UAMS Internal medicine intern_orientation
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Transcript of UAMS Internal medicine intern_orientation
Welcome to Little Rock!
2014-2015 ChiefsNick Gowen
Intern Core Lectures [email protected] 501-831-0036
Sandra Susanibar Intern Morning Report [email protected] 501-258-4092
Heather Moore Schedule [email protected] 501-605-7541
Chief OfficeShorey 3rd Floor Office phone: 686-7088Chief Phone: 291-3246
Office Hours0800-1600Usually one of us is here by 0730Can always contact by phone
Pinnacle Mountain State Park11901 Pinnacle Valley Rd, Roland, AR 72135
Need-to-Know: UAMS
Housestaff Office 3rd Floor Shorey BuildingLinda Lindsey, Sheila Rupley, Melissa Clapp Phone Number and FAX Number on card
Respond PROMPTLY to all emails from these ladies.
Need-to-Know: UAMS
Resident Lounge/ Call Rooms –A3Secured with badge accessDoor codes on cardMAILBOX
E4 Call RoomsNo computers
F6 WorkroomSleep couch, TV, computers
Need-to-Know: UAMS Team 1 Cardiology/CCU: F8 Workroom/
H4
Team 2A/2B Heme-Onc: H7 Workroom
Team 3A/3B Gen Med: F6 Workroom
Abernathy ID Team (6): F6 Workroom
UAMS MICU: E4 Workroom
Need-to-Know: VA Medicine Office: 6A
Gen Med 1-2: 6D workrooms
Gen Med 3-4: 4B workrooms
Team 7/ CCU: 5E workroom
MICU: 1F workroom CCU: 5D SICU: 2C
Need-to-Know: VA
Workroom codes: 5123# If you don’t want it stolen, hide it or keep
it on your person.
Need-to-Know: VA
Call rooms: 1F Door code: Press 2/4, then 3 Call rooms: 7B
5123#Phone, TV, BedsDon’t leave pt information in these roomsPull the door closed
Need-to-Know: VA
To get into the MICU at the VANeed a PIV badgeTake it OUT of the holderHold up to the card scanner
Need-to-Know: VA
Need-to-Know: Clinics
VA – Ft Roots campus, NLRUAMS- 2nd floor, Outpatient center
Need-to-Know: Food Resident Noon Conference
Lunch provided all days but ThursdayWarm Lunch Wednesday
VA OptionsCafeteria, boxed lunches on the ground floor
UAMS OptionsCafeteria: Ground floor, Central Building
Not open on weekends, holidaysLobby Café—First floor, Main Hospital
open on holidays/weekendsDoc Java, The Gathering
June 28
Be sure to come to Dr. Marsh’s reception.
Have a good time. Remember a designated driver.
June 30 Make sure you have a white coat, stethoscope,
penlight, pens, etc. Go see the intern on service. Get hand-off on the
patients you will see in the morning. Ask questions. If on an elective, call the fellow to ask where and when
you need to be on Jul 1. Log into the computer. Make sure your passwords
work. (Do this early in the day.) If you are at the VA, you will need to get your DEA
number (details to follow). Make sure you know where to park (and have your
parking decals).
UAMS
July 1
For MICU and wards, show up at 0530-0600
For electives, show up at the time your fellow stated.
Find night team for hand-off Pre-round, Round, Consults, Orders,
Discharges, Notes Go home and get some sleep.
Petit Jean State Park-Morrilton, AR -approx 1 hour from UAMS-multiple hiking trails-camping
Wards: Pre-rounding
1. Arrive from 0530-0630. NO LATER THAN 0650.
2. Find night float interns for hand-off. Take pagers if you are on call. Discuss pt assignment with resident.
3. Review notes, nursing notes, vitals, labs, imaging, cultures.
4. Interview and examine your assigned patients. 5. Review any pressing issues/questions with
your resident prior to rounds.
Wards: Pre-rounding
6. Correct electrolytes, order blood products, etc.
7. Enter and call expected consultations (discuss with resident)
8. Start on discharges and progress notes if you have time
9. Rounds start at 0800-0830 at UAMS, 0900 at VA
Wards: Rounding
Things to know for rounds:Vital signs trend, I/OsAntibiotics (day/reason), IVFCentral lines, PICCs, NGTs, PEG/G-tube,
Foleys, O2 (how many liters)Skin breakdown—ask nurseDiet/TF/TPN—swallow exam?Baseline functioning—PT/OT needed?Daily labs – can we stop?
Wards: Rounding Two important questions:
Why is this patient in the hospital?What is going to keep him/her in the hospital?
Barriers to discharge:Family support, safe housing, rehabHHA, HHPT, Hospice, Home IV abxMake social workers your friend. Talk to them
early about barriers.
Wards: Rounding Take ownership of your assigned patients.
Pay attention. Know about the basic plan on all of the patients on your team.
When your resident is off, you are in charge. Rise to the challenge.
Rounds is not a competition. Don’t be a jerk.
Don’t bulldoze the medical student presentations.
Wards: Post-Rounds
BEFORE Noon Conference: Call consultants WITH A QUESTIONDischarge plans/orders Daily ordersProceduresTalk with patient familiesDaily notes
Rounds should end by 1100 to allow for time before conference.
Wards: End of the Day
Update hand-off lists. Hand-off to on-call intern may start at 1600 Do not “hand-off” procedures. Direct admissions that arrive before 1600 are
the responsibility of the day team. If it is really important, check it yourself.
MICU
Similar expectations as for wards Rounds start at 0800 on both sides Patients are more complex Don’t forget about pressors and vent
settings KNOW YOUR ABG Residents, fellows, nurses are your
resources
Eureka SpringsApprox 3 hours
to the northArtistic CenterOutdoor and
indoor activities
Call: UAMS Short Call: M-F 1600-1900; 1200-1900 on
weekends, holidaysCover 1: F6, H7, F9, H9
○ Holds the Code pager○ Answer pages, follow up on recs, help with
admissions○ “That’s not my patient” is never a good answer.
There is always something you can do to help.
Call: VA VA short call:
○ M-Th 1600-1900○ F 1600-2200 ○ Sa 1200-2200 ○ Su 1200-1900
Cover 1: GM1, GM2, Team 7 A-LCover 2: GM3, GM4, Team 7 M-ZBoth should respond to codesSame responsibilities
Call: VA
Swing ShiftOn FRIDAY and SATURDAYCome in at 0600, round on no more than 4
patients, leave by 1100Return at 2150 for hand-off, take pagers by
2200Leave at 0700 the next morningYou do NOT round on your post-call
morning
Swing Shift Example Nick is on swing shift cover 1 on Friday He comes in at 0600, pre-rounds on 4
patients. Rounds start at 0900. He presents his patients first, excuses himself from rounds, finishes his orders and notes. He leaves the hospital by 1100.
He comes back at 2150, gets handoff from Cover 1 short call intern.
At 0700 on Saturday, he hands-off to the day team, gives his pagers to the Cover 1 intern. He then goes home. Comes back to work on Sunday unless he is off.
Call Responsibilities Summary of responsibilities posted in all
workrooms Mobile phone numbers of your team Text paging: www.teletouchpaging.com Potential Danger Zones
Patient movement (changes floors, comes up from the ED, moves to or from the MICU/CCU)
Sick patientsDocumentation
Call Responsiblities Admissions
H&P and admission orders○ Be sure all of the criteria are met○ PMH, PSH, FH, SH, Allergies, Meds, ROS of 10-14
systems○ Let the EMR help you
Follow up!
Call Responsibilities
Direct AdmissionsH&P and Orders
ER AdmissionsReview documentation, orders. Follow up.
MICU Transfers/ Transfers from other servicesAccept Note
Night Float: UAMS Rotating interns:
1900-0700—show up no later than 1850 for hand-off
Cover 1 and Cover 2 (F4, A7, E7, F8, H8)Same responsibilities as short callWatch for patient movement. Be proactive.When things are quiet, catch up on reading,
MKSAP, etc. When you are rotating off nights, your Resident
may ask you to round. No more than 4 patients. Leave by 1100.
Night Float: VA Two designated interns
1900-0700 SUNDAY through THURSDAYTHIS SCHEDULE IS DIFFERENT FROM THE
RESIDENT NIGHT FLOAT!Same responsibilities as short call.Be proactive!
Hand-Off
Three Essentials:Face-to-FacePertinent information/Potential issuesAccurate List with expected patients
○ VA Med$ Drive○ UAMS H-Drive
When your Resident is off, it is YOUR responsibility to hand-off to everyone, including the Ward resident
Answering pages
“This is Dr. _____ with Medicine returning a page.”
Be professional at all times. Nurses write down EVERYTHING in the chart. If you get paged more than twice on a patient, go
see the patient.Think before you order. Look at the bigger
picture. If you can’t do something, briefly explain. Report inappropriate interactions to the Chiefs.
Documentation
Daily progress notes EVERY daySOAP NoteCannot steal/addend the med student noteProblem-based plan EXCEPT in MICUDocument any barriers to discharge
Attestation: “Pt discussed with Dr. Attending, 3B
attending of record, who formulated the plan of care.”
Documentation
Discharge summariesDue on the day of dischargeBrief hospital coursePlan for follow up, treatment, etc—very
important for cardiology patients!
Document facts, not opinions. No chart wars.
Do not disparage anyone in the chart.
Documentation
If it isn’t documented, it didn’t happen.Procedure notes with Time OutOn call notes when pt is crashing
Arkansas Symphony OrchestraDiscounted
Tickets for UAMS
Pops and Chamber Series
Broadway shows
Clinics: UAMS Internal Medicine North
Go to clinic on your scheduled day for orientationNotes MUST be completed and signed within
24hrsCheck your in-basket REGULARLY (at least once
a week) Contacts:
○ Dr. Alice Alexander, MD and Heather Thomason, RN
Clinics: Med-Peds
½ UAMS, ½ ACH Circle of FriendsTake drive time into considerationFinish notes on timeDon’t forget to check EPIC when you are at
ACH. Your patients still exist at UAMS!
Clinics: VA
Fort Roots, North Little Rock Assigned to an Attending’s team Contact: Dr. Shagufta Siddiqui or your
attending Finish notes in a timely fashion Take drive time into consideration
To UAMSRiver
Consults Find the right fellow
Where to be, when to roundHow to write your notesMobile phone number
Clinic responsibilities New Consult notes = focused H&P Daily follow up notes = focused SOAP notes Talk to your fellow BEFORE leaving Talk to your fellow about weekends
Clinical DesktopIcon (Stethoscope):
Scroll down to UAMS ON CALL
1. Select date
2. Select Service.
GMC “Essential” consult service 0700-1600 Pre-op clinic Tues and Wed in IM North Usually Thurs PM clinic with Dr Lavender As the intern, you do not accept transfer from
any service without an ATTENDING staffing the patient. Be sure to hand-off to our medicine teams if pt is transferred.
No weekend duties
Geriatrics/ Neurology
Month is split to accommodate both You can take vacation during the
Geriatrics portion (not preferred) on your non-clinic week
Please let us know if you are being used for scut work
Be professional.
Emergency Medicine
12-hr Shifts Should honor 1-in-7 rule Good time to learn procedures Good time to learn Women’s health if
you have VA clinic Good time to make friends with the ED
attendings and residents
Crystal Bridges Museum of American Art600 Museum Way, Bentonville, AR
-Approx 3 hours from UAMS to the northwest-General admission is free-Admission charge for rotating exhibits-Amazing landscaping with walking paths
Jeopardy
5-6 days during elective months (not ED) NOT OPTIONAL AVAILABILITY---need to be able to come to the
hospital immediately if called Payback: educational leave, non-emergent issues
Calling Jeopardy
Call the “Admin” Chief ASAP The Golden Rule. Acceptable reasons:
Acute illness (fever, vomiting, diarrhea, surgery, bleeding, loss of limb)—NOT head cold, allergies, menstrual cycle, HA
Death/Critical Illness of a family member (1st degree + grandparents)—everything else needs approval
Birth of YOUR child
Calling Jeopardy
Unacceptable reasons:“I missed my flight.”
○ Rental car/ Greyhound
“My car won’t start.”○ Phone a friend
“My child is sick”○ with few exceptions
“I don’t feel well.” ○ Take some tylenol.
Calling Jeopardy
Unacceptable reasons:“I overslept.”
○ Then you better hustle!
“It’s snowing/ icing/ raining/ stormy.”○ STAY at the hospital. Pack a winter bag.
“I’m going to a wedding/ party/ shower.”○ Shaking mad
“But I’m having an elective procedure.”○ My ulcer just perforated.
Calling Jeopardy
Unacceptable reasons“I didn’t get the day off I wanted.”
○ The Chief just had a stroke.
Garvan Woodland Gardens540 Arkridge Rd, Hot Springs, AR
-Botanical Garden-Christmas Lights-Admission Fee-Approx 1 hour from UAMS
Expectations of Chiefs
Listen to your concerns Advocate on your behalf Provide correction when required Provide education Follow ACGME
ACGME Guidelines 16 hours (+ 2 hours for handoff) with 8-10
hours in between shifts No more than 10 patient assignments AVERAGE 1-in-7 days off over a month Admissions supervised by Resident When post-nights, leave by 1100 PATIENT CARE COMES FIRST! Let the Chiefs know if you are having
problems.
Conferences Daily Noon Conference
MANDATORY portion of your EducationExcused when on nights, post-nightsExcused for urgent patient care issuesCanceled on holidays and weekends
Monday: Core curriculum (UAMS)
Tuesday: Med-Path Conference (7E, VA)
Wednesday: Board Review/ Core curriculum (UAMS)
Thursday: Grand Rounds (G141, UAMS)
Friday: Resident Presentations/ Journal Club (UAMS)
Conferences
Morning Report
Mandatory for all interns on wards (unless holding code pager at VA)
Off-service interns should attend Ward Resident or Chiefs hold pagers Rotating interns present to Attendings or
Chiefs
M&M Conference
Last Thursday of the month0730 in G137, UAMSALL residents are expected to attend ON
TIMEClosed conference—no students or off-
service
Intern Core Lecture Series
Start the second week in July Attendance is MANDATORY unless you
are off or on nights
Evaluations
Complete on new innovation for every rotation
Check the anonymous click box if you want
ALL attending evaluations are anonymous and pooled together for 6 month blocks
Complete promptly and honestly
Core Competencies 1. Patient Care –
Provide compassionate, appropriate, and effective treatment for all patients
2. Medical Knowledge –Understand biomedical, clinical, and socio-
behavioral knowledge about patient care
3. Practice-Based learning and ImprovementInvestigate, evaluate, and improve patient care
practices
Core Competencies 4. Interpersonal and Communication Skills
Effectively communicate with patients, families, and other healthcare professionals
5. ProfessionalismCarry out responsibilities in a professional
manner
6. Systems-Based PracticeUnderstand and access the systems based
practice of medicine as it applies to UAMS, CAVHS, and the community
Leave
Other than scheduled days off, ALL leave has to go through the schedule chief and Sheila in the housestaff officeStep 3VacationsSick leaveConferences (only if you are a presenter)
UAMS: Check daily VA: Access by starting Outlook after
logging into VA computer You are responsible for information in
both email accounts
Dress Code
Women:Dress clothes on wards, consults, clinicClosed-toed shoes in patient care areasScrubs for call, weekendsKeep in mind that you need to bend over a
lot
Men: Shirts and Ties on Wards, consults, clinicScrubs for call, weekends
VA DEA
2C 155 Write it down and keep it with you. EVERYONE needs to do this once you
have VA Access