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WAYNE STATE UNIVERSITYDETROIT MEDICAL CENTERDEPARTMENT OF INTERNAL MEDICINE2015-2016RESIDENT SURVIVAL GUIDERevision Date: July 2016Created by the Resident Council Intern Representatives of 2004Reviewed and revised by subsequent representatives yearly.Current Edition Edited by: Harold Obiakor (PGY1), Monica Peravali (PGY 1), AbdelazizMohamed (PGY1).Not to be copied, used, or distributed without the express consent of the Internal Medicine Department at DMC. Thisbooklet is to serve as a helpful assistance guide, and not meant to cover all medical scenarios, be all-inclusive fortreatment protocols, or serve as a substitute for the clinician’s own clinical expertise and judgment.
Welcome to the resident survival guide! You are training at one of the places in the countrywith amazing pathology and will work with a great bunch of people.The purpose of this book is to serve as a reference for key information you will needthroughout residency. It is a composite from numerous resources, put together byyour fellow residents. A lot of this book contains helpful information for clinicalquestions. It is to be used as a reference only, not a substitute for your clinicaljudgment. If something here (or anywhere) does not jive with your thinking, THENRECHECK IT YOURSELF AND FOLLOW YOUR OWN BEST JUDGEMENT.The medical team including yourself, your Senior Resident and Attending Physician will bedirecting appropriate medical care and making patient decisions.At the back of the book are pages for your own personal notes. At the end of the year,please forward a copy of this page to your Resident Council representatives. Then we canincorporate any key information that we may have missed into next year’s guide.Thanks! We hope that you find this resource helpful!Internal Medicine Resident Survival Guide-2-
TABLE OF CONTENTSSECTION 1: CONTACT INFORMATIONGeneral Telephone Numbers and Information. .5Food & Lockers .6Paging System . .8Internal Medicine Administration Pager Numbers 9Subspecialty on call Fellow Pager Numbers .9Commonly Called Numbers . 10Information Systems Contacts & Tech Tips . . 11Nursing Station & ICU Phone Numbers. . . 15Subspecialty Clinic Numbers . . 15VA phone numbers . 16Outside Hospitals/Clinics & Medical Records . .17SECTION 2: ROTATION INFORMATIONGuide to Rotations and Medical Floors . 19Intern Etiquette 21Tips from Interns and Seniors . 23Admission Orders 25Do Not Use Abbreviations 26Prisoner Protocol 26Writing Orders . 27Progress Notes . 28Power Notes 29How to Present a Patient . 31Discharge Planning 33Discharge from the ICU 35Dictating 36Consults . 37Death Notes . 38SECTION 3: DOCUMENTATION & BILLINGMedical Documentation – Charting . 39Billing in the Hospital and Ambulatory Setting . 40New Innovations Responsibilities 43SECTION 4: TEACHING INFORMATIONResidents’ Role in Teaching .44Medical Student Expectations . 45Responsibilities to Our Medical Students . . 47SECTION 5: MEDICAL INFORMATION & TIPSAcute Emergencies 52AMS 52Seizures .53Internal Medicine Resident Survival Guide-3-
Chest Pain .54Shortness of Breath .55Stroke (CVA/TIA) .57Alcohol Withdrawal 58How to Read an EKG . 59ACLS . 63Electrolyte Replacement 68Common On Call Complaints & Subspecialty Tips .71Ambulatory 71General . 71Pain 72Cardiology/Hypertension . 76Critical Care/Pulmonary . 89Endocrine . 98ENT 101Geriatrics 102Hematology/Oncology 103Infectious Disease 112Nephrology and Acid Base 117Neurology .120Rheumatology 124Miscellaneous 125Useful Equations 127Core Measures 130SECTION 6: RESOURCESCommunity Resources 132OTHERAcknowledgements 140Corrections & Notes 141Internal Medicine Resident Survival Guide-4-
SECTION 1: Contact InformationGENERAL TELEPHONE NUMBERSThe Detroit Medical Center Internal Medicine Residency program includes training at thefollowing hospitals:Detroit Receiving 313-745-3000Harper University 313-745-8040Veteran’s Hospital 313-576-1000Karmanos Cancer Institute 1-800-KARMANOSRehabilitation Institute of Michigan 313-745-1203Children’s Hospital of Michigan 313-745-5437Sinai/Grace 313-966-3300Hutzel Women’s Hospital 313-745-7555SHIFFMAN MEDICAL LIBRARYWayne State University School of Medicine – Need a One Card for access. The library islocated on 320 E. Canfield St., in the Mazurek Medical Education Commons buildingbetween the School of Medicine and the Harper parking structure.Hours of Operation:Sun 12 p.m. – 12:00 a.m.Sat 12 p.m. – 8:00 p.m.Fri 8:00 a.m. – 8:00 p.m.Mon - Thu 8:00 a.m. – 12:00 a.m.(313) 577-1088WSU ONE CARDWhat is it?An access card for the School of Medicine, University Medical Library and Fitness Center.- it can also get you discounts at restaurants and storesWhere to get it?Wayne State University Main Campus Welcome Center42 W. Warren Avenue, Suite 257313-577-CARDhttp://onecard.wayne.edu/Hours of Operation:M - F 8:30 am – 5:00 pmInternal Medicine Resident Survival Guide-5-
CAFETERIA HOURS and protocol to get fed on call or to get fed at all Detroit Receiving6:30am – 10am11:00 am – 2:00pm5:00pm – 7:00pmHarper HospitalHot breakfast 6:30 – 9:15Grab “n” go 9:15 – 10:30Hot lunch 11:30am – 1:45pmHot dinner 4:00pm – 6:30pmFree coffee for residents in DRH cafeteria7am – 8am and 5pm – 6pm (first and last hours of opening)VA7:00 am – 2 pm Monday – FridayOn call night dinner: To hold an on call meal tray, call 6-4567 well before the dinner hours.To get your tasty meal, go down to basement, south side of building, enter into the tapedoff rectangle (no joke), sign your name on the clipboard. Your meal will be made at thattime.Quizno’s - HarperDMC Midtown Market Place – Brush mallCoffee Shop and Gift store – Hutzel lobbySubway (24h) – DRH, Children’sMidtown Café – Harper/KarmanosBiggby Coffee (24h) – DRH, Children’sWendy’s - HarperSecurityCall 111 at DMC, also this information is on the back of our badge.ParkingParking for all residents is at the Harper Parking structure, across from theProfessional Building. You can park in the DRH underground lot after 6pm on weekdaysand ANY time on weekends. Can also park at the Children’s and Kresge Eye lots.Lockers Harper: Lockers are available in the on-call suite on 7-Brush and the Houseofficer locker-room. Contact the Chief Resident to check out a lock. DRH: Lockers given to you for floor months. This info is included in packets atthe beginning of the month. VA: As far as lockers go, there are some for residents to use, but you have tobring your own lock, they're located in the call rooms and on the 6th floor, closeto CLC services.On consult months: Use the lockers in the 7-Brush on-call suiteInternal Medicine Resident Survival Guide-6-
Resident LoungesDRH - 5N, 4SHarper – 7th floor of Brush buildingWhite coat cleaningLevel 1 of DRH – in main hallway connecting DRH and Harper there is a room with awindow next to the door to drop off white coats and have them dry cleaned for free.Hours: usually 12-4:30pmResident PerksLook for a copy of the DMC Discount Directory on the wsumed website or ask yourResident Steering Committee about this. It is a list of discounts at various places of interestwhich are available to you courtesy DMC Employees Activities Committee.I also advise each of you to sign up at https://tenet.corporateperks.com/ and avail the widerange of corporate discounts available to you across the US. Once you sign up, you canshare the corporate perks with 5 family & friends!The EAC office is across the cafeteria in Harper Hospital, it is open Tuesdays & Thursdaysfrom 8AM-3PM only. You can purchase sports tickets etc. directly from them.Internal Medicine Resident Survival Guide-7-
PAGING SYSTEMDETROIT RECEIVING, HARPER AND KARMANOS HOSPITALSDialing instructions In house access: dial 122 then enter the pager number. Follow prompts.Enter your callback number, press * and enter your pager number. Out of the hospital: dial 1-313-745-0203 then enter the pager number.Follow prompts. Enter your callback number, press * and enter your pagernumber. If page says return call to *53499, call 313-745-3499 on an outside phone If page says return call to *62254, call 313-966-2254 on an outside phoneDO NOT return pages from your personal cell phone. If you must, press *67 and then dialthe callback number. This will remove your number from caller ID. You do not wantpatients to have your personal number!Text paging1. Go to the DMC Intraweb.2. Locate person by name or pager.3. It brings up a list.4. Click on person’s pager number if it is green (active).5. Type in note and send.You may also text page someone from a cell phone if you know the 10 digit numberassigned to the pager. This is located on the back of the pager or through the intrawebpaging page of a specific person.Signing out the pager or changing your greeting Dial 123 or 1-313-745-4050 and follow prompts.VETERENS HOSPITAL In house access: dial 6-1135 –xxxx and follow prompts. Enter the fullnumber, not just the extension when calling from the VA. Both Karmanos and the VA have numbers that start with 576 – XXXX or6xxxx. Entering the whole number (with 576) prevents confusion at thesetwo hospitals. Or you can dial 313-576-1000 ext. 6xxxxYou can look up pagers at the VA using VISTAPagers: 9- 250 or 9-280 then pager Out of the hospital: call the VA operator at 1-313-576-1000 and ask them topageInternal Medicine Resident Survival Guide-8-
Department of IM4201 St. Antoine2E UHCDetroit, MI 48201745-4832Fax 745-4052Michelle BalanShirley KmetzElinda JosephResident ClinicsGMAPPhones in staffing areaHousestaff OfficeDRH5S10Harper 2 HudsonVAMCC3-100745-3265745-8334576-3450DMC Medical Records 4063966-7340745-33224C UHCAIl Medical Records (Outpatient)GMAP745-2899745-4141Medical Educationand Program DirectorsChief Medical ResidentsR. Bloomingdale (DRH)M. Diab(HUH)R. Alhasan (AMB)S. Goyal (VA)A. Zhang (VA Quality)79397947790679568073On Call Department PagersAnesthesia Pain - DRHAnesthesia Pain – HarperBone Marrow FellowCards Resident (Harper)Cards Fellow (Harper)CCU Resident (DRH)ChaplinDermatology 313-436-2848Echo TechEEG FellowEndocrinologyENTGeriatricsGIGYN OncHematologyInterventional RadiologyMedicine on-call HarperMedicine A (DRH)Medicine B 9780656554565548695507777678909975755Dr. D. LevineMed Ed ChairDr. J. WeinbergerPDDr. N. ThatiAPDDr. M. SinghAPDMICUHarperDRHNephrologyNephro, TransplantNeurologyNeuro-radiologyNeurosurgery HarperDRHRadiologyPalliative CarePM&R nights/weekendsPulmonaryStroke pagerToxicologyUrologyInternal Medicine Resident Survival 1619123499973622516111204202829893011
COMMONLY CALLED NUMBERSDRHHarper HutzelABG 2157315AngioLab58325Blood Bank542065856550872Brochoscopy58516Cath Lab52692Central Supp. 533965817157428Chemistry545985855550877Coagulation 30714Core Lab54588CT 083450864Dental51977Dietary532525082557041Drug Info.545565200557025Echo Lab5266652666TEE lab/results52523Echo Results52680Echo Strest lab52679Echo Tech#5298Endoscopy5318858358EP consults52626EP lab52390, 50680EEG583285832857305ER533745147750681ER South59726FISH Cytology60680General Info. 536035881157555Gyn On Call#5741GynOnconcall#5548Hematology 5471459292Home O2 EvalP#9140IR58899Immunology30374KCI Hospice (248) 827-7722Lab Results 541005459857202Life Stress548115481154811DRHHarper HutzelMicrobiology 307003070057202Medical Rec. 5328558022Molecular Genetics32631MRI - inpatient51367MRI – outpatient51376Neuro – Radiology62807Nuclear Med.5841757191Nuclear Stress test52326Nutrition53254Occ. Therapy 535235824257020OMFS54696OR boarding 531825260057279Ostomy nurse95192Pastoral Care 52905#506657279Pathology5894059592Patient Info. t65148Physical Tx. 535355805857020PICC line97547PM&R51000(RIM)Poison control 800-222-1222Pulm. Funct. 547615851657417Radiology546855840257417Rad. Onc.591915919157626Recovery531885852557531Resp. Ther.P#9827 #914057417Security533255835257031Shuttle Bus58353““Smoking Ces. 585165851658516STAT Lab302885855559288Social Work 535755831357051Telepage551515515155151TB/AFB lab30994Ultrasound534655946157558US Tech59513Vascular Lab 534655882857305Virology30710VNAP#6374Internal Medicine Resident Survival Guide- 10 -
INFORMATION SYSTEMS CONTACTCitrix/CIS Helpdesk 966-2400Chris Harwood (DRH physician support)Pager #97530MSIS Helpdesk577-1527 (for GMAP EMR/NextGen & WSU email)TECH TIPS*INSTALLATION INSTRUCTIONS for Citrix on iPad/iPhone1. Go to the App Store and download the latest Citrix Receiver.2. Once the Receiver is installed on your mobile device, click on the icon “CITRIX”on your mobile device. Then click “Get started.”3. The following screens will be for configuration, please use the followinginformation:a. Description: Can be any name; suggest DMC Citrixb. User Name: Your DMC Citrix UserIDc. Password: Your DMC Citrix passwordd. Domain: DMCNT14. Click “save” when all information is entered.5. Now the device is ready!6. Once you click DMC Citrix and enter your credentials, the list of applications willshow up.7. Click the “ ” sign at dazzle and “ ” sign in the list to add to your favorites.8. Click on the Citrix Desktop Icon to launch DMC’s Citrix Desktop on your device.Note: When you change your DMC Citrix Desktop password, you will need to go into youriPhone/iPad Citrix Receiver account and update it.NextGen access from Mac:Two options:#1. Remote Desktop that is pre-existing on your Mac (disadvantage is that you may noticeit doesn’t permit FULL screen - like you get when you are in GMAP. It limits how much youexpand the window). If there is some way to make it FULL screen, I haven’t looked into it,but my computer refuses to do it. But luckily in the meantime, I discovered this upgradedversion, which is Option 2.#2. Remote Desktop app that you can download from App Store. This new app allowsFULL screen, just like you see in the clinic itself, and is much nicer to have. Only problem isit often disconnects or becomes static if you let it idle for more than a couple minutes. Ihave a big screen monitor at home, so I started using this.OPTION 1:1. Using the magnifying glass icon on top right corner (the Macbook search icon), searchfor “Remote Desktop Connection”2. In the window that opens, type: emr.med.wayne.edu, then hit Connect3. In the login window that pops up:- User Name: same as your med.wayne.edu email usernameInternal Medicine Resident Survival Guide- 11 -
- Password: same as your email password- Domain: type in “MED”4. Now you’re in the Remote Desktop, then you can go through the second login that takesyou inside NextGen, just like in clinic.OPTION 2: (better if you want the full screen)1. Go to the Macbook App Store (you can find it on the bar of icons on your desktop, or byusing the Search icon)2. Type in Microsoft Remote Desktop3. Install the app with the red-colored icon (it’s free)4. Open the app (if you can’t find where it installed, use the Search icon to locate it). Gothrough whatever installation questions that remain.5. Once it opens, Click “New” (the plus-sign icon on the top bar of the app). This allows youto add NextGen as a favorite Remote Desktop6. In the window that opens, fill in the boxes as follows:- Connection name: (name it anything you want, like - “Tania’s NextGen Connection”)- PC name: “emr.med.wayne.edu"- Gateway: No gateway configured- Username: "med\(your med.wayne email username)”- Password: your med.wayne email password- Resolution: Native- Colors: True Color (24 bit)- Full screen mode: OS X Native- Start session in full screen to be checkedIf you want to use Citrix at the same time, or do other things on the computer while onNextGen Full-screen, you can always do it on a duplicate desktop - if you press the F3button on your keyboard, on the top you may see Desktop 1, Desktop 2, Desktop 3, and soon clicking on any of those opens a fresh new desktop and allows other things to beopened in parallel. Press F3 again to go back to the other desktops as you need.Assigning another provider to your NextGen Inbox and PAQ while you are away:In the inbox: 1. click on the button next to Tasks2. Select Out of Office Schedule from the list3. Select the delegate name4. Click ADD under the appropriate sections5. click OK6. Don’t forget to switch backFor more NextGen tips, refer to wsumed website**Nathaniel Lewis can help with technical issues for NextGen: 248-581-5733Internal Medicine Resident Survival Guide- 12 -
USEFUL WEBSITES: https://login.wayne.edu/https://login.wayne.edu/ www.wsumed.com - password wsumed. This website has tech tips,schedules, voluntary opportunities, guides, updates from Resident SteeringCommittee, Board Review, Clinical Question of the Month, Patient Safety info,Research Corner, Procedures, Morning Report Blog The Hospital Physician Journal: http://www.turner-white.com/hp/contenthp.php The Cleveland Clinic Journal: http://www.ccjm.org/default.asp Mayo Clinic Proceedings: http://www.mayoclinicproceedings.com/ Evidence Based Medicine Resource: http://www.supersmarthealth.com/ Medline Plus: hinformation.html Emedicine: http://www.emedicine.com/ National Guidelines Clearinghouse: http://guidelines.gov/ The Cochrane Library: 106568753/HOME?CRETRY 1&SRETRY 0 Clinical Knowledge Summaries: http://www.prodigy.nhs.uk/home Center for Reviews and Dissemination: http://www.crd.york.ac.uk/crdweb/ The Ectopic Brain: http://pbrain.hypermart.net/medapps.html Medical Calculator: www.medcalc.com DMC Pharmacy guidelines (great for antibiotic use at DMC!!):http://intraweb/default.aspx?ifscc /pharmweb/http://intraweb/default.aspx?ifscc /pharmweb/ For resident perks: https://tenet.corporateperks.com/ DMC Perfect Care: dmcperfectcare.orgMicromedex – access through citrix for free accessTo make notes that you can access on any electronic equipment, consider programslike: evernote.comApps:NI GME – to document hoursDMC perfect careEpcorates for medsASCVD Risk EstimatorAHRQ ePSS – for screeningUptodateLibrary website from intraweb has some info: http://intrawebcns/MobileGUIDELINES:There are many!A useful place to start is The National Guidelines outlook.office.com/owa/Internal Medicine Resident Survival Guide- 13 -
LOGGING PROCEDURES and DUTY HOURS:New Innovationshttp://www.new-innov.com/login.htm Institution login: DMC (all capital letters) Username PasswordJOHN HOPKINS MODULES:http://www.hopkinsilc.org/ Click on "click here to register" if you are a first time user. When you log in you must select the ILC group you are interested in. (i.e.Internal Medicine Curriculum or Internal Medicine: Medicine ConsultationCurriculum)**residents are responsible for completing the John Hopkins Modules assignedevery 5 weeks. These will be assigned each academic year.CIS & CITRIX AT HOME:www.dmc.org/staff Click on Remote Access to CIS Type username and passwordPACS Web CONNECT: Call 966-2400 to have your account added to the “Vital Clinical Users” Log onto the DMC Citrix Desktop Double-click the PAC Web CONNECT icon. (CXR picture) You do not have to login on the next window, Click “OK”PHARMWEB: Fantastic medication guide for all specialties Log into CIS Enter the Internet and Web-Portal Click on Intraweb tab (at the very top of the page) Click on the “Pharmacy” tab Use the drop down menu to click “Pharmacy Website”HOSPITAL POLICIES:Detailed explanations can be found on the DMC intraweb. Click into the DMC web Portal Click the “Clinical Tools” Tab “Search” Policies in the lower left of the screenInternal Medicine Resident Survival Guide- 14 -
Harper Hospital Nursing Units10 Webber North 576-922910 WebberSouth515096Brush521475 Webber North92135 Webber South5 Brush North5 Brush South4 Webber North4 Webber South4 Brush North3 Webber North3 Webber South3 Brush2 Brush North2 Brush South2 Webber North2 Webber South576-DRH Nursing 115299053093Harper Hospital Intensive Care Units9 ICU58792Cardiothoracic8 PCU652036 ICU586945 ICU4 ICU52297585684T5Q5R4Q-2Burn Unit Step DownCoronary ICUMedical ICUSurgical ICU58849Hemodialysis9 Webber North92509 WebberSouth8 Webber North91268 Webber South576-52277576-56057DRH Intensive Care Units4PSurgical ICU4Q-1Surgical ICU5TNeurotrauma4SBurn UnitSubspecialty Clinics Cardiology, 4C Endocrinology, 4C GI Endoscopy Unit Heart Failure DRH 358745-4525745-3090 47On Call # after 5 p.m. #5456Hem-Onc Clinics 1-800-KARMANOSPulmonary, 4C745-4525Geriatrics, 5B745-1741Neurology745-4275Internal Medicine Resident Survival Guide- 15 -
Infectious Diseases Vaginitis Clinic HIV clinic Nephrology, Ste 917 Transplant Clinic Rheum, Suite 917 General SurgeryVA -7227PDI/Highland Park852-7700 Urology833-3320Outpatient Dialysis Centers CAPD Clinic-Gambro/Motor City Dialysis993-2958 Gambro/Kresge745-1885 Harper Pro Building 013/09/Phone-numbers-VA-update.pdfVA paging system: For 5 digit numbers dial 61135 followed by the 5 digit number followed by your call backnumber. For paging a 7 digit VA pager dial 9 followed by the number and leave a call back number. For paging aDMC pager (4 digit number) dial 7450203.Internal Medicine Resident Survival Guide- 16 -
Phone Numbers of Outside Hospitals/Medical ExaminerBiCountyMedical RecordsEmergency RoomHospital586-759-7370586-759-7310Medical Examiner313-833-2568(Call if death is a result of trauma,suicide, or within 24 hrs. ofadmission)Bon SecoursMedical RecordsMR Fax NumberEmergency 05KarmanosMedical Records1-800-527-6266313-576-9393BotsfordMedical RecordsEmergency e StateHospital248-349-1800BeaumontMedical RecordsMR Fax NumberEmergency 440OakwoodMedical RecordsEmergency ��s ERAdministrationPt. informationMedical -5356ProvidenceMedical RecordsEmergency 5-1203RiverviewMedical RecordsEmergency ceMedical RecordsEmergency Dept.313-966-3300313-966-1092313-966-1010St. John’s MainMedical Records313-343-3400313-343-3780DRHTriageCrisisER x-rayFaxMedical -3423313-745-4038313-745-3285Detroit Psych Insitute313-874-7500Garden CityMedical RecordsEmergency Dept.734-421-3300734-458-4405734-458-3426Henry FordMedical RecordsAfter Hours MREmergency 545Herman Keifer313-876-4826St. John’s MacombEmergency Dept.586-573-5051Medical Records586-573-5080Internal Medicine Resident Survival Guide- 17 -
St. Mary’sMental HealthSocial 876-0335Holy CrossMedical RecordsEmergency Dept.313-369-9100313-369-5727313-369-5689Huron ValleyEmergency Dept.284-360-3400HutzelMedical RecordsEmergency Dept.313-745-7141313-745-0680U of MMedical cal RecordsEmergency Dept.734-655-9253734-655-1200St John’s OaklandMedical RecordsEmergency 13-576-1000Poison Control(HPB)St. Joseph Pontiac313-745-5711Wyandotte734-284-2400Hospice KCI248-827-7722Southeast MIHospice313-578-6300248-858-3000Detroit Area Methadone ClinicsMY FREQUENTLY CALLED NUMBERS:LOCATIONHerman Keifer HospitalMedical Resource CenterMethadone ClinicMetro-EastMetro-East GratiotMetropolitan Rehab ClinicsMich Counselling ServicesNardin Park Drug AbuseNew Light Recovery CenterParkman CounsellingRainbow ClinicSt. Joseph MercyStarr ClinicVA Methadone 0576-1000 ext5252Internal Medicine Resident Survival Guide- 18 -
SECTION 2: Rotation InformationGUIDE TO ROTATIONS:4 1 SchedulingResidents are divided into 5 cohorts (Blue, Green, Purple, Red, and Yellow)Residents will be assigned to general medicine floors or subspecialties rotations for a 4week block which is then followed by 1 week of clinic (hence 4 1)The clinic week overlaps a full weekend, so each resident is guaranteed a “goldenweekend” with two days off in a row every 5 weeksMEDICINE FLOORS1. Get to the hospital on time.2. See new patients/sicker patients first3. Existing patients: Check orders, read nurse’s notes from your shift andovernight, vital signs, progress notes, focused physical exam. If you are not ableto write your notes on all patients prior to rounding, make sure you check thevitals, and do a focused exam. Then, check labs just before rounds.4. Pre-round on patients with your senior as directed by your senior5. Be ready to round with your attending in order to get to morning report on time.6. Morning report: Put your pagers on vibrate. Leave for morning report 5 minutesearly. The morning reports are a golden opportunity to review patient cases,articles, and actually talk through it. This is your time, so it can only be as goodas you make it. Ask questions. And as uncomfortable as it may be when someof the higher ups pimp you, know that you are learning something every time youare unsure of the answer - hey, you probably won’t forget it the next time around!7. Rounds with attending. You have to keep the attending moving and on pace.Remind them that you need to be at morning report/noon conference andindicate the sickest patient that will require the most time on the list.8. Grand Rounds and other resident year specific lectures: Again, try to make it.Put your pagers on vibrate. THIS IS SUPPOSED TO BE “PROTECTED TIME”for your education. Leave so that you can make it. Most attending aresupportive, but if they are not, politely explain this is mandatory and you mustsign in daily.9. Recheck any labs, procedures, write follow up orders, finish notes.10. Be available to take sign-outs from your colleagues.Internal Medicine Resident Survival Guide- 19 -
ooooDRH:There are 4 teams, each with 1 senior, 2 interns. One team will be on call every4th day until 8pm when night float arrives.Call teams will begin admitting at 3pm and stop at 6pm and can admit amaximum of 7 patients for the call period.Patients admitted after 6pm can be triaged with orders by the senior and held fornight float. Night float at DRH will cap at a total of 5 patients, or a total call teamcap of 7 new patients for the call period. Note that the night float is an extensionof the call teamHarper:Interns will be reinstated at Harper. Team structure and call details are yet to bedetermined.VA:oooooooooooThere are 4 teams, each with 1 senior, 2 interns. One team will be on call every4th day until 8pm when night float arrives.On call team will start admitting at 2pm and stop at 6pm to allow for adequate timeto work up all the patients and leave on timeTotal number of patients for the on call team will be 9 patientsOn call team will admit 5 patients till 6pm (will be at senior resident discretion howthe patients get distributed between the interns)On call team will stop admitting new patients at 6pm to prevent violatingmandatory short breakFrom 6pm MOD for the day will start admitting till night float team comes in at 8pmNight float will admit total of 5 patients, should have zero patients waiting on arrivalat 8pmOnce the night float team reaches the cap of 5 patients, MOD will again admit restof the nightAs the total team cap is 9 patients, the on call team will receive 4 patients fromnight float the following day to meet the total number of 9 patientsThe other patient admitted by night float and any patients admitted by MOD willbecome overflow to be distributed to the non-call teams.In the event the on call team gets total of 9 patients before 5pm, the senior residentis expected to have admissions orders entered for all 9 patients and call the MODat 5pm to hand off the other 4 patients to be admitted by MOD.BouncebackInternal Medicine Resident Survival Guide- 2
Internal Medicine Resident Survival Guide - 9 - Department of IM 745-4832 Housestaff Office 4201 St. Antoine Fax 745-4052 DRH 5S10 745-3265 2E UHC Harper 2 Hudson 745-8334 Detroit, MI 48201 VAMC C3-100 576-3450 DMC Medical Records (Inpatient) Michelle Balan 745-4832 DRH 745-3285 .
