Internal Medicine Rotation

Upon completion of the internal medicine rotation, the neurosurgery resident shall be able to:

  1. Discuss a working classification of respiratory failure, and list common causes for each classification (e.g. hypoxia, hypercapneia).
  2. Interpret arterial blood gases, including calculation of the A-a gradient and identification of acid-base abnormalities (e.g. uncompensated acute metabolic acidosis).
  3. Diagnose and treat common fluid balance disorders, including hypovolemia and hypervolemia.
  4. Diagnose and treat common electrolyte disturbances, including: hypo/hypernatremia, hypo/hyperkalemia, hypo/hypermagnesemia, hypo/hypercalcemia and hypo/hyperglycemia.
  5. Interpret an electrocardiogram, including identification of common dysrhythmias (.e.g. atrial fibrillation, ventricular tachycardia).
  6. Identify and initiate treatment for common, acute cardiac events (e.g. myocardial infarction, defibrillation for pulseless ventricular tachycardia).
  7. Outline the common causes and initial empiric treatment of the patient with: pneumonia, urinary tract infection, endocarditis, meningitis, and other common infections.
  8. Classify antibiotics, describe their mechanisms of action and the primary indications for use.

During the rotation, all residents should fulfill the Royal College’s  CanMEDS Competencies.


  1. Establish therapeutic relationships with patients and families, especially with respect to medical illness that affect the nervous system and pituitary disorders.
  2. Conduct, document and present a thorough medical history and physical exam.
  3. With appropriate supervision discuss relevant information with patients and family, especially conditions that have implications in acute surgical patients, such as cardiac, pulmonary and hematologic issues.
  4. To be able to share pertinent information with other health care providers involved in care.
  5. To participate in efficient and effective team handovers


  1. Work/collaborate effectively in an interdisciplinary team, including pharmacists, nurse practitioners, physiotherapists/occupational therapists/speech therapy.
  2. Be able to consult other specialists and subspecialist appropriately to care for more complicated patients.
  3. Be fully involved in educational activities and teaching offered by the service.
  4. Be able to share workload and duties appropriately with other teams, residents and students on the medical service.


  1. Be aware of finite resources utilize in an appropriate cost effective manner.
  2. On a busy service, learn to manage own time, education and personal life for a balanced lifestyle
  3. To learn time management skills in the medical setting.
  4. Be able to triage patients being able to identify medical emergencies that require prompt and immediate management; be able to appropriately triage emergency room and ward consults, and ask for help when required.
  5. Optimize safe and effective care in the acute and chronic care of medical patients


  1. Identify factors which contribute to overall medical health and counsel effectively for illness prevention.
  2. Advocate for timely investigations and tests in management of medically ill patients.
  3. Contribute to overall patient well-being and outcome
  4. Facilitate return of patient to community/alternate care
  5. Put in place community care and follow up to promote health and avoid readmission
  6. Appreciate barriers to care, particularly in underserviced patient groups


  1. Participate in medical/ICU/endocrine rounds and educational activities as able.
  2. Identify and seek out personal learning needs, especially to conditions relevant to neurosurgical patients, such as ICU/cardiac/hematologic/endocrine/pulmonary disorders
  3. Apply principles of critical appraisal to medical information, attend journal clubs
  4. Encourage student and peer learning, take opportunities to teach those junior.
  5. Contribute to development of new knowledge, be involved in appropriate research projects as able.


  1. Demonstrate commitment to appropriate bioethical standards of clinical practice
  2. Demonstrate a commitment to their patients, profession, and society through ethical practice
  3. Exhibit appropriate professional behaviors in practice, including honesty, integrity, commitment, compassion, respect and altruism
  4. Maintain appropriate relations with patients and other health care providers.
  5. Show appropriate respect for opinions of other health care providers
  6. Be able to appraise and identify own limits with respect to knowledge and patient care, and when to ask for assistance and consult effectively