Acting Consultant on Inpatient Service (3rd year consults)

Overview

• The goal of this rotation is to provide a significant demonstration of the progressive growth, independence, maturity and clinical consultative skills of our GI fellows prior to their graduation 
• Two separate 2-week blocks, in the latter half of the third year of fellowship, where senior fellows will function on the inpatient consult service as nearly independent “acting” consultants
• Paired with one first year fellow on the inpatient consult service, but will function and interact differently with the supervisory attendings than they did as first year fellows
• Senior fellows on service perform all duties and responsibilities expected of the consult fellow. They will divide the consultation cases equally with the first year fellows, according to the usual distribution patterns established by the fellows (dependent on individual clinic schedules)
• The third year fellow functioning as an “acting consultant” is expected to independently assess and make arrangements for the evaluation/management of the patient
• The third year fellow is required to competently review the case with the attending on consult service
• May choose to round with the consult service attending, or allow the consult service attending to round independently on the patient
• It is the expectation of the program leadership that the consult service attending will accord the fellow “acting” consultant the clinical latitude for independent decision making, while maintaining oversight that appropriate clinical standards of care are met
• Disagreements must be discussed between the attending and the fellow
• The consult service attending will have the final and binding decision making capacity regarding the disposition of clinical issues
• The fellow as “acting” consultant is expected to participate in procedures that they have recommended for the patient, in exactly the same way that they would be expected to do so as a recently graduated private attending consultant

Principal Teaching/Learning Activities

• Conduct completed evaluation of a patient, and then review the case for the supervising consult service attending.
• May be done verbally, or at the discretion of the attending, by immediately and jointly rounding on the patient
• If the attending is not available to immediately round on the patient, then it is the expectation of the program leadership that the consult service attending will round independently on the patient
• The experience of the fellow “acting” consultant is not to mimic the experience of the first year fellow on inpatient consult service. Rather it is to provide supervised appropriately expanded autonomy and clinical decision making to the senior fellow at a level of what would be expected of a junior attending.
• The role of the consult service attending will be to provide feedback on the clinical decision making

Problem Mix/Patient Characteristics/Types of Encounters

The fellows are exposed to consultations from:

• All over the hospital
• Emergency room
• Acute care clinics
• Various Intensive Care Units
• Surgical floors
• OB/GYN floors
• General medical floors
• Wilmot Cancer Center
• (To some extent) the Pediatric floors (teenagers). 

The Fellow is exposed to a wide variety of consultative questions which 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.