WELCOME!!

1. WELCOME!!

2. Chiefs’ Orientation Dana Angelini Hiloni Bhavsar Brandon Kellie Morgan Oberle Gigi Gaudiano (Med/Peds) June 14th, 2012

3. Topics: • Introductions….. • Who we are • Roles of Chiefs • UH Wards • VA Wards • A Typical Day on the Wards • Ambulatory • The Pager System • Advice

4. Dana Angelini • Undergraduate: University of Dayton • Med School: Wright State University • Home Town: Clinton Township, MI • Talent/Hobby: Baking

5. Hiloni Bhavsar • Undergraduate: Wright State University • Med School: Wright State University • Home Town: Dayton, Ohio • Really...born in India, moved to Dayton '94 • Talent/Hobbies: Throwing dinner parties & cooking!

6. Brandon Kellie • Undergraduate: University of Louisville (GO Cards!) • Med School: University of Louisville • Home Town: Murray, KY • Talent/Hobby: can BBQ and speak southern

7. Morgan Oberle • Undergraduate: University of Evansville • Med School: Indiana University • Home Town: Paoli, IN • Talent/Hobby: running/working out

8. Gigi Gaudiano • Undergraduate: University of Virginia • Med School: University of Virginia • Home Town: Great Falls, Virginia • Talent/Hobby: Cooking, chasing around Domenic

9. Roles of the Chiefs • Medicine Chief Residents: • Rotate every three months • UH Chief #31250 – Morgan Oberle • Office in Lakeside 3 • VA Chief #31533 – Brandon Kellie • Office on 4th floor VA • Ambulatory Chief #31529 – Hiloni Bhavsar • Office on 4th Floor VA • Quality & Pt. Safety Chief #36644 – Dana Angelini • Office on 4th Floor VA/Lakeside 3 • Med-Peds Chief #37297 – Gigi Gaudiano • Office in Lakeside 3

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! (Morgan may have granola bars or celery! )

11. UHUH Campus

12. UH Wards • 8 Medicine Teams Wearn – General Medicine Naff – General Medicine Dworkin – Gastroenterology Carpenter – Infectious Disease, General Medicine Eckel – Nephrology and HTN Hellerstein – Cardiology Ratnoff – Hematology and Oncology Weisman – Hematology and Oncology • 2 ICU's MICU & CICU

13. UH Wards – Sister Teams Sister teams alternate long call days; each team has 2 interns  leading to Q4 “long” call

14. UH WARDS • Hellerstein • Eckel • Each team has 4 interns rotating on Q 4 “long” call • No “sister” team

15. UH WARDS • UH MICU • 2 teams with 2 attendings and 2 fellows; each team with 2 residents and 2 interns • Q 4 long call for interns and seniors (seniors take overnight call) • “Helper” day is your seniors post call day (will sign out to you around 10 AM • UH CICU • Act as “helper” can follow and admit patients • No formal call • Night Float • 3 interns scheduled; 2 present each night; cover the 8 inpatient UH teams

16. Other UH Rotations • Neurology • 2 week rotation on the Neurology consult service • GI-Jeopardy • Rotate on GI consult service but are on call for back up for any absence on UH or VA wards/clincs • MUST have pager on and answered 24/7

17. LOGISTICS of Calls... • Long call – 3 patients by 7pm • Only 1 patient after 6 pm • Medium call – 2 patients by 4pm • Short Call: • UH: 2 Patients (nightfloat admit or unit transfer) • VA: 2 Patients (nightfloat, transfer or NEW) Long Medium Short HAPPY!

18. LOGISTICS: No. of Patients • UH: • 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) • At VA: • Cap=8 all the time

19. cCall and continuity clinic • No Clinic on Long or Medium call. • No short call patients assigned on your clinic day.

20. Days OFF • Dworkin, 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 • Either Sat or Sun off • Eckel or Hellerstein • 1 day off per week: “Happy day” Friday through Monday

21. Days OFF • Night Floats • UH: 3 interns are scheduled but only 2 are on each night; work out days off with each other! • VA: Saturday night is off • UH MICU • Short call day off Friday through Monday

22. UH Team Pagers • Each team (Eckel, Wearn…) will have a pager held by the on call and nightfloat interns • Will mostly be paged by nursing regarding patient issues; not sure the answer???? Just ask your senior!! • Team pagers are also code pagers – on call interns should go to all codes (‘Code Blue’) • Team pager numbers are listed on the pager card in your bags.

23. 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!

24. Conferences - UH Intern Morning Reports – Residents hold the pagers!! • Tuesday AM report from 10:30 – 11am! ** NEW ** • Thursday 10:30am-11:30am • Grand Rounds • Tuesday 12-1pm • Morbidity & Mortality (M&M) • Friday 12-1pm • AgreSoceity • Monthly, Wednesday evenings – more info to come • Noon Conference • Monday, Wednesday and Thursday 12-1pm (with food)

25. UH Miscellaneous • Dictating – Interns must dictate discharge summary for each patient discharged on the DAY OF DISCHARGE • Day of Discharge note = progress note + discharge summary • Dictation number must be written in the chart 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

26. UH Miscellaneous • GME Housestaff Lounge!! • Located on Lakeside 6th floor, next to GME office • Has coffee, bathrooms, T.V., foosball table, computers, food on Sunday nights • THE P.I.T. Fitness Center • Basement of Lakeside • Free card entry, TV's, towel service, open 24/7!

27. Duty Hours etc. • 16: 80: 4 Rule! • 16 hours per long call • 80 hours per week • 4 days off every month • Long call every fourth day • 3 admissions by 7 PM, out by 9 PM, must be out by 11PM • Medium Call – 2 admissions by 4 pm, stay and signout team to intern nightfloat at 7pm

28. UH Resources • The Chief Resident • Your Senior Resident • The DACR/NACR • Other Residents • The Night Floats

29. Louis Stokes Veterans Administration Medical Center

30. VA Wards • Four General Medicine Teams • Blue, White, Green & Orange • 1 resident + 2 interns per team – may have acting interns/medical students • Ward 4A: Orange/White (sisters) • Ward 4B: Blue/Green (sisters) • PCU: telemetry 2nd floor

31. VA Lounge and Call Rooms • Located on the 2nd floor • Four call rooms (bunk bed room for AIs) • Fridge: frozen dinners, ice cream, sorbet, string cheese, muffins, fruit, yogurt, milk, PBJ un-crustables • Coffee machine • Cabinets have: Trail mix, gold fish, peanut butter crackers, pretzels!

32. The VA MICU • 2 resident (day and night), 3 intern team • Q3 call • Admit from 7am to 8pm • Leave by 10 pm • No overnight here either! • Day off is “pre call” day Friday through Sunday

33. Urgent Care Center (UCC) • The VA “Emergency Room” • Staffed by at least 5 residents • One or two attending physicians • Hours are 9-6 with “on-call” resident to arrive at 0800 (you will not be the “on-call” resident this year) • Fast track: sees low acuity issues, med refills….

34. Intern Saturday Coverage • One or 2 Saturday Nights when on ambulatory, UCC, or elective, you will be asked to cover from Saturday 7pm to Sunday 8am for the VA intern nightfloat to get a night off.

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

36. VA Miscellaneous • Garage parking is free! Just need to get a parking pass from VA police dept • VPN access for home CPRS access • Codes at VA are called ‘Dr. Heart’

37. A typical day on the wards • 7am to 7:45am: • Pick up signouts in KACR (at UH – Tower 5) or from intern nightfloat team (at VA you will meet up with VA nightloat intern) • Pre-round • 7:45-8am: Be in your team room to discuss changes overnight and the day’s plan with your senior • 8am to 10:00am (VA) or 10:30am (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”

38. 10:00-12:00: Time to get C.O.L.D. • C: Call your consults • The later you call, the more angry the consultant will be • O: Order Entry • Enter any orders that were not entered on rounds • L: Labs • Run your labs! • 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

39. A typical day on the wards (cont) • 10:30 - 11:30 (UH) or 10:00 - 11:00 (VA) • Resident AM report (M/W/F at UH, T/W/F at VA) • Thursday morning: Intern AM report • Noon-1PM: conference • Afternoon reserved for notes, procedures, teaching rounds, contacting families, following up studies • short call should sign out to their co-intern who is long at 5pm • medium call signs out to nightfloat at 7pm • Long call signs out to nightfloat at 9pm

40. Ambulatory Medicine • Continuity Clinic • Urgent Care Center/Firm Urgent • Primary Care Block • Clinical Skills Block (CSB)

41. Continuity Clinic • One afternoon per week at either the VA or the Douglas Moore Center at UH. • During ambulatory or elective, up to 2 clinics per week • Always the same day each week and with the same attending preceptors • You will develop a set of patients that you follow over 3 years • Clinic cannot be canceled by anyone except the Ambulatory Chief Resident

42. Continuity Clinic Rules • No clinic when • Medium call or on long call days • Vacation • Holidays • ICU’s • Night Float • You DO have clinic when on Elective!!! • Cannot switch clinics amongst yourselves; all schedule changes need to be approved by ambulatory chief resident

43. Primary Care Block • Introduction to Outpatient Primary Care • Introduction to DMC and the Firm Continuity Clinics • Morning Clinical Conferences: 8am Daily • 8:45-12:00: Clinics VA Firm A & B Mon – Thurs • Rheumatology • Diabetes, Renal, HTN • Endocrinology • Dermatology • Women’s Health • Friday AM – Introduction to Quality & Pt. Safety Curriculum

44. Primary Care Block (cont.) • Afternoon Didactic Sessions • Quality and Systems • Cardiovascular Health • Obesity • Managing Difficult Patients • Patient Safety • Professionalism and Writing • Physical Diagnosis • Common Ambulatory Disease Presentations

45. Clinical Skills Block • 2-week outpatient rotation • Hands on activities • Simulation models at the simulation skill center • Humanities in Medicine • End of life care • Cultural Competencies

46. The NIGHTFLOAT TEAM

47. NACR Nightfloat Resident Nightfloat Resident Nightfloat Intern Nightfloat Intern NIGHTFLOAT TEAM The NIGHTFLOAT TEAM

48. The Nightfloat intern • The Nightfloat Intern comes in at 7pm receives the pagers from the non-call teams • The Nightfloat Intern can receive the pagers from the on-call intern at 9pm and must receive the pager by 11:00 pm

49. Night Float Duties • Follow up on unfinished tasks Answer pages • See patients when necessary (must document brief note in chart when you see a patient) • Admit up to 2 patients from 8 pm – 5:30 am • If you have questions – please please ask your nightfloat resident or NACR!!! • Call senior for every CODE WHITE

50. Electives • You have continuity clinic during elective • Your should be answering your pager from 8 to 6 (M-F), no exceptions (unless on approved away elective) • Must attend all conferences (GR, M&M, noon conferences at the VA) • Otherwise, you can choose to do research, a clinical elective on a consult service, or even an ICU rotation. • You have to inform Barb before starting what you will be doing on your elective time . • If you do research or away elective, you need to identify a faculty mentor and should present your work at the Department of Medicine Research Day at the end of the year.