A Day In the Life of ...



An Intern on the UCSF Pediatric Hospitalist Service

0630 - 0700: Sign out
You arrive and receive sign out from the overnight team. It's a busy discussion of overnight events and new admissions - we try to have our night team leave by 0700.

0700 - 0800: Pre-rounding
Now's your chance to examine your patients and check in with the senior resident.

0800 - 0900: Morning conference
The residents, medical students, and faculty come together for morning conference. Conferences include senior morning reports, Grand Rounds, and faculty presentations. Most commonly, conference is led by our second-year residents in consultation with a chief resident. These talks begin with a case presentation, then move into small-group discussions centered on diagnosis and management, and conclude with an evidence-based discussion around answering a clinical question that the case raised.

0900 - 1100: Rounds
Time to join the rest of your team, which includes a senior resident (R3), two fellow interns, an attending pediatric hospitalist, medical students, and a pediatric clinical pharmacist. The bedside nurse joins you at each patient's room. You present your patients to the senior resident, who, in concert with your attending, provides patient-centered teaching as you move through the service.

1100 - 1200: Morning work
This time is reserved for the most pressing patient care tasks, such as calling consults, following up on laboratory studies, and ordering urgent tests.

1215 - 1300: Noon conference and Lunch!
Rejoin your fellow residents and grab some lunch in the cafeteria (with your lunch stipend provided by the residency) before coming over to noon conference. These talks come in a variety of formats, and are given by a wide array of individuals. Conferences include faculty lectures (from both within and outside the Department), Grand Rounds with the entire department, Chief-led teaching, and a monthly intern-only check-in session ("Intern Time Out").

1300 - 1500: Afternoon work
Time to buckle down to remaining patient care tasks. You may be admitting new patients, following up on laboratory tests, discussing cases with consultants, writing progress notes, and re-examining patients as necessary.

1500-1530: Subspecialty teaching
The hospitalist teams join together for a teaching conference from our subspecialist physicians. There are a pre-defined set of topics, but these are very flexible to allow discussions relevant to care of current inpatients.

15:30- 1700: The rest of the work!
Now is the time to finish up any final tasks you have left on your to-do list for the day. You'll be working closely with your senior resident regarding ongoing patient management issues; your attending physician is also very present and may schedule in some time for additional teaching, depending on the demands of the service on any particular day.

1700 - 1730: Sign out
Your nighttime relief comes in and you sign the service out. The day is done – head home and get some rest!


An R2 on the UCSF Inpatient Heme-Onc Service

0630 - 0700: Sign out
The day shift residents arrive and receive sign out from the overnight resident. The discussion includes significant overnight events, new admissions, and any pertinent new laboratory data. There is one R2 on overnight taking care of the hematology, oncology, and bone marrow transplant service. The daytime team has two R2 on Heme-Onc and one R2 on the BMT service.

0700 - 0800: Pre-rounding
Residents spend this time examining patients and formulating patient care plans to present on rounds.

0800 - 0830: Morning conference
The residents on the heme-onc service and bone marrow transplant services have a specially designed morning curriculum. A faculty member or fellow leads an interactive teaching conference each morning, which cover a core set of hematology and oncology topics over the course of the rotation.

0830 - 1100: Rounds
Residents are joined for morning rounds by a fellow, an attending, a pharmacist, a nutritionist, nurse practitioners, social workers, and bedside nurses. Rounds begin in a conference area to facilitate multidisciplinary discussions, and then the smaller team (residents, attending, fellow, nurse practitioners, and bedside nurses) continues on for bedside rounds and teaching.

1100 - 1200: Work
This time is reserved for tackling the most pressing patient care tasks, such as calling consults, discharging patients, and follow-up discussions with families.

1215 - 1300: Noon conference and Lunch!
The R2s join the larger noon conference with all the residents and medical students at the Mission Bay campus. Daily noon conferences include talks by faculty from Pediatrics as well as other departments, ancillary care providers (Child Life, social work, palliative care), monthly journal clubs, and resident-led conferences, to name a few.

1300 - 1700: Work
Residents spend the afternoon admitting new patients, following up on laboratory and radiology reports, discussing cases with consultants, and writing daily progress notes.

1700: Sign out
The night team receives sign out, and the day team heads home! Strong work!


An R3 in the ZSFGH Nursery

0630: Arrive for sign out.
The overnight R3 signs out the intensive care nursery and newborn nursery services.

  • The overnight R3 works with an overnight intern from pediatrics or family medicine to cover the inpatient ward, the neonatal service, and assist with difficult cases in the ED. An attending pediatrician (the “nocturnist”) is available to assist the overnight team. This is an incredible experience, strengthening autonomy and building triage skills.
  • The daytime team consists of an R3, two interns, and one or two medical students. The entire daytime team receives sign out from the night team. The R3’s supervise to help interns build and strengthen effective handoff skills.

0700 - 0800: Interns pre-rounding
The nursery senior talks with the charge nurse about the current service, prioritizes pre-rounding tasks, and discusses patients and daily plans with the interns.

0800 - 0900: Morning conference.
There is a different type of teaching conference scheduled each morning. Conferences include case reports lead by residents, lectures from subspecialists, mock codes, morbidity and mortality reports, and Grand Rounds.

0900 - 1100: Walk rounds
The nursery team rounds with the neonatologist on service. At any given time, the service generally consists of critically ill patients, lower-acuity NICU patients, and well infants. Interns present patients to the rest of the team (charge nurse, bedside nurse, and pharmacist), and the senior resident takes the lead in running rounds. Bedside teaching by the attending and senior resident is an important part of the patient discussions.

1200 - 1300: Noon conference
A wide variety of teaching conferences are held over the noon hour. Topics range from subspecialty didactics to mock codes to advocacy training!

1400 - 1445: Interdisciplinary rounds (Tuesday and Thursday)
The nursery R3 leads the extended team, including social workers, the charge nurse, the nursery nurse manager, and public health nurse liaison, in a discussion of the psychosocial needs of each patient. These discussions not only help facilitate excellent patient care, but also give residents insight into (and experience referring patients to) resources and medical support services available in our community.

1500: Ice Cream (Friday)!
Yes, ice cream. Take a break and join your classmates and colleagues in the Pediatric Urgent Care workroom for San Francisco's own Mitchells Ice Cream. Almost everyone in the Department stops by, so this is a great time to get to know other residents, attendings, and support staff!

1730: Team sign-out
The night R3 and R1 arrive and take the reins. A job well done; time to head home and relax!