Intern Orientation- Some Helpful Info

1. Intern Orientation- Some Helpful Info Seth Yandell Chief Resident

2. Welcome • Important contacts for questions or problems: • Myself • Your residents • Tracie, Sherie, and Julie • In the clinic- Gayle, Nancy, Sonya • Dr Carroll • Dr Quiceno • Dr Feldman

3. Day to Day Activities On Wards • Day starts at 7am • On call you are responsible for admissions and codes from 7am-7am so you must be here during those times without exception • We cap at 5 new patients per intern (plus a total of 2 handoffs) on a call night, or an intern can cap if he/she has a total of 12 patients at the end of the day (patients discharged earlier in the day do not count towards the 12 total) • On your post call day you round, attend attending rounds at 10:30 if it is a M/W/F, attend conferences then leave the hospital by 1pm

4. cont • Daily- round on patients and speak with each attending daily regarding pt assessment/plan (speak with your resident before calling an attending for the first few months so you know you are calling the attendings with the pertinent info/plan) • Conferences- mandatory, we have them daily at noon M-F (always catered), we also have Wed morning conference at 7:30am and Coffee with Cardiology on Fri at 7:20am. If you fall below 75% attendance of these you can be subject to disciplinary action (up to and including non-advancement). • Checkout- list is kept current on Caregate then checkout is performed prior to leaving hospital (you are listed with your checkout interns on the calender). Include pertinent information and any work to be done (it is a good idea to keep meds/allergies updated on these lists). • Pagers- You have to call the page operator daily to check out your pager, you are responsible for your pt’s till 5pm daily during the week and noon on the weekends (and 1pm postcall) so do not check out your pagers until those times. (i.e. this is Dr Yandell and I need to check out my pager to Dr Das till 7am tomorrow)

5. cont • Attending Rounds- While on wards you have them M/W/F from 10:30am-noon so plan on being done rounding in time for this • Interns conference- with Dr Feldman every Tues at 11am, one intern will be scheduled every month to assign the other interns to present during the month, this is a required conference for interns on wards but everyone is invited and your attendings will let you leave to attend this conference- you will not learn more in any conference all year than you will in intern conference • Off Days- already scheduled (you have your pre-call T/Th/Sat/Sun off during the month) • Clinic- As a categorical you will have a scheduled clinic day throughout your 3 yrs (this day remains the same during your residency), clinic starts at 1:30, you can have anywhere from 3-7 patients a day. There is a special scheduling twist- if you have a Tues clinic and are post call on tues then you have to make up your clinic on wed; if you have thurs clinic and are post-call on that thurs you have to makeup the clinic on the Monday prior to that thurs. (ex if I usually have clinic on Thursday of the upcoming week but am going to be postcall on that Thursday then I will have clinic on Monday of the upcoming week instead). If as a prelim you are interested in participating in clinic for the year let me know in the next couple of weeks and you can be set up with myself or another 3rd year resident to work with in clinic through the year. We had a prelim do this last year and she found it very educational.

6. Patient Care • Forms, Forms, Forms…… • There is one for everything • DKA protocols, Stroke protocols, Acute Coronary Syndrome, Electrolyte Sliding Scale for K/Mg/Phos repletion, Insulin Sliding Scale, Restraints etc…… • Samples

8. Admission orders • Insert sample

9. Green Stickers • Insert picture

10. Patient Name MR# DOB

11. Discharge Forms • Insert sample

12. Discharge Summaries/Records • Discharge Summaries- Brief summary of pertinent hospital course/findings/resolutions with medications and discharge instructions/f/u- Do not run on forever (hint- figure out what you will say before you start, use the pause button, and try to do it with the chart and discharge form in front of you so you can dictate meds/pertinent labs/dates etc straight from the chart) • Records- Stay up to date with your charts by calling medical records (on the lower level on the way towards Jackson) once weekly to see if there are any records they need to pull for you for you to finish • Clinic Records for Categoricals- Our clinic has there own paper record which has to be kept up regularly. Go to the clinic’s medical records (across the hall from the ACC) once weekly and sign off on labs and call patients with follow up when needed. • If you don’t stay up to date with this you will get a nasty letter from Dr. Rinner about how you are a failure and are fired (Ok I made the failure/fired part up, but you will get a derrogoratory letter telling you to update your records or you will lose your privileges)

13. Do you need help? • Social Workers- your best friends • PT/OT/ST • Pharmacists • Nurses • Nurse Psychiatry Liason • PCT’s

14. Non wards months • Hours and responsibilities vary depending on the rotation and attending • Call the attending at least the week prior to starting the rotation to get details on their expectations • Ask your fellow residents about their prior experiences

15. Resident Conferences/Journal Club/Potpourri/CPC/M&M • Everyone gives one 1hr resident conference on a internal medicine topic of your choice (please run your idea past me before you start so I can let you know whether it has been covered in the last year so we aren’t bored with redundancy)- try to be somewhat narrow in your topic selection so you don’t get overwhelmed • 3 journal club presentations through the year- approx 15 minutes for each one, pick large journals or groundbreaking studies • Might have to present or help prepare a case for Potpourri, CPC, or M&M conferences

16. Vacation- Now we’re talking • You are allowed to take up to 5 days of vacation on non-wards months • These days should be taken consecutively (barring emergency) and preferrably either the first or last week of the month (to limit breaks in pt care) • If you miss more than five days in a month due to some dire unforseen circumstance (you or someone you love dearly better be real sick or dead!) then the extra days will have to be made up • If you have left over vacation days at the end of the year you will be paid for the left over hours (you should have at least 5 days worth the first year since you can only take 25 of the 30) • Only one intern/resident can be taking vacation on a rotation at a time • After verifying that no one else on the same rotation is taking vacation at the same time, then fill out the vacation request form and turn it in to Sherie >30 days prior to the start of the vacation (and really the earlier the better) • If you are a catagorical let Sonia in the clinic know as soon as you know when you are going to take vacation so she can block out your schedule and not schedule patients- this should be done 5-6 weeks ahead of time at least to limit inconvenience to your patients and the clinic staff

17. ICU (I Can’t Understand!!!) • 7am to 7pm daily • Intense rotation • Procedures, procedures, procedures- tons of fun • Work one weekend during the month

18. Speaking of Weekends/Holidays • Depends on which rotation you are on whether you will have to work a weekend • Holidays are also dependent on the rotation and attending (if you are on ICU and are scheduled to work Christmas then you might as well buy a Santa hat and beard)

19. Important Codes/Numbers • Physician dining lounge on 1st floor: 214 • Physician lounge on 9th floor: 997722 • Call Rooms: B 231, C 214, D 451 • Sherie: 6176 • Page Operator: 8480 • Chief: 8810 office and pager 214-786-2942, if I am off then call my cell phone 972-890-2107 or my home phone 972-617-0414 and if I don’t answer leave a message and I will reply

20. Computer Programs • Caregate- used daily with web powerchart, crosscover, and links to resources like MD consult (full access) and Ovid-pubmed (login to caregate is network login and password) • Synapse- for accessing radiology images/reports (login name is texas\networkloginname, password is same as network password) • Welford- for the categoricals this is your new nemesis (I will schedule a time with you upstairs and walk you through some tricks that I have learned to speed up the process)

21. More programs • Citrix Program Neighborhood- Can be found in programs or on desktop of computers at work, login is same as network login/password. Use this program to access copath. To access from home go to elink.texashealth.org and download the citrix program, after that you can access copath or welford from home (I will show you how to do the welford access after the first few months in clinic) • Copath- sign on and password set up as employee ID#, this is a nice asset to see path reports which don’t show up on caregate

22. Couple of finishing points… • Be involved • Do abstracts/posters- if you need a case just ask and I can find you one • Research- most of our attendings are interested in research so just ask them or if you need an idea talk to myself/Dr Quiceno/Dr Carroll/ or Dr Feldman • Go to talks (free good meals, you can network, and if you pay attention you can sometimes learn something) • When we have get togethers with the housestaff show up and enjoy your coworkers company outside of work.

23. Let’s have some fun this year