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“Need to Know” Information
Katherine Tatar, MD Chief Resident
Office: 330-375-3735
Pager: 330-971-2607
Cell 330-559-2735
Schedules, schedules, schedules
Master rotation schedule
Monthly “call schedule”
Med team schedules
ICU schedule
CCU schedule
Check regularly…I will let you know about updates
Changes had to be made this past week to the July med team and
call schedules--- PLEASE CHECK TODAY to confirm what day you
start
www.imsumma.org
Viewing your master schedule
Master Schedule
Monthly “Call Schedule”
Residents
Interns
Interns on
Electives Interns on
Med Teams
(A,B,C,D)
Interns on
ICU or CCU
Call:
Overnight
shifts
(admitting or
“night float”
AI2/AI3)
Day Pager:
7AM-6:30PM
-Carry AI2/AI3
pager
Med Team Schedule
Night admitting: 7:30PM-approx 11AM
July is ONLY month where you will also do at least
1 night as AI2 or AI3 (night float) instead of admit to
get experience (STARTS at 6:30PM-7:30AM)
AI2/3 “Day Pager”
-usually do 2 days
throughout month
on med team
-7:00AM – 6:30PM
-Respond to Code
Blues/Stroke
Teams IN
ADDITION to
normal med team
responsibilities
Admitting
- 4 Med Teams
(A,B,C,D)
-each team admits
every 4th day
(24hours)
-either day or night
admitting
-day: 7AM to ~7PM
-Night: 7:30PM-
11AM (round with
team in AM)
-Look for dates
with your med
team letter under it
Night Admitting
Day Admitting
ICU Schedule
Nights: 5PM-5AM
Night
Shift
Med Team Admitting
Day AI-1 “Admitting Intern” 7AM to ~7PM
Work with AR-1
Carries their personal pager only
Respond to ER and Floor Medicine consults
Respond to pages regarding your team’s patients on the floor
AR-1 (Admitting Resident) will receive pages about consults first, and then will notify you of the consult
Night AI-1 7:30PM to ~11AM
Admissions over night with the night AR1
In AM: write notes and round with day team on patients seen or admitted overnight
Day Pager & Night Float
Respond to all floor pages
Work with AR2 “Floor Resident”
Code Blue and Stroke Teams/Neurology Teams
Back up for AI-1
Daytime: Hold both, AI2/3 Pick up in Cafeteria at 7am
Code Blues (except in ICU/CCU)
Stroke Teams/Neurology Teams
Sign out at 6:30pm
Nighttime: 2 interns Resident’s Lounge 6:30pm
ALL Code Blues, Stroke Teams/Neurology Teams, RAPID RESPONSES
Morning report at 7AM weekdays
• AI-2 “Floor Intern”
• Pager 4574
• 3 West, 4, 7
• AI-3 “Floor Intern”
• Pager 3976
• 5, 6, PACU
ICU Responsibilities
ICU Intern
Pager 4726
Respond to ALL Code Blue pages
Daytime: Arrive 5:00am for sign out at the T-3 “Fishbowl”
Write progress notes with other interns, daily ICU activities
Answer pages on “teaching” ICU patients
Answer emergent pages on “non-Teaching” patients
Sign out to night team at 5:00pm in T-3 “Fishbowl”
Nighttime:
Follow up on any outstanding issues the day team signed out
Answer pages on “teaching” ICU and emergent issues on “non-teaching” ICU patients
Assist ICU resident with new admissions if time permits
CCU Responsibilities
CCU Intern Pager 4614
Arrive for sign out at 6:00am in CCU fishbowl
Respond to ALL Code Blues
Write progress notes with other interns and other daily CCU activities
Answer all pages regarding CCU patients
Sign out to night team at 6:00pm in CCU fishbowl
Nighttime: follow up on any outstanding issues the day team signed out, answer pages regarding CCU patients, respond to ALL Code Blue pages
Most months, CCU night intern only on Fri/Sat/Sun nights
Assists CCU resident with Code STEMI’s/new admissions if able
Responsibilities
So… What are my hours?
Day AI-1(Admitting) 7AM-7:30 PM
Day AI-2/3 (“Day Pager”) 7 AM- 6:30 PM
Night AI-1 (Admitting) 7:30 PM- 11:00 AM
Night AI-2 6:30 PM- 7AM(morning report)
Night AI-3 6:30 PM- 7AM(morning report)
Night ICU-I 5 PM- 5 AM
Night CCU-I 6 PM- 6 AM
Putting it all together
Med Team
7AM (cafeteria) to 5PM on weekdays
Your team admits every 4th day
Look for your med team letter under each date
Day AI1: 7AM to 7:30PM
Night AI1: 7:30 PM to 11:00 AM
Will hold “day pager” (AI2/3) periodically (7 AM-6:30 PM)
Electives
Discuss hours and weekends with senior, attending
Will hold “day pager” (AI2/3) periodically (7 AM-6:30 PM)
“Cross-coverage” (XCVR)
2 weekends per month
Can be AI1, AI2, or AI3
Always, always check the call schedule
Putting it all together
ICU
Daytime: 5 AM to 5 PM
Periodically hold the ICU intern pager during the day (respond to ALL Code Blues)
Nighttime: 5 PM to 5 AM
Only ICU intern at night (Mon-Sun)
Carry personal pager AND ICU intern pager
Respond to ALL Code Blue Pages
CCU
Daytime: 6 AM to 6 PM
Periodically hold the CCU intern pager during the day (respond to ALL Code Blues)
Nighttime: 6 AM to 6 PM
Only CCU intern at night (Most Months: Fri/Sat/Sun nights only, no CCU intern Mon-
Thurs night)
Carry personal pager AND CCU intern pager
Respond to ALL Code Blue Pages
What about time to recharge? Vacation
A total of 3 weeks throughout the year
Submit all vacation requests as soon as possible
Forms are always in my office and my office is always open
MUST USE 1 week before January 1st
Must take 5 consecutive weekdays (i.e. Monday-Friday)
You will either get the weekend before or after off as well
NO VACATIONS in July, December or June
NO VACATIONS during ICU, CCU, or Night Float months
Transitional/Preliminary residents: Must use 1 week for the last week of June
No Guarantees, Plan Ahead!
Vacation Request Deadlines
August and September schedules already completed, will be uploaded
to the website soon
Ideally, will be making the schedules several months in advance
Remember, at least 1 week MUST be taken before January 1st
DEADLINE FOR OCTOBER & NOVEMBER REQUESTS:
Friday July 14th
DEADLINE FOR JANUARY-MAY REQUESTS:
Friday September 15th
Vacation Request Deadlines
August & September schedules are already completed
Will be posted to the website next week
At this point:
I have only TWO interns who have given me specific vacation requests
for August & September (Ahmed & Tatineni)
Several of you may not be able to take vacation in October & November
(eg if you’re on NF/CCU/ICU both months)
PLEASE LOOK AT YOUR MASTER ROTATION SCHEDULE TODAY
Get back to me by MONDAY (July 3rd) if you forgot to turn in a
request for August or September
As this will require me to modify the current schedules (not always easy)
Remember to fill out a vacation request form (located in my office)
Off Call Requests
Off Call Requests
Use these for important events Weddings, graduations
Allowed one request per month…1-2 days (Saturday/Sunday)
If you request a weekday, you are still expected to work your usual shift but I will
not assign you “call” (i.e day pager)
Will NOT be accepted on ICU or CCU months Unless extenuating circumstances arise, which may lead to master rotation schedule
changes
Try to turn in along with vacation requests but if something comes up later
than that come see me
Call Changes
MUST be approved by me
can NOT violate duty hours
USMLE STEP 3
Categoricals
Needs to be done before the end of PGY2
Prelim/transitionals
SCHEDULE ON AN ELECTIVE MONTH
Conferences
July: 12:00 conference, core series of lectures
ICU/CCU Interns excused
All other interns expected to attend
Typical noon conference
MANDATORY (unless on CCU/ICU/Nights/Post-call)
12:00 – 12:15 Patient Care Conference
12:15 – 1:00 Lecture, board review, grand rounds, etc.
Located in the PCS Basement Auditorium (55 Arch St)
Reminder page sent out usually around 11:00AM
Grand Rounds
Every Wednesday of every month at 12:00
Usually in Firestone Auditorium
Conferences
Conferences
IMC Didactics
For all interns/residents during their IMC rotation
Every Tuesday and Thursday from 8-8:30AM
You will receive an IMC month schedule from Cindy Hanna
One assigned presenter per session but all residents should
come prepared to discuss the case
www.summalearner.com
IMC Didactics
IMC Didactics
Video Tutorials
A series of 6 tutorials designed to help address some
common scenarios encountered while on call
General Overview of taking Call
Chest Pain
Hypertension
Hypotension
Shortness of Breath
Abdominal Pain
On Call Videos
Username: imc
Password: bullpen
What about the Boards?
Medical Knowledge Quality Improvement Project
-For Categoricals
MKSAP Quizzes-Proctored in Dept of Medicine
-30 Question Quizzes required in each subspecialty (while on the
rotation).
-Must get 80%. If lower, must retake and pass.
-2 random 60 question quizzes each year. First must be taken by the
end of November.
Procedure Policy
Full Policy Listed in the Graduate Medical Education Procedures/Policy Manual
Information also found on IM Summa on Conference Calendar
Applies to: Central Line (Internal Jugular, Subclavian, Femoral)
Endotracheal intubation
Chest Tube (tube thoracostomy)
Arterial Line
Paracentesis
Thoracentesis
Lumbar puncture
Procedure Policy
MUST be credentialed for intubations and central lines PRIOR to their
ICU or CCU rotation
Step 1
Resident has completed didactic test on indications, contraindications, and
troubleshooting strategies associated with the procedures.
Step 2
Resident has completed procedure under supervision of an attending (in
person) with a high-fidelity simulator and performed all critical actions
DONE IN THE SIM LAB
Resident is now able to perform the procedure under supervision of a
credentialed *attending physician.
*Senior residents and fellows are not permitted to supervise any PGY1 or other resident doing an invasive
procedure. An attending must be scrubbed in.
Procedure Policy
Step 3 (Applies to Senior Residents only)
Resident has completed the pre-determined number of
procedures under the supervision of a fully credentialed
physician and is now credentialed to perform the procedure
independently (with approval of the attending/credentialed
physician).
Procedure Policy
Take Home: PGY1s are NEVER to perform a
Med Ed identified invasive procedure without a certified
Attending physician physically in the room and
scrubbed with them
Procedures
We will try to get you into the sim lab before your ICU month to
be Step 2 Certified in Central Lines and Endotracheal Intubation.
Typically we have the Sim Lab on the 2nd and 4th Fridays of the
month.
Procedure Credentialing
Duty Hours
Log Procedures
Request Evaluations
New Innovations
Logging Duty Hours
MUST LOG DURING:
July
ICU/CCU Months
February
Procedure Logging Sim Lab also has log requirement for Categoricals who will
eventually progress to Step 3. Yes, you should log both in New
Innovations and on their form!
Med Team Workflow / Teamwork • A day in the life…..
– 7:00 AM: Standard start time; typically print a list, meet your team for sign-out, eat breakfast, etc. Then start writing your assigned notes.
– 9:00 AM: Begin rounding with attending and rest of the team. This
time varies depending on the med team or specialty, but you should aim to have all your notes completed prior to 9:00 AM unless you’re told otherwise. • Caveat: 7:00 am start time is optional. If you cannot complete your
notes prior to rounds you can come in earlier. You must have 10 hours out of the hospital between shifts however.
– 12:00pm- 1:00pm: Patient Care Conf. / Noon Conf. • Beginning in August each Med Team and some subspecialties will give
20min case presentations at the patient care conf. Check the CALENDAR for the Conf. Schedule!
Workflow / Teamwork
A day in the life….. 1- 5:00pm
Finish rounding, complete epic sign out, floor work, order AM
labs on all your patients, discharges, discharge summaries.
Sign out in person to the floor intern if there are pressing issues
that may come up for them or need checked on. Ex: follow up troponin, CXR, H/H, etc.
Check Epic/IMC mailbox and complete all telephone encounters
or documents.
ALWAYS check with your senior resident before leaving.
Help your fellow interns. Never watch someone else
work…pitch in.
Knowledge Base
Study…. Don’t forget how to do it!
Read…every night, even if its not very much
MKSAP will be provided for you (Categoricals).
There are copies of MedStudy and MKSAP in the Chief’s office
Copy them but leave the originals!
Try and read the sections related to your electives
First Day
Med Team Interns:
Regular day or AI2/3: 7AM in the Cafeteria
Night admitting: 7:30PM in ED consult room or Resident’s lounge
(page your senior)
First Day
ICU Interns:
Day shift: 5AM in the T3 ICU fish-bowl
Night shift: 5PM in the T3 ICU fish-bowl
ICU Team should meet in T3 fish-bowl tonight for sign-out
CCU Interns:
Day shift: 6AM in the CCU (T1) fish-bowl
Night shift: 6PM in the CCU (T1) fish-bowl
CCU Team should meet in the CCU (T1) fish-bowl tonight for sign-out
First Day
Electives:
Typically work Monday through Friday with 1-2 weekends of “cross
cover” throughout the month (either night float or admitting intern)
Check CALL SCHEDULE to make sure you aren’t cross covering
this weekend
Usually begin at 7AM unless told otherwise
Try paging your senior later today
Call/e-mail me with questions
MOST IMPORTANTLY…
When in doubt– CALL YOUR SENIOR
Your priority is the patient
Your seniors WANT you to call them with questions or concerns
At some point, you will inevitably feel as though you’re “nagging”
people to do what’s best for your patient (eg calling down to radiology
to get your patient with a STAT CT down as soon as possible, or
following up with a nurse to make sure a medication was given)
Be nice and considerate
Help when you can (within your capabilities)
Focus on your primary goal: doing what’s best for the patient
If you’re not sure about something– ALWAYS ASK
Your senior, your attending, the chief (me), our faculty
Someone is ALWAYS here to help you
Remember: These are YOUR patients now
Take ownership and responsibility
Advocate for them
Don’t let stress or fatigue allow you to forget why you’re here
Double and triple check your work
Before submitting an order– confirm it’s on the right patient and that it’s the right order
Make sure you know the risks and indications of whatever medication/procedure/test you are ordering and always keep that in mind
Make checklists!!!!
Make a list for each patient– things to do/order/follow-up on/change
Cross things out as you go
Do NOT rely on memory alone--- these are people’s lives
When you are stress or tired or distracted you WILL forget– so write everything down
MOST IMPORTANTLY…
Have fun!
Work as a TEAM
Always keep in mind-- your actions will impact not only your patients’
lives but their families
Remember– it is a PRIVILEGE to have a job that pays you to serve
others
So be kind and work hard– the rest will fall into place
MOST IMPORTANTLY…
Chief Resident
Katie Tatar, MD [email protected]
Pager: 330-971-2607
Office: 330-375-3735
Cell: 330-559-2735