Nilesh Patel, MD, MS, is stepping into his role as chief resident for Duke University Hospital this week.
Going into the new academic year, he has been thinking about ways to improve patient care and better support Duke’s internal medicine residents. Dr. Patel, who completed his residency at Duke, has spent the last year as a faculty member in Hospital Medicine, rounding on general medicine in Duke University Hospital, so he has had many opportunities to observe and think about patient care and the resident experience.
One thing Patel says he’s gotten interested in is how the chief residents can help educate and support residents when they are in the hospital overnight and don’t have all the resources that residents have during day shifts, such as access to conferences or having a consult service that is immediately available.
Patel would like to find ways to make more resources available for residents working at night.
Patel said supporting and providing resources for residents in general is one of his, and the three other incoming chief residents’, top priorities for the year. Patel’s co-chief residents are Coral Giovacchini, MD; Bonike Oloruntoba, MD; and Aaron Mitchell, MD.
“Our biggest goal is to make sure that we are as approachable and supportive as possible,” Patel said. “If the residents need anything this year, whether it’s taking care of patients, problems in their personal lives or finding resources for advancing their careers, we want to be easily accessible.”
Patel said there should never be a time when residents feel like they don’t have a support system, from the chief residents who are available 24 hours a day, seven days a week, to the senior assistant residents and attending physicians.
“The thing that makes Duke special is that you have an incredible group of caring, compassionate, brilliant individuals who are dedicated to caring for our patients,” Patel said. “I expect to be at the hospital late in July, August and September, and many of our faculty do, too, so our interns and residents can transition into their new roles as quickly as possible.”
Providing educational opportunities is part of the support Patel would like the chief residents to provide this year.
“One of the greatest opportunities that we have is to teach our residents and medical students not only during the structured time, but during the enormous number of reports that the chief residents lead, the unstructured reviewing of cases,” Patel said. “These learning opportunities are something that the chief residents are intimately involved in, so we can teach not only the zebra cases, but also the day-to-day cases that our residents spend most of their time thinking about.”
Other areas Patel has been thinking about over the last year include rapid response codes and quality improvement projects. He says he would like to develop a way for residents to approach rapid response triage (RRT), so that they have the opportunity to care for some of the sickest patients on the floor before the patients go to the ICU (these are patients who are not in cardiac arrest but who are either having a respiratory problem or who are becoming ill quickly).
Patel also has been thinking about quality improvement projects that would improve patient care and allow residents and faculty who are rounding on internal medicine services to be more efficient. Patel said he is working on a project on the paging culture here at Duke, but longer term he’d like to develop broader projects on how residents and faculty are using Maestro Care or changes in the way physicians transition patients. Patel expects other challenges to come up.
The four incoming chief residents have already identified duty hours, the bed expansion, and the increase in the number of patients residents see overnight as areas they will need to watch and troubleshoot.
“The question is how can we as chief residents continue to support and make sure residents have the time and the accessibility to what they need in order to learn as much as they were from each rotation before the changes took place,” Patel said.
Patel and his co-chief residents will have many opportunities to work together and find ways to make rotations, conferences and reports good learning opportunities for residents.
One thing that Patel feels does set up the chiefs for success is that they are all graduates of the residency program and good friends.
“The four of us have been fortunate enough to go through residency together and be friends long before this year started. We’ve been coming up with ideas on our own to hopefully move the residency program forward,” he said.
After his chief resident year, Patel, who attended Emory University School of Medicine, will return to Hospital Medicine at Duke. He says it’s a good fit for him because there are so many learning and clinical opportunities – two reasons he went into medicine.
“Hospital Medicine has a brilliant group of clinical faculty who are invested in the quality of this hospital and taking care of patients,” he said.
In his down time, Patel enjoys running, spending time with family, and reading. He also looks forward to spending time outside of the hospital with his fellow chiefs and residents.