Day in the Life

Hello everyone, my name is Mike Anacker, and welcome to the day in life of a first year resident at C.S. Mott Children’s Hospital at the University of Michigan. I want to take you through a typical day on the inpatient wards, where, as interns, we rotate for approximately 5 months of our first year. Hopefully this helps answer some key questions you may have regarding the workflow, structure, and lifestyle at Michigan. Go Blue!


6:30 AM to 8:00 AM – Pre-rounding: I arrive at the hospital, and the night team is ready to give updates on any overnight changes on my patients. I also get sign-out on any new patients admitted to our service. After sign-out is complete, I use MiChart (Michigan’s EMR/Epic) to obtain labs, vitals, and review imaging studies. With the important data collected, I make my rounds to each patient’s room. I examine each patient and briefly talk with parents and patients about overnight events. I come up with a clinical plan for each patient and make notes to present on rounds. After “pre-rounding,” my senior resident helps review my plans and offers advice on any changes I’ve made.


8:00 AM to 8:45 AM – Morning Report: After pre-rounding, I join my co-residents for coffee, bagels, and other snacks at morning conference. Conferences are located on the 12th floor of Mott with quite the view – windows with almost a full 360 degree view overlooking the city of Ann Arbor as well as the nearby Arboretum and parks.


Morning conferences are typically case-based, resident-driven, and very interactive. Residents ask questions and work through the case together while the attending physicians help guide the discussion and highlight key learning points.


8:45 AM to 11:00 AM – Rounds: After morning conference, we spend the time before 9:00 am re-grouping with the team before rounds. I meet my team in the team room and await the arrival of the attending physician. The team includes the attending physician, fellow (subspecialty rotations), senior resident, co-intern, sub-interns, medical students, our resident assistant and often a clinical pharmacist and dietitian. The team travels to each patient’s room and gathers at the patient’s bedside for family centered rounds. Presentations of each patient take place with nursing staff and the family present in the room. After the presentation and any changes in plan are discussed, family members take the opportunity to ask questions. Any issues or concerns are addressed with the entire team present, so we can all be on the same page. Usually with each patient, either the fellow or attending will point out a key clinical pearl or physical exam finding to enhance daily learning. Rounding directly with specialists lets us have in-depth discussions about complex care and helps to develop a sense of collegiality between the residents and the entire pediatric faculty group.


11:00 AM to 12:00 PM – Work-Time: After rounds, I complete orders, follow-up on pertinent studies, call consultants, and discharge patients home. Throughout the morning, our Resident Assistants are incredibly helpful offloading our administrative tasks such as scheduling follow up clinic appointments and obtaining outside records. This lets me focus on patient care responsibilities instead of waiting on hold to schedule follow-up.


12:00 PM to 1:00 PM – Noon Conference: At noon, I attend a weekday educational conference. These conferences are generally lecture-based topics covering the core pediatric curriculum. The topics range from specialty based, to general care, to hospital improvement and initiatives. A catered, healthy lunch is provided every day and I’m able to spend time with my fellow residents. It is nice to break away from inpatient responsibilities to have dedicated learning time. Our senior resident tries to make sure we attend conference every day.


1:00 PM to 5:30 PM – Work Time: In the afternoons, I continue managing my patients, following up on labs and studies, and completing clinical plans. I write my daily progress notes in the EMR system and send them to be reviewed and signed by the attending. I also admit or transfer new patients to my service and guide medical students through patient encounters. Many afternoons also contain brief teaching sessions by our attending physicians. They will focus on a key element of their practice and provide concise clinical pearls for more comprehensive understanding of commonly treated conditions. At some point in the afternoon, I’ll head off to our Pediatric Resident Lounge to grab coffee and snacks. About one day per week I head off to see patients at my Outpatient Continuity Clinics, and about twice a week, I have the opportunity to head home early, when my work is completed.


5:30 PM - Evening Sign-Out: The night team comes in at 5:30 PM to take sign-out and assume care of my patients. I make sure to give them a brief synopsis of the patient’s condition and daily progress. I highlight key elements of the plan for them to complete and monitor overnight. Once I sign-out to them, I am able to head home to spend the evening with friends and family.