1	Intern Survival Guide 2007-2008 Chief Residents June 19, 2008
2	Welcome to Houston! Things to Do… Shopping Sports Theatre Concerts Fine Dining Clubs Galveston Schlitterbahn Museums
3	Our Fearless Leaders Chairman Dr. Phillip Orlander Program Director Dr. Mark Farnie
4	Associate Program Directors
5	Chief Medical Residents (CMRs)
6	Residency Information Site http://www.uth.tmc.edu/schools/med/imed/residency/resinfo.htm Weekly conference schedule Administration contact info Pictorial Roster Online Evaluations Chief’s Corner Articles, core lecture series, orientation manuals Rotation Curriculum & Objectives Policy & Procedures Manual
7	Parking LBJ – Free onsite parking HH – UT Professional building or Prairie View A&M nursing school parking garages
8	Educational Resources Jesse Jones Library - all major online journals www.library.tmc.edu Register for remote access - FREE Kirkendall Library (1&4,2) MSB 1.150 LBJ Library 4th floor - use your ID badge Chiefs Corner Up To Date available at LBJ and Hermann
9	Pagers To directly page someone: 713-605-8989 or 8175 at Hermann Enter 5 digit pager number of the person you want to page Enter call-back # (include area code) HH extension: 4xxxx; LBJ 6xxxx Sign page with “*” and your pager # Or call the page operator: Hermann: dial “0” or 713-704-4000 LBJ: 65566 or 713-566-5566
10	Schedule www.amion.com Password: uthim Call & Clinic Schedules Vacation schedule Yearly rotation schedule Post Call Cover Send Text pages Scheduling Chiefs: Kim.n.tyler@uth.tmc.edu Erica.e.hightower@uth.tmc.edu
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13	…Schedule Holiday/Weekend Schedule Float comes in at noon No post-call cover at Hermann or LBJ Vacation (2 weeks + 4-day holiday) all interns off last week of June Schedule Changes: may swap with another intern, but must by approved by CMR Yearly Medicine In service exam in October Yearly Med Peds In service exam in July
14	Procedure Log Must complete and log 10 of the following: Advanced cardiac support Abdominal paracentesis Arterial puncture Arthrocentesis Central venous line placement Lumbar puncture Nasogastric intubation Pap smear and endocervical culture Thoracentesis
15	Dress Code Be professional Daily scrubs are okay for ER, ICU, CCU and on overnight call
16	1^st day Before each rotation Page resident or intern day before (www.amion.com) Obtain check out from resident/intern http://secure1.mhhs.org/checkout Inquire about patients you need to see Time of rounds
17	Memorial Hermann Hospital
18	Life at Hermann Orientation packet online @ resinfo Chief’s Office 713-500-6523 MSB 1.136 Open Door - always welcome to page us Medicine Office (Susan, Phyllis, Charity, Sue) 713-500-6527 MSB 1.134
19	Things to know www.newphysicianlink.org Labs, radiographic studies, notes Can access at home All H&Ps and consult notes MUST be dictated Herman page operator: Dial 0 or 44000 Resident Lounge – 4^th floor of Robertson All morning reports/conferences in MSB Meal tickets in MSB 1.134
20	Morning Report @ Hermann General Morning Report On Call Intern and Consult resident present Presenters prepare 1-2 slides with teaching points Mon, Th, Friday @ 8am MSB 2.135 (G.100 on Wednesdays) Chairman’s Morning Report Post Call Resident presents admissions overnight Tuesdays @ 8am in G.100 Dr Willerson Morning Report for ward teams Saturdays @ 6:45am in Kirkendall Library (MSB 1.150) Post Call Resident presents
21	Morning Report Tips for Presentation Concise, chronological history is key! PERTINENT positive and negative ROS in HPI Thorough physical exam Have all laboratory and radiological data handy Be ready to complete the differential diagnosis Helpful links: http://courses.washington.edu/med665/student/ http://content.nejm.org/cgi/repritn/352/1945.pdf http://medicine.ucsd.edu/clinicalmed/oral.htm
22	Hermann Wards Team structure is 1 resident & 2 interns Q4 overnight call Cap is 10 new pts/team + 4 ICU transfers or 4am, whichever comes first Post-call checkout to “post-call cover” Must leave hospital by 1pm Checkout to night float intern all other days
23	Hermann Renal Wards One resident and 2-4 interns Take admissions daily from 7am to 5pm No cap No overnight call Checkout to night float intern at/after 4pm
24	Hermann CCU One resident and one intern team on call overnight Short call from 7am to noon or 4 admissions Q4 call from noon to 7am On call team cross covers all patients at night Admit to Cardiac Critical care Unit & to InterMediate care Unit (IMU on Cullen 3)
25	MICU One resident-one intern team on overnight call (q3-q4): Admit new patients; cover old patients Write progress notes on all MICU pts. Rounds at 8am eICU at HH - orientation on 1st day to online progress/procedure notes
26	Float Intern Responsible for overnight cross-coverage for teams that are not on-call (4pm-7am) 3 medicine teams Renal team Observation team at LBJ Receive Check-out in person Answer all your pages! Telephone/Verbal Orders - sign them! If any question: See patient and write brief note Backup is Float Resident Don’t be afraid to page the primary team!
27	Daily Checkout Checkout to the float intern: only for cross-cover Do not check out procedures, notes, discharges, potential ICU transfers etc. Starts at 4pm during the week 12pm on weekends and official UT holidays In person Use online checkout sheet http://secure1.mhhs.org/checkout (no www.)
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29	Directions
30	First Day at LBJ Orientation June 20^st Check in at physician services Pick up call room keys ($15 deposit) Get your personal HCHD ID # Go to security Obtain parking sticker Obtain ID badge (lets you into parking lot)
31	LBJ: Important Phone Numbers Page Operator (713) 566-5566 Medicine Office on 4^th floor (713) 566-4550 Mrs. Kim Concepcion Chief’s Office (713) 566-6199 – open door policy & always welcome to page us
32	LBJ Rotations General Medicine Wards Emergency Medicine 11 hour shifts Dr. Phong Nguyen – schedules shifts Ambulatory Rotation Rotate through several subspecialty medicine clinics Ready Reserve
33	LBJ Rotations (cont’d) Night Float 4pm-7am M-F, Noon – 7am on weekends and holidays; split month with another intern MICU Observation Team / Team E Admit M-F; no overnight call Renal Consults
34	LBJ Wards… Team Structure: 2 residents & 4 interns Call Q4 – Cap is 20 patients Post call checkout to cover resident at noon Daily non post call checkout is to Float Intern TEAM E / Obs Team: 1 resident and 2 interns, no overnight call
35	LBJ: things to know Computer access: EpicWeb http://epicweb.hchd.tmc.edu (can access from home internet also) MuseWeb Login – Museweb Password – Muse!Web Lounge on 3C On-call meal tickets (pick up from Kim in medicine office) Library on 4^th floor with computers and in Annex All reports/conferences in the LBJ Annex
36	Morning Report @ LBJ Intern & Medical Student Morning Report M & W @ 8am in Annex On call interns present Presenters prepare 1-2 slides with teaching points Dr. Mehta’s Morning Report Tuesdays @ 8:45am in 3C Rotating interns present General Morning Report Th-Fri @ 8am in Annex On call interns present on Fridays
37	Ready Reserve To cover EMERGENCIES Ambulatory Months Pagers on at all times & must call back in a timely manner Do not leave town Notify CMR if you will be out of touch .…You can be pulled at any time Sick calls: verify with a doctor’s note Abuse of system will result in extra ready reserve duties and additional call assignments
38	MD Anderson Cancer Center
39	MDACC Orientation For MDACC, Herman oncology and LBJ heme/onc interns on 1^st day of rotation Monday 6/25/07 @ 8am Green Zone Tower 11th floor Fellows office (G11.3315) Chief Resident at MDACC Dr. Vince Cataldo (713) 792-0067 Page Operator 713-792-7090 Rotate through various clinics
40	MDACC Call Schedule - varies All residents/interns at HH, LBJ, MDACC cover night call at MDACC--> overnight call will average once a week Hospitalist is available until 10pm daily to answer questions Oncology fellows in MICU are the overnight back-up You are excused post-call at 12 pm
41	MDACC Conferences at MDACC Attend UT-IM Core Curriculum lectures @ medical school Go to all other MDACC conferences Food All meal tickets for call will be provided by the MDACC Chief Fellow and provided at orientation
42	St. Lukes Episcopal Hospital
43	SLEH Checking in / Orientation Orientation will occur on the first day of the rotation June 20^th @ 2pm C030 (Cooley Building, B1 level) If you are post-call: Inform attending and resident so that you can go to orientation Collect the pager and go to work the next day Orientation with the residents on the 3rd
44	SLEH (cont’d) Chief Medical Resident (Baylor) Dr. Greg Gaspard Office - 832-355-4963 Pager – 713-605-8989 x26401 Any questions/problems that arise during the month can be addressed by the UT CMR
45	SLEH (cont’d) Call at St. Luke’s Cross-coverage and up to 5 new admissions Code pagers to be picked up at MR at 9am On-call resident will page you with admission See patient & call the admitting attending to go over case and treatment plan In-house residents for backup
46	MDACC and SLEH Orientation packets for both institutions are available on resinfo Please familiarize yourselves with all the pertinent information prior to going to the particular hospitals
47	Medical Records Dictate H&Ps and Consult notes @ Hermann Discharge Summaries @ all hospitals Brief hospital course, studies, procedures, discharge medications and follow-up Death Summaries Dictate on the day of discharge PROMPTLY Write Procedure Notes Co-sign medical student notes & verbal orders
48	Medical Records (cont’d) Abbreviations that are NOT allowed QD, QOD, u, mcg, HCTZ Corrections One line through the correction Initial & Date Decimals 1 but not 1.0 0.1 but not .1
49	Deaths Death Pronouncement Basic physical exam, document date and time Call family if not around Call resident &/or attending Call Chaplain and Decedent Care (or ask the nurse) Dictate!!!!!!!!!!!!! Autopsies - ask family if present Medical Examiner
50	Continuity Clinics UT Professional Building Sheri Janowski 832-325-7462 LBJ Clinic Donna McKee 713-566-5079 You are excused from Clinic: CCU, ICU, ER, post-call, vacation You must confirm clinic cancellations
51	Noon Conference Daily MSB 2.103 at HH, Annex 212 at LBJ Grand Rounds on Tuesdays Core Curriculum lectures noted on schedule Residents rotating at MD Anderson & St. Lukes required to attend lectures at their respective hospitals, but come back to MSB for Core Curriculum lectures
52	Attendance Attendance is required at all conferences (morning report & noon conference) Sign in Attendance of < 70% will result in: An extra 8 hour ER shift at LBJ in addition to clinical duties Letter placed in your permanent file Meeting with Chairman or Program Director
53	Other Educational Activities Journal Club at Star Pizza monthly Chairman Rounds at Hermann Dr. Fred rounds at LBJ Teaching Slide Shows MKSAP Reviews
54	Mentors Each intern has an assigned CMR mentor
55	Social Events Welcome Party Osler Internal Medicine Faculty versus Resident Softball Game Superbowl Party Housestaff Parties at HH Happy Hours Christmas Party
56	Even More Orientation LBJ Orientation June 20^th St. Lukes Orientation June 20^th UT GME Orientation June 21^st Hermann Orientation June 22^nd AllScripts Orientation D DAY is the 24^th: FIND YOUR RESIDENT THE DAY BEFORE - plan to be at the hospital by at least 7:30am Don’t forget to HAVE FUN!
57	Questions ????