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Abha Khandelwal MS, MD Rush University Medical Center Department of Cardiology.

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Presentation on theme: "Abha Khandelwal MS, MD Rush University Medical Center Department of Cardiology."— Presentation transcript:

1 Abha Khandelwal MS, MD Rush University Medical Center Department of Cardiology

2 CWRU Weatherhead OSU Rush Medical Center


4 Location Population Density Hospital Density Legal Density

5 Established relationship amongst practioners More variability in management strategies More ancillary services Established relationship between patient and pracitioner Less direct access of patients to Attendings. More standard management strategies More access to physicians with sub-specialized interests Conferences where complicated cases can be discussed in a multidiscplinary fashion. Allowance in time devoted to research and academic pursuits.


7 Attitude ApplyAppreciate Acknowledge Adapt Success

8 Admit patients Cross cover Write orders Communicate with RN Write notes Obtain medical records Perform procedures Run codes Talk with families Follow up on test results Arrange Dispositions

9 At home: Schedule: Plan ahead Outsource: When possible Hobbies: Continue them At work: Organizing Data H&P Cross cover Sleeping Eating


11 Attitude Apply Appreciate Adapt Success


13 Patient Care Tech Nurse Pharmacy Doctor

14 Primary physician Volunteers Pharmacy Specialists Nurse Nutrition Social Work PT/OT Phlebotomy Radiology Transport resident intern fellow student CNA techs Wound care housekeeping RT NP Nutrition Delivery

15 Accumulate data H&P OSH Identify dangerous situations Learn basic principles To be a scapegoat

16 AMI SBO DKA Sepsis GI bleed ACLS/PALS BM BS Pain BP Nausea Insomnia

17 Comprehend the clinical situation of the patient being managed Master procedural/Exam/diagnostic skills Manage dispo and social issues for the patient Teach the intern/medical students Keep charge nurses informed

18 Manage the complex care teams that are involved in managing a patient Ensure patient safety Ensure education for all levels of the team

19 Set expectations at the start of month Review progress in middle Summarize at the end

20 Attitude Apply Appreciate Acknowledge Adapt Success

21 A Give 80 meq of potassium B Give insulin C Do nothing this is normal D Give hypertonic saline E None of the above 124 100 2.6 13 29 1.0 400

22 Talk to colleagues who have done the rotation. Use evidence based medicine to guide you management decisions. Websites:,,,,,,, www.acponline.org

23 Seattle heart failure model Chads2 TIMI Risk calculator in STEMI/NSTEMI Ekg guide


25 Understand Acid/base PNA hospital score Score for sepsis for Activated protien C Ventilator extubation criteria Electrolytes

26 Rounds: Identify pertinent information Learn to group things together (meds, labs, sx) Synthesize a cohesive management plan based on guidelines Procedures: Know the indications and potential complications Research: Case Reports PubMed: gastric massage

27 Heme/Onc: Neutropenic fever, transfusion thresholds, oncologic emergencies ID Sanford, travel hx, antibiotic hx, immunizations Surgery Ileus, nutrition, anatomy, bm, pain control Pediatrics Milestones, congenital syndromes, embryology Renal Electrolytes, urine sediment, nephrotic, vs nephritic.

28 Attitude ApplyAppreciate Acknowledge Adapt Success


30 Attitude


32 Adapt: and be efficient Acknowledge: and learn your role in the team Appreciate: and be respectful to all members of the team, understand their perspective Apply: book knowledge into practical/clinical knowledge Attitude: Stay positive


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