Resident patient load

[DisorderedDoc417]

Hi everyone! I’m hoping to gather data on what Residents see daily on the inpatient portion. Our typical situation is to have seen a minimum of 8 patients first year and 11 patients during second year.

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[clausewitz2]

Hi everyone! I’m hoping to gather data on what Residents see daily on the inpatient portion. Our typical situation is to have seen a minimum of 8 patients first year and 11 patients during second year.

Our inpatient experiences as interns had us usually with 5 patients, but it was on a dual diagnosis unit with the expectation that we'd be doing at least an hour of motivational interviewing with each patient every day. Second year we have 6-10 depending on the service. On consults our lists could become fairly ridiculous and it was not uncommon to be following 15-20 patients, although not necessarily seeing all of those daily (and sometimes they were intubated and sedated so a fairly short interview regardless!)

 

[bedevilled ben]

Hi everyone! I’m hoping to gather data on what Residents see daily on the inpatient portion. Our typical situation is to have seen a minimum of 8 patients first year and 11 patients during second year.

Exact same for us for inpatient. Eight patients intern year, 11 patients second year, typically 1-2 discharges and 1-2 new admissions daily.

 

[NickNaylor]

As an intern, I can’t remember having more than 6 patients at any one time on an inpatient service. As a PGY-2, we might cover 6-8 with a full census. One of our sites is fairly high volume and we might have an admission and a discharge in addition to 4-5 follow-ups, though that would be a pretty busy day for our sites.

Of course, weekend rounding is another thing altogether, but our interns don’t do weekend rounding.

 

[DisorderedDoc417]

As an intern, I can’t remember having more than 6 patients at any one time on an inpatient service. As a PGY-2, we might cover 6-8 with a full census. One of our sites is fairly high volume and we might have an admission and a discharge in addition to 4-5 follow-ups, though that would be a pretty busy day for our sites.

Of course, weekend rounding is another thing altogether, but our interns don’t do weekend rounding.

On our weekends we just do work ups as interns. Generally between 25-30 HPs from friday night till Sunday night.

 

[bashir]

On our weekends we just do work ups as interns. Generally between 25-30 HPs from friday night till Sunday night.

I don't see how that's possible. Am I missing something? That would be an hour and a half per patient for interview, staffing, writing a note, and orders, assuming you didn't eat, sleep, etc. for two days.

 

[Onions]

We are told not to carry more than 8 patients on the units. This at times turns into 10 or 12 if no one is looking. After hours, it's, well, after hours. I think the most I've ever done in a single 12 hour shift on nightfloat was like 10 or 11 evals.

Yeah, I'm slow with my writeups. I stayed until noon finishing up haha.

 

[SmallBird]

Hi everyone! I’m hoping to gather data on what Residents see daily on the inpatient portion. Our typical situation is to have seen a minimum of 8 patients first year and 11 patients during second year.

That seems a lot?

I carried 5 as an intern, up to 6 as a PGY-2, 4 as a child fellow, now 9 as an attending.

 

[SpinDktr]

**Back in my day in aught seven**... Our unit had 2 attendings and 3 interns for a 15 bed unit. So it was usually 5 per intern, because it was almost always full.

There was one week when both other interns were out (One sick, the other on maternity leave), and it was just me for 2 attendings. I thought I did a great job, keeping up with charting, orders, discharge summaries and everything the attendings wanted.

Then like a few weeks later, I got called into the program director's office with concerns I wasn't "listening" to my patients enough. I am a very patient person, but I very nearly got to a breaking point then. I tried to point out just how "unfair" the situation was, but that was when I realized just how unempathic even psychiatrists could be. Of course I wan't listening to patients, not with 15 of them and 2 demanding attendings wanting me to finish their paperwork for them.

Mind you this was just one week of carrying 15, it was usually 5, but to be written up for doing triple duty?? It does get better though. Eventually you too can be the attending taking a **** on all the lowly interns.

 

[DisorderedDoc417]

I don't see how that's possible. Am I missing something? That would be an hour and a half per patient for interview, staffing, writing a note, and orders, assuming you didn't eat, sleep, etc. for two days.

60 minutes to both see a patient and document the history and physical, multiply it by 25. Usually in the hospital 12 hrs on Saturday, 12 hours on Sunday, and just for 4 or so hours Friday evening after everyone leaves. We do this approximately 1 in 6 weekends.

 

[DisorderedDoc417]

**Back in my day in aught seven**... Our unit had 2 attendings and 3 interns for a 15 bed unit. So it was usually 5 per intern, because it was almost always full.

There was one week when both other interns were out (One sick, the other on maternity leave), and it was just me for 2 attendings. I thought I did a great job, keeping up with charting, orders, discharge summaries and everything the attendings wanted.

Then like a few weeks later, I got called into the program director's office with concerns I wasn't "listening" to my patients enough. I am a very patient person, but I very nearly got to a breaking point then. I tried to point out just how "unfair" the situation was, but that was when I realized just how unempathic even psychiatrists could be. Of course I wan't listening to patients, not with 15 of them and 2 demanding attendings wanting me to finish their paperwork for them.

Mind you this was just one week of carrying 15, it was usually 5, but to be written up for doing triple duty?? It does get better though. Eventually you too can be the attending taking a **** on all the lowly interns.

Each attending generally has between 8-14 patients in my hospital. We pick up 6 of them from day 1 and each resident on the inpatient side of things does 2 HPs on a typical workday in addition to the 6 we follow (3 and 8 patients respectively for PGY2). Of course if everyone gets maxed out, we see more. The discharges range usually from 2-4 a day. It’s definitely a busy place, I’m just wondering how it compares to most. I do worry that the volume takes away from my ability to get to better know the patients at times, or to read up on things, but it is pretty clear that my job can feel like I’m just teeing up the documentation so that the attending can come in quickly and do the fun part. The good of it is that I’m repeatedly seeing how things are treated and becoming very efficient on the weekends.

 

[DisorderedDoc417]

We are told not to carry more than 8 patients on the units. This at times turns into 10 or 12 if no one is looking. After hours, it's, well, after hours. I think the most I've ever done in a single 12 hour shift on nightfloat was like 10 or 11 evals.

Yeah, I'm slow with my writeups. I stayed until noon finishing up haha.

We sometimes have to carry more patients, but it is rare. Generally we don’t carry more or less than our amount. 12 HPs is about the max I’m capable of in a day, the brain is mush by that point.

 

[Onions]

the brain is mush by that point.

Oh my brain was mush alright. The funniest part was that I had discharged all but one of those patients I saw that night. The one I admitted happened to have been the only one that never said anything about killing himself.

 

[clausewitz2]

Each attending generally has between 8-14 patients in my hospital. We pick up 6 of them from day 1 and each resident on the inpatient side of things does 2 HPs on a typical workday in addition to the 6 we follow (3 and 8 patients respectively for PGY2). Of course if everyone gets maxed out, we see more. The discharges range usually from 2-4 a day. It’s definitely a busy place, I’m just wondering how it compares to most. I do worry that the volume takes away from my ability to get to better know the patients at times, or to read up on things, but it is pretty clear that my job can feel like I’m just teeing up the documentation so that the attending can come in quickly and do the fun part. The good of it is that I’m repeatedly seeing how things are treated and becoming very efficient on the weekends.

This makes me glad for my program's culture. If my slots are full, that's it, the do not do H&Ps. If I am doing an H&P it is because they have been assigned to me and I will be following them. In PGY-2 we do short calls in our psych ED, so if I happened to admit someone the previous evening to the floor I am currently on and it is an interesting case, I might ask to follow them, but that is pretty much the only circumstance i'd go over.

If we take vacation or are out, our co-residents on the same service are responsible for medical decision-making in theory, but the geris, kiddos and eating disorder folks have their own PAs/NPs looking after them medically and typically complicated cases are already being followed by our Family Medicine service.

The attending picks up the slack for h&ps, d/c summaries and progress notes of the residents who are out.

 

[Bad Moose]

My personal record is 54 patient encounters including progress notes, psych evals, consults and ER visits in 24 hours. It was terrible.

 

[NickNaylor]

My personal record is 54 patient encounters including progress notes, psych evals, consults and ER visits in 24 hours. It was terrible.

That’s insane. There’s zero chance that would be allowed at our program.

 

[clausewitz2]

That’s insane. There’s zero chance that would be allowed at our program.

Same here. We are a big program, so we have separate residents covering inpatient units, different residents in the Psych ED, and yet more different residents on the consult service. Having encounters split across the three service areas in the same day just isn't a thing.

 

[FatherPsychiatry]

PGY-1: 6-7 patients.
PGY-2: 3-4 patients. But we start our outpatient practice this year so we are only on the inpatient unit for the first half of the day. Might come back for a family meeting or something in the afternoon but otherwise the intern/attending covers afternoon stuff with the patients.

 

[DisorderedDoc417]

This makes me glad for my program's culture. If my slots are full, that's it, the do not do H&Ps. If I am doing an H&P it is because they have been assigned to me and I will be following them. In PGY-2 we do short calls in our psych ED, so if I happened to admit someone the previous evening to the floor I am currently on and it is an interesting case, I might ask to follow them, but that is pretty much the only circumstance i'd go over.

If we take vacation or are out, our co-residents on the same service are responsible for medical decision-making in theory, but the geris, kiddos and eating disorder folks have their own PAs/NPs looking after them medically and typically complicated cases are already being followed by our Family Medicine service.

The attending picks up the slack for h&ps, d/c summaries and progress notes of the residents who are out.

We do all our own discharge orders, summaries. Everything just gets the 4 sentence attestation from the attending.

 

[clausewitz2]

We do all our own discharge orders, summaries. Everything just gets the 4 sentence attestation from the attending.

I am saying we do all of those things, but only on the patients we follow.

 

[clozareal]

Intern here. We carry 8 patients max on our inpatient unit on our first year. Typically we have between 4-6. Not sure about the rest of the years.

 

[Nasrudin]

This variation is wide. One thing that's unclear is the level of support variation. I could see a ton of patients if all the collateral was obtained. Records from outside hospitals obtained. If there was ample talk therapeutic venues for the patients. If the nurses didn't require being followed to make sure things got done. If I wasn't needed to run security for agitation episodes. If I didn't have to do many of the SW duties. If I didn't think seeing a patient for 10-20 minutes a day at least wasn't part of the job.

But given the above 10 was too much, which happened at times. 8 was cap, with a huge difference between 6 and 8.

An MSE from down the hall and after group rounding once you've done an intake. And then cranking a note. Repeating x 10-20. And putting out fires. That's what the job become at anything 10 or above. Maybe that's what the job is mostly. But that and heavy bureaucracy of inpatient units makes it unpalatable for me.

Good luck y'all.

Over 10 consistently or 60 encounters in 24 hours...... seriously consider a transfer if you can swing it.

 

[DisorderedDoc417]

This variation is wide. One thing that's unclear is the level of support variation. I could see a ton of patients if all the collateral was obtained. Records from outside hospitals obtained. If there was ample talk therapeutic venues for the patients. If the nurses didn't require being followed to make sure things got done. If I wasn't needed to run security for agitation episodes. If I didn't have to do many of the SW duties. If I didn't think seeing a patient for 10-20 minutes a day at least wasn't part of the job.

But given the above 10 was too much, which happened at times. 8 was cap, with a huge difference between 6 and 8.

An MSE from down the hall and after group rounding once you've done an intake. And then cranking a note. Repeating x 10-20. And putting out fires. That's what the job become at anything 10 or above. Maybe that's what the job is mostly. But that and heavy bureaucracy of inpatient units makes it unpalatable for me.

Good luck y'all.

Over 10 consistently or 60 encounters in 24 hours...... seriously consider a transfer if you can swing it.

Unfortunately second year will include 11 every day, and doing the above things you mention, AND helping first years in July... until probably September.

 

[Nasrudin]

Unfortunately second year will include 11 every day, and doing the above things you mention, AND helping first years in July... until probably September.

Well. That sucks. At least you guys won’t be surprised by a ****ty job as attendings. You’ll know what to sniff for.

There’s something wrong in the financials of your institution. They’re too top heavy. They have lazy attendings. Too many admins. Something.

But they’re using you for RVU’s.

For those patient care duties. They should have a genius attending following you around. Dropping gems of knowledge and insight in your ear as your plodding along.

Unionize. Revolt.

Or transfer.

Or just survive it.

What can we do.

As attending you can just leave. And work for their competitors. But... yeah. Sucks.

 

[MedMan80]

Academic program in NE

As an intern on inpatient we would see 12, senior resident also 12..unit almost always full, sometimes chronic patients so not too complex..Busy call and one can easily see ~12 consults and 15 or so followups, luckily attending saw the patients on the inpatient unit in addition to everything you saw (often they would be lazy and not see your patients, which I know was illegal)..

this thread should be an indication to students interested in psych that there's a wide variation between resident loads, lighter loads = more time to digest the case and more time for supervision..just keep that in mind...

 

[MedMan80]

Well. That sucks. At least you guys won’t be surprised by a ****ty job as attendings. You’ll know what to sniff for.

There’s something wrong in the financials of your institution. They’re too top heavy. They have lazy attendings. Too many admins. Something.

But they’re using you for RVU’s.

For those patient care duties. They should have a genius attending following you around. Dropping gems of knowledge and insight in your ear as your plodding along.

Unionize. Revolt.

Or transfer.

Or just survive it.

What can we do.

As attending you can just leave. And work for their competitors. But... yeah. Sucks.

In our institution it was the culture that Attendings can fall back to residents for the work, hence that's why they probably tolerated lower attending salary in lieu of lighter work loads

 

[DisorderedDoc417]

Well. That sucks. At least you guys won’t be surprised by a ****ty job as attendings. You’ll know what to sniff for.

There’s something wrong in the financials of your institution. They’re too top heavy. They have lazy attendings. Too many admins. Something.

But they’re using you for RVU’s.

For those patient care duties. They should have a genius attending following you around. Dropping gems of knowledge and insight in your ear as your plodding along.

Unionize. Revolt.

Or transfer.

Or just survive it.

What can we do.

As attending you can just leave. And work for their competitors. But... yeah. Sucks.

Luckily there is no call and no inpatient during third and fourth year of residency so it becomes pretty Cush. People seem to leave her program well prepared.

 

[clausewitz2]

Well. That sucks. At least you guys won’t be surprised by a ****ty job as attendings. You’ll know what to sniff for.

There’s something wrong in the financials of your institution. They’re too top heavy. They have lazy attendings. Too many admins. Something.

But they’re using you for RVU’s.

For those patient care duties. They should have a genius attending following you around. Dropping gems of knowledge and insight in your ear as your plodding along.

Unionize. Revolt.

Or transfer.

Or just survive it.

What can we do.

As attending you can just leave. And work for their competitors. But... yeah. Sucks.

This is what scares me

Luckily there is no call and no inpatient during third and fourth year of residency so it becomes pretty Cush. People seem to leave her program well prepared.

We also have no call after 2nd year, so crushing workloads are not a necessary.prereq.

 

[DisorderedDoc417]

This is what scares me


We also have no call after 2nd year, so crushing workloads are not a necessary.prereq.

It isn’t “crushing”. I mean, it is work, but it is a hell of a lot nicer than a blue-collar job. The 2 workups each take an hour and the follow ups maybe 30 minutes a piece, that leaves an hour for lunch and an hour for inefficiencies throughout the day. My docs are paid on production though, not to teach explicitly, and that model means they work and we learn through observation.

 

[clausewitz2]

It isn’t “crushing”. I mean, it is work, but it is a hell of a lot nicer than a blue-collar job. The 2 workups each take an hour and the follow ups maybe 30 minutes a piece, that leaves an hour for lunch and an hour for inefficiencies throughout the day. My docs are paid on production though, not to teach explicitly, and that model means they work and we learn through observation.

When do didactics or family meetings or hearings or talking to outpatient providers or getting collateral happen? Or managing basic medical issues or doing prior authorization and doc-to-docs or discussing the case with long term facilities to convince them your patient is suitable? Or catatonia scales or AIMS or Y-BOCS when appropriate or basic supportive therapies?

Or is the expectation that you are not going to be doing notes during that time and your estimate of time per patient is just contact/orders/day stuff and you do the documentation after?

 

[DisorderedDoc417]

When do didactics or family meetings or hearings or talking to outpatient providers or getting collateral happen? Or managing basic medical issues or doing prior authorization and doc-to-docs or discussing the case with long term facilities to convince them your patient is suitable? Or catatonia scales or AIMS or Y-BOCS when appropriate or basic supportive therapies?

Or is the expectation that you are not going to be doing notes during that time and your estimate of time per patient is just contact/orders/day stuff and you do the documentation after?

Didactics are a half day once a week that is protected. Basic medical issues are a part of the interaction with the patient — we review labs and treat of course! Phone calls and the like happen throughout the day... and we have Ancillary staff to do some of the things you note above. I’m not “convincing” anyone to take my patients, there are other employees more skilled in navigating those waters, ie social workers. Doc to docs, family meetings, scales all happen — But usually we’re still out the door by 4:30pm.

 

[DisorderedDoc417]

Didactics are a half day once a week that is protected. Basic medical issues are a part of the interaction with the patient — we review labs and treat of course! Phone calls and the like happen throughout the day... and we have Ancillary staff to do some of the things you note above. I’m not “convincing” anyone to take my patients, there are other employees more skilled in navigating those waters, ie social workers. Doc to docs, family meetings, scales all happen — But usually we’re still out the door by 4:30pm.

Where I think we miss out is some of the neat anecdotal pieces and chalk talks with academic attendings who had way lower patient loads where I trained in medical school. This is more the community model.

 

[clausewitz2]

Where I think we miss out is some of the neat anecdotal pieces and chalk talks with academic attendings who had way lower patient loads where I trained in medical school. This is more the community model.

I often find challenging talks pretty low yield but actually discussing the patients and formulations of them at some length is useful, provided that the attending in question is actually inclined to be thoughtful. Do you guys get time to carry therapy patients before PGY-3? I have two (maybe three) right now and i would resent them a bit if I had to be seeing them after 5 consistently and especially if I had to do supervision in the evening...

 

[FlowRate]

We follow 4 inpatients intern year and 6 pgy-2. At one site, we do most of the social work stuff. At another site, some social work stuff is taken care of for us. It's very manageable (it's very rare for me to have to stay late.)

Night float at one site averages around 6 consults a night. The most consults I did in one night was 8 or 9. I can typically do an easy consult (callback to signed note) in 45 minutes to 1 hour and a complex consult / discharged ED consult rarely takes more than 2 hours. At another site, we do 2-3 admission and 2-3 ED consults overnight, on average--complicated by covering the inpatient unit and dealing with RN pages and what not. Rare inpatient consults at both sites. Haven't done our third site yet.

 

[DisorderedDoc417]

Where I think we miss out is some of the neat anecdotal pieces and chalk talks with academic attendings who had way lower patient loads where I trained in medical school. This is more the community model.

But I think we turn out to be suprisingly resilient, efficient, and knowledgeable when we graduate compared to some of our more academically oriented compadres.

I often find challenging talks pretty low yield but actually discussing the patients and formulations of them at some length is useful, provided that the attending in question is actually inclined to be thoughtful. Do you guys get time to carry therapy patients before PGY-3? I have two (maybe three) right now and i would resent them a bit if I had to be seeing them after 5 consistently and especially if I had to do supervision in the evening...

Second year we spend our half day after didactics in clinic instead of back on the units. But it is a clinic half day all year and we carry many more patients than just 5.

 

[clausewitz2]

But I think we turn out to be suprisingly resilient, efficient, and knowledgeable when we graduate compared to some of our more academically oriented compadres.


Second year we spend our half day after didactics in clinic instead of back on the units. But it is a clinic half day all year and we carry many more patients than just 5.

For long term therapy or just general outpatients? Either likely useful, just curious

 

[DisorderedDoc417]

For long term therapy or just general outpatients? Either likely useful, just curious

Psychotherapy is something we focus on PGY3/4. Just outpatient treatment for now.

 

[FlowRate]

When people talk about covering 8-10 patients as PGY-2, is that solo or are there interns also caring for the same patients?

 

[Onions]

When people talk about covering 8-10 patients as PGY-2, is that solo or are there interns also caring for the same patients?

A PGY-1 and I are on the unit now. It's a smaller unit, census of just 16 patients. We split them down the middle, picking up slack for each other if one of us has a bunch of discharges on a given day. This is largely because the unit attending just doesn't care how we choose to take the cases. Some attendings in my program assign cases to their residents.

We don't actually get any outpatient exposure until 3rd year, but the director of our outpatient department is working on changing that. I'll be picking up my first therapy cases about now, which is not, admittedly, significantly before the start of 3rd year...Should be fun: I presently have no confidence in my psychotherapeutic abilities.

 

[clausewitz2]

When people talk about covering 8-10 patients as PGY-2, is that solo or are there interns also caring for the same patients?

Our general adult unit (not chronic psychosis, eating disorders, old people, trauma/high functioing personality, dual diagnosis, ID/autism) has about 30 beds plus a six bed behavioral ICU. There are three residents on the unit (including me) at the moment and a nurse clinician. Three attendings. One attending is not allowed to work with residents yet cause he is new, so nurse clinician works with his patients. We residents are assigned specific beds and admit/follow/discharge whoever is in those beds. Pretty good SW support so aftercare and most calls to families are taken care of for is, but I consistently have 7-9 patients. Turnover on this unit is quick, so 3-4 admits/discharges a day plus commitment hearings twice a week (about 30% involuntary). My worst day ever was three admits, three discharges, and two hearings. Still, I have never felt really tapped out and am consistently done before 5.

 

[DisorderedDoc417]

When people talk about covering 8-10 patients as PGY-2, is that solo or are there interns also caring for the same patients?

8-11 patients by ourselves, in my case. I am an intern and so there are no interns under me doing my work for me XD

 

[DisorderedDoc417]

Our general adult unit (not chronic psychosis, eating disorders, old people, trauma/high functioing personality, dual diagnosis, ID/autism) has about 30 beds plus a six bed behavioral ICU. There are three residents on the unit (including me) at the moment and a nurse clinician. Three attendings. One attending is not allowed to work with residents yet cause he is new, so nurse clinician works with his patients. We residents are assigned specific beds and admit/follow/discharge whoever is in those beds. Pretty good SW support so aftercare and most calls to families are taken care of for is, but I consistently have 7-9 patients. Turnover on this unit is quick, so 3-4 admits/discharges a day plus commitment hearings twice a week (about 30% involuntary). My worst day ever was three admits, three discharges, and two hearings. Still, I have never felt really tapped out and am consistently done before 5.

Sounds we are similar although we care for the folks you have in parentheses as well. I am usually done by 5pm at night, the problem is that my time is spent interviewing patients alone and documenting all day. Other universities have chalk talks, discussions with attendings on cases, etc. I think what we do gears me to be leagues ahead of some of my same level colleagues who spend more time chalk talking, but I also believe that gap probably closes a few years into practice and so I’ve left my time in residency with less book experience and more street psych smarts. Can some of this be overcome with self study? Of course. But as a famous person once said, never describe what an ocean looks like if you’ve never seen one. I think those chalk talks are an invaluable part of an excellent education.

 

[DisorderedDoc417]

Sounds we are similar although we care for the folks you have in parentheses as well. I am usually done by 5pm at night, the problem is that my time is spent interviewing patients alone and documenting all day. Other universities have chalk talks, discussions with attendings on cases, etc. I think what we do gears me to be leagues ahead of some of my same level colleagues who spend more time chalk talking, but I also believe that gap probably closes a few years into practice and so I’ve left my time in residency with less book experience and more street psych smarts. Can some of this be overcome with self study? Of course. But as a famous person once said, never describe what an ocean looks like if you’ve never seen one. I think those chalk talks are an invaluable part of an excellent education.

Then again, the grass is always greener, so I will keep working hard and doing my best, hoping to be what I set my sights on before I started residency, an awesome psychiatrist!

 

[clausewitz2]

Sounds we are similar although we care for the folks you have in parentheses as well. I am usually done by 5pm at night, the problem is that my time is spent interviewing patients alone and documenting all day. Other universities have chalk talks, discussions with attendings on cases, etc. I think what we do gears me to be leagues ahead of some of my same level colleagues who spend more time chalk talking, but I also believe that gap probably closes a few years into practice and so I’ve left my time in residency with less book experience and more street psych smarts. Can some of this be overcome with self study? Of course. But as a famous person once said, never describe what an ocean looks like if you’ve never seen one. I think those chalk talks are an invaluable part of an excellent education.

We take care of patients with those diagnoses, just on other rotations on other units. We are big and a tad hyperspecialized.

I tend not to find chalk talks very useful for the most part (point me in the direction of appropriate literature or books and give me that same time to read, it will be vastly more efficient), but case discussions with attendings are invaluable when the attendings in question are interested in walking through their thought process and relaying their clinical experience. That helps instantiate theoretical knowledge in the real world.

 

[DisorderedDoc417]

We take care of patients with those diagnoses, just on other rotations on other units. We are big and a tad hyperspecialized.

I tend not to find chalk talks very useful for the most part (point me in the direction of appropriate literature or books and give me that same time to read, it will be vastly more efficient), but case discussions with attendings are invaluable when the attendings in question are interested in walking through their thought process and relaying their clinical experience. That helps instantiate theoretical knowledge in the real world.

Yes. When I say chalk talk I just mean time to sit with the attending informally to discuss salient and practical clinical pearls through the process you describe above.