Medicine Resident

From Virtual Rounding

As a Medicine resident working as a virtual rounder, you also have the option to be even more helpful to your teams by doing work that requires more medicine knowledge and expertise. Below are some things that resident virtual rounders have done for their teams. All of these are of course team- and workflow-dependent, so you should communicate with your inpatient resident about which of these roles they would like you to do. Obviously, it's not possible for you to do all of these things and prep progress notes simultaneously, so you have to choose what the most useful tasks are with your inpatient team. If you have a non-resident virtual rounder working with you in a buddy system, we recommend having them do notes and hospital courses while you do some of the below tasks.

Placing Orders

During rounds, many resident rounders would place orders for their teams during rounds to save the teams time. The key thing is to have a system for communicating back to the inpatient team what orders you did and did not place. Possibilities for this include:

  • Designating a time during rounds when you say exactly what you did. "I ordered the lasix and follow-up BMP/Mg."
  • Writing down what you did in the handoff and checking off the tasks you completed: [x] lasix 40mg x1
  • Texting the inpatient team what orders you placed

Paging consults

This was particularly useful on some of our ICU teams where consults are very time-sensitive. The rounder would listen in on rounds and then page any consultants immediately after the discussion, either to their own phone or to the intern or resident's phone.

Prepping admissions

When mid-rounds admissions come in, you have the option to break off and begin prepping it while the team continues to round. When rounders did this, they would typically sign in as RC for the patient, take pass-off, place admission and any time-sensitive orders, and start doing the chart biopsy and prepping an admission note. If the patient is sick or unstable, your ability to prep their admission will be more limited and you should use your judgment about when to tell your team to go see the patient themselves in person. If they're more stable, most rounders found they could prepare a relatively comprehensive initial plan for the patient. They would then "present" the patient back to the inpatient resident and intern for them to go see the patient in person, make any additional changes to the plan, and the finish the note.

Signing in as RC

Aside from when a rounder was prepping admissions, we don't recommend routinely signing in as RC. However, some ICU teams found it useful for resident rounders to sign in as RC to answer pages during rounds. This is because key nursing pages ("Please come assess") are uncommon in the ICU, where the RNs are all in the same unit as the team and can come get them in person for anything urgent.

If you are signed in as RC for any patients on your list, it is very important that you have a quick and reliable way to quickly get in touch with your team, either via the Teams call or via text, for any time-sensitive pages that require their immediate attention.