24 HOURS
ON RED TEAM
What goes into training future physicians inside one of the country’s largest and busiest teaching hospitals?
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Medical school is notoriously difficult. The bar for entry is high and the schedules and workloads are demanding, even grueling. In third year, medical students formally start their clinical training – called a clerkship – and, depending on the rotation, at least once a week they can expect to be in the hospital for shifts that last 24 hours. By the time handover is finished, it’s often closer to 26. It’s done in the name of shaping students into physicians who can manage heavy and frequently complex patient caseloads with expertise, grit and compassion.
As one of the largest teaching hospitals in Canada, Sunnybrook Health Sciences Centre is home to medical students assigned to the University of Toronto’s Peters-Boyd Academy for much of the duration of their clinical rotations. Over the course of their training, students are immersed in hands-on learning at the patient bedside and integrated into care teams. Though they are not yet able to practice medicine independently – they still need to graduate from medical school then complete additional years as a resident doctor to do that – they are guided by staff physicians and teachers as they hone their clinical decision-making.
Meet Radha Sharma and Zwetlana Rajesh
They are on the second block of their third-year clerkship. For the last eight weeks, they’ve worked closely together on the wards throughout their internal medicine rotation on Red Team, one of four colour-coded internal medicine teams.
Red Team is made up of a staff physician, junior and senior residents, and medical students assigned to a specific ward over the course of the rotation’s block. Zwetlana and Radha are paired up with each other for nearly every shift, what they call ‘the buddy system.’
Owing to its size, diverse patient population and areas of clinical expertise, trainees at Sunnybrook can expect to see the full spectrum of patient care. Staff physician preceptors and senior residents oversee clerks’ clinical training so they can master the fundamentals of how to assess, diagnose and treat patients in clinical and acute care settings.
“Sunnybrook is a really great place to see a lot of complex cases where you’re managing multiple different medical problems,” says Zwetlana. “You also get to see how one patient interacts with many different services.”
“Because we’re a trauma centre, and we have a lot of tertiary care specialists on board, we get to see a part of medicine that maybe you wouldn’t see at a rural site or a community site,” Radha adds.
By way of example, she explains, “The Odette Cancer Centre is here, so we have a lot of patients where we may not be directly treating their cancer, but we’re still very involved in their care. It’s nice to be connected with those specialties as well.”
It’s at Sunnybrook that Radha and Zwetlana have seen the kinds of physicians they want to be – from the mentorship and guidance they’ve received, to the standard of advocacy and patient care they’ve witnessed.
During a 24-hour internal medicine shift, Zwetlana and Radha will move between the ward and different clinics before seeing patients overnight in the Emergency Department. We joined them for a behind-the-scenes look at what it takes to train to be a doctor in one of the largest and busiest teaching hospitals in the country.
7:41 a.m.
The day begins early. Zwetlana lives in downtown Toronto and commutes to Sunnybrook on the shuttle bus that travels between the hospital’s three main campuses and Women’s College Hospital. She and Radha – who lives within walking distance – meet by the student lockers located down the hall from Sunnybrook’s Education Centre. They drop off their things and get ready for the day. Some mornings there is a brief resident-led seminar for the clerks and on others, including today, they head straight to the wards on C-Wing.
8:29 a.m.
Zwetlana and Radha settle in and meet with Red Team’s senior medical resident, Dr. John Talia and junior resident, Dr. Germain Ho. Dr. Talia briefs them on the four new admissions that arrived from the Emergency Department overnight and assigns them their patients for the day.
8:51 a.m.
Dr. Kaveh Shojania, the staff physician on Red Team, arrives and Dr. Talia runs the list of patients Red Team has on their unit. They discuss how they’ve come to their diagnoses for patients, treatment options, referrals and consults with other teams and specialties, as well as discharge timelines. As medical students, Zwetlana and Radha need to show that they understand what symptoms are relevant to making a diagnosis, how different medications interact with one another and with different conditions, how social determinants of health could impact their patients’ recovery, among many other competencies necessary to being a physician.
9:15 a.m.
Zwetlana and Radha each have two patients assigned to them. On her first patient consult, Zwetlana discusses different pain and wound care management options for Lea. Complications from a skin condition and limb swelling have put Lea in the hospital for several days, though she may be ready to go home soon.
9:56 a.m.
Code Blue is called in T-Wing at the other end of the hospital. In addition to being on Red Team, during the day Zwetlana and Radha are also part of a larger team that will respond to a Code Blue in any part of the hospital. Code Blue is called when a patient needs immediate medical attention and resuscitation, ranging from fainting to a heart attack or stroke. When it’s called on the overhead, Radha and Zwetlana are expected to quickly finish or drop what they’re doing and immediately run to wherever the Code Blue has been called.
It’s important to remember that the Sunnybrook campus is large. The hallway on the ground floor spans more than a kilometer from end to end with offshoots in multiple directions. Depending on the wing, there can be eight floors to go up or down. Once they arrive in T-Wing, there is a mass of at least 20 other staff from different teams to attend to the patient and make sure they’re stabilized.
10:29 a.m.
They return to the ward on C-Wing and Radha has a consult with one of her patients, Kathy. As with most of the patients they are seeing, Kathy is older with multiple co-morbidities and complex care needs that can make going home challenging. The vast majority of patients on the ward are over the age of 70, and many are older than 80.
10:33 a.m.
The broader care team gathers together for the morning Bullet Rounds, this time with a full interdisciplinary team of nurses, a social worker, pharmacist, the unit’s patient care manager, physiotherapist and others. Dr. Talia once again runs through the list of patients on the unit. One of the main cases they discuss is the discharge of a patient with precarious housing, who the team fears may end up living back on the street.
11:00 a.m.
Zwetlana and Radha take a break for paperwork. They need to document patient notes and provide a comprehensive overview of their patients’ conditions and care plans for other staff and physicians to refer to during their stay in the hospital, as well as after discharge.
12:23 p.m.
Zwetlana and Radha run to another Code Blue in the cardiac unit. “They had it handled,” Zwetlana says later. “The in-house team had enough members to support the code.”
1:25 p.m.
While Radha checks in on her patients on C-Wing, Zwetlana heads to Sunnybrook’s Rapid Referral Clinic. The clinic sees patients referred from the Emergency Department on an out-patient basis who require urgent care and referrals to other specialties, but who don’t need to be admitted to the hospital.
2:00 p.m.
Red Team regroups again for afternoon rounds and to review patient cases with updates from the morning. Zwetlana and Radha work with Dr. Talia to solve problems around patients’ medication dosages and to make decisions for the next courses of treatment.
2:36 p.m.
The third Code Blue of the day is called. “It’s never like this. Someone must have said it would be quiet today,” Radha jokes. The code is cancelled by the time Zwetlana and Radha arrive.
3:03 p.m.
Zwetlana and Dr. Shojania meet with a patient to discuss discharge plans. At first, the patient is hesitant to leave the hospital. “It was a difficult talk, but ultimately they agreed going home is in their best interest,” Zwetlana says.
3:43 p.m.
Zwetlana finally gets a chance to eat lunch. She and Radha spend the next few hours catching up on patient notes and charting, and checking in on their patients still on the unit. They then take a short break before the overnight shift begins.
6:00 p.m.
Zwetlana and Radha, alongside other internal medicine clerks, meet up with the overnight senior medical resident, Dr. Helia Nabavian. It’s a tradition for the clerks and senior resident to get a coffee or tea together before they head to the Emergency Department for the night.
Overnight in the Emergency Department
Zwetlana and Radha are in the second half of their eight-week internal medicine rotation, which means they’ve graduated to pager duty. For any question or consult related to patients under the internal medicine umbrella that comes up overnight, it’s their job to respond and escalate to the senior resident as needed. Pages can be related to anything from a medication change to patient agitation or changes in vitals. Zwetlana is managing the pager tonight, though she is sharing the on-call responsibility with Radha.
“The challenge is sometimes you could be doing a consult in the Emergency Department, but you could have something else come up in the wards, then you’d have to prioritize,” Zwetlana explains.
“Radha and I have a good system where if we’re both on call and one of us is in the middle of a consult in the ED when we’re paged, we would just ask the other person to see what was happening in the wards.”
For the next twelve hours, Zwetlana and Radha see patients in the ED and answer pages that need internal medicine support. In between stretches of assessing and reassessing patients, answering and triaging pages, dropping off care orders to the ED and doing consults on the wards, the two will head back to their call rooms to finish their notes and hopefully get some rest.
6:26 a.m.
As their duties in the ED come to an end, Radha and Zwetlana grab a coffee before getting ready for the morning handover.
7:47 a.m.
Red Team gathers again to review the cases they saw overnight, including patients who were newly admitted to the unit.
8:32 a.m.
One of Zwetlana’s patients on the unit from the day before had bleeding and issues overnight that required a transfusion, a call to the rapid response team and consults with other specialties. Before she gets ready to leave, Zwetlana goes to check how he’s doing.
9:08 a.m.
After nearly 26 hours in the hospital, it’s time for Zwetlana and Radha to go home. They’ll get some rest then spend their few days off studying for exams as they wrap up the internal medicine block. With little downtime in between, they’ll soon be working with entirely new teams in different specialties across Sunnybrook and other Peters-Boyd Academy sites.
Later.
Over the eight weeks of their rotation on Red Team, Zwetlana and Radha saw their confidence and skills flourish, and they completed the block knowing these traits will carry over to their careers as physicians, whatever speciality they ultimately pursue.
“We’ve grown so much as learners, and we’ve learned so much along the way. Looking back, it’s really great to see how things progressed over the last eight weeks” says Zwetlana. “When we finished internal, I messaged Radha: ‘I’m so excited to see what Dr. Sharma will do.’”
Before they started their clerkship, the two knew each other only as classmates. But working alongside each other so closely over the rotation, Radha and Zwetlana have formed a tightly-knit friendship, bolstered by their support of one another and their growth as learners.
“I’m so proud of us; for taking on more tasks as the weeks went on, being responsible for more patients, being able to manage issues on the ward overnight, and doing consults, and becoming more confident with our own abilities,” says Radha.
“A lot of it is the words that we say to each other, showing up for each other and getting good feedback and being reassured that, you know what, we are in the right place. We’re doing it for the right reasons, and we’re doing a good job.”
Credits
Story by Brianne Tulk
Photography by Kevin Van Paassen
Web Design by Yara McDonald
24 HOURS ON RED TEAM
What goes into training future physicians inside one of the country’s largest and busiest teaching hospitals?
Medical school is notoriously difficult. The bar for entry is high and the schedules and workloads are demanding, even grueling. In third year, medical students formally start their clinical training – called a clerkship – and, depending on the rotation, at least once a week they can expect to be in the hospital for shifts that last 24 hours. By the time handover is finished, it’s often closer to 26. It’s done in the name of shaping students into physicians who can manage heavy and frequently complex patient caseloads with expertise, grit and compassion.
As one of the largest teaching hospitals in Canada, Sunnybrook Health Sciences Centre is home to medical students assigned to the University of Toronto’s Peters-Boyd Academy for much of the duration of their clinical rotations. Over the course of their training, students are immersed in hands-on learning at the patient bedside and integrated into care teams. Though they are not yet able to practice medicine independently – they still need to graduate from medical school then complete additional years as a resident doctor to do that – they are guided by staff physicians and teachers as they hone their clinical decision-making.
Meet Radha Sharma and Zwetlana Rajesh
They are on the second block of their third-year clerkship. For the last eight weeks, they’ve worked closely together on the wards throughout their internal medicine rotation on Red Team, one of four colour-coded internal medicine teams.
Red Team is made up of a staff physician, junior and senior residents, and medical students assigned to a specific ward over the course of the rotation’s block. Zwetlana and Radha are paired up with each other for nearly every shift, what they call ‘the buddy system.’
Owing to its size, diverse patient population and areas of clinical expertise, trainees at Sunnybrook can expect to see the full spectrum of patient care. Staff physician preceptors and senior residents oversee clerks’ clinical training so they can master the fundamentals of how to assess, diagnose and treat patients in clinical and acute care settings.
“Sunnybrook is a really great place to see a lot of complex cases where you’re managing multiple different medical problems,” says Zwetlana. “You also get to see how one patient interacts with many different services.”
“Because we’re a trauma centre, and we have a lot of tertiary care specialists on board, we get to see a part of medicine that maybe you wouldn’t see at a rural site or a community site,” Radha adds.
By way of example, she explains, “The Odette Cancer Centre is here, so we have a lot of patients where we may not be directly treating their cancer, but we’re still very involved in their care. It’s nice to be connected with those specialties as well.”
It’s at Sunnybrook that Radha and Zwetlana have seen the kinds of physicians they want to be – from the mentorship and guidance they’ve received, to the standard of advocacy and patient care they’ve witnessed.
During a 24-hour internal medicine shift, Zwetlana and Radha will move between the ward and different clinics before seeing patients overnight in the Emergency Department. We joined them for a behind-the-scenes look at what it takes to train to be a doctor in one of the largest and busiest teaching hospitals in the country.
7:41 a.m.
The day begins early. Zwetlana lives in downtown Toronto and commutes to Sunnybrook on the shuttle bus that travels between the hospital’s three main campuses and Women’s College Hospital. She and Radha – who lives within walking distance – meet by the student lockers located down the hall from Sunnybrook’s Education Centre. They drop off their things and get ready for the day. Some mornings there is a brief resident-led seminar for the clerks and on others, including today, they head straight to the wards on C-Wing.
8:29 a.m.
Zwetlana and Radha settle in and meet with Red Team’s senior medical resident, Dr. John Talia and junior resident, Dr. Germain Ho. Dr. Talia briefs them on the four new admissions that arrived from the Emergency Department overnight and assigns them their patients for the day.
8:51 a.m.
Dr. Kaveh Shojania, the staff physician on Red Team, arrives and Dr. Talia runs the list of patients Red Team has on their unit. They discuss how they’ve come to their diagnoses for patients, treatment options, referrals and consults with other teams and specialties, as well as discharge timelines. As medical students, Zwetlana and Radha need to show that they understand what symptoms are relevant to making a diagnosis, how different medications interact with one another and with different conditions, how social determinants of health could impact their patients’ recovery, among many other competencies necessary to being a physician.
9:15 a.m.
Zwetlana and Radha each have two patients assigned to them. On her first patient consult, Zwetlana discusses different pain and wound care management options for Lea. Complications from a skin condition and limb swelling have put Lea in the hospital for several days, though she may be ready to go home soon.
9:56 a.m.
Code Blue is called in T-Wing at the other end of the hospital. In addition to being on Red Team, during the day Zwetlana and Radha are also part of a larger team that will respond to a Code Blue in any part of the hospital. Code Blue is called when a patient needs immediate medical attention and resuscitation, ranging from fainting to a heart attack or stroke. When it’s called on the overhead, Radha and Zwetlana are expected to quickly finish or drop what they’re doing and immediately run to wherever the Code Blue has been called.
It’s important to remember that the Sunnybrook campus is large. The hallway on the ground floor spans more than a kilometer from end to end with offshoots in multiple directions. Depending on the wing, there can be eight floors to go up or down. Once they arrive in T-Wing, there is a mass of at least 20 other staff from different teams to attend to the patient and make sure they’re stabilized.
10:29 a.m.
They return to the ward on C-Wing and Radha has a consult with one of her patients, Kathy. As with most of the patients they are seeing, Kathy is older with multiple co-morbidities and complex care needs that can make going home challenging. The vast majority of patients on the ward are over the age of 70, and many are older than 80.
10:33 a.m.
The broader care team gathers together for the morning Bullet Rounds, this time with a full interdisciplinary team of nurses, a social worker, pharmacist, the unit’s patient care manager, physiotherapist and others. Dr. Talia once again runs through the list of patients on the unit. One of the main cases they discuss is the discharge of a patient with precarious housing, who the team fears may end up living back on the street.
11:00 a.m.
Zwetlana and Radha take a break for paperwork. They need to document patient notes and provide a comprehensive overview of their patients’ conditions and care plans for other staff and physicians to refer to during their stay in the hospital, as well as after discharge.
12:23 p.m.
Zwetlana and Radha run to another Code Blue in the cardiac unit. “They had it handled,” Zwetlana says later. “The in-house team had enough members to support the code.”
1:25 p.m.
While Radha checks in on her patients on C-Wing, Zwetlana heads to Sunnybrook’s Rapid Referral Clinic. The clinic sees patients referred from the Emergency Department on an out-patient basis who require urgent care and referrals to other specialties, but who don’t need to be admitted to the hospital.
2:00 p.m.
Red Team regroups again for afternoon rounds and to review patient cases with updates from the morning. Zwetlana and Radha work with Dr. Talia to solve problems around patients’ medication dosages and to make decisions for the next courses of treatment.
2:36 p.m.
The third Code Blue of the day is called. “It’s never like this. Someone must have said it would be quiet today,” Radha jokes. The code is cancelled by the time Zwetlana and Radha arrive.
3:03 p.m.
Zwetlana and Dr. Shojania meet with a patient to discuss discharge plans. At first, the patient is hesitant to leave the hospital. “It was a difficult talk, but ultimately they agreed going home is in their best interest,” Zwetlana says.
3:43 p.m.
Zwetlana finally gets a chance to eat lunch. She and Radha spend the next few hours catching up on patient notes and charting, and checking in on their patients still on the unit. They then take a short break before the overnight shift begins.
6:00 p.m.
Zwetlana and Radha, alongside other internal medicine clerks, meet up with the overnight senior medical resident, Dr. Helia Nabavian. It’s a tradition for the clerks and senior resident to get a coffee or tea together before they head to the Emergency Department for the night.
Overnight in the Emergency Department
Zwetlana and Radha are in the second half of their eight-week internal medicine rotation, which means they’ve graduated to pager duty. For any question or consult related to patients under the internal medicine umbrella that comes up overnight, it’s their job to respond and escalate to the senior resident as needed. Pages can be related to anything from a medication change to patient agitation or changes in vitals. Zwetlana is managing the pager tonight, though she is sharing the on-call responsibility with Radha.
“The challenge is sometimes you could be doing a consult in the Emergency Department, but you could have something else come up in the wards, then you’d have to prioritize,” Zwetlana explains.
“Radha and I have a good system where if we’re both on call and one of us is in the middle of a consult in the ED when we’re paged, we would just ask the other person to see what was happening in the wards.”
For the next twelve hours, Zwetlana and Radha see patients in the ED and answer pages that need internal medicine support. In between stretches of assessing and reassessing patients, answering and triaging pages, dropping off care orders to the ED and doing consults on the wards, the two will head back to their call rooms to finish their notes and hopefully get some rest.
6:26 a.m.
As their duties in the ED come to an end, Radha and Zwetlana grab a coffee before getting ready for the morning handover.
7:47 a.m.
Red Team gathers again to review the cases they saw overnight, including patients who were newly admitted to the unit.
8:32 a.m.
One of Zwetlana’s patients on the unit from the day before had bleeding and issues overnight that required a transfusion, a call to the rapid response team and consults with other specialties. Before she gets ready to leave, Zwetlana goes to check how he’s doing.
9:08 a.m.
After nearly 26 hours in the hospital, it’s time for Zwetlana and Radha to go home. They’ll get some rest then spend their few days off studying for exams as they wrap up the internal medicine block. With little downtime in between, they’ll soon be working with entirely new teams in different specialties across Sunnybrook and other Peters-Boyd Academy sites.
Later.
Over the eight weeks of their rotation on Red Team, Zwetlana and Radha saw their confidence and skills flourish, and they completed the block knowing these traits will carry over to their careers as physicians, whatever speciality they ultimately pursue.
“We’ve grown so much as learners, and we’ve learned so much along the way. Looking back, it’s really great to see how things progressed over the last eight weeks” says Zwetlana. “When we finished internal, I messaged Radha: ‘I’m so excited to see what Dr. Sharma will do.’”
Before they started their clerkship, the two knew each other only as classmates. But working alongside each other so closely over the rotation, Radha and Zwetlana have formed a tightly-knit friendship, bolstered by their support of one another and their growth as learners.
“I’m so proud of us; for taking on more tasks as the weeks went on, being responsible for more patients, being able to manage issues on the ward overnight, and doing consults, and becoming more confident with our own abilities,” says Radha.
“A lot of it is the words that we say to each other, showing up for each other and getting good feedback and being reassured that, you know what, we are in the right place. We’re doing it for the right reasons, and we’re doing a good job.”
Credits
Story by Brianne Tulk
Photography by Kevin Van Paassen
Web Design by Yara McDonald