At all three institutions, inpatients are admitted to the general medical, surgical, pediatric, obstetrics/gynecology, psychiatry or subspecialty surgical wards. Residents on these services have direct patient care responsibility, and fellows in Endocrinology and Metabolism serve as consultants under the supervision of the Endocrine attending of the month. In addition, Endocrine fellows, under the supervision of Principal Investigators in the Endocrine Division, may elect to participate in the clinical research protocols that comprise the Division's portfolio of the GCRC.
Each trainee serves as consultant for approximately 375 inpatients at Bellevue Hospital, Tisch Hospital and the Veterans Affairs Hospital per year. These combined services generate an average of 12-16 new consults weekly. As a result, each of the four fellows on the clinical service see approximately 3-4 new consults per week, and follow an average of 5-6 additional patients after initial consultation until hospital discharge.
As consultants on the general medical wards, trainees in Endocrinology and Metabolism coordinate the recruitment of the diagnostic and therapeutic capabilities of the Medical Center to the acute and ultimately long-term care of the inpatients upon whom they consult. They obtain a history from and examine each patient, speak directly with members of the housestaff team requesting consultative services, order the appropriate diagnostic measures, directly facilitate follow-up of these measures, guide in the interpretation of results, and develop both acute and long-term care plans for each of the inpatients that they evaluate.
The fellows write informative and detailed consultation notes, incorporating, when appropriate, relevant findings from the scientific medical literature and providing the residents and students with reference material. When called upon for an emergency, they determine if it is indeed an emergency; if so, they immediately contact the Endocrine Service attending, see the patient and provide a written interim note, and present the case formally and completely to the attending within 24 hours. In addition to their responsibilities to the patients and their primary care housestaff, the trainees teach the residents and medical students on the Endocrine and Metabolism rotation, and insure that all patients are presented to the attending of the month prior to their final consultation note.