1. WELCOME!! 1

2. Chiefs’ Orientation June 14th, 2012 Scott Denstaedt Marty Tam
Angel Qin
Khanjan Shah
June 14th, 2012 2

3. Starting intern year…
SUCCESS!

4. 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 4

5. 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

6. 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

7. 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

8. 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

9. 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 9

10. 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! 10

11. UHUH Campus
Lerner Tower
Lakeside ED
Seidman 11

12. Louis Stokes Veterans Administration Medical Center12 12

13. 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 13

14. UH Ward Teams Hellerstein (Cardiology) Eckel (Nephrology)
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

15. 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

16. 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)

17. UH ICUs MICU CICU 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
5 seniors, 2+ interns, 1 fellow
Interns do 1 week of days, 1 week of nights

18. 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

19. 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

20. 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!

21. LOGISTICS: Team Caps UH: VA:
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 21

22. 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

23. 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

24. 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” 24 24

25. 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 25 25

26. Typical Ward Day 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 26 26

27. 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 to answer questions or provide assistance! 27

28. The night float team 28 28 28

29. The NIGHTFLOAT TEAM NACR Night float Resident Night float Intern 29 29

30. 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 30 30 30

31. 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 31 31

32. 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

33. Call and Continuity Clinic
No Clinic on Long or Medium call.
No short call patients assigned on your clinic day.

34. 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 34

35. 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  type pager number  *beepbeepbeep*  you call back number*your pager number#
For VA pagers, dial xxxx (pager number)  *beep beep beep*  your call back number*your pager number# 35 35

36. Other Rotations
Geriatrics
E-team
Jeopardy
Elective
UCC 36

37. 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

38. E-team Only during the busiest months at UH
One intern + hospitalist attending
8 patient cap, off on Sundays
Lots of independence

39. 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

40. 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 40

41. 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 41

42. Example Elective Tracking

43. 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 43

44. 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) 44

45. Conferences - VA Monday: Noon conference
Tuesday: Grand Rounds televised from UH at noon
Wednesday: M&M at noon
Thursday: Intern Morning AM
Your resident will take your pager
Be on time!!
Friday: Noon-conference 45

46. 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 46

47. 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 47

48. 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 48

49. 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 49

50. Ambulatory Medicine Continuity Clinic Urgent Care Center
Primary Care Block
Clinical Skills Block (CSB) 50

51. 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 51

52. 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

53. Primary Care Block Introduction to Outpatient Primary Care
Introduction to DMC and the VA continuity clinics
Morning Clinical Conferences: 8 AM daily 53

54. 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 54

55. Professionalism 55

56. Professionalism: Attire
Men
Shirts and ties
Women
Professional
Keep white coats clean
No denim
Do not show up to Morning Report looking sloppy 56

57. 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 the Ambulatory Chief
DO NOT
DO NOT TEXT PAGE
DO NOT CALL THE CELL PHONE OF THE CHIEF YOU KNOW

58. 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 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 58

59. 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
Conference attendance is part of your ACGME graduation requirements 59

60. 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 60

61. Things to do in the CLE Sports SO MUCH GOOD FOOD
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!! 61

62. And so much more

63. QUESTIONS?? 63

64. We are looking forward to a great year together!!! -SMAK64 64