Medical Chief Residents' Intern Orientation 2009

“A Day in the Life of a BMC Intern”

Your Chiefs

Located across the corridor in Evans 116 (8-7253)

Also an office on the 6th floor HAC (4-5642)

VA Chief – Anju at the moment

5222 – the oncall pager

Stop us in the hallway, at conference, in clinic etc. – we’re here to help you

Pre-rounding

7am pick up sign-out (9am on Sundays @BMC): ENC 8th floor work room HAC one of two 6th floor conference rooms VA 2-South conference room

Pre-round on patients – collect vitals, assess any patients active overnight, ins and outs, weights...

Don’t forget the Telemetry (upcoming intern conference session)

Check stability of any new Short Call “holdovers”

ICU pre-rounds are a little more involved

Ward rounds and presentations

Usually start 7.30am, Attdg present alternate days

24hr events, any new tests and results, morning vitals

See the patient with your team – interns lead at the bedside!

Then present your assessment and plan by problem (don’t forget to address FEN, Ppx, Dispo, and Code when relevant)

Organize your ‘scut sheet’ Rounds complete by / pause @10am Morning

Report

The superstar intern

How old is the central line? Can any IV meds be changed to PO? Can they come off telemetry? Can the IVF be stopped? Will they need PT prior to discharge? Can you D/C the Foley catheter? Can you advance the diet? Are they moving their bowels? How close are we to discharge? Are the meds adjusted for renal/hepatic

failure? Does the patient understand their care?

Putting in Orders

Sunrise (SCM) order entry Phlebotomy draws are 7am, 10am, 1pm,

4pm, 7pm, 10pm, 1am, 4am. (AM draws usually 7am on the wards)

If you can’t find it, try the % sign

Call consults early please (the fellows will ♥ you)

Radiology requests are a consult! Call down if its STAT

Don’t forget to let the nurse know!

Progress notes

Are now on SCM!!!

Are required 7 days of the week

Attending rounds

You should receive 3 attending round sessions per week

You should also seek expectations / mid-way feedback / end of rotation feedback from Attdg and Resident

Noon conference

Monday – HAC A/B Tuesday – Intern conf in Evans – compulsory! Wednesday – firm conf (11.30) or M&M Thursday – HAC A/B Friday – Emergency series / Grand Rounds

You will be fed ☺ Attendance goal 80% We will hold your pagers 12 – 1pm

Afternoons

Follow up results, consults, images Always update the patient! CLINIC Procedures – supervision, help

Record temporarily by an SCM list or emails to self

Teaching

Calling a Code: 8-7777 or 4-7777

On call schedules Long call

Max 5 for Early Long, 5+2 for Late Long Early call out by 9pm, Late is overnight

Post call Short call

Max 5 Early to 12, Late to 5pm (should be out by 7pm)

Routine Or day off

Units are q4 overnight Weekend coverage assignments

Survival tips

If you’re standing, sit You’ll get out of this experience what you put

into this experience Don’t assume anything… Use the resources around you:

Resident, med students Chiefs, PDs RNs, pharmacists, PT/OT, case managers Subspecialty fellows BMC intranet Uptodate, online journals Each other

Admitting patients

Resident will receive Admitting and ED pages IBEX is the ED board

See the pt as soon as they arrive, at least to ‘eyeball’ and write holding orders

Using the order sets – quality improvement H&P is online – every patient needs an intern

or resident H&P Assigning a pager to the patient

SCM documents

Medication Reconciliation

Discharging patients

The computerized Discharge Summary Can “copy forwards” from H&P – but check its

relevant and accurate Discharge Medication Reconciliation in

Logician – cut and paste the med list into the DSUMM

Print out the Med Rec E-prescribe / Pharmacy arrange new meds Page One for services Discharge Order

Follow-up appointments

Signout (after notes done, labs ordered, checked in w/ patients and resident)

To Who? Long call <7pm NF junior >7pm

Divert your pager!

SBAR: Situation Background Assessment Recommendations

Pager etiquette

Ambulatory curriculum

The Medicine Residency Website

Feedback appreciated!Jason is website lead

The West Roxbury VA

Location of WXVAOrange line to Forest Hills, then 36 bus

YOU SURVIVED THE WHALEWATCH, YOU’LL SURVIVE BMC INTERNSHIP!

YOU SURVIVED THE WHALEWATCH, YOU’LL SURVIVE BMC INTERNSHIP!