WELCOME!!
Dec 30, 2015
• Introductions• Roles of Chiefs• UH Wards• VA Wards• Typical Day on the Wards• The Pager System• Other Rotations• Conferences• Misc• Ambulatory• Professionalism• Advice• Questions
Overview
Scott Denstaedt
• Undergraduate: University of Michigan• Med School: Wayne State University• Hometown: Clarkston, MI• Hobbies: tasting exotic beers, Game of
Thrones• Fun fact: speaks Japanese
Marty Tam
• Undergraduate: University of Michigan• Med School: Ohio State University• Hometown: Sterling Heights, MI• Hobbies: sports, travel, food, drink, life• Fun fact: almost was killed by a lion during
medical school
Angel Qin
• Undergraduate: Duke University• Med School: Case Western Reserve University• Hometown: Chengdu, China Chicago, IL• Hobbies: cooking, trying new foods, travel• Fun fact: danced ballet for 8 years
Khanjan Shah
• Undergraduate: Furman University• Med School: University of South Carolina• Hometown: Greenville, SC• Hobbies: working out, reading, eating good
food• Fun fact: Aspired to be a pizza delivery girl for
most of my childhood
Roles of the Chiefs• Rotate every 3 months• UH Chief #31250 – Marty Tam
• Office in Lakeside 3• VA Chief #31533 – Angel Qin
• Office on 4th floor VA• Ambulatory Chief #31529 – Scott Denstaedt
• Office on 4th Floor VA• Quality & Pt. Safety Chief #36644 – Khanjan Shah
• Office on 4th Floor VA/Lakeside 3
Roles of the Chiefs• We are the advocates for the residents
• Call us with problems or issues that arise• Timely and specific please…we can’t help you if
you don’t let us know.
• We are your mentors• We provide support for your professional
develoPMent, education, and your psycho-social well-being
• We have candy!
Naff Wearn
Carpenter Dworken
Weisman Ratnoff
Hellerstein Eckel
Sister teams alternate “long” call daysEach team has 2 interns Q4 “long” callHellerstein and Eckel do not have sister teams
UH Ward Teams
UH Ward Teams
• Hellerstein (Cardiology)– Team room on Lerner Tower 5– 2 senior residents, 4 interns, sometimes a fellow
• Eckel (Nephrology)– Team room on Lakeside 5 (between 50 and 55)– 2 senior residents, 4 interns
UH Ward Teams
• Naff and Wearn (General medicine)– Team rooms on Lakeside 20– 1 senior resident, 2 interns
• Carpenter (Infectious disease, HIV patients)– Team room on Lerner Tower 8– 1 senior resident, 2 interns
UH Ward Teams
• Dworken (Gastroenterology, Hepatology)– Team room on Lakeside 55– 1 senior, 2 interns– Round separately with the Liver attending
• Weisman and Ratnoff (Heme/Onc)– Weisman on Seidman 4 (hospitalist)– Ratnoff on Seidman 3 (oncologist)– 1 senior, 2 interns
UH ICUs• MICU
– Lerner Tower 3– 5 seniors (4 on days, 1 on nights); 4 interns– Interns take call with their seniors Q4; seniors stay
overnight– 1-2 attendings, 2 fellows, 2 teams
• CICU– Lerner Tower 3– 5 seniors, 2+ interns, 1 fellow– Interns do 1 week of days, 1 week of nights
VA Ward Teams
• Four general medicine teams• Blue and Green are sister teams• White and Orange are sister teams• 1 senior, 2 intern teams• Q4 long call• Team rooms on 4th floor
VA MICU• Two seniors (one on days and one on nights)• Three interns, Q3 call• Admit from 7 AM to 8 PM• Leave by 10 PM• Day off is “pre call” day Friday through Sunday
LOGISTICS of Calls... • Long call – 3 patients by 7 PM
• Only 1 after 6 PM, 2 after 5 PM• Medium call – 2 patients by 4 PM• Short Call:
• UH: 2 Patients (nightfloat admission or ICU transfer)
• VA: 2 Patients (nightfloat, transfer, or NEW)• Cycle: Long Medium Short HAPPY!
• UH:• 10 patient cap on all UH ward rotations EXCEPT
Ratnoff and Weisman which will cap at 8 (rolling cap)
• Your short call day will also cap at 8 (based on number of patients you start with in AM; not rolling)
• VA: • Cap = 8 all the time
• Caps increase if you have acting interns
LOGISTICS: Team Caps
Days OFF• Dworken, Carpenter, Wearn, Naff, Ratnoff, Weisman, and VA Wards
o Short or Happy days that fall on Saturday or Sundayo “Golden” = both weekend days offo “Black” = work both weekend dayso “Silver” = either Sat or Sun off
• Eckel or Hellersteino 1 day off per week: “Happy day” Friday
through Monday
•Night Floats• UH: 3 interns are scheduled but only
2 are on each night; work out days off with each other!
• Send schedule to chiefs; if you are going to a ward rotation, you should not work the last Sunday
• VA: Saturday night is off
•UH MICU• Helper day off Friday through
Monday
Days OFF
Typical Ward Day• 7 AM to 7:45 AM
• Pick up signouts from night float team on Lerner Tower 5 at UH and blue team room at the VA
• Pre-round• 7:45-8 AM: Be in your team room to discuss changes overnight and the
day’s plan with your senior• 8 AM to 10 AM (VA) or 10:30 AM (UH)
– Rounds with attending• New patients – present H&P
• Present the pertinent data, remember you only have 2 hrs for rounds
• Old patients – present new data, events overnight and then your assessment and plan• Your A/P may be right or wrong but the best way to learn is to
take a shot – don’t just present the data and then look at your attending and resident and wait for them to tell you what to do
• Be organized—”have a system”
After Rounds
• C: Call your consults• Consultants will appreciate the early call
• O: Order Entry• Enter any orders that were not entered on rounds
• L: Labs• Run your labs
• D: Discharges• Get them out• Should have daily note on the day of discharge as well (very brief)
• N: Notes• Don’t start your notes until the rest of the work is finished
• 10:30-11:30 AM (UH) or 10-11 AM(VA)• Resident AM report (M/W/F at UH, T/W/F at VA)• Thursday morning: Intern AM report + Tuesday at UH
• Noon-1 PM: daily conference• Afternoon for notes, procedures, teaching rounds,
contacting families, following up studies, etc• Short call interns and “happy” interns can signout to
their co-interns when their work is done• Medium call signs out to night float at 7 PM• Long call signs out to night float at 9 PM
Typical Ward Day
Meet the DACR/NACR/MAN…
• Day Acting Chief Resident/Night Acting Chief Resident/Medical Admitting Nurse
• Role is to distribute admissions, run codes, and overall monitor the daily flow of the internal medicine inpatient service
• Available 24 hours/day at pager 30512 to answer questions or provide assistance!
The NIGHTFLOAT TEAM
NACR
Night float Resident Night float Resident
Night float Intern Night float Intern
Intern Role on Nightfloat
• The night float intern comes in at 7 PM and receives the pagers from the non-call teams
• The night float intern can receive the pagers from the long call intern at 9 PM and must receive the pager by 11 PM
• Please be pro-active and help your co-intern out if they’re still in the hospital late
Night Float Duties
• Follow-up on unfinished tasks• You may be asked to go evaluate a patient; if
you do, please write a brief Clinical Event Note
• If there are any questions/concerns, please ask your seniors and NACR
• A senior should go with you to every CODE WHITE during the first 6 months
Duty Hours
• On long call, sign out at 9 PM, MUST be out by 11PM
• On medium call, signout at 7 PM• UH: Lerner Tower 5• VA: VA Blue room• Duty hours not to exceed 80 hours/week
• No Clinic on Long or Medium call.
• No short call patients assigned on your clinic day.
Call and Continuity Clinic
Team Pagers
• Each team will have a pager held by one of interns on the team and then signed out to nightfloat in the evening
• Will mostly be paged by nursing regarding patient issues
• Team pagers are also code pagers – long call interns should go to all codes (‘Code Blue’)
• Team pager numbers are listed on the pager card
How to send a page!
• UH– Dial 222 type pager number *beep beep beep*
your call back number*your pager number #
• VA– For UH Pagers, dial 9-207-7244 type pager number
*beepbeepbeep* you call back number*your pager number#
– For VA pagers, dial 9-440-562-xxxx (pager number) *beep beep beep* your call back number*your pager number#
Geriatrics
• New this year; 4 week block• 3 interns + Geriatrics attending• 2 interns on wards, one intern at the VA• Other health care settings such as skilled
nursing facilities, home calls
E-team
• Only during the busiest months at UH• One intern + hospitalist attending• 8 patient cap, off on Sundays• Lots of independence
• Pager must be on 24/7• No pay back as it is an official rotation• Called to cover for inpatient and outpatient• Weekends are off
Urgent Care Center (UCC)
• The VA Emergency Room• Staffed by at least 3 residents
• One or two attending physicians• Hours are 8 AM – 6 PM
Electives• There will be continuity clinics once a week during your
electives • This is the time to explore your academic interests (get
involved in research, participate on different consult services)
• On elective, you are also backup jeopardy, so please keep your pagers on!
• You are expected to attend Grand Rounds and M&Ms• If you do research, you are expected to present a poster at
the Department of Medicine Research Day held every May
• DISCHARGE SUMMARY: do on the day of discharge
• Do them as soon as you write the discharge order
• Residents must do discharge summaries when intern has the day off
• Crucial for patient safety and care
DISCHARGE SUMMARIES
Conferences - UH• Intern Morning Reports – Residents hold the pagers!!
– Tuesday AM report from 10:30 – 11 AM– Thursday 10:30 AM – 11:30 AM
• Grand Rounds• Tuesday 12-1 PM
• Morbidity & Mortality (M&M)• Friday 12-1 PM
• Agre Society• Monthly, Wednesday evenings – more info to come
• Noon Conference• Monday, Wednesday and Thursday 12-1 PM (with food)
Conferences - VA• Monday: Noon conference• Tuesday: Grand Rounds televised from UH at
noon• Wednesday: M&M at noon• Thursday: Intern Morning Report @ 10-11
AM• Your resident will take your pager• Be on time!!
• Friday: Noon-conference
• GME Housestaff Lounge!!• Located on Lakeside 6th floor, next to GME office• Has coffee, bathrooms, TV, foosball table, computers,
food on Sunday nights
UH Miscellaneous
VA Lounge and Call Rooms
• Located on the 2nd floor• Fridge: frozen dinners, ice cream, sorbet, string
cheese, muffins, fruit, yogurt, milk, etc• Coffee machine• Cabinets: all sorts of snacks
Intern Saturday Coverage
On Saturday nights when on ambulatory, UCC, or elective, you will be asked to cover from Saturday 7 PM to Sunday 8 AM for the VA intern nightfloat to get a night off
VA Miscellaneous
• Garage parking is free! Just need to get a parking pass from VA police department (bring license, insurance, registration)
• VPN access for home CPRS access• Codes at VA are called “Dr. Heart” and are
called overhead
Ambulatory Medicine
• Continuity Clinic• Urgent Care Center• Primary Care Block• Clinical Skills Block (CSB)
Continuity Clinic• One afternoon/week either at the VA or at the Douglas Moore
Clinic at UH• No clinic when
• Medium call or on long call days• Vacation• Holidays• ICU’s• Night Float
• You DO have clinic when on Elective• To main continuity, you cannot switch clinics amongst yourselves;
all schedule changes need to be approved by ambulatory chief resident
Urgent Care (UCC)
• Emergency room experience; at the VA• You will either do it as a rotation or during
ambulatory• If you are there as a rotation, you are
expected to be there from 8 AM to 6 PM
Primary Care Block• Introduction to Outpatient Primary Care• Introduction to DMC and the VA continuity clinics• Morning Clinical Conferences: 8 AM daily
Clinical Skills Block
• 2-week outpatient rotation• Hands on activities• Simulation models at the simulation skill
center (next to the VA)• Humanities in medicine• End of life care• Cultural competencies
Professionalism: Attire
•Men• Shirts and ties
•Women• Professional
•Keep white coats clean•No denim•Do not show up to Morning Report looking sloppy
Professionalism: Absences
• If you have to call in sick > 1 day, you will need a doctor’s note from the Bolwell Family Practice clinic • You will be able to get a same-day appointment
• If you are sick for > 2 days and do not have a doctor’s note, you will be assigned extra weekend coverage and/or weekend jeopardy
• Call-offs: You must PAGE 31529 the Ambulatory Chief• DO NOT EMAIL• DO NOT TEXT PAGE• DO NOT CALL THE CELL PHONE OF THE CHIEF YOU KNOW
Professionalism: Electives• Attend all Grand Rounds and M&M’s• You are back up jeopardy!! = pager on• If you are going out of town for the weekend, as a
courtesy please notify the ambulatory chief prior to leaving
• Elective is not vacation• Please email Barb 2 weeks prior to starting your
electives; Quality chief will be keeping track of electives• Research for more than 2 weeks = present at Research
Day
Professionalism: Conference Attendance
• Please be on time; our speakers usually have prepared a well thought out talk/powerpoint, so please be respectful of the time they spent
• Noon conference: • UH: Mon-Wed-Thurs • VA: Mon-Thurs-Fri
• Grand Rounds on Tuesday: UH & VA• M&M Fridays @UH, Wednesdays @VA• Conference attendance is part of your ACGME
graduation requirements
Some friendly words of advice…
• Catch up on sleep when you can!• Talk to a chief resident/APD/KBA before a personal problem
gets out of hand – someone is always here!• Please support each other – intern year is tough, but also fun!• Maintain personal and family relationships outside of the
hospital; make new friends while you’re here• Take care of yourself; it’s the only way you will be able to
provide good care to your patients• LOVE what you do
Things to do in the CLE
• Sports– The Cavaliers, the Browns,
the Indians, the Lake Erie Monsters
• SO MUCH GOOD FOOD– Lola/Lolita/B-spot,
Superior Pho, Wonton Gourmet, Bangkok Thai, the Harp, Momochos, Fire, Sasa, Luxe, Southside, Parallax, Dante + Gingko, the Black Pig, Soho, etc etc
• AND SO MUCH GOOD DRINKS– Fairmount martini bar, Great
Lakes brewery, Market Garden, Town Hall, Nanobrew…
• Beautiful scenery– Cleveland Metroparks– Edgewater Park– Mentor on the Lake
• Summer festivals galore• CEDAR POINT!!