WELCOME!! 1

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

Starting intern year… SUCCESS!

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

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

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

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

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

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

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

UHUH Campus Lerner Tower Lakeside ED Seidman 11

Louis Stokes Veterans Administration Medical Center 12 12

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

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

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

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)

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

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

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

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!

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

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

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

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

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

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

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! 27

The night float team 28 28 28

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

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

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

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

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

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

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 9-207-7244  type pager number  *beepbeepbeep*  you call back number*your pager number# For VA pagers, dial 9-440-562-xxxx (pager number)  *beep beep beep*  your call back number*your pager number# 35 35

Other Rotations Geriatrics E-team Jeopardy Elective UCC 36

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

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

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

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

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

Example Elective Tracking

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

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

Conferences - VA Monday: Noon conference Tuesday: Grand Rounds televised from UH at noon Wednesday: M&M at noon Thursday: Intern Morning Report @ 10-11 AM Your resident will take your pager Be on time!! Friday: Noon-conference 45

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

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

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

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

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

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

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

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

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

Professionalism 55

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

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 31529 the Ambulatory Chief DO NOT EMAIL DO NOT TEXT PAGE DO NOT CALL THE CELL PHONE OF THE CHIEF YOU KNOW

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 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 58

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 Fridays @UH, Wednesdays @VA Conference attendance is part of your ACGME graduation requirements 59

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

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

And so much more http://www.clevescene.com/

QUESTIONS?? 63

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