Intern Orientation 2015 Welcome l Dr Robert

Intern Orientation 2015

Welcome l Dr. Robert Salata l l Interim Chair, Department of Medicine Dr. Robert Bonomo l l Vice Chair for VA Chief of Medicine, VA

Program Leaders l Keith Armitage, MD l l Program Director Carla Harwell, MD l Associate Program Director § l § Ambulatory Programs, Woman’s Health l Procedures, Inpatient Medicine Associate Program Director § Starting July 1 § l Patient Safety and Quality Amanda Clark, MD l Associate Program Director § l Ambulatory Block curriculum Hiloni Bhavsar, MD l Charles Lopresti, MD l Associate Program Director § Primary Care, Health Care Disparities, Woman’s Health Associate Program Director Ronda Mourad, MD l Simran Singh, MD l l l Clinical Skills Block Crystal Lantz. De. George, MD l Associate Program Director § Starting August 1

Administration l l l Dr. Salata Dr. Bonomo Dr. Sarah Augustine l l ‘runs the VA’ Dr. Raj Chandra l Gen Med l Teaching and nonteaching l Deena Segal l l Carol Bennett l l Administrative Coordination for Educational Programs VA Housestaff Office Barbara Bonfiglio l UH Housestaff Office § § § Notary Historian Copy machine queen Amateur psychiatrist Provider of batteries

Most Importantly: Chief Residents l Cassandra Kovach § l Brian Hambley § l VA Jason Tuckerman § l Ambulatory Dhruti Chen § l UH Pt Safety Nathan Stehouwer § Med Peds

Chiefs…. . l l l Q 3 month rotation UH 31250 VA 31533 Ambulatory 31529 Med-Peds 36672 Patient Safety and Quality 36644

Who are you? l l l 34 Categorical IM 4 Med-Peds 8 IM Prelims 12 Neurology Prelims 14 Anesthesia Interns

The goals of internship l Learn Patient Care l l l Supervised clinical experience reflection 36, 000 admissions/year § l l You will do about 200 Fund of Knowledge Career Goals l l Subspecialty training Primary care Research Other

The ‘curriculum’ of Internship l The goal- gain clinical competence in the care of adult patients (ACGME Competencies) l l l “the patient is the curriculum” General medicine and specialty wards; ICU and ambulatory rotations, clinical skills block, neurology Noon conference l l l Other conferences Attending rounds; walk rounds Morning report Grand Rounds Reading ACP curriculum

ACGME Competencies l l l Patient Care Medical Knowledge Practice Based Learning and Improvement l l l Communication Professionalism Systems Based Practice And then there are the Milestones….

Research and Elective Time l l No “assigned” elective Be available 8 -5, M-F; let the Chief Resident know about other time away Dr. Salata, Dr. Bonomo, Program Directors and Chief Residents can assist in picking elective and research mentors GI Elective/Jeopardy l Required to go to all conferences

Annual Events l Intern Mini-retreat- October/November l l l l l Getting feedback on the program Professional Development Bronson Day Holiday Party Morale Week Spring Dinner – May 26, 2016 Intern Retreat- June, 2016 End of the Year Picnic- June 2016 End of Internship- June 23, 2016 l Last week of June = 5 th week vacation

Evaluation and Feedback: Getting and giving l l l l “Self feedback” Electronicwww. myevaluation. com Attending feedback! Rotation and program feedback On-going feedback about the way things are going Semi-annual review Doors of Program Directors are always open (honestly)

Faculty Mentors l l Meet December or January with one of the program directors Dr. Salata, Dr. Bonomo, Chief Residents Meeting with subspecialty directors, fellows and peers l l New Fellowship time line…. Picking a faculty advisor

Duty Hours l l Icompare! 80 hour work week l Averaged over rotation l 16 hours § § l 8 -10 hours out of the hospitalbetween periods of duty § l Work flow, efficiency There will be a ‘system learning curve’ Should leave at 9; must leave by 11 1 in 7 - averaged over 28 days l Schedule complexity…. .

Duty Hours l Monitoring l l Rotation evaluations Web based surveys (program and ACGME) Signout rounds with Chief Residents and Program Directors Each Block- one week audit via www. myevaluation. com

Duty Hours- Icompare l l http: //www. jhcct. org/i compare/default. asp One year randomized trial looking at flexibility in duty hours on patient outcomes + 80 hours, 1/7 No 16 hours rule for PGY 1 s

Duty Hours l Days off- You may need to be proactive if you miss a day l Please let me know if you feel you are not in compliance Keith. Armitage@uhhs. c om kba@case. edu l l

Misc. Stuff Email all communication from the residency, hospital GME office, etc. will be to uhhs. com or UHhospitals. org mail. uhhs. com; outlook Patient related emails- UH or VA only!! HIPPA Social Media… PHI Switch dates/block schedule Clinic Maternity/Paternity leave Vacations

Misc. stuff, cont Meal tickets/swipe card Jeopardy schedule (“safety net” for urgencies) call offs…. Step III- must be done by end of PGY 2 year Discharge summariesmust be done the day of discharge

Misc. , Medical records Typical daily schedule 7: 00 -8 Preround 8 -10: 30 Work Rounds 10: 30 -11: 30 Morning Report (residents M, W, F; interns Tu, Th at 11) (10 -11 VA) 11 -12 Attending Rounds* 12 -1 Noon Conference (M&M- Fri. UH, Wd VA) Grand Rounds- Tuesday starting Sept. 1 -2 Attending Rounds* What are “pre-rounds” Leave/Sickness-

Misc. l l Computer resources Core Library Dress Code Intern Orientation Handbook

Lakeside Hospital l 1837. Federal government appropriated $20, 000 for a Marine Hospital on Lakeside Avenue. 1866. City Hospital on Wilson Street. 1898. Lakeside Hospital opened. l l l 1908. Cost $2. 33/day. Average daily census 212. Medical staff from WR Faculty. 1992 Lerner Tower 2012 Seidman UHHS system……

Flexner Report 1910 l 1904. AMA and Carnegie Foundation commissioned survey by Abraham Flexner. l l Abraham Flexner l “ The Medical Department of Western Reserve University is next to Johns Hopkins University which, for various reasons, occupies an exceptional position, the best in the country. ” Letter from Flexner to WRU President Thwing following his visit. Visited all 155 medical schools then operating in US & Canada. Only two medical schools considered as excellent in both clinical and laboratory facilities: Johns Hopkins and Western Reserve. “Excellent laboratories, in which teaching and research are both vigorously prosecuted…. Lakeside Hospital, an endowed institution of 215 available beds, [is] thoroughly modern in construction and equipment. ”

University Hospitals Move to University Circle l l l Lakeside Hospital & ward circa 1932 1925. 1926. 1929. 1931. Mac. Donald House. B&C. Institute of Pathology. Lakeside Hospital Hanna House 1923. Medical School moved to University Circle.

My advice……. . l Ask questions……………… Know Your Limitations; Ask for Help You NEVER have to be Alone l l l Learn to say “I don’t know” (don’t make it up) Ask for feedback Have fun Always take a patient centered approach Develop Effective Time Management and Teamwork Skills

More Take Home Points *Yes, the Schedule may (will) change *Focus on: Attentive Patient Follow-up [nightfloat admissions!] Knowing Where Your Limits Are Asking “Why? ” Support each other! *As I said…………. Expect to Work Hard. . . AND HAVE FUN!

Intern orientation…