The Inpatient General Medicine Teaching Service, composed of ten resident teams, is the core of the Department of Medicine’s clinical teaching experience. Working in teams led by junior residents and supervised by attending physicians with a commitment to bedside teaching and direct observation, the Inpatient General Medicine Teaching Service is where residents grow from interns with great potential into skilled clinicians.
As the general medical service for a leading academic medical center, residents care for patients of high complexity and acuity, seeing the pathology of every organ system and delivering the best care to a socioeconomically and geographically diverse patient population.
On Mass General’s Inpatient General Medicine Teaching Service there are two types of teams: Bigelow and Flex.
The six Bigelow teams are composed of four interns and a junior resident who oversee the care of 16 patients. Bigelow teams are regionalized to clinical care on a single floor, allowing close bonds with nursing staff and increased ability to care for high acuity patients. Interns on the team share responsibility for all patients, and rotate through a four-day cycle of tasks.
- The “call” intern admits up to five patients in a 24-hour period and cross-covers patients on the floor at night, with night-time supervision and teaching provided by senior residents (see "Night Teach" section below). "Post-call" is the second day of the four-day cycle
- The “lead” intern leads team rounds on all established patients, creating the clinical diagnostic/therapeutic strategy for the day and leading the bedside interview and physical exam
- The “swing” intern takes the lead in communicating with consultants, addressing acute clinical issues at the bedside, managing key time-sensitive tasks and coordinating and performing procedures
The junior resident supervises the care provided by the team and leads discussion and teaching on rounds. Bigelow teams are staffed by two attendings, each carrying ½ the patient census. These faculty are chosen and paired to optimize clinical learning for the team.
The four Flex teams are composed of two interns and a junior resident who oversee the care of 12-13 patients. Flex teams are regionalized to clinical care on either 1 or 2 floors, allowing close bonds with nursing staff and increased ability to care for high acuity patients. Each Flex intern has primary responsibility for his/her own 6-7 patients, and admits to his/her own list during daytime hours, on an alternating day cycle with the Flex co-intern. The junior resident supervises the care provided by the team and leads discussion and teaching on rounds. Flex teams are staffed by a single attending, chosen to optimize clinical learning for the team.
The Bigelow and Flex team structures complement one another from a clinical growth and educational standpoint. Both have in-depth patient exposure and teaching, with the Bigelow experience highlighting a wide breadth of patients within a team dialogue atmosphere and the Flex experience highlighting a deep and singular ownership allowing oversight on all aspects of care from admission to discharge.
Medical students are actively incorporated into both patient care and education, with Bigelow teams having integrated sub-interns, and Flex teams having integrated clerkship students.
A diverse group of attendings join on the Inpatient General Medicine Teaching Service, hailing from the Inpatient Core Educator Faculty, Hospital Medicine Unit, General Medicine and Subspecialty Core Visit Faculty, and Chief Residents.
Residents are assigned to a clinical firm (spanning 2 floors/4 teams) for their time on the Inpatient General Medicine Teaching Service, allowing longitudinal clinical growth and mentorship alongside the nurses, chief residents, firm chiefs, and Inpatient Core Educator Faculty on the firm. This clinical firm system dovetails with the residency’s academic mentorship firm system.