Graded pass/fail only.

This two-week, full-time elective will focus on the role of the observation unit as a point in the transition of care of select emergency department patients to either short-term management or further inpatient care. Observation medicine has been shown to be effective in reducing hospital costs as well as length of stay in addition to improved patient outcomes. It is an important triage tool that students need to be familiar with prior to entering internal medicine residency. The purpose of this elective is to teach students to recognize what kinds of medical admissions are appropriate for admission to the observation unit and then admit those patients to the observation unit at night. Additionally, the goal is for students to become more comfortable answering cross cover issues on inpatient as well as observation unit patients as this is an important skill for intern year.

Students will work at night under the supervision of one of the three nocturnists who admit patients to the 1 Tower Observation Unit. Students will get the opportunity to take reports from emergency room physicians and determine if a patient is appropriate to the observation unit. If accepted to the observation unit, then the student will admit the patient to the observation unit including all admission orders and overnight management. Students will also be exposed to giving appropriate sign outs or hand offs to the daytime observation unit team on the patients they admit. Additionally, students will be given experience in dealing with cross coverage issues on patients admitted to the observation unit and medical wards in order to become more comfortable with this important intern responsibility. All activities will be performed under the supervision of the nocturnist or night hospitalist. Participation in a curriculum tailored to the above will be an essential part of the elective to supplement the activities of this elective rotation. The ultimate goal is to provide a bridge into more independent patient care in preparation for intern year.

Grading will be on a Pass/Fail basis.

Students must complete the following requirements in order to receive two weeks credit:
- A curriculum on the basics of the observation unit, common overnight calls, and basic management of common observation unit diagnoses will be reviewed and discussed nightly with the supervising nocturnist.
- At the end of the rotation, a brief one-page reflection of student's experience working the night shift and or a meaningful experience with a patient will be required.
- PASSING requires completion of ten 8-hour shifts over the two-week course and completion of the curriculum or equivalent number of hours.
- FAILING will result from unexcused absence from the night shift or not turning in reflection paper at the end of the course.

Methods of Assessment:
1) Overall participation in the program; 2) Self-assessment reflection.