Welcome to MSKCC! Department of Medicine Orientation

1. Welcome to MSKCC! Department of Medicine Orientation 2008-2009

2. A Comprehensive Cancer Center • Provide Cutting Edge Medical Care • Specialized Services for Patients and Families • All Medical Subspecialties Represented • All Patients have a Primary Attending but are taken care of by Multidisciplinary team • NPs, PAs, Nurses, Social Workers

3. Structure of Medicine Service at MSKCC • Medicine Housestaff Services: • GI: GI A & GI B • Allogenic Bone Marrow Transplant • Breast • Genitourinary • Leukemia • Lymphoma • General Medicine • Medicine Nurse Practitioner Services • Thoracic Oncology • Autogeneic Bone Marrow Transplant /Multiple Myeloma /Benign Heme • Head/Neck, Melanoma, Sarcoma (HMS)

4. Medicine Team Structure • Service Attending • Oncology Fellow (except GI, Breast) • Resident (1-2) • Intern (2-3) • Sub-interns (1-2) • Nurse practitioner (on Allo, GU, Leukemia, Lymphoma) • Social worker/Case manager

5. DOM Inpatient Services Pairings • General Medicine • GI Oncology • Leukemia • Allo-BMT • Lymphoma • GU Oncology • Breast Oncology

6. Medicine Team Structure • All services include 2 residents • Both residents should supervise both interns and work as a complete team. • For continuity of care, do no divide the service! • Residents DO not leave without interns and sub-interns unless intern/ SI on call

7. Sub-interns • Take call with the resident they are assigned to at the beginning of their rotation • Maintain their signout with approximately 5-6 patients • Will have to have their orders co-signed by a resident • Not allowed to discontinue orders

8. Daily Structure • Day starts at 7am • Interns pick up signout • Residents pick up NF admissions • Pre-Rounds • Attending Rounds: ~ 8 am • Morning Report M-W (11am Sharp) • Thursday is Intern Report • Work • Afternoon Conference (1pm Sharp) • Work • +/- PM Attending Rounds • Sign Out to NF(5:30pm or later)

9. Daily Structure • Call • Each day 6 Interns/Residents are on call • From 7am to ~4pm Non-Call Teams Admit to their service or sister service • On Call Team Admits from 4-8pm • Generally admit to your svc or sister service but can admit to any service depending on volume • Sign New Admissions out to NF Intern

10. Daily Structure • Code/Consult Resident • Duty of one On Call Resident/Night Float • Code Leader from 7am to 8 pm • Gen Med, Renal and Cardiology Consults • 4pm to 7am Weekdays • For all surgical, NP services as well as ICU and Gen Med svc (intern-attn only svc) • Do consult, call and discuss with on call attending • Only do NEW consults • If consult is done in evening hours and there are labs/imaging to f/u sign out recs to primary team AND overnight code consult

11. Daily Structure • Night Float: • Interns X-Cover Inpatient Services • Cover from 5:30pm – 7am weekdays • Cover 8pm - 7am Sat/Sun • Residents • Come on in staggered fashion (6, 7pm) • Admit to all services • High Quality Admission Notes • Sign out admission in AM to day resident • 7 pm resident is code/consult • Hospitalist A/B starting at 7pm • A covers Auto and admits to Auto, M/S, H/N • B covers Thoracic, Gyn Onc and admits to Thoracic, Gyn Onc

12. Daily Structure • Weekends (Posted on Chief’s Door) • No Golden Weekends • Either on call or “rounding” • May sign out to on call intern no earlier than 2:30pm • Must have complete team-to-team signout prior to weekend to insure excellent patient care • Moonlighters and Elective Residents help on several services (get them signout on Friday; we will provide you with their cell phone #s)

13. Expectations • Operate within the MSKCC culture • This is your program/hospital • Responsible to chiefs and faculty • Respect facilities and peers • Learn from and support each other • Professionalism is a must • Proper dress • No open toe shoes • No Green Scrubs!!! • Cleanly Shaven

14. Conference Schedule • Morning Report • Residents Monday-Wednesday 11am DOM library • Interns Thursday 11am DOM library • If you see something, say something • Afternoon Conference • Daily at 1pm (Friday is Professor Rounds) • Lunch served, get food on time

15. Conference Schedule • Grand Rounds • Fridays at 8am in Hoffman Auditorium • White coats and sit as a group to promote housestaff presence. • Conference attendance is mandatory • If you are late, be polite • Don’t leave a mess

16. Medicine Reconciliation Reconciliation is the process of comparing what medication the patient is taking at the time of admission or entry to a new setting or level of care, with what the organization is providing (admission or new medication orders) to avoid errors such as conflicts or unintentional omissions. Upon discharge the patient’s reconciled list of admission medications should be compared against the physician’s discharge orders along with the last day’s MAR.

17. Medicine Reconciliation at MSKCC • Please be aware that dedicated pharmacists are actively involved in discharge medicine reconciliation at MSKCC • They may contact you to discuss your patients’ discharge prescriptions • Please try to place discharge prescription orders in the computer the day prior to discharge to facilitate the process