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 upper-level resident (PGY 2 or 3), two-three 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 five patients during the day – Early Call from 7 am to 1 pm, Middle Call from 1 pm to 4 pm, and Late Call from 4 pm to 7 pm. There is no Middle Call on Saturday, Sunday, and designated holidays. Each team’s total cap at the VAMC is 20 patients.

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

The VA Night Team

The VA night team is staffed by an intern and upper level resident who are responsible for cross cover on all the medicine housestaff services from 7 pm to 7 am. The night team has each Friday night off while an intern and resident who are not on an inpatient service perform the cross cover on Friday nights. The night team is supervised by the overnight Hospitalist and performs two-three admissions.

The VA Medical Intensive Care Unit

The VA MICU is a 12 bed unit that is staffed by four upper-level residents. There are no interns in the VA MICU. The residents are on q4 overnight call. The VA MICU is a mix of pulmonary/critical care 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 four beds dedicated to Palliative Care. Residents get first hand knowledge about end of life issues, hospice, and palliative care medicine.