THE VIRGINIA MASON CLINIC MEDICINE RESIDENCY 200708 Seattle, WA

1
THE VIRGINIA MASON CLINICMEDICINE RESIDENCY
2007-08Seattle, WA
2
Welcome to Seattle
3
Virginia Mason Medical Center
Virginia Mason is located here
4
Which is also here
5
Seattle

• Referral center, not just medical, for NW
• Arts, entertainment, shopping, education,
  medicine
• Opportunity
• Top employers Boeing, Microsoft, Amazon,
  University of WA, VMMC
• The lifestyle
• Sea to sky
• Rain think green
• -our little secret

6
New York
Seattle
7
VIRGINIA MASON PAST PRESENT
8
Virginia Mason Medical Center
Established 1920 Mason Clinic (physician
group) Virginia Mason Hospital (80-beds) -
modeled on Mayo Clinic Virginia Mason named
after the daughters of James Tate Mason, M.D.,
and John M. Blackford, M.D., who co-founded the
clinic with radiologist Maurice Dwyer, M.D.
9
Virginia Mason Medical Center
MILESTONES
1927 first ECG west of Mississippi 1928 first
Surgical residency in NW 1936 Dr. Mason president
of AMA 1939 first Medicine residency in NW 1992
first SNF for AIDS patients 1995 1000th renal txp
- leader in NW
10
Virginia Mason Medical Center
Multi-Subspecialty Tertiary care hospital - 336
beds, gt400 MDs Full Medical and Surgical ICU
(34 beds) Benaroya Research Institute - nearly
200 researchers with a budget of more than 20
million a year
11
Virginia Mason Medical CenterOver 100 residents
in the medical center

• Internships
• Medicine
• Categorical
• Primary Care
• Preliminary
• Surgery
• Categorical
• Preliminary
• Transitional Year

Residencies Internal Medicine General
Surgery Radiology Anesthesiology
Fellowships Regional Anesthesia Minimally
Invasive Urology Pancreaticobiliary Research ERCP
12
Virginia Mason Medical Center

• 2006 random survey of 5000 MDs and 500
  complementary providers
• VM providers exceeded all other Seattle
  institutions.
• More than half of the top physicians in the
  medical specialties practice at VM, (56).

13
Virginia Mason Recognized for Quality Care
14
Virginia Mason Medical Center Master Plan Diagram
15
Project has begun and will be completed in
February 2010 your R2 year here
16
INTERNSHIP YEAR
17
Graduate Medical Education
Internships
5/yr Preliminary
10/yr Categorical (up to 4) Primary Care
12/yr Transitional
18
Graduate Medical Education
Internships 13 four-week rotations per year
Categorical Prim Care Prelim
T.Y. Wards 5 5 6 2 ICU 2 1
1 1 Night Float 1 1 1 1 ER 1 1
1 1 Electives 3 3 4
4 Primary Care 1 2 0 4
Surg Vacation 3 Wks 3
Wks 3 Wks 3 Wks
(varies with inidividual goals)
19
Sample Categorical Intern Schedule
20
Sample Primary Care Intern Schedule
21
Sample Transitional Year Intern Schedule
22
Sample Preliminary Intern Schedule
23
WARDS
24
Wards
Structure 4 Ward teams 1
Hospitalist 1 Resident 2 Interns /-
Med Student
Same as University Ward Attending (unlike other
community programs)
Hospitalist group -experienced, reliable, team
with experience in educating residents -full-time
inpatient teaching role -minimizes attending
education (how do we order that?) -adherence to
safety and quality performance enhanced -reigning
Teachers of the Year Alvin Calderon, Jen Ashley
25
Wards
Structure Each hospital floor is
Specialized 17 Neurology, Nephrology Team
A 16 Pulmonary 15 Oncology Team B 14
Geriatrics 10 GI Team C 9
Orthopedics 8 Telemetry Team D 7
Telemetry
Teams A/B and C/D accept admissions on
alternating days
General Medicine and Surgical patients also
present on most floors
26
Wards

• Admission system
• Teams admit 7AM-7PM every other day
• Nightfloat covers 7PM-7AM
• Patients distributed in the AM
• No 24 hour shifts

A Admission day
27
Sample Schedule
28
Wards

• Intern Caps
• Wards
• 8 patient contacts per day
• (includes new patients and f/u patients)
• 3 admission max. on admitting day
• 4 admission max on Sat or Sun
• 4 admits over 12 hours for Night Float
  intern
• if an intern starts with 6 patients on a call
  day, he or she can admit a maximum of 2 new
  patient
• if an intern starts with 8 patients, he or she
  will not admit

29
Wards
Intern Caps Wards 8 patient contacts per
day (includes new patients and f/u
patients) 3 admission max. on admit day or 4
on Sat/Sun Night Float 4 admissions per
night
30
Virginia Mason Medical Center
NIGHT FLOAT SIGN OUT 700-730 AM
Time

• Housestaff meet to discuss the events of the
  night shift and to hand-off overnight admissions

31
Virginia Mason Medical Center
Rounds 0800-1200

Time

• Interns see their patients and review
  labs/overnight events.
• Develop a skeleton note on the computer, edited
  in rounds
• Residents available after 8am morning report
• Start with high priority patients, intern begins
  presenting when ready. Keep patients from
  waiting

32
Virginia Mason Medical Center
MULTIDISCIPLINARY ROUNDS 900-915
Time

• House staff run the list with RNs, case
  managers, pharmacists, and social workers,
  focusing on issues of patient safety, disposition
  and services after discharge.

33
Virginia Mason Medical Center
ROUNDS 915-1200
Time

-Rounds are lead by senior resident -Interns
present patients as soon as possible after seeing
-Using cellphones and computers on wheels to get
work done w/o delay -Interns present to
residents, hospitalists facilitate
34
Virginia Mason Medical Center
NOON CONFERENCE 1215-1300
Time

35
Conference with cyclic curriculum Lead by
subspecialty faculty and general interernists
36
Virginia Mason Medical Center
TEACHING ROUNDS 1300-1345
Time

• Case-Based
• Attended by subspecialists from Hem/Onc, GI,
  ID, Cards, Nephro, Rheum Neuro

37
Wards

• Our inpatient system
• Caps the number of patients to meet educational
  goals
• Maintains compliance with the 80 hr work week
• Balances between Professional and Private life
• Eliminates the Boom Bust of a Q4 call system
• Our inpatient goals
• Excellent Patient care and Safety
• Diversity in Patient population
• Time for Bedside Learning
• Time for Conferences
• Time for Reading
• Time to spend on the rest of your personal life

38
ICU

• Leaders in assuring quality and safety
• Regular review of key topics sepsis, VAP,
  glucose control, central line safety
• ACLS simulation, central line simulation
• Experience integrated care across professions

39
ICU
40
ICU

• Short shift rounds with ICU attending, leave
  earlier
• Long shift intern and resident working together,
  staff admissions with ICU attending
• Night shift intern and nocturnist working
  together from 7p-7a

41
ICU

• Closed ICU system (no ward team coverage)
• 3 interns, 2 residents
• 2 daytime intensivists, 1 nocturnist
• 1 day off in 6 for interns
• Shift schedule

42
Virginia Mason Medical Center
Work Hours Compliant with 80 hour work week
Regular review of work hours by residency
leadership No 246 shifts at this time
43
ELECTIVES
44
ELECTIVE ROTATIONS

• Outpatient services (e.g. nephrology) focus on
  outpatient management of patients and education
  before service
• Absence of fellows means closer teaching
  relationship with attendings
• Includes in-patient consults in attached
  hospital, reflecting real world patient mix
• Ability to tailor experience to learners goals

45
CONTINUITY CLINICS

• Downtown Seattle (main campus)
• Interns are mentored at the hospital attached
  downtown residents clinic
• Resident clinic is within the GIM practice
• Clinic includes a resident run, case-based
  learning module each week
• Weekly review covers key primary care topics,
  serving both as a boards review tool and
  practical curriculum.

46
CONTINUITY CLINICSadditional choices to add
in 2nd and 3rd year

• Suburban Clinics
• Federal Way, Lynnwood, Kirkland
• Carolyn Downs (Indigent Care)
• Pike Market (Indigent Care)
• North District Public Health
• HIV Clinic
• Collaborative practice
• your patients have coverage of internist partner
  in your absence.
• Allow mentor development and full range of
  practice skills efficiency, billing, procedures

47
eMEDICINE
48

Virginia Mason Medical Center

• Paperless wards charting - all notes, orders,
  labs and vitals on-line via single software suite
  (Cerner)
• Digital radiology accessible on any computer
  monitor
• Hospital wide wireless broadband network with
  mobile computers-on-wheels (COWS)
• Electronic records and results cross inpatient
  and clinic settings

49

Virginia Mason Medical Center

• Up-To-Date, OVID, Cochrane, MD Consult
• Library hundreds of full text online journals
• Tracemaster online patient ECGs
• Stentor online patient imaging studies
• Cerner paperless medical record order entry
• Available 24/7 at home through VPN tunnel
  (Citrix).

50
Virginia Mason Medical Center
All call rooms have telephone and computer
51
CAREER
52
GRADUATES
2006 Rheum North Carolina Pathology Hospitalist
3 of 8 Primary Care 3 of 8 2005 Hem/Onc
Case Western Primary Care Fellowship OHSU
Hospitalist 2 of 9 Primary Care 5 of
9 2004 Cardiology St. Raphael's, CT
Geriatrics Emory University Gastroenterology U
niversity of New Mexico Hospitalist 3 of 9
Primary Care 3 of 9
2003 Pulmonary/Critical UC Irvine
Pulmonary/Critical OHSU Hospitalist 4 of 11
Primary Care 5 of 11 2002 Nephrology Lenox
Hill, NY Pulmonary/Critical UCSD
Endocrinology NYU Sports medicine Cleveland
Clinic Hem/Onc University of Florida
Anesthesia VMMC (x2) Hospitalist 1 of 10
Primary Care 2 of 10
53
Virginia Mason Medical Center
American Board of Internal Medicine 96
three-year rolling pass rate MedStudy Board
review Free to all second year residents. Boards
review course Funded through professional
stipend. Travel for conferences Through a
retired faculty funded endowment
54
BENEFITS
55
Virginia Mason Medical Center
Meals Breakfast (4.00) and Dinner (6.50) for
every resident 365 days/year. And likely going
up Parking Free to all residents. Travel Fully
paid to any conference you have an abstract
accepted to. Professional Stipend 500 per year,
(can be saved up to 1500 during 3rd year)
56
Virginia Mason Medical Center
Away/overseas electives accommodated, (examples
Nepal, Thailand, Alaska). Misc Lab coats
60/R1, 30/yr R2 R3, Scrubs, locker and
mailbox 24/7 access, Subsidized movie tickets,
ski passes, sports tickets, gym
memberships Family subsidized VM daycare
facility Medical insurance for you/DP/family/kids
with no premium
57
SOCIAL
58
Virginia Mason Medical Center
INTERN PICNIC
Meet your co-interns and residents at the
beginning of the year!
See the sights!
59
Virginia Mason Medical Center
FALL RETREAT
All categorical and preliminary medicine
residents spend two days on retreat working on
teamwork, communication, and personal growth
60
Internal Medicine Residency Leadership Team

• Alvin Calderon, MD, PhD, Acting Program Director
• -hospitalist and former Chief Resident
• Roger Bush, MD, Program Director
• -11 years leading program. National leader in
  resident education, RRC member. Is stepping down
  this fall
• Paul Smith, MD, Associate Program Director
• -Internist at VM since 1984. Primary Care track
  coordinator
• Michael Westley, MD, Key Clinical Faculty
• -leads ICU, Code 4/MET team training, procedure
  simulation
• Carrie Horwitch, MD, MPH, Key Clinical Faculty
• -Continuity clinic, HIV clinic
• Susie Rheinberger, Program Coordinator

61
Come join us!
62
Thanks for visiting!Further questions? Please
contact usVirginia Mason Medical
CenterGraduate Medical Education, H8-GME925
Seneca StreetSeattle, WA 98101(206) 583-6079
Or email the Chief Resident at
Jeffrey.Knight_at_vmmc.org