UHN/MSH Medical Consult Service
The Medical Consultation Service performs consults on all of the inpatient services of the University
Health Network (Toronto General, Toronto Western, and Princess Margaret Hospitals) and Mount Sinai
Hospital. Most of the consultations are concerned with preoperative assessment of patients who have
surgical procedures planned and investigation and management of perioperative complications.
The residents are expected to:
- Determine the question which is being asked
- Perform the appropriate history and physical examination
- Gather other relevant clinical data (laboratory tests, X-rays, information from other clinicians)
- Write a concise consult note which focuses on the point of the consultation
- Review the case with their assigned staff person
- Provide appropriate follow-up throughout the rest of the patient’s hospitalization
The service includes an out-patient consultation experience at all 3 sites (MSH, TGH, and
TWH). Residents will participate in the pre-operative assessment clinics and attend the
high risk pregnancy clinic at MSH (Ontario Power Generation site).
Formal educational activities for the services are conducted throughout the week.
- Case Presentation Rounds
- Evidence Based Rounds
- "Staff Teaches" Rounds
- Physical Examination Rounds
Residents are also expected to attend Medical Grand Rounds and are encouraged to attend
General Internal Medicine Noon Rounds throughout the week.
The residents will be on call on average every third night and every second week-end. Call may
be taken from home, if the resident can return to the hospital within twenty minutes.
Coverage on weeknights and weekends will be for all hospital sites. The residents must
understand that it is their responsibility to return to the hospital when called by a resident or
nurse from any service. If the resident lives too far from the hospital to return within twenty
minutes, the resident may stay in the TGH residence I the designated duty room for our
service. The key is available from the Medical Education Office. On nights and weekends, the
resident is responsible from transportation from home to the hospital. Any subsequent
transfers between sites may be via taxi. Receipts should be saved and given to Dr. Otremba’s
secretary. The Department of Medicine is NOT responsible form lot/garage parking or parking
The residents are encouraged to introduce themselves to the head nurses on the surgical floors
and to get to know the nursing staff, as this will ease communication and suggestions. The
Medical Consult Service is the primary consultation service for all medical problems. In
particular, all cardiology problems are referred first to our service. If the consults is directed at
cardiology, the cardiology residents will usually direct the nurses to contact our service first. If
we decide to involve other consults, the resident should directly speak with the subspecialty
resident to direct the question and receive a response.
The consult team staff will evaluate the residents and these evaluations will be discussed with their
staff person at the end of the rotation. Residents are encouraged to suggest changes, which will
improve the academic experience and organization of the service. Your evaluation will be based upon
fulfilling CanMeds 2005 objectives during the rotation.
OBJECTIVES FOR THE SERVICE
The medical consultation Service at the University Health Network/Mount Sinai Hospital has four major
educational objectives for trainees rotating through the program.
1. Issues in Perioperative Care
The curriculum and content of the Medical Consultation Service concern the care of patients referred
by non-medical services, primarily surgical services. The majority of these patients will be undergoing a
surgical procedure and will be seen either preoperatively, postoperatively, or both. As such, there are
several medical issues that require addressing during this care period, including cardio-respiratory risk
stratification, optimization, interactions with anaesthesia, and general medical care for patients with
complex medical conditions. Approximately one-third to one-half the consultations will concern
cardiovascular disease, including coronary artery disease, arrhythmia, hypertension, valvular disease and
heart failure. Additionally, patients with COPD and diabetes and chronic renal insufficiency make up a
large component of these patients.
2. Medical Complications of Pregnancy & Gynecology
Residents rotating through Mount Sinai Hospital will be exposed to patients in the Obstetrics and
Gynecology department. Core competency is expected of the resident in areas such as investigation
and management of thrombo-embolic disease, hypertension, heart failure, and evaluation of dyspnea
and chest pain in pregnant or post-partum patient.
3. Medical Problems in Psychiatric Patients
The psychiatry service is very active one. Invariably, there will be consults requested from the caring
psychiatrist. Residents will be expected to be competent in evaluation and treatment of: delirium,
common neurologic diseases (stroke, dementia, seizures, and Parkinson’s disease), hypertension,
diabetes, and electrolyte disturbances.
4. Learning How to be a Consultant
The Service also focuses on teaching residents how to move from primary caregiver to consultant.
Issues such as timeliness and communication skills are stressed. Residents are taught to write notes
that are more ‘consultant-like’ rather than the kind of notes for primary care physicians performing
admissions. Residents are taught to identify the question or issue and address it directly. These are
important skills for internists and other specialists who rotate through our program such as
anaesthetists, and they are stressed throughout the clinical rotation.
A defined curriculum outlined in our ‘consultation package’, together with formal teaching sessions,
allows the resident to formally review the material. Evidence based medicine and in particular review
of Bayesian concepts (likelihood ratios, pre- and post-test probabilities) are stressed. The patient
material allows for application of this evidence at the bedside.