A Day in the Life

Day in the Life of a PGY1 Resident at Henry Ford Hospital

Ruchi Mangal

• 6:20 am: Start off your day by arriving to the hospital bright (still mostly dark) and early, grab coffee from the resident lounge and settle in for the day.
• 6:30 am: Take sign out from the night resident. They will tell you everything that happened overnight with your patients since you saw them last. You can start reviewing your patient’s charts, talking to their nurses and preparing to present them. You should also round on your patients during this time.
• 8:00 am: We have morning report twice a week during this time where all internal medicine residents gather in the lecture room and one of our co-residents will present a patient. You will get your turn to do this at least once throughout your intern year as well. It is a great opportunity to discuss differential diagnoses and management principles.
• 8:30 am: Once lecture is over, or if it’s a non-lecture day, you will finish up the prerounding morning by meeting back in your workroom with your attending and team. You will then start rounds and go down your list, patient by patient, discussing their care and seeing all the patients on your list as a team.
• 11:00 am: Rounds end, your senior and attending go to patient progressive rounds (a multidisciplinary meeting with nurses, case managers and doctors) and you get to start on your daily work. This includes writing notes, updating hospital courses and team communications, discharging patients, and updating families. This is also your time to reach out to consultants for advice on patient care.
• 12:00 pm: Time for lunch lecture! Food is provided and you get to see all your co-intern friends while learning a new topic every day!
• 1:00 pm: Lunch is over and it’s time to go back to work! You get a snack and go back to your workroom and finish the tasks that you started after rounds. This is also your time to do some teaching and learning with your med students, go practice ultrasound on patients who need a scan, or even do paracentesis with supervision for patients that need them. Your time is your own to get your work done and respond to anything someone may need to care for your patients.
• 4:00 pm: If you are not on on call, sign out your patients to the on-call team. Head home and enjoy your evening!
• 4:00 pm: If you are on call, the second part of your day starts now. You will be on call every fourth day. During the day you will do the same activities with the addition of admitting patients as they come to your floor. At 4pm, you will take sign out from all your co-residents that are covering patients on your floor.
• 8:00 pm: This is the entirety of your call shift. You will have admitted patients all day and responded to any concerns about any patients on your floor after you received sign out at 4 pm. You will see the night resident come in and give them sign out. After you give sign out and finish your admission notes/orders, you are good to go for the night. Get a good night of sleep and get ready to do it all over again tomorrow morning!

Day in the Life of a PGY2 Resident on the Medical Intensive Care Unit at Henry Ford Hospital
Jonathan Major

• 630-7am: Arrive at the medical intensive care unit (MICU) by 6:30 to receive sign out from the overnight resident. Settle into the workroom and claim your computer for the day. We’ll hear about any changes to our patient’s clinical status, notable labs, or decisions that were made during the night. The team changes daily in the MICU, so we take this time to split the list amongst the residents.
• 7-8am: Chart review your patients for the day and start on the progress note. Then, we’ll examine our patients and note any changes and the ventilator settings if applicable. After gathering all the information, we’ll run our plan for the day by the fellow before rounds.
• 8-830am: Attend the daily lectures in the MICU conference room. These are done by various Pulmonary Critical Care staff, or potentially a MICU pharmacist. Topics range from ventilator management, interpreting TEG, or differences between vasopressors, etc. This is also a great time to catch up with your co-residents in other pods and share interesting cases.
• 830-11am: Daily rounds! In the MICU, rounds are usually performed bedside amongst a large interdisciplinary team of pharmacists, respiratory therapists, nurses, residents, fellow, and attending. We start with the patients admitted by the overnight resident so they can head home for the day. The attendings do a great job of incorporating relevant teaching points during rounds and giving appropriate feedback regarding your plan for the day.
• 11-1pm: Right after rounds, we reach out to consultants to implement the plan and finish up progress notes. In the MICU, we don’t attend noon conference... but we do make sure to run down and grab some lunch and see our co-residents.
• 1-4pm: In the afternoon, most of the time is spent following up on action taken during the morning and doing various procedures. MICU rotations provide a lot of opportunities to place lines and perform POCUS. Also, during this timeframe, it’s important to call and update families regarding their loved one's clinical updates.
• 4-8pm: For those of us not on call, if our work is finished, we sign out to the on-call resident at 4pm. If we’re on call, we take admissions and manage the team’s patients until the night resident comes on at 8pm. Don’t get too stressed, there’s always a fellow and attending around to run things by. Overall, MICU is a very exciting (and at first, nerve racking) experience. The support from fellows, staff, nursing, respiratory therapy is tremendous, and all contribute to a well- rounded rotation.

Day in the Life of a PGY2 Resident on Night Float at Henry Ford Hospital
Marielle Cabe
People say second year is the year that you really start to become a physician and a lot of it is due to the skills that you learn on nights. Because of changes to the academic schedule that happened because of resident feedback, we don't start doing night float until our second year which allows you to learn the hospital system and basic medicine before becoming the "primary" physician overnight.

• 6:30 pm: I wake up from the pitch black to my partner knocking on the door. They've just come home from work, and we get a precious hour to hang out.
• 7:00 pm: I like to log into our EMR (EPIC) from home to get an idea of what the night will bring. I'm heading into H2, our specialty nephrology floor. Luckily tonight it looks like I only have 5 open beds and most of them have patients already assigned to come.
• 7:30 pm: Kiss my partner goodbye and time to head into the hospital. Since I'm inverse commuting, there's almost never any traffic.
• 8:00 pm - 9:00 pm: After getting my little Papa Joe's treat from our favorite hospital store, it's into the trenches. Sign-out usually takes 30 minutes or so and is always punctuated by messages from nurses and calls from floors wanting to give report to transfer.
• 10:00 pm - 12:00 am:  Since most of the beds were already assigned before I got into the hospital, I get most of my admissions under my belt early. Fortunately, the interns are starting to hit their stride and a lot of the information needed for the admissions process was already entered by them in some of the charts. What's nice about night float is that you are generally able to sit with your admissions to come up with your plan and see how it plays out throughout the night. This is also the time when lab results for routine labs start coming in. Since H2 is a nephrology floor, our patients do not get their electrolytes automatically repleted by nursing so a lot of this time is also spent ordering potassium, phosphate, and magnesium repletion. On other floors, our nurse-drive electrolyte replacement protocol takes care of this.
• 12:00 am - 1:00 am: Since we cover quite a few services overnight, we tend to have at least eight residents (IM PGY2-3s) on night float every night. We tend to gather in our resident lounge where we spend time discussing patient care, catching up, and indulging in hospital snacks (or even delivery food!). Walking with your friends around a quiet hospital is such an underrated experience.
• 1:00 am - 2:00 am: A code blue is paged over the intercom so my coresidents and I head there. As a part of the overnight team, we are all part of the code team. The B1 night float (a PGY3) is the code leader. This code appeared to be a syncopal episode, and we are dismissed after the patient is stabilized and can go back to our floors.
• 2:00 am - 5:00 am: This time-period either flies or creeps by. On my busier nights, this time is when a lot of admissions come and I'm usually going back and forth between rooms. In my case tonight, most of the anticipated admissions either fall off or end up not coming. A lot of people use this time to catch up on studying, working on research projects, or sleeping. We also share the load with our colleagues when they are getting slammed. During one infamous night when I had a lot of admissions, my coresidents added information and prepared the assessment and plans for my pended patients so that I could finish my admissions faster.
• 5:00 am - 6:30 am: Nursing conducts their last round of checks before they sign out at 7 so some questions come in at this time. This is also the time that I take to check over the list to remind myself of what interventions I did overnight to relay to the day team.
• 6:30 am - 7:00 am: Saying hello to the incoming teams. This is usually much quicker than the evening signout since these residents carry the same few patients and they know the background much better.
• 7:00 am - 8:30 am: Most days these times are spent finishing up notes, reviewing any new labs that have come back on my overnight admissions prior to rounds, or in some cases catching a quick nap. On Wednesdays, we have night float rounds which is an educational conference where we discuss our most interesting cases with the Department of Medicine Chair Dr. Scher.
• 8:30 am - 10:00 am: It's time to round! Staff always starts with the night float cases in order to get us out in time for us to get some zzz's. On light nights when I have very few admissions, I am able to be out by 9:00 am though the general expectation is that the shift ends at 10:00am.
• After it's a quick drive home and a quick getting ready to try to get a solid 8 before it all starts again.

Day in the Life of a PGY3 Resident at Henry Ford Hospital
Tyler Andrews
My typical day as a PGY3 resident begins around 5:30 AM when the alarm goes off and the routine kicks in. By 6:30 AM, I arrive at HFH to receive sign-out from the night float, marking the start of my clinical responsibilities. From 6:30 to 8:30 AM, I pre-chart on patients, assess new admissions from the previous night, and discuss treatment plans with the PGY1 residents, setting the stage for the day ahead.

At 8:30 AM, the attending physician arrives, and our team begins rounds, focusing first on the overnight admissions. Collaborative rounds take place from 11:00 to 11:30 AM, involving case managers, pharmacy, and therapy teams to ensure a comprehensive inpatient and discharge plan is in place. Following this, we spend time reviewing the daily plans as a team until noon, ensuring everyone is aligned and updated. The day’s pace continuous with an educational conference at noon, complete with catered food, providing a brief but welcome break.

After lunch, we return to the floor to wrap up daily tasks, which include writing notes, planning patient dispositions, and consulting with subspecialty teams. Lightning rounds at 3:00 PM highlight priority discharges for the following day, making sure that patient flow remains efficient. If on a non-call shift, sign-out occurs at 4:00 PM, allowing us to head and finally engage in life tasks like dinner and exercise. When on call, the responsibilities extend into the night, covering admissions and cross-covering other floors until sign-out to the night float at 8:00 PM.