The Richard L. Roudebush Veterans Administration Medical Center (VAMC) provides acute and chronic care for veterans and is a statewide and regional referral base for other VA hospitals. A host of highly-dedicated clinician educators support the high quality of teaching and learning. In addition to the general medicine wards, there is a closed ICU rotation, both MICU and CCU, and a highly-rated continuity clinic experience. The VA hospital serves veterans in Indiana and eastern Illinois. As such, it is both a primary and tertiary care center. Many patients from central Indiana use the hospital and its clinics as their source for primary care, while others may be referred in for complex problems requiring specialized care. The facility is fairly new, with state-of-the-art intensive care units updated in early 2000.
The Richard L. Roudebush Veterans Administration Medical Center (VAMC) provides acute and chronic care for veterans and is a statewide and regional referral base for other VA hospitals. The medicine department at the VA has a long history of providing outstanding quality teaching through a host of highly-dedicated, award-winning clinician educators. This strong commitment to education has led to an environment that emphasizes resident and student learning in conjunction with patient care. The teaching faculty have been presented with numerous teaching awards from the residents, students, and the IU Department of Medicine.
Housestaff rotating on general medicine wards take call with their ward teams every fifth night. One general medicine ward team (consisting of one resident, two interns, pharmacist, 0-1 subinterns and 1-3 medicine clerkship students) is on-call every evening. Interns take call from 7:00 am on the assigned call day and stay overnight with their own team. They are encouraged to change-over by noon and may stay as late as 1:00 pm the following day. On Sunday through Thursday, residents start call at 9:00 am. They may leave the hospital no later than 3:00 pm the following day. Interns admit medicine patients with their residents, cross-cover all the medicine patients in the hospital, and assist with codes. Residents admit medicine patients, back up the interns on cross-cover issues, provide general medicine consults, and run codes along with the ICU resident. The team follows patients it admits while on-call until discharge from the hospital, except when a patient requires intensive or non-medicine care. Admissions and cross-cover issues do not need to be staffed overnight, but there is always backup for the on-call teams from fellows and staff. Housestaff are protected post-call and do not take admissions. Two of the five ward teams are staffed by hospitalist faculty, two are staffed on a rotating basis by members of the dedicated teaching faculty who also supervise VA resident continuity clinics, and the fifth team by various other faculty with an interest in teaching.
The VA has a closed ICU. The three residents rotating in the VA Pulmonary Critical Care ICU rotation and the one resident on the Cardiac Care Unit rotation take ICU call every fourth night. There is a second housestaff member of the VA CCU team who does not take overnight call. In addition to housestaff, these teams consist of a dedicated fellow, ICU pharmacist, care coordinator, and outstanding subspecialty faculty. In addition, the CCU team works closely with the EP and cardiac cath procedure faculty and fellows. Backup is always available for the on-call teams in the form of fellows and staff. Housestaff are protected post-call and do not take admissions. Post-call residents must leave the hospital by 1:00 pm on post-call days. As with ICU services, residents do not attend continuity clinic during the ICU month.
The VA has a dedicated teaching firm that encompasses all residents who have a VA continuity clinic. The faculty include endocrinologists, geriatricians, a rheumatologist, and general internists with special interests in women's health, pre-operative assessment, and diversity. This group of clinician-educators also support the academic half-day lectures, morning reports, student lectures on the wards, and staff two of the inpatient teams at all times. Residents on ambulatory will rotate through the general medicine teaching clinics, urgent care clinics, procedures clinic, and/or the unique multi-disciplinary PRIME clinic.
