Work rounds have received little attention in the medical education literature. At the outset of the second post graduate year, medical residents are expected to function, without much guidance, as both team leaders and teacher. New York State health code regulation 405 restrict house staff work hours and may influence the manner and content of work rounds. The goals of work rounds were identified through a literature review and our own experiences. A 36-item questionnaire utilizing the identified goals was used in this cross-sectional descriptive study. The participants were the Program Directors of New York State Internal Medicine residency programs. Each of the fourteen goals identified reflects one of three resident behaviors: patient care, teaching, and evaluation. The goals that received the highest importance scores were patient management and updating team leader of events. Ninety percent (90%) or more of the participants indicated that patient management, teaching clinical reasoning and problem solving, verifying important chart data, and verifying physical examination should be performed "often" or "almost always." Most programs employed verbal instructions but only few held conference or provided literature on the expectations and conduct of work rounds. New York State Internal Medicine program directors perceive work rounds as primarily a patient care task, and many rely on verbal instructions to convey the objectives to the house staff. While previous research has demonstrated that work rounds are an important setting for house staff education, this study reveals that in most New York State programs this opportunity may be missed.

Primary care physicians play a major role in the risk stratification of patients with coronary artery disease (CAD) preparing for noncardiac surgery. Preoperative risk assessment takes into account the type and urgency of surgery and the extent of underlying CAD. With this approach, patients can be categorized as being at high, intermediate, or low risk for postoperative cardiac complications. Judicious use of preoperative noninvasive cardiac testing may help identify those patients at particularly high risk for such complications.

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With effective communication, optimal use of perioperative therapeutic techniques, and postoperative follow-up, the medical, surgical, and anesthetic teams can prevent or minimize cardiac complications that occur during the postoperative period. Up to 50% of postoperative myocardial infarctions may be silent, or they may present as congestive heart failure, hypotension, or arrhythmia. Dyspnea is a common finding. All high-risk patients should be monitored in the intensive care unit during the first 7 days after surgery, when adverse cardiac events are most common.