The MTU Structure

The General Medical Teaching Units are preceptor-based teams which maintain a geographic home base as much as possible.  Each team is headed by a Teaching Unit Director whose responsibility is to ensure the effective functioning of the Unit.

FMC - Blue Team This team consists of 3 seniors (1 emergency liaison and 1 ward senior), 4 to 5 junior residents and 3 clinical clerks. The emergency liaison senior serves as the consultant to the ER department (8am to 5pm), helps out with procedures, attends sign in and sign out rounds, and substitutes as the MTU ward senior when the ward senior is post call. the third senior acts as a teaching resident on the ward.

PLC - Green and Gold Team

The PLC has 2 smaller teams: the green and the gold team.
The green team has 3 senior residents, 3 juniors and 3 clinical clerks. The gold team has 2 junior residents, 3 clinical clerks and no senior. The attending on gold team takes the role of the senior.
The emergency liaison senior (and the senior call at night or on the weekends) triages to both teams. During working hours the senior residents have no clinical responsibilities for the ward patients on gold team except for emergencies. The emergency liaison senior may be asked to supervise procedures on the gold team.
There must be 1 member of the gold and green team (clinical clerks or junior resident) on call every night and on weekends. This on call person is first call for ward issues. In addition, he/she is expected to round on his/her team's patients, write progress notes on weekends. The junior residents on call are expected to back up/supervise the clinical clerk.
On weekends, the senior resident is expected to help round on green team. He/she should also be aware of any critically ill patient on the gold team.

Admission of Patients to the General MTU

The emergency room physician contact the senior resident on call is she/he feels a patient requires admission to the MTU.
A senior resident cannot decline a patient over the phone. If the senior resident feels that the case is clearly inappropriate, he/she must contact the attending before declining to see the patient.
If the patient is deemed to be a good MTU patient and is stable (i.e. does not require emergency resuscitation), then the senior is to accept the patient in the MTU. The admitting junior resident or clinical clerk should then see the patient to start the initial workup. This need not be done in the emergency room and can be done on the wards. The senior should review the case with the junior/clinical clerk afterwards. The junior resident/clinical clerk is responsible for writing up the history/physical examination and orders. The note written by the senior resident should be a brief note that highlights the pertinent medical problems and management plans.
It is inappropriate for the senior resident to access a stable patient (complete history, physical exam) before the junior resident/clinical clerk has done them.
If a patient in ER is unstable then the senior resident should contact the clinical clerk/junior resident to help with the initial management and resuscitation. This is a very important part of teaching.

What is a good MTU case?

Every patient has something to teach us, and thus everyone is a good teaching case.  Unfortunately we cannot take care of all the medical patients in the hospital.  The senior may have to turn down patients (after discussing this with the attending).  Great MTU cases include:

• Patients with a single system problem

• "bread and butter" cases (i.e. pneumonia, pyelo etc).

• sick patients with multisystem disease.

• Patients with good physical exam findings, unusual x-rays etc.

Remember that the MTU is there to teach clinical clerks and family practice residents who need to see bread and butter medicine .Senior residents are not allowed to give phone advice to physicians calling from outside the hospital, nor can the senior resident accept transfers from other hospitals.  The physician should be instructed to contact the general internist on call. Family physicians have an active role in both FH and PLC.  The Family Physician of a patient admitted to the MTU must be consulted regarding the care of his/her patient.  This is important for the continuity of patient care, particularly in discharge planning.  In some cases, it may be appropriate to transfer care from MTU entirely to the Family Physician or a hospital list once an acute illness has passed.  Close liaison with the Family doctors is a central component of a consultant's work and these patterns of communication must be strongly established during residency training.

General MTU Junior

A major goal of the MTU organization is to optimize the early involvement of medical residents in patient care in the Emergency Department.  The senior resident will be initially contacted by the Emergency physician and after a telephone conversation or a brief assessment in the Emergency Department the senior may then decide to admit the patient to the MTU and call the junior resident.  If the patient is stable and does not require immediate treatment or observation in the Emergency Department, the junior resident who is expected to discuss the initial management plan with the senior resident prior to contacting the preceptor.The junior resident is responsible for the day to day care of patients whom they have admitted, and will supervise the activities of the clinical clerks who share their patient assignments.  As well, the junior resident is expected to maintain communication with the Attending physician, the Family physician, nursing staff and the senior resident about the treatment plans for the patients under their care, and will serve as the primary physician for the patient while in the hospital

.Responsibilities of the Junior Resident

• Admit new patients to the MTU.

• Round on his/her patients’ everyday. Obtain lab results/x-ray results. Develop a daily management plan. Write daily progress notes.

• Liaise with the family doctor, home care, consultants in addition to the senior resident and attending physician in order to coordinate care both in the hospital and in the community.

• Dictate discharge summary. Write off service note.

• Perform bedside procedures.

• Participate in rounds.

• Teach clinical clerks.

• Round on all MTU patients on weekends and write progress notes.

• Contact the patient’s family doctor both on admission and at the time of discharge.

• Help residents who are post call to leave at noon by covering the post-call resident’s patients including tracking down any outstanding tests, talking to consultants, families, etc.