample training and experience are provided to gain expertise in procedures such as paracentesis, central line insertions, arthrocentesis, lumbar punctures and tracheal intubation. All residents complete a half-day procedure-skills workshop prior to starting residency, and additional basic procedural skills workshops will be scheduled during the residency to refine these skills. Residents may access Mayo's web-based "Procedure Skills Curriculum" on the Mayo Intranet for "just-in-time" review prior to performing a procedure at the bedside. The program maintains a computerized database of procedural competence for each resident. Residents also have scheduled learning experiences in the Simulation Center.

Highly skilled allied health staff perform nearly all ancillary procedures, such as venipunctures, electrocardiograms, starting intravenous fluids, drawing blood gases, and inserting urinary catheters. This allows residents to spend more time at their patients' bedsides and in self-directed learning.

Call
Interns stay overnight on "long call" every sixth night. Second and third year residents take call every fourth to sixth night. Because allied health staff members perform all ancillary procedures, residents have time for rest and reading while on call. In addition, admission caps, service census caps, back-up procedures, and a sophisticated computerized medical record help to balance resident education and service responsibilities. Almost 50 percent of the time, residents are assigned to outpatient or consultative months without responsibility for night call.

Duty Hour Limits
Limiting workload and limiting hours worked are educationally and medically sound approaches to residency training in the increasingly intense environment of the academic medical center. In accordance with ACGME requirements, residents are not allowed to be on duty for more than 30 hours or to work more than 320 hours per month. Each resident has on average at least one day off per week. We have implemented several strategies to control workload, total and consecutive duty hours and days worked. All services have service size caps, admission caps, and duty hour limitations, often lower than those required by the ACGME. We have systems to handle overflow, overcap, floats and post call continuity clinic for intern/resident services that warrant them. Duty hours are closely monitored to ensure compliance.

Medical Students
Students from Mayo Medical School as well as a large number of visiting students rotate on many services. Since many Mayo residents plan an academic career, the students provide opportunities to develop teaching, mentoring, and supervisory skills.

Patient Mix
As a regional medical center for the upper Midwest, Mayo Clinic Rochester registered more than 338,000 unique patients last year. Approximately 80 percent of the clinic's patients are self-referred and come from within one day's drive of Rochester. Although Mayo Clinic has a reputation for successfully managing the most obscure and difficult medical problems for people from around the world, common medical concerns are actually the norm. This mix of "bread-and-butter" general medicine patients and a robust referral practice allows residents to see and treat patients with an exceptional variety of illnesses.