One of the most challenging aspects of being a full-spectrum, team based primary care family physician is being prepared to care for highly complex, multi-system impaired patients who rely heavily on Urgent Care and Emergency Services for their often unstable conditions. These patients are often hospitalized at great cost to them, their families and the health system for exacerbations that could be managed in a well-run team based primary care setting. One of the most important aspects of learning to care for these complex patients is doing a thorough and efficient history and physical exam---pinpointing which conditions are deteriorating, at what pace, and what immediate interventions might shift them back into balance, thus eliminating the need for hospitalization. Often first year residents are not given the chance to focus solely on Admissions, with multiple double-jeopardy distractions like cross covering units, going to the operating room, etc. In order to provide residents with optimal learning around complex patients, we developed a very unique Evening Admit rotation for the second half of the first year. This rotation is supervised by professional Nocturnist who are highly skilled at doing efficient and effective admits in the middle of the night. The shift hours are right at the peak of admissions, to assure maximal experience during this three-week rotation.

Goals and Objectives:

  • Focused, timely history and physical examination and initial management for complex, newly admitted patients to inpatient services.
  • Real-time hand-overs in a structured way from daytime teaching services.
  • Effective engagement with supervising Nocturnist and consultants to set framework of care and breadth of differential and treatment plan.

Location(s): Residency Practice, Concord Medical Center

Distance from Family Medicine Residency Practice: 0.0 m – 6.0 m

Admits Sample Schedule, Education Experiences:

  Monday Tuesday Wednesday Thursday Friday
AM 1 PM - 5 PM Team Based Clinic 1 PM - 5 PM Team Based Clinic 1 PM - 5 PM Team Based Clinic Workshops 1 PM - 5 PM Team Based Clinic
PM 7 PM - 2 AM Admits 7 PM - 2 AM Admits 7 PM - 2 AM Admits 7 PM - 2 AM Admits 7 PM - 2 AM Admits


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