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Welcome to MSKCC!

Welcome to MSKCC!. Department of Medicine Orientation. Orientation Overview. GME – Folder and Forms The Medicine Service at MSKCC A Day in the Life of Interns & Residents Being on Call Being on Night Float Nuts and Bolts – Last Minute Tips Computer stuff. GME – Folders and Forms.

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Welcome to MSKCC!

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  1. Welcome to MSKCC! Department of Medicine Orientation

  2. Orientation Overview GME – Folder and Forms The Medicine Service at MSKCC A Day in the Life of Interns & Residents Being on Call Being on Night Float Nuts and Bolts – Last Minute Tips Computer stuff

  3. GME – Folders and Forms • Sign confidentiality agreement • Sign DEA acknowledgment (2 pages) • Blue prescription card • White card of important phone numbers & HIS user ID • Fill out contact information sheet

  4. GME – Folders and Forms • Supplies Requisition Form – scrubs/whitecoat • Sheet of Life • Chemotherapy Cheat Sheet • Code/Consult Responsibilities • Night Float Information Sheet • Electives Information Sheet • Pager Forwarding Instructions

  5. The Structure of the Medicine Service

  6. Structure of the Medicine Service • Internal Medicine Programs at MSKCC New York Presbyterian Hospital – Cornell New York University St Luke’s Roosevelt Hospital Beekman Hospital SUNY Downstate Hospital Methodist Hospital New York Hospital – Queens Jacobi Hospital MSKCC has six Transitional Year Interns rotating through Medicine

  7. Structure of the Medicine Service Medicine Housestaff Services: Gastrointestinal/Sarcoma  GI A & GI B Allogeneic Bone Marrow Transplant Breast Genitourinary/Head and Neck Leukemia Lymphoma

  8. Structure of the Medicine Service Medicine Nurse Practitioner (NP) Services: Thoracic Oncology (Lung) Autogeneic Bone Marrow Transplant/ Melanoma/Multiple Myeloma/Benign Heme

  9. Structure of the Medicine Service Housestaff Service Pairing (for call and weekend cross-coverage) 1. GI & Allo BMT 2. Breast & GU/H&N 3. Leukemia & Lymphoma

  10. Structure of the Medicine Service Medicine Team Structure: Service Attending Oncology Fellow (except GI) Resident (1-2) Intern (2-3) Nurse Practitioner Social Worker/Case Manager

  11. Structure of the Medicine Service Nurse Practitioners DO take elective chemo admits DON’T take acute admissions from UCC work weekends (their patients are covered by housestaff or fellow)

  12. Structure of the Medicine Service Fellows Mentor - Supervisor - Teacher Round on Saturday, off Sunday Address management questions Supervise new admissions Supervise housestaff procedures if not certified Write Saturday notes on NP patients

  13. Structure of the Medicine Service All services include 2 residents (except GI A, GI B, AlloBMT) Both residents should supervise both interns and work as a complete team For continuity of care, do not divide the service!

  14. Structure of the Medicine Service Sub-Interns Take call with their residents Maintain their own signout with a maximum of five patients Orders will be entered by resident Not allowed to give verbal orders

  15. A Day in the Life

  16. A Typical Day 7 am Sign In DOM Library Residents  pick up NF admissions Interns  pick up signouts Sign in Service Pagers 7:30 Pre Rounds Interns Round on patients Residents  see Night Float admissions* 8 am Attending rounds begin on floors 11 am Morning Report (Residents M/T/W, Interns on Thursday) 1pm Core Curriculum Conference & Lunch 2 pm Case Manager/Discharge Rounds (residents) 2-5pm Admissions, daily work, chart rounds, review signout w/resident 5 pm Signout to NF Interns (weekdays) – Sign out Service Pagers 8 pm Signout to NF Interns (weekends) – Sign out Service Pagers *For Off-Service patients, Resident should scribble a quick note in the chart establishing who the primary team is and what the contact pager will be – either their pager or the interns.

  17. Attending Rounds AM Rounds – each patient is seen by the team Interns are allowed to do “work” when their patients are not being discussed PM Rounds – “card flip” rounds Usually take place ~ 4:30 pm

  18. Being On Call

  19. Being “On Call” at MSKCC Call Schedule: www.amion.com password: sloan2 No overnight call Weekdays: 4pm – 8pm Weekends: 7am – 8pm Admissions Types: Service or sister-service admissions Nurse Practitioner Service “Off Service” General Medicine Admissions

  20. Being “On Call” at MSKCC “Off Service” Patients +/- underlying malignancy diagnosis Admitted with General Medical diagnosis (GI bleed, COPD exacerbation, etc) Covered by housestaff (usually AlloBMT) Admit order should include “off-service”

  21. Being “On Call” at MSKCC CODE/CONSULT Resident Code Leader: Weekdays 4pm – 8pm Weekends 7am – 8pm Consults: Cardiology, Renal, Gen Medicine Only NEW consults from non-med services Consults from med services should go directly through medical resident Evaluate the patient – then you MUST call the page operator to speak with the attending on call for that service Pick up the code/consult pager from Chiefs at 4pm Sign out code/consult pager to NF resident at 8pm

  22. Admissions H&P Only need one note (intern or resident) Document PMHx, PSHx and past ONC history Document ROS Complete Physical Exam including neuro evaluation Calling the Attending Questions about management should be directed towards the inpatient service attending Attendings should be made aware of any significant change in patient status

  23. Elective Residents Primary responsibility is to elective to which you are assigned May attend Morning Report and Core Conference Take an average of 5-6 calls/month, including weekend calls Look for your call schedule by your NAME ELECTIVE CALL, SERVICE CALL, GI ROUNDS MUST signout your admissions at 7am in the DOM Library when you are post-call

  24. Weekends at MSKCC No Golden Weekends Weekend Rounding Schedule: posted each week on Monday NP patients: residents pick up NP signout Sat & Sun NP notes: Saturday  Fellows Sunday  Residents

  25. Being on Night Float

  26. Intern Night Float Shifts: Weekdays: 3 interns; 5pm – 7am Weekends: 2 interns; 8pm – 7am No Admitting responsibilities Cover housestaff and NP patients

  27. Intern Night Float You’re never alone!! NF interns are paired with a NF resident Chief Rounds: 5:30 – 6pm in Library Reminders: always check your lists see every fever – and DOCUMENT it! if patient status changes, have a low threshold for calling the attending

  28. Resident Night Float Admit to Medicine Services: Service or sister-service NP service Off Service ICU transfers Cover intern night float Acts as Code/Consult Resident Signout admissions - DOM Library @ 7am

  29. Resident Night Float Night Float Resident Journal Club Wednesday 7:30 – 8 am Code/Consult Resident will present Articles chosen from GenMed literature Night Float Resident Rounds Tuesday, Thursday, Friday 7:30 – 8 am Brief presentations of overnight admissions with discussion of differential diagnosis and management issues

  30. Night Float at MSKCC DO NOT SLEEP IN HALLWAYS OR LIBRARY!!!!!! On Call Room Located on M1516 Ask chiefs for password ONLY for medicine housestaff

  31. Nuts & BoltsLast Minute Tips

  32. Pager Forwarding Pick up Service Pagers at start of rotations: ex. GI A Intern #1  9161 Lymphoma Intern #2  9122 With signouts, forward pagers: 5-8 pm: GI A Intern #1  NF Intern Coverage signout and forward pager 7 am: NF Intern Coverage  GI A Intern #1 signout and forward pager *Leave pagers in DOM Library **NF Interns : Do not accept signout without pager forwarding

  33. IDs, Coats, Scrubs, Food… ID Cards: Security 9am – 3pm for pictures Whitecoat/Scrubs: General Stores On Call Meal Cards: ask Chiefs Information/Paging: see Sheet of Life

  34. Neutropenic Fever Examine & evaluate each febrile patient use “fever” stickers NO rectal exams for neutropenic fever stool can be sent for guaiac Neutropenic fevers: Double gram (-) coverage i.e. Zosyn & Amikacin

  35. Infection Control Hand Washing is IMPERATIVE!! Follow contact precautions located on each doorway Approval for ID Abx (9am – 5pm) Beeper # 1100

  36. Last Minute Survival Tips Renew IV fluids, IV drips, PCA’s and order Coumadin daily Order “am labs” the day before Keep Type and Screens up to date (q72hrs)! Dress professionally: no GREEN SCRUBS

  37. Note Writing Avoid ERROR-prone abbreviations: avoid “qd”  use “daily” avoid “MSO4”  use “morphine sulfate” Write notes legibly!! Date & TIME every note! Include your NAME & PAGER # with every note

  38. Death & Dying Identifying with young, dying patients DNR discussions “Coping with MSKCC” lunch Q2 weeks with Rachel Odo – social worker Our door is ALWAYS OPEN! Confidential!

  39. Last Minute Survival Tipscont’d DNR discussions: • Housestaff have authority to write DNR orders. Document discussion with patient in the medical record and note change in status in the order book • If this should happen after hours or over the weekend, call the covering attending to notify them of the change in status. • Always do what is in the best interest of the patient!

  40. Memorial Sloan Kettering Cancer Center The Best Cancer Care Anywhere Means You!

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