Pgy2 bootcamp or How to be an upper level resident

Things to think about BEFOREJuly 1st

By Your Friendly Chiefs

In a short time, you will be holding code pagers, noticing your name listed behind attendings on H&Ps, internally screaming in terror as little intern eyes look up to you for answers. Yes, you made it to second year… Now what?

The Great Transition

Assume that July-Sept interns know nothing. Help out on wards as much as you can. PGY-2

and PGY-3 does NOT mean “never writes progress notes.”

Your place is in the work room—NOT in the call room or lounge.

Always follow up on important things yourself. Interns are NOT your employees. They are your

colleagues—treat them as such!

Interns

ACGME mandates that PGY-1s should not be in house >24hrs. Get your post-call interns out quickly!

ACGME mandates that PGY-1s should not be responsible for more than 10 patients. In the MICU, this may need to be 8 given the increased acuity.

Critique your interns often and respectfully and NEVER in front of attendings or medical students. Don’t wait till the end of the month if you are noticing issues.

Don’t be jerks to off-service interns. Give them patients that have something to do with their field if possible.

Interns

Except in the MICU, days off will be determined by the UL (upper level) on service.

Try to get your schedule done in the first few days (and send a copy to Heather). THIS IS A REQUIREMENT AT THE VA.

Try to give post-call interns the next day off if possible.

Don’t forget to factor in intern clinic days which do NOT count as days off.

Schedules

Don’t forget to check the call schedule before making your off-days calendar.

Be sure to coordinate with your co-residents on other teams to be sure an UL is always available for the interns 3A, 3B, Team 6 2A, 2B Gen Med 1&2, 3&4 VA MICU, CCU, Team 7

Schedules

Residents on 2A and 2B need to avoid taking weekends off for both patient continuity (weekend fellow doesn’t know the patients) and collegiality (your co-resident has to do more weekend notes if you take off).

If you need to change a call, arrange for coverage, etc., PLEASE notify Heather to make the appropriate changes in Amion. Your pager will thank you.

Schedules

See the patients every day at some point.

Run the list to prioritize tasks after rounds.

Place orders on rounds. Call consults.

Use your ancillary staff to your advantage.

Wards

Talk with your fellow often.

Don’t be afraid to ask for help, phone a friend.

Know your limits.

Know the limitations of your interns.

MICU

Discharge planning 0830-0900 every weekday (except VA

holidays) Painful, but can be helpful Ask positive open-ended questions Use your Team Coordinator as much as

possible

The VA

You will be slow. Workflow: Called about pt see pt write

admission orders write note Write down your PE Be organized. USE THE LIST! You are responsible for all admissions until 15

minutes prior to your shift ending. If you need help, call Chiefs during the day,

floor resident at night.

Admit

When talking to ED staff, ALWAYS BE RESPECTFUL even if they are not.

DO NOT FIGHT WARS IN THE CHART. Email the Chiefs the same day if

inappropriate interactions occurred. Tell the ED staff when you are busy with

multiple admissions.

Admit

UAMS—starting July 1 All general medicine admissions– round-robin

regardless of cap Restarts at 0700 3C/3D can take Geriatrics patients Reconcile numbers with hospitalist NO LATER

than 0530

Admit

H-drive IM Residents MED ADMIT LOGThis should be used for ALL medicine admissions from the ED. Should also note what team changes occurred after admission. Turn into Chief office prior to leaving for the month of July.

VA Every 3rd and 5th admission go to Team 5 Other admission are round-robin to Gen Meds Don’t always have to start with GM1 If more than 4 admissions at once, call Chiefs

for help. Use a list to keep track of patients admitted.

Admit

Teams should be notified about all admissions that come before 4pm.

Heme-Onc fellow need to be called for ALL heme-onc admissions.

Pulmonary fellow should be called for ALL CF and MICU admissions.

ID attendings should be called about their admissions.

Admit

Keep a list of expected and arrived patients. Enter basic orders before direct admissions

arrive if you have time. Update the boards by 0530. Interns can help

with this. Show up at least 10-15 minutes before your

call shift to get hand off.

Call

When a pt dies, transfers to the unit, or changes code status, an Attending MUST be notified, and this must be DOCUMENTED in the chart. Call the attending listed “on call” for that evening Document NAME OF ATTENDING in transfer note,

death note, or code status note Needs to be done preferably as pt is transferring Heme-Onc fellow or Pulmonary fellow are suitable for

MICU, 2A, 2B patients. Document a name. Interns can help with this.

Call

If you are the MICU UL at night and the floor UL calls to transfer a patient, accept the patient.

If you are the floor UL and you transfer a sick patient to the unit, don’t abandon the patient if the MICU UL is busy.

At night, help each other out as much as possible!

Call

HUSTLE! You are in charge now. Even if it is not a “real”code, an UL needs to

stay with the patient (or at least near the room) until they are taken to the ED or transferred to a higher level of care.

If you don’t know what else to do, ask for help.

USE YOUR ACLS CARD!!!! Remember: Chest compressions, EPI

Code Blue

Have your interns and students look up information, write orders, call family, call consults (e.g. surgery, cardiology), perform chest compressions.

Be the boss. If it’s too loud, ask people to stop talking. Don’t be afraid to kick people out of a crowded room (i.e. students, superfluous staff, gawkers). Nursing and other staff need to know who is in charge, or chaos will ensue.

Code Blue

Anesthesia is not in-house at the VA at night.

Get your “red dot” early—this involves doing an online module through TMS and intubating in the OR.

The glidescope is your friend: Use it! Anesthesia should be able to intubate on the

floor at UAMS (this is preferred) and in the MICU at night.

Code Blue

It’s in your job description to be an educator . “Educating” can be formal didactic sessions,

bedside teaching on rounds or pre-rounds, mini-sessions as questions or issues arise.

Pick simple topics that can generalize to many specialties.

Physical exam techniques count as topics. Try to teach one thing per day—more if you

have time.

Medical Students

Use students judiciously to obtain ancillary history, medical records, med recs (maybe later in the year), etc.

Let them help with procedures (as long as no HIV/HCV).

Assign 2-4 patients per day depending on your census. Assign 4-6 patients for AIs and higher functioning students.

Give them feedback on presentations, notes, PE skills, etc.

Medical Students

Tell them to sit as far forward as possible at Grand Rounds and Med-Path

Tell them to accompany you to ACD, morning report

Send them to their patients’ procedures

Medical Students

Take them seriously. We can’t fix a problem if we don’t know about it.

Complete them in a timely manner for the rotation, attending, interns, and medical students.

Be specific. If a particular issue is repeatedly problematic, write it down.

For medical students: If you wouldn’t want to work with a student in 1-2 years as an intern, tactfully reflect that in your evaluation. Be specific about things they can improve in the “Not on the Dean’s Letter” section.

Evaluations

Good: “John was punctual and eager to help. He was prepared for rounds, responded well to feedback. He reads about his patients and functions at a level superior to his peers. He will make a fine house staff officer in the future.”

Good: “Mary had some difficulty at the beginning of the rotation in preparing for rounds, identifying important issues but improved with feedback and was functioning at the expected level of a MS3 by the end of the rotation. I expect she will continue to improve with reading and practice. ”

Evaluations

Good: “Jimmy seemed disinterested in this rotation. He was often late, unprepared, not able to fully participate on rounds. His performance did not improve with feedback from both residents and attending physicians.”

BAD: “How did they let this kid into medical school! He is the most unprofessional jerk I have ever met. He made my life miserable. He should be kept away from patients at all costs, preferably locked up in the penitentiary!”

Evaluations

Use the chain-of-command Current attending or Chiefs should be the first

call Don’t email Hagedorn or Marsh directly If the problem is with a Chief other Chief or

Dr. Saccente

Problems

It is not the responsibility of this residency to ensure you get the fellowship or job of your choice. No jeopardy

Arrange your own coverage Email to Nick, Heather, and Sheila with the following:

Dates you will be absent and Location Rotation you are missing Coverage you are arranging (CC to email) Payback you are providing

Fellowship/Job Interviews

But I’m on an elective, so I can just no-show… Email to Nick, Heather, and Sheila with the

following: Dates you will be absent and location Rotation you will be missing Fellow or attending who gave you permission to

be absent (CC to email) Failure to show for any assigned rotation without

permission will be brought to the attention of the program director.

Fellowship/Job Interviews

Conference Attendance A priority for Dr. Marsh Feedback and participation

Pagers during Morning Report, ACD We will hold your pagers during ACD You should hold your interns pagers during

morning report and intern core lectures

New Things

Off-service interns come to our conferences. Exceptions: M&M, Systems

Attending rounds finish at 1100. Remind your attending at the start of rounds

ACD starts at 1300. There will be a sign-in sheet.

EVERYONE who is not off or on vacation should be attending M&M conference. Coffee available: first come, first serve

New Things

VA Night Float Resident night float remains the same (Mon- Fri

nights) Intern night float starts on July 1

SUNDAY – THURSDAY NIGHT

New Things

VA Swing Shift Friday and Saturday Short call intern stays till 2200 (10pm) Comes in at 0600, sees FOUR patients, rounds,

completes notes, leaves NO LATER than 1100. Returns at 2150, stays till 0700 the next

morning, then goes home DOES NOT ROUND on post-call morning.

New Things

Tell your ATTENDING to round early on days when your intern is on swing shift

Prioritize their patients to get them out on time

New Things

Clean out your mailbox. Check your VA email (start Outlook—takes

forever) Get your UAMS parking decal at the police dept. Make sure your TMS stuff is up to date at the VA. Get your BLS/ACLS if it is due. Come to M&M in the morning and BE ON TIME.

Housekeeping

Come to lunch with the new interns on Friday

at 1130

Housekeeping