Chief Resident Overview - School of Medicine

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Chief Resident
Overview
June 14, 2013
Welcome Interns!
Your Chiefs
Crystal Lantz-DeGeorge, M.D.
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Hometown: Tiffin OH
Undergrad: The Ohio State University
Med School: Wright State University Boonshoft SOM
Professional Interest: Primary Care
Mommy of identical
twin 8 month olds
Sumit Bose, M.D.
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Hometown: Pittsford NY
Undergrad: Johns Hopkins University
Med School: GWU
Professional Interest: Allergy/Immunology
Can do an amazing dance with a
wheeled walker
Kamal Shemisa, M.D.
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Hometown: Westlake OH
Undergrad: Kent State University
Med School: NEOMED
Professional Interest: Cardiology
Lover of cats and cardiology
Claire Sullivan, M.D.
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Hometown: Rocky River OH
Undergrad: John Carroll
Med School: University of Cincinnati
Professional Interest: Cardiology
Obsessed with Cleveland
Navin Vij, M.D. (Med/Peds)
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Hometown: Bloomington, MN
College: Rice University
Med School: Baylor
Professional Interest: Health Policy
Former professional Bhangra dancer
Roles of the Chiefs
• Rotate every 3 months
• UH Chief - #31250 – Claire Sullivan
• Office in DOM 3rd floor
• VA Chief - #31533 – Kamal Shemisa
• Office on VA 4th Floor
• Ambulatory Chief - #31529 – Sumit Bose
• Office on VA 4th Floor
• Patient Safety & Chief - #36644 – Crystal Lantz-DeGeorge
• Office in DOM 3rd floor
Roles of the Chiefs
• We are your ADVOCATES
• Call us with any problem or issue that arises in a TIMELY and
SPECIFIC manner
• We can’t help you if you don’t let us know the problem
• We are your MENTORS
• We embrace the opportunity to provide support for you professionally, educationally and psychosocially
• We have been in your shoes!
• We remember well the struggles of intern year and are here to
help you in any way we possibly can
Block Zero
• June 24th-June 30th
• No days off
• Many extra interns on teams to divide the work and
admissions
• Constant senior supervision due to rotating extra senior
helpers who will work with non-call teams from 5pm-10pm
• Ask questions!
UH Campus
UH teams
• Ward Teams
• 2 General Medicine
• 6 Sub-Specialty
• MICU
• CICU
• UH Nightfloat Team
Naff
Gen Med
Wearn
Gen Med
Carpenter
ID
Dworkin
GI
Weisman
Heme/Onc
Ratnoff
Heme/Onc
Eckel
Nephrology
Hellerstein
Cardiology
ICU Rotations
• At UH
• MICU
• CICU
Other UH Rotations
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Geriatrics
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2 week rotation
Jeopardy
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Rotate on a consult service while on back-up call for any
absence on UH or VA wards/clinics
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MUST have pager on 24/7 including weekends
E Team
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Work 1:1 with hospitalist during winter months
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Back up Jeopardy
Team Caps
• UH ward teams cap at 10 patients per intern except for the
Seidman teams which cap at 8
• VA ward teams cap at 8 patients per intern
• No short call on weekends
• Intern + AI @ VA = 10; AI+AI paired together = 10 if one senior,
12 if two seniors
• Intern + AI @ UH = 12 when 2 seniors; 10 when 1 senior
Intern Call/Duty Hours
Call Schedule: Long  Medium  Short  Happy 
• Long Call admits 3 patients
- Last patient no later than 7:00 pm
- Interns should be done staffing patients and sign out to NF by
9:00 PM
- Must be out by 11:00 PM
Intern Call/Duty Hours
• Medium call admits 2 patients
- Last patient by 4:00 pm.
- Holds the Team Pager until 7:00 pm
- Signs out to NF at 7:00 pm.
Intern Call/Duty Hours
• Short call admits 2 patients
- By 12:00 PM at UH and 1:00 at the VA
- MICU and Night float patients ONLY at UH
- Can be new patients at VA
- No patients on clinic days or if intern has 8 patients
- Signs out to Medium call intern as early as 4:00 pm
Call Sequence
UH MICU
- 4 interns and 5 residents per rotation; Interns paired with resident
for long call
- Interns will get last admission by 7 pm, should leave by 9 pm, must
leave by 11 pm
- Patients admitted by the NF will be distributed by the MICU fellow in
AM to keep teams even and optimize work flow in the MICU
- The post call resident will present and leave, sign out to the post call
intern
- The helper resident will supervise the post call intern and will help
until the intern has completed their work, usually around 5pm
The New CICU for Interns
• 2 interns scheduled in the CICU:
-Day intern: works 7 AM-7 PM. May follow/admit one
to two patients under supervision of senior resident.
-Night intern: works 7 PM-7 AM. Helps with cross-cover,
gains valuable night ICU experience including procedures, and
possibly allows for on-call resident to take a nap.
• Interns will do one week of nights and one week of days during two
week rotation
• Both interns have Sunday off (accommodate switch days and
transition from nights to days)
Intern Call/Duty Hours
• All teams will have double seniors until block 3-4
• Orphan coverage: When you are on call and your team
senior isn’t
• On Call interns will be covered by the assigned
orphan resident
• Ask your seniors how to look this up
• Always page the senior as soon as you get an
admission to speed up the process
Typical Day
• 6:45-7:00: Get sign out from NF on Tower 5
• 7:00-7:45: Pre-round on your patients
• Get patient assignments from NF seniors
• 7:45-8:00: Run overnight events with senior resident
Address any major issues before rounds
• 8:00-10:30: Rounds with attending
• 10:30-11:30 : MR for residents (MWF) and interns (T/Th)
• 12:00-1:00: Noon Conference
10:30-12:00: Time to get C.O.L.D.
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C: Call your consults
• The later you call, the more angry the consultant will be
• Ask your senior for advice on how to call the best consult
before your first one
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O: Order Entry
• Enter any orders that were not entered on rounds
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L: Labs
• Run your labs!
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D: Discharges
• Get them out!
• At UH, dictate your day of discharge note in your
discharge summary
• At the VA, type the discharge summary on the day of
discharge
Conferences - UH
• Intern Morning Reports – Residents hold the pagers!!
• Tuesday AM report from 10:30 – 11am! ** NEW **
• Thursday 10:30am-11:30am
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Noon Conference
• Monday, Wednesday and Thursday 12-1pm (with food)
Grand Rounds
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Morbidity & Mortality (M&M)
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Tuesday 12-1pm
Friday 12-1pm
Agre Society
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Occur monthly on Wednesdays
Typical Day
• Afternoon: Follow-up on studies, consults
• Sign out to co-intern/resident and attend clinic on clinic days
• Admit new patients and staff with team resident or on call
resident
• On long call day sign out between 9-11pm
• On medium call day sign out at 7pm
• On short/happy day leave as early as 4pm
Sign Out
• Sign out is an exchange of information to ensure excellent
patient care
• As an intern sign out
• What is important?
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FU CT PE  If positive, start heparin
FU ECG and troponins  If troponin positive, treat for ACS
FU I/O’s, goal 1L negative  If not at goal, give 80 IV Lasix
FU H&H  If Hb <7, transfuse 2U PRBCs
• What is not important? Avoid having the NF do your work
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FU Nutrition recs
FU CT A/P done for cancer staging
FU ANA
ANYTHING THAT WILL NOT CHANGE OVERNIGHT MGMT
Intern Expectations
• Interns have primary care responsibility for all patients
assigned. These responsibilities include:
• performing a complete admission history and physical
• formulating a diagnostic and therapeutic plan with the
resident and attending
• When surveyed, patients almost always identify the INTERN as
their primary provider while they were hospitalized
Intern Expectations
• The admission history and physical must be on the
patient’s chart within 24 hours of admission.
• The Intern is responsible for all day-to day management
issues, which must be reflected in a daily Intern progress
note (limit copy pasting)
Intern Expectations
• All patients assigned to the intern are
• to be examined by the Intern every day
• Interns have primary responsibility for discharge summaries,
but this should also be shared with the resident depending on
work load and workflow
• If the intern is off, the discharge summary must be done by
the covering resident, or the attending
Intern Expectations
• Interns should report any significant change in status of
patients under their care to the supervising resident
• These include significant
• change in vital signs
• change in mental status
• change in status requiring a rapid response team (=code
white)
• Interns have 24/7 in house supervision by residents,
fellows, or attendings
Intern Expectations
• Discharges are the primary responsibility of the intern, but
residents frequently help, especially early on
• DAY OF DISCHARGE dictations – ask your seniors for help
• Do not hesitate to ask your senior especially early on
Intern Expectations
• ANESTHESIA INTERNS MUST LEAVE BY
9 PM IF ON CALL!!!
• ACGME rules for anesthesia are different from those for
categorical and preliminary medicine interns
Resident On-Call
• Are responsible to staff their own teams if the patient is
available prior to 4:00 pm.
• On call residents stay until at least 9:00 PM
• Weekend team covering resident staffs until at least 1:00 PM
On call senior will staff “orphan” interns after 4:00 PM
during the week and after 1:00 PM on weekends
Days OFF!
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Dworkin, Carpenter, Wearn, Naff, Ratnoff,
Weisman, and VA Wards
• Short And/Or Happy Days on Saturday or
Sunday
• In a 4 week block, 4 days off:
• 1 “Golden” – Sat AND Sun off
• 2 “Silvers” – Either Sat OR Sun off
• 1 “Black” – No weekend days off
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Eckel and Hellerstein
• Happy Day Friday through Monday
• 1 Day off per week
Days OFF!
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Night Floats
• UH: 3 interns are scheduled but only 2 are on each night;
work out days off with each other!
• Email your days off schedule to ambulatory chief
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VA: Saturday night is off
UH MICU
• Short call day off Friday through Monday
UH Team Pagers
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Each team (Eckel, Wearn…) has a team pager
•Held by medium call until 7 pm
•Pager signed out to NF Intern at 7 pm
•Long call intern signs out their patients at 9 pm
•Held by intern nightfloat
7pm-7am
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Team pagers are also code pagers – on-call interns
should go to all codes (‘Code Blue’)
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Team pager numbers are listed on the pager card in
your bags
Meet the DACR/NACR/Admissions
Coordinators…
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DACR = Day Acting Chief Resident
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NACR = Night Acting Chief Resident
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PGY3 helps admit and triage new admissions, runs codes, manages
medicine consults
Admissions Coordinators = Toni, Lisa, Kathy
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Direct phone 67121
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Pager 30512
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Work Room 42508
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Distribute admissions to you during the day
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Be nice to them!
UH Miscellaneous
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GME Housestaff Lounge
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Located on Lakeside 6th floor, next to GME office
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ID Badge required for entry
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Has coffee, bathrooms, T.V., foosball table, computers
THE P.I.T. Fitness Center
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Basement of Lakeside
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Free card entry, TV's, towel service, open 24/7!
UH Resources
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Your Senior Resident
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The DACR/NACR
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Other Residents
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The Night Floats
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The Chief Resident
Louis Stokes Veterans
Administration Medical Center
VA teams
• 4 General Medicine Teams
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VA Orange
VA White
VA Blue
VA Green
• VA MICU
• VA Nightfloat Team
VA Wards
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1 resident + 2 interns per team – may have acting
interns/medical students
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Ward 4A: Orange/White (sister teams)
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Ward 4B: Blue/Green (sister teams)
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PCU: telemetry 2nd floor
VA Lounge
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Located on the 2nd floor
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Fridge: frozen dinners, ice cream, sorbet, string cheese,
muffins, fruit, yogurt, milk, PBJ uncrustables
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Coffee machine
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Cabinets: Trail mix, gold fish, peanut butter crackers,
pretzels!
VA Conferences
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Monday: Noon conference
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Tuesday: Grand Rounds televised from UH at noon
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Wednesday: M&M at noon
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Thursday: Intern Morning Report @ 10am-11am!
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Your resident will take your pager
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Be on time!!
Friday: Noon conference
VA Miscellaneous
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Garage parking is free! Just need to get a parking sticker from
VA police dept
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VPN access for home CPRS access
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Codes at VA are called ‘Dr. Heart’
VA MICU
• 3 interns and 2 residents per rotation
• Interns are q3 call.
• Day senior 8a-8p
• Night senior: 8p-8a
• Interns will get last admission by 7 pm, should leave by 9 pm, must
leave by 11 pm
• Sign out to night senior
• Patients admitted by the night senior go to the intern on call the
next morning
Nightfloat Rotations
The UH NIGHTFLOAT TEAM
NACR
Nightfloat Resident
Rotating MSIII
Nightfloat Intern
Nightfloat Resident
Nightfloat Intern
NIGHTFLOAT TEAM
Nightfloat Intern
UH Nightfloat Intern
• Works from 7 pm-7 am
• Meets the NACR and NF Residents in the KACR
• Gets sign out from teams (mediums at 7:00 PM and Longs at
9:00 PM) and manages cross cover issues
• Work with the NF resident to help answer
questions/manage ill patients
UH Nightfloat Intern
• PGY3 NACR and 2 PGY2 NF Residents are always available
if you need help - questions regarding your admissions,
extra set of eyes to see a sick patient
• You may be asked to admit 1-2 patients on busy nights and
staff with NF resident.
• NF interns must go to Code Whites on patients you’re
covering
• Senior residents must go in the first 6 months
• Alert them immediately
VA Nightfloat Team
• One Nightfloat Intern who manages cross-cover
• 7pm-7am
• Day off Saturday
• One Nightfloat Resident who does overnight admissions
Intern Saturday Coverage
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One or 2 Saturday Nights when on ambulatory, UCC,
COE or elective, you will be asked to cover from
Saturday 7pm to Sunday 8am for the VA intern
nightfloat to get a night off
Ambulatory Medicine
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Continuity Clinic
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Urgent Care Center
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Primary Care Block (PCB) / Ambulatory Block
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Clinical Skills Block (CSB)
Continuity Clinic
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One afternoon per week at either the VA or the Douglas
Moore Center at UH
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During ambulatory or elective, up to 2 clinics per week
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Always the same day each week and with the same attending
preceptors
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You will develop a set of patients that you follow over 3 years
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Clinic cannot be canceled by anyone except the Ambulatory
Chief Resident
Continuity Clinic Rules
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No clinic when
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Medium call or on long call days
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Vacation
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Holidays
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ICU’s
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Night Float
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You DO have clinic when on Elective!!!
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Cannot switch clinics amongst yourselves; all schedule
changes need to be approved by ambulatory chief resident
Urgent Care Center (UCC)
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The VA “Emergency Room”
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Staffed by at least 2 seniors plus variable number of
interns
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One or two attending physicians
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Hours are 9-6 with “on-call” resident to arrive at 0800
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Fast track: sees low acuity issues, med refills….
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Great learning opportunity in seeing the
“undifferentiated” patient
PCB / Ambulatory
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Introduction to Outpatient Primary Care
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Introduction to DMC and the Firm Continuity Clinics
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Morning Clinical Conferences: 8am daily
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8:45-12:00: Subspecialty VA Clinics
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Some Full UCC Days
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Subspecialty or continuity clinics in the afternoon
Clinical Skills Block
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2-week outpatient rotation in the Spring
Hands on activities
Simulation models at the simulation skill center
Humanities in Medicine
End of life care
Cultural Competencies
Learn presentation skills
Mock Codes
Learn procedural skills
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Back up Jeopardy
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Code Blues
Code Whites (UH)
** 1ST six months – an upper level must go to all Code Whites with
an intern**
• Sick or decompensating patients on the floor
• Initial response from ICU nurse, intern, and PGY
• DACR/NACR for level 2 code white
• If you want to transfer to MICU, call MICU fellow
• Always write a Clinical Event Note!
Code Blues
• Check your own pulse first!
• “Too many chefs spoil the soup”
• One person leads the code
• Make sure you get involved – Line up for CPR!
• Maintain a calm quiet atmosphere
• Run labs for the resident
• Keep the ACLS cards in your pocket until you are comfortable
with the protocols
• Usually not expected to run codes until PGY2 year, but you may be
the first responder!
• Make sure your BLS and ACLS are up to date
• Code leader writes a CODE BLUE NOTE and someone must notify
family
Professionalism: Attire
• Men
• Shirts and ties
• Women
• Professional
• Keep white coats clean
• No denim
• Do not show up to Morning Report
looking sloppy
Professionalism: Absences
• Referral to RECC
• 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
• While on elective, you are expected to attend all Grand
Rounds and M&M’s
• Please note that when you are on elective, you are back up
jeopardy!!
• You are expected to have your pager turned-on throughout
your elective rotation
• If you are going out of town for the weekend, please notify
the ambulatory chief prior to leaving
• Elective should not be treated as vacation
• Please email Barb 2 weeks prior to starting your electives
Professionalism: Conference
Attendance
• Be on time!
• Noon conference:
• UH: Mon-Wed-Thurs
• VA: Mon-Thurs-Fri
• Grand Rounds on Tuesday: UH & VA
• M&M Fridays @UH, Wednesdays @VA
Professionalism: Discharge
Summaries
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Do them the day of discharge
Do them for your intern
Do them for your friends
Do them for your patients
Weekend coverage is responsible for discharge summary
Coverage and Schedule Switches
• All coverage arrangements and schedule switches
must be approved by the Ambulatory chief
• Switches must be arranged before 1 week of
rotation starting
• Weekend Coverage switches before 48 hours of
day
Finally Friday
• Weekly newsletter containing must read info!
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Sent out Thursday evening
Announcements
Upcoming events
Weekend coverage assignments
Board Review
Other Resources
• Department of Medicine Website
• Medicine.case.edu
• “Like” us on Facebook!
• Facebook search “CWRU Department of Medicine”
Annual Events
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Intern Welcome Dinner (next Monday!)
Intern Mini retreat (Oct)
Bronson Day (May)
Holiday Party (Dec)
Spring Dinner (May)
Intern Retreat (June)
End of the year picnic (June)
End of Internship (last week of June, vacation!)
Intern Welcome Dinner
Intern Retreat
Bronson’s Day
Spring Dinner
We’re a family
We have fun!
These will be your cool senior residents
Scott, Caroline, Vivek and Angel
Let’s get
him
Yep
Pie Eating contest
But sometimes when you’re not looking…..
Pie Eating Champion!
You might end up like Yogesh
Friendly Advice
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Catch up on your sleep when you have a chance
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Talk to a chief or program director before personal problems
get out of hand – we are here for you!
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SUPPORT EACH OTHER!
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Maintain personal and family relationships outside of the
hospital; make new friends while you’re here
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Take care of yourself; it’s the only way you will be able to
provide good care to your patients
Things to do in Cleveland
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Indians
Cavs
Browns
Lake Erie Monsters
East 4th
West 6th
West Side Market
Little Italy
Art Museum
Bodies Exhibit
Edgewater Park
Metroparks
Zoo
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Goodtime 3
Wineries
Great Lakes Brewery
Larchmere
Shaker Square
Chagrin Falls
Lakeview Cemetery
Rock and Roll Hall of
Fame
Cleveland Orchestra
Blossom Music
Festival
Lola
www.clevelandindependents.com
www.coolcleveland.com
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Winking Lizard
Panini's
Cain Park
Luna Bakery
Playhouse Square
Aurora Outlets
Cedar Park
Kalahari Water Park
Put n Bay
Kelley’s Island
Air show
Rib Festival
Etc Etc
Final Thoughts
SCHEDULES!
Naff
Gen Med
Wearn
Gen Med
Carpenter
ID
Dworkin
GI
Weisman
Heme/Onc
Ratnoff
Heme/Onc
Eckel
Nephrology
Hellerstein
Cardiology
Questions?
We are looking forward to a great year together!!!
-VBLSS

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