McLean: North Belknap (NB-1 and 2)

Marion Eakin and Paul Hammerness

Patient population

Predominance of chronically ill, psychotic patients with schizoaffective, bipolar or schizophrenia. Significant substance abuse and axis II comorbidity is common. Average length of stay is slightly longer than on Blake 11.

Patient load

Initially 2-3, increased to 5-6 by end of rotation.

Rounds

Typically begin at 9 a.m. Pre-rounding is not necessary, but plan to arrive 15-45 minutes early to review overnight admissions, manage paperwork, and otherwise collect your thoughts. While format for rounds may vary, generally the nurses will report overnight events, and then the team meets with patients individually for a brief interview, which is done by the resident and/or the attending.

Other Responsibilities

- Daily progress notes, written on a standard form; complete as much as possible during rounds.

- Orders for medications, consults

- Communication with outpatient treaters

- Individual meetings with patients, generally three times a week, in the late morning or afternoon

- Disposition, including follow-up appointments, is arranged by social services

- On outpatient clinic days and Wednesdays, residents need to come for rounds only

Conferences

NB Case Conference, in the past has occurred on NB1 on Tuesdays. An outside senior faculty member interviews one of the inpatients selected by the team.

Supervision

The attending meets with each resident for an hour each week for individual supervision.

The chief resident usually meets with 2 residents at a time for an additional hour.

Admits

Done by CEC; most new patients arrive overnight.

Documentation

Daily progress notes using McLean forms.

Other requirements while on this rotation

1. Group program:

In the past, residents ran a dual-diagnosis group in the partial hospitalization program, which most found to be a less-than-stellar experience. The group experience is currently being revamped; stay tuned.

2. Oral Boards training:

Eliza Menniger works with residents in groups of two to prepare for the oral boards by doing supervised 30-minute patient interviews once a week.

Coverage

The unit rarely calls during off hours, but technically the resident is first line backup, followed by attending. During vacations and night float, the NB attendings cover the patients.