Internal Medicine Residency Program

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Internal Medicine Residency Program

• Cooper University Hospital
• Robert Wood Johnson Medical School

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Internal Medicine Residency Program

• Key Personnel
• Academic activities
• Rotations
• Call Schedule
• Continuity Clinic

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KEY PERSONEL

• Chief of medicine Dr. Joseph Parrillo
• Program Director Dr. Vijay Rajput
• Assistant Program Directors
• Dr. Antoinette Spevetz
• Dr. Anna Headly
• Dr. Elizabeth Cerceo
• Program Coordinators
• Laura Chropka
• Emily Hartsough
• Chief Residents
• Patricia Henry, Imran Shariff, Utkal Patel and
• Jad Skaf.

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ACADEMIC ACTIVITIES

• Morning Report
• Noon conferences
• Chief Rounds
• Grand Rounds
• Journal Club
• Literature and Medicine conference
• Morbidity and Mortality conference
• Board review course
• Autopsy Conference

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Morning Report

• Cases are usually presented by the night float
  team and by PGY-2s and 3s, occasionally by PGY-1
  on electives
• Morning report is mandatory for all PGY-2 and
  PGY-3
• Also Mandatory for Interns on electives.
• Interns on floors, units, ER are not expected at
  morning reports

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Morning Report
Day Conference Time Location
Monday Chief Rounds 900 - 1015 Dorrance 119
Tuesday Morning Report 730 - 830 Dorrance 119
Wednesday Morning Report 730 - 830 Dorrance 119
Thursday MKSAP 730 830 Dorrance 119
Friday Variable Subspecialty, Ambulatory MR 900 - 1000 Dorrance 119
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Morning Report

• 730-830 except mon and fri 0900
• Mandatory for all PGY-2 and PGY-3 except when you
  are in ICU/CCU/ER/MAR-D/Vacation.
• Mandatory for all PGY-1 on electives.
• PGY-1 on floors/ICU/CCU-PCU are excused, but are
  encouraged to attend if time permits.
• Attendance will be taken during first 15 minutes.
• Must attend at least 70 conferences.
• Attendance will be discussed during semi annual
  evaluations

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Chief Rounds

• Monday 900 1015 in Dorrance 409
• A great learning opportunity BE ON TIME.
• Mandatory for all housestaff including PGY1
  except when in ER/ICU/CCU.
• Usually run by Dr. Parrillo or Dr. Viner usually
  with subspecialty attending
• Interactive discussion about core clinical topics
• 2-3 cases prepared by PGY-3 on teaching rotation
  with literature review on the topic

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Grand Rounds

• Every Thursday at 1100 AM in ER building Room
  240
• Mandatory for all house staff except in
  ER/ICU/NF.
• Presented by Cooper Faculty or Outside speakers
• It is followed by either a Housestaff meeting,
  journal club, MM conference

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MM Conference

• Conference to improve patient safety and patient
  care
• On first Thursday of month at 1200 after Grand
  rounds in ER building Room 240
• Mandatory for all housestaff
• Case is prepared by PGY-3 on teaching service or
  chief residents

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Noon Conference

• Every day at 1200 except on Thursday
• In Dorrance 119
• Didactic lecture on Inpatient care / Primary care
  core topics
• 80 attendance is required
• Often with food !!!!!

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CLINICS

• One ½ day session per week for continuity clinic
• You have to attend clinic while on all rotations
  except ICU, CCU/PCU, Night float.
• Will start in July 6
• Categorical interns will get 1 month of
  ambulatory clinic in the first year, and more
  ambulatory time in the 3rd year
• If you are post overnight call on your clinic
  day, you have to reschedule it on some day during
  same week/next week or swap your call

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EVALUATIONS

• On www.new-innov.com
• 360 degree evaluations
• Multiple verbal evaluations and feedbacks during
  rotations
• Scheduled evaluations with program directors

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DICTATIONS

• It is an interns responsibility to dictate chart
  on any service.
• Ideally should be dictated on day of discharge,
  no later than 72 hrs.
• If chart is not dictated in time, attending will
  lose clinical privileges

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Jeopardy

• Designed to provide coverage for emergencies only
• Acute personal/family illness
• Unforeseen errors in scheduling
• You will be on Jeopardy for 1-2 blocks during a
  year
• While on jeopardy,
• you are required to be available on Phone and
  beeper 24 X 7
• Respond to pages within 15 minutes
• Be available for clinical duties within 1 hr
• If you covered someone while you were on
  Jeopardy, that person is expected to pay you back
  same/equivalent amount of time
• All uses of the jeopardy system resulting in the
  absence of three or more days in 6 month period,
  either consecutively or cumulatively, will be
  reviewed by the chief residents and Dr. Rajput.

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Jeopardy

• Following services are covered by Jeopardy
  system
• ICU
• CCU
• NF
• MAR-D
• Neurology
• Floor services if it occurs on more than 2
  consecutive days
• Following services are NOT covered by Jeopardy
  system
• Electives
• Hem Onc
• Floors if it occurs only for 1 day

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How to Make Friends

• Communicate with nurses/ancillary staff
• Clean up after yourselves.
• Leave things as you found them.
• Put charts back when you are done.
• Never use the unit secretarys phone or chair.
• Remember We are all members of the same team
  medical students, nurses, nurse tech, physical
  therapist, social worker, home care coordinator,
  case manager, transporter, pharmacy courier,
  ..EVERYONE IS PART OF YOUR TEAM !!

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Dress Code

• No jeans or t-shirt
• No open toed shoes.
• You may wear scrubs only if you are on call or
  post call.

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REMEMBER

• BE NICE to everyone !!!
• Respect everyone, thats the way to earn respect
  for yourself !
• Always work as team !
• Dont be afraid to ask questions !
• You can always get help from your residents,
  chief residents, or attendings, but if you need
  help fast remember the phone number 8758 !

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ROTATIONS AND CALLS

• Medicine floors
• Medicine Consults
• Admitting Team
• ICU
• CCU/PCU
• Selective Hem Onc, Neurology
• Elective Pulmonary, Renal, ID, GI,
  Rheumatology, Endocrine
• Night float
• Vacation

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Medicine Floors

• All patients admitted to medicine service are
  divided amongst total 7 teams/firms HA, HB, HC,
  HD, HH1, HH2 and HP
• Teams are divided geographically
• HA HH Overflow
• HB 10th floor
• HC Pavilion
• HD 8th floor
• HP Private firm
• Goal of these system is better patient care and
  equal distribution of work.
• These are not absolute rules you may have
  patients outside your assigned floor.

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Medicine Floors

• HA, HB, HC, and HD
• 1 hospitalist, 1 resident, 1 intern
  students/Sub-I
• In the first few days of your floor month, you
  should only be seeing as many patients as you can
  handle. Your Resident should help you by
  following the others.
• As you progress and become more comfortable on
  the floors, you should take over much of the
  responsibility for seeing the patients in the
  morning.
• In the beginning of the year, in the beginning
  of your rotation, you should not be following
  more than eight patients.
• By the end of your rotation, the absolute
  maximum number of patients you should see is 10.
  Even that is extreme.
• Teams are capped at 16 patients. After that,
  patients are the attendings responsibility alone.

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Medicine Floors

• HP
• Private attending (CamCare)
• 1 resident, 1-2 intern.
• Same caps.
• If service exceeds 16 patients, the remaining
  patients are to be made non-teaching. Your
  resident should discuss this with the attendings
  so that the non-teaching patients are identified.
• HH1 and HH2
• Non teaching firms designed to reduce house staff
  workload - No housestaff during daytime.
• Team of Attending student.
• These patients are covered by on call intern.
• These services are cpvered by a moonlighter (Team
  3).

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Medicine Floors

• Typical day
• Come at 6am, get sign-out from on-call team
• 615 800 ? See acutely ill patients, new
  patients, discharges and old patients. Resident
  usually comes at 645 700. Discuss any acute
  issues with resident. Labs usually return around
  9am.
• 930 1000 ? Work rounds with resident and
  other members of team, call consults etc
• 1000 am 1145 ? Teaching rounds with attending
• 1145 1200 ?Take care of important issues, get
  food for noon conference
• 100 330 ? follow ups, discharge papers for
  next days discharges, call PMD and family etc.
• 400 ? signout rounds with attending
• After signout rounds, finish any outstanding work
• Required to attend all conferences except MR

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Call on Medicine Floors

• Usually Q 4 day short call
• From 400 pm to 800 pm during weekdays
• From 800 am to 800 am on Saturday ( Overnight
  call )
• From 800 am to 800 pm on Sunday
• Provide cross-coverage for patients from other
  team.
• Helps MAR for admission.
• Expect to do up to 3 admissions on night float
• Signs out to NF interns at 800 pm except on
  Saturday

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Medicine Floors

• CALLS

TEAM 1

HA HB Consults Hem Onc
TEAM 2

HD HP HC Neuro
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Medicine Floors

• WEEKEND ROUNDS
• Either resident or intern has to come round on
  each day of weekend
• A weekend rounding schedule will also be provided
  to make sure everyone gets time off
• Sign out at 1200 noon to on-call intern

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Consult Team

• All interns get to do 2 weeks of Medicine
  consults.
• The consult team consists of 1 resident and 1
  intern.
• Consult on medical issues on patients of OB-GYN,
  trauma, surgery, orthopedics, etc.
• More will be explained when you are on this
  rotation.

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Medicine Admitting team

• 1 MAR (resident) and 1 MAH (hospitalist).
• They are responsible for all the admissions
  between 7 am till 4 pm and rounding on admitted
  pts in ED.
• MAR-D will be helped by the short call staff (1
  resident and 2 interns) between 4pm and 8pm.
• You may be called out to help with an admission
  from 4pm-8pm when you are on short call
• MAR-NF will frequently call on the interns to
  help on admissions as well.

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Medicine Admitting team

• During Weekends, there is only 1 MAR during the
  day (8 am to 8 pm) and 1 overnight (8 pm to 8 am
  ).
• Interns who are on call on weekends help MAR in
  admissions.

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Night Float

• From 8 pm to 8 am
• NF team works Sunday Friday, off on Saturday
• Consists of 1 MAR-NF, 2 floor interns and 1
  MAI-NF/another MAR-NF.
• Responsible for admissions from 800 pm to 700am
• Meets IM residents and Dr. Rajput in D-119 for
  discussing overnight admission/issues from 7-15-8
  am
• Excused from other conferences.
• Must submit Night Float Portfolio.

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CCU/PCU

• Usually 3 medicine Interns one ER intern
• CCU one intern one PGY-2 and CCU fellow
• PCU interns PCU fellow
• PCU interns round on patients in PCU
• CCU interns and residents divide patients in CCU

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CCU/PCU

• Typical day
• Come at 700 am, get sign-out from on-call team
• CCU rounds start at approximately 9am
• PCU rounds start when CCU rounds are finished.
  This is attending dependant.
• Expected to leave usually 500 pm
• Required to attend all conferences except MR and
  Chief round

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CCU/PCU

• Calls
• Q4 overnight call
• From 400 pm to 700 am on weekdays
• From 800 am to 800 am on weekends
• On weekends half of the CCU notes should be
  written by overnight team
• Cover all PCU, CCU patients
• Must leave before noon on post-call days
• Do not cover CADV patients on floors (team 3
  covers them)

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ICU

• 2/3 month will be day shift, 1/3 month on night
  shift.
• Total 3 ICU teams
• Red team 1 intern, 1 resident, 1 fellow 1PGY3
• Blue team 1 intern, 1 resident, 1 fellow
• Green team (INCU) 1 fellow only
• NF team 1 intern, 1 resident and 1 fellow
• We are currently instituting a new call schedule
  to increase the amount of days off for each team.
  Pay attention to amion.

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ICU

• Day shift
• Usually come at 615-630
• Round typically starts at 830 900
• Leave at 300 if not on call, leave at 700 if on
  call
• Cap Interns 6 pt, Residents 8 pt
• Night shift
• From 700 pm to 700 am

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Hem/Onc

• 1 intern, 1 resident and 1 fellow
• Responsible for primary pts only, not consults
  patient
• Typical Day
• 7am-4pm
• Get sign-out from Night float team
• Round with the team around 9 am
• Leave typically at 400 pm if you are not on call
• Attend all conferences EXCEPT morning report
  Calls Take Q 4 call for Team 1
• Need to cover one day of the weekend in 2 weeks
  to round

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Neurology

• 1 intern and 1 resident (usually PGY-3)
  neurology residents
• Responsible for primary pts and consults patient
• Typical Day
• 7am-4pm
• Get sign-out from Night float team
• Typically, consult round occurs in afternoon
• Attend all conferences EXCEPT morning report (can
  attend MR if time permits)
• Calls Take Q 4 team 2 calls
• The intern or resident must round one day each
  weekend.

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Call rooms

• Current call rooms location

NF Interns and MAR 7th floor Solarium 3 5 together, then 1
ICU Call room in ICU 1,2,3,4 then
CCU team 2nd floor (dungeon) 5 then 2 then 4
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Vacations

• PGY 1
• 2 half-month blocks approximately last 6-8
  days and 5 days off on Xmas or New Year
• PGY 2/3
• 2 half-month blocks 5 days off on Xmas or New
  Year

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AMION

• Schedules are published online
• https//www.amion.com
• Password Cooper University Hospital
• Master schedule for the year will be released at
  the beginning
• Call schedules will be released every month/every
  2 months.

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• GOOD LUCK
• And
• Welcome to the Cooper Family