Scott Denstaedt
Marty Tam
Angel Qin
Khanjan Shah
June 14 th , 2012

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• Introductions
Roles of Chiefs
UH Wards
VA Wards
Typical Day on the Wards
The Pager System
Other Rotations
Conferences
Misc
Ambulatory
Professionalism
Advice
Questions

• Undergraduate: University of Michigan
• Med School: Wayne State University
• Hometown: Clarkston, MI
• Hobbies: tasting exotic beers, Game of
Thrones
• Fun fact: speaks Japanese

• Undergraduate: University of Michigan
• Med School: Ohio State University
• Hometown: Sterling Heights, MI
• Hobbies: sports, travel, food, drink, life
• Fun fact: almost was killed by a lion during medical school

• Undergraduate: Duke University
• Med School: Case Western Reserve University
• Hometown: Chengdu, China  Chicago, IL
• Hobbies: cooking, trying new foods, travel
• Fun fact: danced ballet for 8 years

• Undergraduate: Furman University
• Med School: University of South Carolina
• Hometown: Greenville, SC
• Hobbies: working out, reading, eating good food
• Fun fact: Aspired to be a pizza delivery girl for most of my childhood

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Rotate every 3 months
UH Chief #31250 – Marty Tam
• Office in Lakeside 3
VA Chief #31533 – Angel Qin
• Office on 4th floor VA
Ambulatory Chief #31529 – Scott Denstaedt
• Office on 4th Floor VA
Quality & Pt. Safety Chief #36644 – Khanjan Shah
• Office on 4 th Floor VA/Lakeside 3

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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.
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We are your mentors
We provide support for your professional develoPMent, education, and your psycho-social well-being
We have candy!

Seidman
UH
Lerner Tower
Lakeside
ED

Naff Wearn
Carpenter Dworken
Weisman Ratnoff
Hellerstein Eckel
Sister teams alternate “long” call days
Each team has 2 interns  Q4 “long” call
Hellerstein and Eckel do not have sister teams

• Hellerstein (Cardiology)
– Team room on Lerner Tower 5
– 2 senior residents, 4 interns, sometimes a fellow
• Eckel (Nephrology)
– Team room on Lakeside 5 (between 50 and 55)
– 2 senior residents, 4 interns

• Naff and Wearn (General medicine)
– Team rooms on Lakeside 20
– 1 senior resident, 2 interns
• Carpenter (Infectious disease, HIV patients)
– Team room on Lerner Tower 8
– 1 senior resident, 2 interns

• Dworken (Gastroenterology, Hepatology)
– Team room on Lakeside 55
– 1 senior, 2 interns
– Round separately with the Liver attending
• Weisman and Ratnoff (Heme/Onc)
– Weisman on Seidman 4 (hospitalist)
– Ratnoff on Seidman 3 (oncologist)
– 1 senior, 2 interns

• MICU
– Lerner Tower 3
– 5 seniors (4 on days, 1 on nights); 4 interns
– Interns take call with their seniors Q4; seniors stay overnight
– 1-2 attendings, 2 fellows, 2 teams
• CICU
– Lerner Tower 3
– 5 seniors, 2+ interns, 1 fellow
– Interns do 1 week of days, 1 week of nights

• Four general medicine teams
• Blue and Green are sister teams
• White and Orange are sister teams
• 1 senior, 2 intern teams
• Q4 long call
• Team rooms on 4 th floor

• Two seniors (one on days and one on nights)
• Three interns, Q3 call
• Admit from 7 AM to 8 PM
• Leave by 10 PM
• Day off is “pre call” day Friday through Sunday

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Long call – 3 patients by 7 PM
• Only 1 after 6 PM, 2 after 5 PM
Medium call – 2 patients by 4 PM
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Short Call:
UH: 2 Patients (nightfloat admission or ICU transfer)
• VA: 2 Patients (nightfloat, transfer, or NEW)
Cycle: Long  Medium  Short  HAPPY!

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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)
VA:
• Cap = 8 all the time
Caps increase if you have acting interns

• Dworken, Carpenter, Wearn, Naff,
Ratnoff, Weisman, and VA Wards o Short or Happy days that fall on Saturday or Sunday o “Golden” = both weekend days off o “Black” = work both weekend days o “Silver” = either Sat or Sun off
• Eckel or Hellerstein o 1 day off per week: “Happy day” Friday through Monday

• Night Floats
• UH: 3 interns are scheduled but only 2 are on each night; work out days off with each other!
• Send schedule to chiefs; if you are going to a ward rotation, you should not work the last Sunday
• VA: Saturday night is off
• UH MICU
• Helper day off Friday through
Monday

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7 AM to 7:45 AM
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• Pick up signouts from night float team on Lerner Tower 5 at UH and blue team room at the VA
Pre-round
7:45-8 AM: Be in your team room to discuss changes overnight and the day’s plan with your senior
8 AM to 10 AM (VA) or 10:30 AM (UH)
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– 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
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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”

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C: Call your consults
• Consultants will appreciate the early call
O: Order Entry
• Enter any orders that were not entered on rounds
L: Labs
• Run your labs
D: Discharges
• Get them out
• Should have daily note on the day of discharge as well (very brief)
N: Notes
• Don’t start your notes until the rest of the work is finished

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10:30-11:30 AM (UH) or 10-11 AM(VA)
Resident AM report (M/W/F at UH, T/W/F at VA)
Thursday morning: Intern AM report + Tuesday at UH
Noon-1 PM: daily conference
Afternoon for notes, procedures, teaching rounds, contacting families, following up studies, etc
Short call interns and “happy” interns can signout to their co-interns when their work is done
Medium call signs out to night float at 7 PM
Long call signs out to night float at 9 PM

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D ay A cting C hief R esident/ N ight A cting C hief
R esident/ M edical A dmitting N urse
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!

Night float Resident
Night float Intern
NACR
Night float Resident
Night float Intern

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The night float intern comes in at 7 PM and receives the pagers from the non-call teams
The night float intern can receive the pagers from the long call intern at 9 PM and must receive the pager by 11 PM
Please be pro-active and help your co-intern out if they’re still in the hospital late

• Follow-up on unfinished tasks
• You may be asked to go evaluate a patient; if you do, please write a brief Clinical Event
Note
• If there are any questions/concerns, please ask your seniors and NACR
• A senior should go with you to every CODE
WHITE during the first 6 months

• On long call, sign out at 9 PM, MUST be out by
11PM
• On medium call, signout at 7 PM
• UH: Lerner Tower 5
• VA: VA Blue room
• Duty hours not to exceed 80 hours/week

• No Clinic on Long or Medium call.
• No short call patients assigned on your clinic day.

• Each team will have a pager held by one of interns on the team and then signed out to nightfloat in the evening
• Will mostly be paged by nursing regarding patient issues
• Team pagers are also code pagers – long call interns should go to all codes (‘Code Blue’)
• Team pager numbers are listed on the pager card

• UH
– Dial 222  type pager number  *beep beep beep*  your call back number*your pager number #
• VA
– For UH Pagers, dial 9-207-7244  type pager number  *beepbeepbeep*  you call back number*your pager number#
– For VA pagers, dial 9-440-562-xxxx (pager number)  *beep beep beep*  your call back number*your pager number#

• Geriatrics
• E-team
• Jeopardy
• Elective
• UCC

• New this year; 4 week block
• 3 interns + Geriatrics attending
• 2 interns on wards, one intern at the VA
• Other health care settings such as skilled nursing facilities, home calls

• Only during the busiest months at UH
• One intern + hospitalist attending
• 8 patient cap, off on Sundays
• Lots of independence

• Pager must be on 24/7
• No pay back as it is an official rotation
• Called to cover for inpatient and outpatient
• Weekends are off

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• The VA Emergency Room
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Staffed by at least 3 residents
One or two attending physicians
Hours are 8 AM – 6 PM

• There will be continuity clinics once a week during your electives
• This is the time to explore your academic interests
(get involved in research, participate on different consult services)
• On elective, you are also backup jeopardy, so please keep your pagers on!
• You are expected to attend Grand Rounds and M&Ms
• If you do research, you are expected to present a poster at the Department of Medicine Research Day held every May

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DISCHARGE SUMMARY: do 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
Crucial for patient safety and care

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• Intern Morning Reports – Residents hold the pagers!!
– Tuesday AM report from 10:30 – 11 AM
– Thursday 10:30 AM – 11:30 AM
Grand Rounds
• Tuesday 12-1 PM
Morbidity & Mortality (M&M)
• Friday 12-1 PM
Agre Society
• Monthly, Wednesday evenings – more info to come
Noon Conference
• Monday, Wednesday and Thursday 12-1 PM (with food)

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

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GME Housestaff Lounge!!
Located on Lakeside 6 th floor, next to GME office
Has coffee, bathrooms, TV, foosball table, computers, food on Sunday nights

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Located on the 2 nd floor
Fridge: frozen dinners, ice cream, sorbet, string cheese, muffins, fruit, yogurt, milk, etc
Coffee machine
Cabinets: all sorts of snacks

On Saturday nights when on ambulatory, UCC, or elective, you will be asked to cover from Saturday 7 PM to Sunday 8 AM for the VA intern nightfloat to get a night off

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• Garage parking is free! Just need to get a parking pass from VA police department
(bring license, insurance, registration)
VPN access for home CPRS access
Codes at VA are called “ Dr. Heart ” and are called overhead

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One afternoon/week either at the VA or at the Douglas Moore
Clinic at UH
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No clinic when
Medium call or on long call days
Vacation
Holidays
ICU’s
• Night Float
You DO have clinic when on Elective
To main continuity, you cannot switch clinics amongst yourselves; all schedule changes need to be approved by ambulatory chief resident

• Emergency room experience; at the VA
• You will either do it as a rotation or during ambulatory
• If you are there as a rotation, you are expected to be there from 8 AM to 6 PM

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Introduction to Outpatient Primary Care
Introduction to DMC and the VA continuity clinics
Morning Clinical Conferences: 8 AM daily

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2-week outpatient rotation
Hands on activities
Simulation models at the simulation skill center (next to the VA)
Humanities in medicine
End of life care
Cultural competencies

• Men
• Shirts and ties
• Women
• Professional
• Keep white coats clean
• No denim
• Do not show up to Morning
Report looking sloppy

• If you have to call in sick > 1 day, you will need a doctor ’ s note from the Bolwell Family Practice clinic
• You will be able to get a same-day appointment
• If you are sick for > 2 days and do not have a doctor’s note, you will be assigned extra weekend coverage and/or weekend jeopardy
• Call-offs: You must PAGE 31529 the Ambulatory Chief
• DO NOT EMAIL
• DO NOT TEXT PAGE
• DO NOT CALL THE CELL PHONE OF THE CHIEF YOU KNOW

• Attend all Grand Rounds and M&M ’ s
• You are back up jeopardy!! = pager on
• If you are going out of town for the weekend, as a courtesy please notify the ambulatory chief prior to leaving
• Elective is not vacation
• Please email Barb 2 weeks prior to starting your electives; Quality chief will be keeping track of electives
• Research for more than 2 weeks = present at Research
Day

• Please be on time; our speakers usually have prepared a well thought out talk/powerpoint, so please be respectful of the time they spent
• Noon conference:
• UH: Mon-Wed-Thurs
• VA: Mon-Thurs-Fri
• Grand Rounds on Tuesday: UH & VA
• M&M Fridays @UH, Wednesdays @VA
• Conference attendance is part of your ACGME graduation requirements

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• Catch up on sleep when you can!
• Talk to a chief resident/APD/KBA before a personal problem gets out of hand – someone is always here!
• Please support each other – intern year is tough, but also fun!
Maintain personal and family relationships outside of the hospital; make new friends while you’re here
Take care of yourself; it’s the only way you will be able to provide good care to your patients
LOVE what you do

• Sports
– The Cavaliers, the
Browns, the Indians, the
Lake Erie Monsters
• SO MUCH GOOD FOOD
– Lola/Lolita/B-spot,
Superior Pho, Wonton
Gourmet, Bangkok Thai, the Harp, Momochos,
Fire, Sasa, Luxe,
Southside, Parallax,
Dante + Gingko, the
Black Pig, Soho, etc etc
• AND SO MUCH GOOD
DRINKS
– Fairmount martini bar,
Great Lakes brewery,
Market Garden, Town
Hall, Nanobrew…
• Beautiful scenery
– Cleveland Metroparks
– Edgewater Park
– Mentor on the Lake
• Summer festivals galore
• CEDAR POINT!!

• http://www.clevescene.com/

We are looking forward to a great year together!!!
-SMAK