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2006-2007 Seattle, WA. The Virginia Mason Clinic Medicine Residency. Virginia Mason Medical Center. Virginia Mason is located here. Past and Present. Established 1920 Mason Clinic (physician group) Virginia Mason Hospital (80-beds) - modeled on Mayo Clinic

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slide2

Virginia Mason Medical Center

Virginia Mason is located here

virginia mason medical center

Established 1920

Mason Clinic (physician group)

Virginia Mason Hospital (80-beds)

- modeled on Mayo Clinic

“Virginia Mason” named after the daughters of James Tate Mason, M.D., and John M. Blackford, M.D., who co-founded the clinic with radiologist Maurice Dwyer, M.D.

Virginia Mason Medical Center

virginia mason medical center5

• Multi-Subspecialty Tertiary care hospital

• 336 beds,>400 MD’s

• Full Medical and Surgical ICU (34 beds)

• Benaroya Research Institute

• Nearly 200 researchers with a budget of more than $20 million a year

Virginia Mason Medical Center

virginia mason medical center7

Milestones

1927 First ECG west of Mississippi

1928 First Surgical residency in NW

1936 Dr. Mason president of AMA

1939 First Medicine residency in NW

1992 First SNF for AIDS patients

1995 1000th renal txp - leader in NW

Virginia Mason Medical Center

virginia mason medical center8
Virginia Mason Medical Center

• Wide Ranging Case Mix

- Referrals from Washington, Alaska, Idaho, Montana counterbalanced by patients from the local community

• Outstanding Faculty

• Innovative Environment

• Strong sense of camaraderie

mentors faculty
Mentors & Faculty
  • Faculty choose VM because they want to teach and work with residents
  • 1:1 Resident to faculty ratio on subspecialty rotations
  • 24 hour attending coverage on both the wards and ICU services
  • Opportunity to build close relationships with mentors (for career counseling & research)
virginia mason medical center10

Virginia Mason Medical Center

• Random survey 5000 MD’s and 500 complementary providers

• VM providers exceeded all other Seattle institutions.

• More than half of Seattle’s top physicians in the medical specialties practice at VM (56%).

54 of the 96 “best Med docs in Seattle”

slide11

Virginia Mason Medical Center

Residencies:

Internal Medicine

General Surgery

Radiology

Anesthesiology

Fellowships:

Regional Anesthesia

Esophageal Research

Minimally Invasive Urology

Pancreaticobiliary Research

Internships:

Medicine

Categorical

Primary Care

Preliminary

Surgery

Categorical

Preliminary

Transitional Year

graduate medical education

Internships:

Graduate Medical Education

10/yrCategorical

(up to 4) Primary Care

5/yrPreliminary

12/yrTransitional

graduate medical education14

Internships:13 four-week rotations per year

Categorical Prim Care Prelim T.Y.

Wards 5 5 6 2

ICU 2 1 1 1

Night Float 1 1 1 1

ER 1 1 1 1

Electives 3 3 4 4

Primary Care 1 2 0 *4 Surg

Vacation 3 Wks 3 Wks 3 Wks 3 Wks

Graduate Medical Education

“Quality of Life” rotations – weekends off, no call.

*(varies with individual goals)

slide15

Sample Categorical

Intern Schedule

slide16

Sample Primary Care

Intern Schedule

slide17

Sample Preliminary

Intern Schedule

slide18

Sample Transitional

Year Intern Schedule

slide20

Elective Rotations

  • Outpatient services (e.g. nephrology) focus on outpatient management of patients
  • Absence of fellows means closer teaching relationship with attendings
  • Includes in-patient consults in attached hospital, reflecting real worldpatient mix
slide21

Continuity Clinics

• During internship, residents are mentored at the downtown campus outpatient clinic.

  • Downtown clinic includes a popular, resident run case-based didactic series.
  • Clinic didactics cover key primary care topics, serving as both practical curriculum and boards review tool.
slide22

Continuity Clinics

During the 2nd and 3rd years of training, residents may select from a variety of outpatient settings, tailored to individual goals.

  • Downtown Clinic (attached to hospital)

- Collaborative Practice (expanded to Lynnwood)

  • Suburban Clinics

- Federal Way, Lynnwood, Kirkland

  • Carolyn Downs (Indigent Care)
  • Pike Market (Indigent Care)
  • North District Public Health
  • HIV Clinic
slide24

Wards

Structure:4 Ward teams

1 Hospitalist

1 Resident

2 Interns

+/- Med Student

Same as University “Ward Attending” (unlike other community programs)

slide25

Wards

Each team covers a geographic cell:

17: Nephrology

16: Pulmonary

15: Oncology

14: Geriatrics

10: Gastroenterology

9: Orthopedics

8: Telemetry

7: Telemetry/IMC

Team A

Team B

Teams A/B and C/D accept admissions on alternating days

Team C

Team D

slide26

Wards

Admission system:

  • Teams admit 7AM-7PM every other day
  • Nightfloat covers 7PM-7AM Sun-Thurs nights
  • Teams admit overnight twice a month
  • Patients distributed in the AM

A = Admission day O = Overnight call

slide27

Wards

Intern Caps:

Wards:

Sunday to Thursday: 8 patient contacts per day

(includes new patients and f/u patients)

3 admission max. on admitting day

  • if an intern starts with 6 patients on a call day, he or she can admit a maximum of 2 new patient
  • if an intern admits 6 patients on a call day and discharges 5, only 2 new admissions are possible
  • if an intern starts with 8 patients, he or she will not admit, even on a call day
slide28

Wards

Intern Caps:

Wards:

Sunday to Thursday: 8 patient contacts per day

(includes new patients and f/u patients)

3 admission max. on call day

Friday and Saturday: 5 overnight admissions

Night Float: (Sun-Thur) 4 admissions per night

slide29

Mon-Thur

7:00-7:30

NF Sign-Out

NF Sign-Out

7:30-8:00

Morning Report

Grand Rounds

7:30-09:15

Pre-rounds

9:15-9:45

Multidisciplinary

9:45-12:00

Rounds

12:15-1:00

Noon Conference

1:00-1:45

Teaching Rounds

Intern Report

Virginia Mason Medical Center

Night Float Sign Out 7:00-7:30 AM

Time

Fridays

  • Housestaff meet to discuss the events of the night shift and to hand-off overnight admissions
slide30

Mon-Thur

7:00-7:30

NF Sign-Out

NF Sign-Out

7:30-8:00

Morning Report

Grand Rounds

7:30-09:15

Pre-rounds

9:15-9:45

Multidisciplinary

9:45-12:00

Rounds

12:15-1:00

Noon Conference

1:00-1:45

Teaching Rounds

Intern Report

Virginia Mason Medical Center

Pre- Rounds 7:30-9:15

  • Interns see their patients and review labs/overnight events.
  • Develop a skeleton note on the computer, edited during rounds
  • Residents available to help after 8am

Time

Fridays

slide31

Mon-Thur

7:00-7:30

NF Sign-Out

NF Sign-Out

7:30-8:00

Morning Report

Grand Rounds

7:30-09:15

Pre-rounds

9:15-9:45

Multidisciplinary

9:45-12:00

Rounds

12:15-1:00

Noon Conference

1:00-1:45

Teaching Rounds

Intern Report

Virginia Mason Medical Center

Multidiciplinary Rounds 9:15-9:45

Time

Fridays

  • House staff “run the list” with RN’s, case managers, pharmacists, and social workers, focusing on issues of patient safety, disposition and services after discharge.
slide32

Mon-Thur

7:00-7:30

NF Sign-Out

NF Sign-Out

7:30-8:00

Morning Report

Grand Rounds

7:30-09:15

Pre-rounds

9:15-9:45

Multidisciplinary

9:45-12:00

Rounds

12:15-1:00

Noon Conference

1:00-1:45

Teaching Rounds

Intern Report

Virginia Mason Medical Center

Rounds 9:45-12:00

Time

Fridays

  • Interns present to the resident & hospitalist
  • RN’s and other team members participate
slide33

Mon-Thur

7:00-7:30

NF Sign-Out

NF Sign-Out

7:30-8:00

Morning Report

Grand Rounds

7:30-09:15

Pre-rounds

9:15-9:45

Multidisciplinary

9:45-12:00

Rounds

12:15-1:00

Noon Conference

1:00-1:45

Teaching Rounds

Intern Report

Virginia Mason Medical Center

Noon Conference 12:15-13:00

Time

Fridays

slide34

Mon-Thur

7:00-7:30

NF Sign-Out

NF Sign-Out

7:30-8:00

Morning Report

Grand Rounds

7:30-09:15

Pre-rounds

9:15-9:45

Multidisciplinary

9:45-12:00

Rounds

12:15-1:00

Noon Conference

1:00-1:45

Teaching Rnds

Intern Report

Virginia Mason Medical Center

Teaching Rounds 13:00-13:45

Time

Fridays

• Case-based discussion with a subspecialist (“chalk talk” + bedside)

slide35

Wards

Our resident admitting system:

• Eliminates the “Boom & Bust” of a Q4 call system

  • Caps on patient load to meet educational goals
  • Daily census hovers at 5 to 6 patients per intern
  • Minimizes overnight call (10-12 for internship year)
  • Maintains compliance with the 80 hr work week
  • Balances betweenProfessional and Private life
slide36

Wards

Our inpatient goals:

  • Excellent Patient care and Safety
  • Diversity in Patient population
  • Time for Bedside Learning
  • Time for Conferences
  • Time for Reading
  • Time to spend on the rest of your personal life
slide40

ICU

Closed ICU system (no ward team coverage)

  • 3 interns, 2 residents
  • 2 daytime intensivists, 1 nocturnist
  • 1 day off in 6 for interns
  • Shift schedule
slide41

ICU

  • Short shift: rounds with ICU attending, leave early
  • Long shift: intern and resident working together, staff admissions with ICU attending
  • Night shift: intern and nocturnist working together
slide42

ICU

  • “Nocturnist”: a dedicated ICU hospitalist (attending) who stays in the ICU overnight with the intern
  • Advantage: attending-to-intern one-on-one teaching during night shifts
slide43

Rapid Response Team

MD, Critical Care RN, & Resp. Therapist

  • Team responds to acute situations before they become critical
  • Opportunity for residents to gain experience in evaluating sick patients and initiating resuscitation

Since the teams inception, there has been a decrease in CPR codes.

slide44

Virginia Mason Medical Center

Work Hours:

• Fully compliant with 80 hour work week and 24 / 6 rule on wards and ICU

• Ward Interns average 65 hours/week

• ICU Interns average 72 hours/week

slide46

Virginia Mason Medical Center

  • Paperless wards charting - allnotes, orders, labs and vitalson-line via single software suite (Cerner)
  • Standard cut and paste word processing functionality
  • Digital radiology accessible on any computer monitor
  • Hospital wide wireless broadband network with mobile computers-on-wheels (COWS)
  • Approx. 1:1 computer-to-patient ratio on the wards
  • Approx. 2:1 computer-to-patient ratio in the ICU
slide47

Virginia Mason Medical Center

  • Up-To-Date, OVID, Cochrane, MD Consult
  • Library – hundreds of full text online journals
  • Tracemaster – online patient ECG’s
  • Stentor – online patient imaging studies
  • Cerner – paperless medical record & order entry

• Available24/7 at home through VPN tunnel (Citrix).

slide48

Virginia Mason Medical Center

All call rooms have telephoneandcomputer

slide49

Virginia Mason Medical Center

Library

24/7 access by magnetic card lock

House-staff Lounge

graduates
Graduates

Graduates 2000-2006

33% Fellowship

41% Primary Care

26% Hospitalist

Hem/Onc, Pulmonary/CCU, GI, Cardiology, Neph, Endocrine, Rheum, Sports Med

scholarly activity
Scholarly Activity

• All Categorical & Primary Care Residents participate in scholarly activity

• > 50% of residents publish or present at local and national meetings

• Expenses to present at academic meetings is fully funded by the program

slide53

Virginia Mason Medical Center

American Board of Internal Medicine:

96% three-year rolling pass rate

MedStudy:

Free to all second year residents.

Boards review course:

Funded through professional stipend.

slide55

Virginia Mason Medical Center

• Meals:Breakfast ($4.00) and Dinner ($6.50) for every resident 365days/year.

• Parking: Free to all residents.

• Travel:Fully paid to conferences if you have an abstract accepted

• Professional Stipend:$500 per year, (can be saved up to $1500 during 3rd year)

slide56

Virginia Mason Medical Center

• Away/overseaselectives accommodated, (examples Nepal, Thailand, Alaska).

• Misc:Lab coats $60/R1, $30/yr R2 & R3, Scrubs, locker and mailbox 24/7 access,

• Subsidizedmovie tickets, ski passes, sports tickets, gym memberships

• Family:subsidizedVM daycare facility

slide58

Virginia Mason Medical Center

Summer Picnic

Meet your co-interns and residents at the beginning of the year!

slide59

Virginia Mason Medical Center

Fall Retreat

All categorical and preliminary medicine residents spend two days on retreat working on teamwork, communication, and personal growth.

slide63

Thanks for visiting!

Further questions? Please contact us:Virginia Mason Medical CenterGraduate Medical Education, H8-GME925 Seneca StreetSeattle, WA 98101(206) 583-6079

Or email the Chief Resident atKatherine.Naylor@vmmc.org