Intern Orientation- Some Helpful Info

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Intern Orientation- Some Helpful Info

• Seth Yandell
• Chief Resident

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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

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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 1030 if it is a M/W/F, attend
  conferences then leave the hospital by 1pm

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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 730am and Coffee with
  Cardiology on Fri at 720am. 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 pts 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)

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cont

• Attending Rounds- While on wards you have them
  M/W/F from 1030am-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 130, 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.

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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

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Admission orders

• Insert sample

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Green Stickers

• Insert picture

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Patient Name MR DOB
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Discharge Forms

• Insert sample

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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 clinics 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 dont 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)

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Do you need help?

• Social Workers- your best friends
• PT/OT/ST
• Pharmacists
• Nurses
• Nurse Psychiatry Liason
• PCTs

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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

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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 arent bored with redundancy)-
  try to be somewhat narrow in your topic selection
  so you dont 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 MM conferences

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Vacation- Now were 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 gt30 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

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ICU (I Cant Understand!!!)

• 7am to 7pm daily
• Intense rotation
• Procedures, procedures, procedures- tons of fun
• Work one weekend during the month

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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)

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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 [phone] or my
  home phone [phone] and if I dont answer
  leave a message and I will reply

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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)

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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 dont show up on caregate

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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.

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Lets have some fun this year
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