Chief

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WELCOME!!
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Chiefs Orientation
Scott Denstaedt Marty Tam Angel Qin Khanjan Shah
June 14th, 2012
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Starting intern year
SUCCESS!
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Overview

• Introductions
• Roles of Chiefs
• UH Wards
• VA Wards
• Typical Day on the Wards
• The Pager System
• Other Rotations
• Conferences
• Misc
• Ambulatory
• Professionalism
• Advice
• Questions

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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

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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

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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

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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

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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

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Roles of the Chiefs

• We are the advocates for the residents
• Call us with problems or issues that arise
• Timely and specific pleasewe cant help you if
  you dont let us know.
• We are your mentors
• We provide support for your professional
  develoPMent, education, and your psycho-social
  well-being
• We have candy!

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UHUH Campus
Lerner Tower
Lakeside
ED
Seidman
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Louis Stokes Veterans Administration Medical
Center
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UH Ward Teams
Naff Wearn
Carpenter Dworken
Weisman Ratnoff
Hellerstein Eckel
Sister teams alternate long call days Each team
has 2 interns ? Q4 long call Hellerstein and
Eckel do not have sister teams
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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

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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

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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

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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

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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

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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

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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!

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LOGISTICS Team Caps

• 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

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Days OFF

• Dworken, Carpenter, Wearn, Naff,
• Ratnoff, Weisman, and VA Wards
• Short or Happy days that fall
• on Saturday or Sunday
• Golden both weekend days off
• Black work both weekend days
• Silver either Sat or Sun off
• Eckel or Hellerstein
• 1 day off per week Happy day Friday through
  Monday

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Days OFF

• 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

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Typical Ward Day

• 7 AM to 745 AM
• Pick up signouts from night float team on Lerner
  Tower 5 at UH and blue team room at the VA
• Pre-round
• 745-8 AM Be in your team room to discuss
  changes overnight and the days plan with your
  senior
• 8 AM to 10 AM (VA) or 1030 AM (UH)
• Rounds with attending
• New patients present HP
• 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 dont just present
  the data and then look at your attending and
  resident and wait for them to tell you what to do
• Be organizedhave a system

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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
• Dont start your notes until the rest of the work
  is finished

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Typical Ward Day

• 1030-1130 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

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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!

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The night float team
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The NIGHTFLOAT TEAM
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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 theyre still in the hospital late

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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

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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

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Call and Continuity Clinic

• No Clinic on Long or Medium call.
• No short call patients assigned on your clinic
  day.

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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

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How to send a page!

• UH
• Dial 222 ? type pager number ? beep beep beep ?
  your call back numberyour pager number
• VA
• For UH Pagers, dial 9-207-7244 ? type pager
  number ? beepbeepbeep ? you call back
  numberyour pager number
• For VA pagers, dial 9-440-562-xxxx (pager number)
  ? beep beep beep ? your call back numberyour
  pager number

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Other Rotations

• Geriatrics
• E-team
• Jeopardy
• Elective
• UCC

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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

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E-team

• Only during the busiest months at UH
• One intern hospitalist attending
• 8 patient cap, off on Sundays
• Lots of independence

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• 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

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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

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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 MMs
• If you do research, you are expected to present a
  poster at the Department of Medicine Research Day
  held every May

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Example Elective Tracking
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DISCHARGE SUMMARIES

• 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

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Conferences - UH

• Intern Morning Reports Residents hold the
  pagers!!
• Tuesday AM report from 1030 11 AM
• Thursday 1030 AM 1130 AM
• Grand Rounds
• Tuesday 12-1 PM
• Morbidity Mortality (MM)
• Friday 12-1 PM
• Agre Society
• Monthly, Wednesday evenings more info to come
• Noon Conference
• Monday, Wednesday and Thursday 12-1 PM (with food)

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Conferences - VA

• Monday Noon conference
• Tuesday Grand Rounds televised from UH at noon
• Wednesday MM at noon
• Thursday Intern Morning Report _at_ 10-11 AM
• Your resident will take your pager
• Be on time!!
• Friday Noon-conference

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UH Miscellaneous

• GME Housestaff Lounge!!
• Located on Lakeside 6th floor, next to GME office
• Has coffee, bathrooms, TV, foosball table,
  computers, food on Sunday nights

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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

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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
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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

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Ambulatory Medicine

• Continuity Clinic
• Urgent Care Center
• Primary Care Block
• Clinical Skills Block (CSB)

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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
• ICUs
• 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

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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

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Primary Care Block

• Introduction to Outpatient Primary Care
• Introduction to DMC and the VA continuity clinics
• Morning Clinical Conferences 8 AM daily

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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

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Professionalism
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Professionalism Attire

• Men
• Shirts and ties
• Women
• Professional
• Keep white coats clean
• No denim
• Do not show up to Morning Report looking sloppy

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Professionalism Absences

• If you have to call in sick gt 1 day, you will
  need a doctors note from the Bolwell Family
  Practice clinic
• You will be able to get a same-day appointment
• If you are sick for gt 2 days and do not have a
  doctors 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

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Professionalism Electives

• Attend all Grand Rounds and MMs
• 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

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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
• MM Fridays _at_UH, Wednesdays _at_VA
• Conference attendance is part of your ACGME
  graduation requirements

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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
  youre here
• Take care of yourself its the only way you will
  be able to provide good care to your patients
• LOVE what you do

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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!!

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And so much more

• http//www.clevescene.com/

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QUESTIONS??
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We are looking forward to a great year
together!!! -SMAK