Rotations at the Malcom Randall VA Medical Center

Rotations at the Malcom Randall VA Medical Center

The VA Medical Center (VAMC) is located across the street from Shands Hospital. It is a 239 bed VA hospital that serves veterans throughout North Florida and South Georgia. It is the second largest VA system in the country. The VA patient population provides residents the opportunity to treat the “core” disease states in Internal Medicine. These include COPD, coronary artery disease, cancer, and more. More importantly, the VA patient population is very willing and grateful to have their care provided by residents in training.

The General Medicine Inpatient Teaching Services
At the VAMC, patients are cared for by medical housestaff under the supervision of Department of Medicine faculty that include Hospitalists. There are four general medicine teams at the VAMC: Blue, Green, Orange, and Red. One attending, one resident, two interns, and medical students are assigned to each of the medicine services. General Medicine Teams rotate call every four days:

Early Call – Middle Call – Late Call – Golden Day

Each team admits a total of 5 patients during the day – Early Call from 7am to 1pm, Middle Call from 10am to 4pm, and Late Call from 1pm to 7pm.  There is no Middle Call on Saturday, Sunday, and designated Holidays.  The total team cap at the VAMC is 20 patients.

Similar to Shands, if an admission team reaches cap, there are 3 Hospitalist Services that admit overflow patients.

The VA Night Team
The VA night team is staffed by an intern who is responsible for cross cover on all the medicine housestaff services from 7pm to 7am.  The night intern has each Friday night off while an intern who is not on an inpatient service does the cross cover on Friday nights.  The night intern is supervised by the overnight Hospitalist and performs one admission.

The VA Medical Intensive Care Unit
The VA MICU is a 12 bed unit that is staffed by FOUR PGY 2 or PGY 3 residents. There are no interns in the VA MICU. The residents are on q4 overnight call. The VA MICU is a mix of pulmonary and cardiology patients. Both a Pulmonary and a Cardiology attending staff the VA MICU.  In addition, the VA Pulmonary and Cardiology fellows are available to help residents with patient care. The VA MICU provides senior residents the skills and confidence to manage critically ill patients. It also affords them an excellent opportunity to hone their procedural skills.

Geriatric Evaluation and Management (GEM)
The GEM unit at the VAMC provides residents the opportunity to learn about geriatric and palliative care medicine. The GEM unit provides sub-acute care to veterans who are not able to go to extended nursing care or home. During the GEM month, residents are part of a large intra-disciplinary team that includes physical therapists, occupational therapists, speech therapists, dieticians, and case managers. Residents learn about many of the issues that geriatric patients face in their medical care. In addition, the GEM unit has 4 beds dedicated to Palliative Care. Residents get first hand knowledge about end of life issues, hospice, and palliative care medicine.