INTRODUCTION
The Sinai-Grace hospital Internal Medicine Training Program offers you training of exceptional quality and balance. Our goal is to provide an optimal, individualized educational experience, humane work scheduled without compromising training standards and to develop competent internists who combine excellent interpersonal skills with superb clinical acumen.
The Sinai-Grace based program in internal medicine is fully
integrated with
The Sinai-Grace based program includes a strong general
medicine inpatient service, a complete range of medical specialties serivices,
and a busy ambulatory center for outpatient training experience. The program is
supervised by over 25 full-time and part-time Sinai-Grace based faculty. All
educational, research and service activities of Sinai-Grace Internal Medicine
Training Program are under the direction of the office of the Chief of Medicine
at
Physician Title/Specialty
Hematology/Oncology
Mohamed
Siddique, MD Program
Director, Internal Medicine Training Program;
Chief of
General Internal Medicine
Marc Feldman, MD Associate Director; Internal Medicine Training Program;
SGH Year III Medical Student Clerkship Coordinator;
General Internal Medicine/Geriatrics
Director, Sleep Laboratory;
Geetha Krishnamoorthy, MD Director, Internal Medicine Board Review Course;
General Internal Medicine
John Haapaniemi, DO Section Chief, Pulmonary/Critical Care Medicine;
Chief of the Medical Staff, SGH
Thomas Piskorowski, DO Medical Director, MICU;
Pulmonary/Critical Care Medicine
Elie Aboulafia, M.D Director, Vascular Laboratory
Antonio Carrillo, MD Section Chief, Cardiology
Marc Meissner, MD Cardiology/Electrophysiology
Hassan Makki, MD Pulmonary/Critical Care Medicine
Director, MICU
Manuel Sklar, MD Section Chief, Gastroenterology
Anupam Suneja, MD Geriatric Medicine
DEPARTMENT OF INTERNAL MEDICINE
The Department of Internal Medicine is the largest medical
department at
Ambulatory Medicine
One half day each week, residents have office hours at the
medical clinic in the Sinai-Grace Primary Care Center which is located at
Additional elective outpatient rotations are available with numerous private attending physicians, and many subspecialty clinics are also available.
Critical
Our 51 bed state-of-the-art critical care units are staffed by intensivists, pulmonologists and cardiologists. The center offers clinical experience with an array of critically ill patients with medical, cardiac, trauma or post-operative problems. Our critical care units include the Surgical Intensive Care Unit, Medical Intensive Care Units, Cardiac Intensive Care Unit and the Intermediate Medical Care Unit.
Intermediate Medical Care Unit
This 28-bed step-down unit complements the critical care unit and is staffed by full-time faculty.
This 41-bed unit complements the Cardiac Care Unit and is staffed by physician assistants and/or full-time staff physicians.
The hospital maintains an active inpatient, acute/chronic dialysis unit. Our residents are exposed to all the complexities of management of these patients.
PROGRAM DESCRIPTION
The goal of the
The quality of our resource base is unparalleled in the region, including patients, facilities and faculty. The program offers the necessary depth of knowledge and experience to pass the American Board of Internal Medicine (ABIM) certifying examination with the flexibility of achieving individual goals.
WHAT IS INTERNAL MEDICINE?
· The largest primary care specialty in
the
· Is an ever-changing and rapidly advancing discipline.
· Involves the diagnosis and non-surgical treatment of all illnesses in adults and adolescents.
· Its practitioners must continually update their knowledge in many areas including:
· Allergy
· Arthritis
· Blood diseases
· Cancer
· Diabetes
· Digestive diseases
· Illness in elderly
· Diseases of the heart and blood vessels
· Hormonal disorders
· Hypertension
· Infections
· Intensive Care
· Kidney diseases
· Respiratory disorders
· Internal medicine also incorporates an understanding of:
· Wellness (disease prevention and health promotion)
· Substance abuse
· Mental health
· Medical ethics
· Women’s health
· Effective treatment of common problems of the eye, ears, skin, nervous system and reproductive organs
Residents have several options to get help if they feel their resources are inadequate to cope with their workload during an in-house call or they are uncomfortable with a particular clinical or administrative situation:
1) The resident can contact one of the three CMRs who can provide advice and/or direct additional resources to assist the resident.
2) The resident can contact the IMCU attending physician, who is an attending physician caring for patients in Intermediate Medical Care Unit, and who is physically present in the hospital. The IMCU attending physician’s job description includes providing support to any of the medical residents on in-house call when necessary.
3) The resident can contact the physician administrator on-call for the department of medicine. This is a senior faculty member who is available by pager or phone to help with administrative issues primarily but can also assist with clinical problems. The physician administrator call schedule is posted on-line and in the department of medicine.
4) The resident can contact the program director, either of the two associate program directors or any of the senior faculty members by pager or phone. All of these individuals have made commitments to help any medical resident requesting assistance.
Contact information for all of the individuals mentioned above can be obtained on-line from the DMC corporate directory, from the Hospital communications operator and from the department of medicine pocket phonebook that is published and widely distributed annually.
WHAT IS AN INTERNIST?
An internist is someone who is:
· A trained specialist who possesses a personal and long-term commitment to patients, broad knowledge and skill in diagnosis and treatment, and has a caring bedside manner which encompasses the humanistic qualities of integrity, respect, compassion, sensitivity and listening.
· Trained to treat both the common and the complex illnesses and offers high quality primary care to adults and adolescents in the office or clinic, during hospitalization, in long-term and in hospice care facilities.
· Trained to be non-judgmental in understanding human behavior which enables them to help people alter harmful behaviors and to motivate patients to get and stay well.
· A coordinator of patient care when other medical specialists, such as when surgeons, are involved in the care of a patient.
· Often serving dual roles as primary physicians to patients and as medical consultants to physicians in other specialties.
PHYSICIAN IMPAIRMENT: BEING AWARE
· Over 100 articles in the past decade have been published regarding substance abuse among medical students, residents and practicing physicians.
· Identification of substance abuse is always difficult.
· Recognition of commonly described signs of substance abuse is important. These signs include:
· Poor rapport with patients and families
· Unreliability
· Frequent absences
· Inappropriate appearance
· Inability to work collaboratively with other health professionals
· Inadequate preparation
· Inability to adequately plan a patient assessment
· Inability to implement management plans
· Awareness of these signs, and sudden changes in performance, is essential in reporting concerns about a colleague’s behavior and competency to the program director. This information can lead to:
· Timely, appropriate and helpful intervention.
· Recognition and intervention can achieve the ultimate goal of rehabilitation and recovery for the physician in training.
PROGRAM
OVERVIEW
The emphasis at this level of training is the application of the knowledge acquired during medical school. This is accomplished through rotations on the general medicine wards. Emergency medicine and critical care rotations provide in-depth exposure to acutely ill patients. During each ward rotation, our residents function as a team consisting of two PGY-Is and one PGY-II or III. The team approach is the foundation for all our medical services. Attending staff is available 24-hours a day. Teaching and patient care rounds are conducted daily.
The rotations for the PGY-I year are listed below:
General Medicine - 6 months ED - 3 or 4 weeks
Cardiology Floor - 1 month MDM - 1 month
MICU - 1 month Psychiatry - 3 or 4 weeks
Vacation 3 weeks Elective 1 to 2 weeks
The major emphasis at this level
of training is the expansion of each resident’s knowledge base and
development of teaching and leadership skills.
Subspecialty rotations are the basis for the
The rotations for the PGY-II year are listed below:
General Medicine - 3 months Pulmonary - 1 month
MICU - 1 month Endo - 1 month
Cardiology Floor - 1 month ID - 1 month
Heme/Onc - 1 month Neurology - 1 month
Nephrology - 1 month Vacation - 3 weeks
The major emphasis at this level of training is the consolidation of each resident’s knowledge base. Each resident assumes the role of a unit supervisor, teacher for first year residents and medical students, and provides consultations to other services.
The rotations for the PGY-III year are listed below:
General Medicine - 2 months Rheumatology - 1 month
MICU - 1 month Geriatrics - 1 month
Cardiology Floor - 1 month Elective - 4 month
Gen. Medicine Consults 1 month Vacation - 3 weeks
GENERAL MEDICINE WARD ROTATION
PURPOSE
The purpose of the General Internal Medicine Ward Rotation is to provide an intense and broad inpatient experience resulting in the acquisition of knowledge and skills necessary to manage patients with complicated multisystem diseases.
TEAM STRUCTURE
• Team Leader – PGY-II or PGY-III medicine resident
• Two (2) interns
• One sub-intern (WSU year 4 medical student; depending on student scheduling).
• One or two WSU III year 3 students (depending on student scheduling).
• One or two PA students, podiatry residents or pharmacy interns
Each team will have one teaching-attending physician assigned for the month. There will be six or seven “A”-Medicine teams on the wards at all times.
CALL SCHEDULE
Long Call
• Every 7th day. Starts at
• Admission Cap: 10 patients per team.
Long call team starts code blue coverage at
Short Call
• Twice per week beginning at
DAILY SCHEDULE
Work Rounds
• Should start promptly at
• Rounds last until
• On post-call days, work rounds will be conducted by the teaching attending. All new patients admitted on the call day will be discussed. The post-call team should have seen their old patients preferably prior to work rounds with their teaching attending.
Morning Report
• This is a mandatory conference held
on Monday, Tuesday, Wednesday, Friday and Saturday which begins at
• On Thursdays, Medical Grand Rounds
are held in the Ground Floor Auditorium from
Peripheral Smear Slide Rounds
• The schedule for peripheral smear rounds is distributed by e-mail and posted in the Department each month. The teaching microscope is located in the small conference room. You will have these rounds weekly when assigned to the medical wards. Your team’s assigned day is linked to your call day for the month. These rounds are mandatory.
• The team should be ready with CBC data and all important peripheral smears of the patients admitted on their last call day.
• Peripheral smear rounds are conducted by a faculty member with expertise in evaluating blood smears.
Teaching Rounds
• Teaching rounds are conducted by the team’s teaching attending three times per week for 1.5 hours per session.
• Occasionally, teaching rounds may be conducted by a “visiting professor” from central campus.
• This is a mandatory conference from
• From
Chart Rounds
• Chart rounds should start between
• Patient charts should be reviewed for completion of planned activities. Problem lists should be updated.
• This time should also be used for relevant teaching by the resident.
Sign Out
• Interns should give a detailed written and verbal sign out to the corresponding intern on call after 5:00 pm. Residents should give sign out to the resident on call if any serious problems are anticipated.
RESPONSIBILITIES
Non-Call Day
1. See the assigned patients, check
lab/radiological studies and be ready for work rounds by
2. Present patients on rounds and take notes on things to be done that day. Round with charts and write orders during rounds.
3. Attend all conferences/teaching rounds as described.
4. Write notes on all patients daily using “SOAP” format.
5. Carry data cards for all patients (available in Medicine office) or use an PDA (e.g. Palm, Clie or pocket PC) to tract patient data. Data should be updated daily.
6. Procedures should be done by interns with resident supervision.
7. Attend chart rounds with resident, update problem list.
8. Fill out discharge instruction forms, medication prescriptions and dictate a discharge summaries on all patients upon their discharge from the hospital.
9. Give detailed written and verbal sign
out on their patients to the corresponding intern on call after
10. Communicate with attending physicians regarding patient care.
11. Write detailed transfer summaries, on-service and off-service notes and acceptance notes with a detailed impression and management plan.
Call Day
1. See the assigned patients, check labs prior to a.m. rounds.
2. Carry code blue beeper from
3. Finish follow up and notes on patients already on the service.
4. Interns will be assigned new patients by the residents. Interns should do a detailed H&P and write the H&P on all their new patients.
5. Required procedures (LP, central line, etc.) should be done with resident supervision. Gram stains; peripheral smears and x-rays should be reviewed with the resident.
6. Old charts of the patients who have been admitted to the hospital in the past should be reviewed and a brief summary of the old admission data should be included in the admitting H&P.
7. Service sheets and problem lists should be completed and placed in the chart for all admissions.
8. Cover 5797 for intern-A or 5799 for
intern-B (cross coverage beepers) after
9. Cross coverage is primarily done by interns with resident’s help.
10. Respond to all code blues.
11. Data cards (electronic or paper) should be filled out for all patients.
12. Code status (i.e. limitations placed on treatment) should be addressed in appropriate situations.
13. Attending physicians of all new patients should be contacted and the management plan discussed. You must always care for patients under the supervision of an attending physician.
Resident
Non-Call Day
1. Start work rounds promptly at
2. See all the patients on the service and formulate a management plan for the day for each patient during work rounds.
3. Attend all conferences/teaching rounds as described.
4. Help interns in carrying out the day’s activities, supervise and teach procedures.
5. Ensure the presence of the team at all conferences.
6. Make sure attending physicians are contacted about management plans, discharges and consults.
7. Teach interns and students during work rounds and chart rounds.
8. Conduct regular x-ray rounds.
9. Conduct chart rounds preferably on all days except weekends and post call days.
10. Work closely with sub-interns and co-sign all their orders.
11. Dictate discharge summaries for all charts not dictated by the sub-interns on their ward team.
Call Day
1. Carry code blue beeper from
2. See and examine all new patients including transfers assigned to the ward team, discuss management plan with interns and students and dictate detailed H&P.
3. Supervise cross coverage by sub-intern and co-sign their orders.
4. Review gram stains, peripheral smears and x-rays with the team.
5. Make sure attending physicians are contacted for all new patients and for problem cross-coverage patients.
6. Function as the code blue team leader, fill out code blue form, contact attending, family or MICU as needed and talk to family regarding an autopsy and organ donation, when appropriate.
The three-year experience at
EVALUATION AND EXAMINATIONS
1. Each resident is evaluated by all team members and the faculty rounder. Oral feedback is given mid-month and at the end of month. A webbased evaluation is completed at the end of each month using MyEvaluations.com.
2. Each PGY-1 is observed doing a complete history and physical examination at least once during their first year by a CMR or other faculty. Adequacy of clinical skills is evaluated by the observer.
3. All PGY-Is, PGY-IIs and PGY-IIIs take
the National In-Training Examination during October of each academic year. This is a standardized multiple-choice test
administered to medical residents across the
4. Each month an Internal Medicine exam is given to all interns and residents via the internet. One subspecialty area is covered per month. The answers are graded and feedback is given to the housestaff.
REQUIRED RESOURCES
1. A current standard textbook of internal medicine, such as Cecil’s or Harrison’s.
2. A manual of medical therapeutics, such as “The Washington Manual.”
3. Current journal articles provided by the Chief Medical Resident during morning report or by the residents themselves as apropos for interesting or complex patients seen on the medical team.
4. Current MKSAP published by the ACP-ASIM.
5. OHEP Internal Medicine Board Review Course which uses as its curriculum the “Mayo Internal Medicine Board Review” text.
NOTE: The last two sources are especially relevant for PGY-IIIs.
THE DAILY BULLET CASE PRESENTATION AND DISCUSSION
1. A bullet case presentation is a one minute oral synopsis of the patient’s initial presentation (signs & symptoms) to hospital.
2. For the discussion, each active problem is prioritized from most to least important and addressed in order of priority with the following components:
a. How the working diagnosis was made (physical exam, lab, or other studies) and what workup is underway to confirm the diagnosis.
b. Initial therapy.
c. Response or expected response to therapy.
d. Estimate of when the therapeutic goal for the problem will be reached so that the patient can be discharged from the hospital.
e. How the problem should be followed as an outpatient.
NOTE: The discussion should be concise and last about 2-3 minutes. Discharge planning starts when the patient is first seen on the floor (i.e., social service vs. home health care, PM&R, etc.)
4. Basic questions to consider to facilitate organizing your thought process:
a. Why is the patient here?
b. What are the patient’s problems?
c. What is being done for the patient’s problem?
d. What
has to be accomplished so the patient can go home?
e. When can the patient go home?
f. How will the patient be followed after hospital discharge?
g. Are there any financial or social barriers with regard to the post discharge plan?
If you can’t answer all of these questions, your evaluation of the patient’s clinical situation is incomplete.
WORK CONDITIONS
Duty Hours
All house officers have one full day (24 hours) away from hospital and outpatient responsibilities weekly. Duty hours will not exceed 80 hours per week including “on call” hours. An “On call” day will last no more than 24 hours and residents must leave the hospital within 30 hours of the start of “call” to go home and rest.
Post Call Day
Attending Work Rounds:
To be done on post-call day with attending rounder/faculty
between
Evaluation and Feedback
Mid and end month meetings with your rotation supervisor
provide immediate critique to residents about your current rotation
performance. The evaluation of your performance on the rotation will be done
using the MyEvaluations.com website each month. This evaluation will become
part of your permanent file. You should also meet with your advisor at least
quarterly. At each meeting an evaluation form will be completed (using
MyEvaluations.com) and signed by both you and your advisor. These evaluations
will be a permanent part of your personnel file at
Order Writing
All orders on teaching cases are to be written by assigned residents and students. See policy section.
Advisor-House Officer Program
House officers are assigned a personal advisor from among the full-time faculty. In concept, the advisor acts as a big brother/big sister, advising the resident in professional as well as personal decisions. Residents may select alternative or additional advisors. All residents and interns will meet regularly either with their advisor or a designated faculty member as described in Evaluation and Feedback above.
At that time, the house officer’s file will be reviewed for procedure logs, in-service results, evaluations, etc. The house officer’s goals, objectives, progress and/or concerns, etc., will also be discussed. A brief summary of this meting will be documented and signed by both parties. These evaluations become a permanent part of the personnel file.
NON-TEACHING SERVICE
PHYSICIAN ASSISTANT (PA) SERVICE
INTRODUCTION
Patients from nursing homes, stable patients requiring prolonged hospital stay may be admitted to B-Service which is covered by physician assistants (PAs). The PAs on this service function similar fashion to housestaff on the teaching service (i.e. they are responsible for writing progress notes, orders, on-going management, etc.). Housestaff have no direct responsibility for this service. However, house officers are responsible for pronouncing death (when requested by the PA) and for any and all code blues in the hospital. Procedures on B-Service medicine patients are to be done by A-medicine upon request.
Attending Physician of Record
• The physician who has accepted responsibility for providing care to the patient during the patient’s hospital stay.
• This physician provides feedback on the day-to-day management of the patient.
ADMISSIONS/TRANSFERS
Transferring patients from A-Service to B-Service does not occur except in rare cases that will be considered on a case-by-case basis by the chief medical resident. In the event the transfer is deemed necessary, the attending physician of record or his designee (i.e. covering physician) must be notified of the transfer.
RESIDENT
RESPONSIBILITY TO
“NON-TEACHING PATIENTS”
It is the policy of this residency program that residents manage patients that are assigned to a specific teaching service. In general “non-teaching” patients are the responsibility of physician assistants, moonlighting physicians and attending physicians.
Situations may arise when a “non-teaching” patient requires the immediate assistance of a resident. These situations are generally emergencies such as a cardiac arrest or a serious allergic reaction. In these emergent situations the medical residents have a responsibility to care for the patient. Whenever, a “non-teaching” patient is evaluated for transfer to the teaching service, the resident doing the evaluation will communicate directly with the “A-medicine” resident.
PROBLEM LIST
On admission, the problem list (Blue heavy stock paper) should be placed in front of all patient charts. All active problems should be listed in order of severity. Inactive problems should be listed on the provided column.
This problem list should be reviewed during chart rounds and should be updated (i.e., indicate if problem is resolved, add new problems, etc.). The problem list is part of the medical record and this should be filled out on a consistent basis. This is primarily the intern’s responsibility.
“AT RISK” LIST
PURPOSE: To provide coverage for the inevitability of a house officer’s illness.
1. Each month an “at risk” list is made of those Sinai-Grace residents who are on a non-call or research month. The purpose is to provide coverage for any resident or intern who cannot fulfill their duties because of illness. Sinai-Grace residents cover Sinai-Grace Hospital services (ICU, medicine wards, etc.) irrespective of whether the intern/resident who is ill is a Sinai-Grace based resident or a rotator, (e.g., Transitional, Anesthesia, etc.)
2. Interns will only cover interns. Interns cannot cover a resident.
3. Because of the limited number of interns available during a given month (they have few non-call months), PGY-2s and PGY-3s may be “at risk” to cover either an intern or a resident.
4. During the month you are “at risk,” you are expected to be available (i.e. available by pager at all times during the 24 hour period) on the assigned days. NO EXCUSES for unavailability will be accepted. The schedule is available early enough the previous month so that your plans can be made accordingly.
5. If you are sick on your “at risk” day, it is your responsibility to inform one of the CMR’s immediately about your illness preferably by 7 AM of your day “at risk” (Inform a CMR immediately if you become ill later during the day). Reporting an illness at the time you are contacted to fulfill your at risk responsibility will be regarded as unprofessional behavior.
6. The “at risk” intern or resident cannot switch or cancel their call without approval from the CMRs or the Program Director.
7. If the “at risk” intern or resident is not available for the call, the Program Administrators Committee (Program director, Associate Program directors, CMRs and Program administrator) to evaluate the circumstances and decide what action to take. Actions may range from a reprimand to formal probation for unprofessional behavior. Extra “at risk” day may also be assigned in future months.
8. Situations for which the “at risk” list may be used for coverage include but are not limited to: Covering call on an inpatient rotation and covering daily work for an inpatient rotation. The Program Administrators Committee (or its designee) will decide if the “at risk” list will be utilized in any given instance.
9. Rotations during which you will be placed on the “at risk” schedule:
a. Elective rotations (i.e., any non-call month)
b. Subspecialty rotations (i.e., any non-call month)
c. Research Rotations
DEPARTMENT OF
INTERNAL MEDICINE
ATTENDANCE POLICY
All time away from training must be approved by the Program Administrators Committee. In general, all requests for time away from training, for any reason, are to be made in writing and given to Carol Maurizio (or her designee) in the Medicine Education Office. Situations that occur suddenly, such as unexpected illness, should be communicated to the Medicine Education Office (i.e. Carol, a CMR) as soon as possible. If Carol or the CMRs are not available then you must contact one of the core faculty (i.e. Drs. Feldman, Munasinghe, Karim, Siddique, etc.). Your time away from training must be tracked as the ABIM has time-in-training requirements that are used to determine ABIM certifying examination admissibility (i.e. whether ABIM will permit you to sit for the internal medicine board exam).
It is recognized that occasionally it is necessary to attend to personal business during the week. This should be arranged well in advance and should be done during the afternoon, on a non-clinic day and after all required clinical responsibilities are completed. Coverage must be arranged with a fellow house officer. Both the time away and the coverage while away must be approved by one of the Chief Medical Residents.
Any unauthorized time away from training will result in loss of vacation time and/or extension of training. See the policy concerning the “At Risk” list for details of how call coverage is the achieved when a resident is unable to do “call” because of illness or personal emergency.
TIME-OFF POLICY
We recognize the need for residents to be away from their duties for a variety of reasons including personal illness, illness of a family member or other significant personal crises. In order to meet the requirements set by the American Board of Internal Medicine (ABIM) for eligibility for certification, RRC training guidelines and institutional patient care responsibilities, the following policy is established to govern time away from the training program.
1.
This policy shall go into effect
2. For the purpose of this policy, time off will be calculated in terms of days.
3. A week shall be considered to be seven days long – Sunday through Saturday.
4. The American Board of Internal Medicine permits a resident to be off a maximum of 91 days (or 13 weeks) during their 36 months of training and still be eligible to take the internal medicine certifying examination. Furthermore, the board requires that 3 weeks of vacation be taken each academic year. You may not forgo vacation to shorten your training.
5.
Effective
1. Planned Personal Days Away from Training
a. This time away from training is granted for requests deemed reasonable by the program administrator committee. This committee meets weekly and consists of the program director, the associate program director, the CMRs and the education coordinator.
b. Shall be taken during non-call months only.
c. A maximum of ten days may be taken over the 36-month training period.
d. Requests for planned personal days must be submitted to the Education Coordinator, Carol Maurizio, 35-days in advance.
2. Unplanned Personal Days Away from Training
a. Shall include personal illness, illness of child, etc.
b. Resident must notify one of the CMRs as soon as possible about an unplanned absence from the training program.
c. Should the resident have clinic scheduled on their unplanned personal day, they must notify the clinic faculty team leader as soon as possible.
3. Medical Leave
Requests for time away from training for medical reasons will be evaluated on a case by case basis by the Program Administrators Committee.
4. Completion/Non-completion of Rotation
The rounder will be responsible for noting on the evaluation form whether a resident has had an excessive number of days off from the rotation. These cases will be taken to the Program Administrator’s Meeting (PAM) for a determination of whether or not the resident will receive credit for the rotation.
5. Exceeding
91 days away from training
In the event a resident exceeds the 91 days away
from training, the time beyond 91 days will have to made up before the resident
can be granted admission to take the ABIM certifying examination. Any appeal of
this rule would have to be made directly to the ABIM as it is their rule not
the training program’s rule. The ROC and the program director must also
recommend graduating residents for admission to the certifying examination but
that recommendation is independent of the ABIM time in training requirements.
The ABIM policy is included in this manual for your edification.
AMERICAN BOARD OF INTERNAL MEDICINE
LEAVE OF ABSENCE POLICY
1. As of
2. To be eligible to take the ABIM certifying exam, minimum training duration will be 33 months. Any additional time away will need to be made up by extension of training.
3. Residents in programs with four weeks of vacation/year will have to either extend training or use vacation time (or a combination of the two) for LOA for any reason -- including parental or maternity leave.
4. The ABIM has basically taken the position that “. . . it is not educationally sound that such duties (maternity and child care) should substitute for training experiences, nor is it educationally justifiable that residents who do not use parental leave be required to train longer than those that do.”
5. Trainees will not be permitted admission to the examination prior to completion of the required training.
6. A resident that finishes the PGY-3 year by the end of August will be eligible to take the certifying examination with the class finishing the end of June. If the end date is in September or later, the candidate will have to wait to take the exam the following year.
7. Trainees will not be granted credit toward the thirty-six month training requirement for training or experience taken as a house physician, sub-intern, extern, research associate, etc.
8. Trainees will not be permitted to forgo vacation time to reduce the three-year training requirement.
INTERVIEWING POLICY
Recognizing the need for residents to interview for fellowship training or primary care positions, the following rules are established to govern such activity:
1. Any time taken off for an interview that requires time away from training (i.e. interviews that occur during any scheduled rotation) requires approval of the Program Administrators Committee.
2. A maximum of five days may be taken from any one ward, ICU or a subspecialty ward rotation and must not involve a call night.
3. The house officer must arrange for coverage of his/her patient care responsibilities for the rotation and for the medical clinic. The arrangements for coverage must be acceptable to the Chief Medical Residents for both inpatient and outpatient responsibilities.
4. Flights should be scheduled in the evening with return the following day (i.e., the day of
the interview).
5. Vacation time should be used whenever possible for interviews. Plan ahead!
6. Time away from your assigned rotation to interview is considered time away from training and is included in the 91 days you are permitted in your three years of training by the ABIM.
7. Failure to follow this policy, as outlined above, will result in disciplinary action to be determined by the PAM and/or ROC committees. This can include but is not limited to extension of your training and/or probation for unprofessional behavior.
MOONLIGHTING POLICY
Criteria:
1. Moonlighters should be at the PGY-II or higher level of training.
2. Shifts will probably be 6-12 hours in duration. This may change depending on need.
3. Moonlighter must not have received any unsatisfactory evaluations within the last 12 months. No ratings of 3 or less in any category on a rotation evaluation form for the last 12 months.
4. Moonlighters must not be on probation. Anyone who is on probation cannot moonlight until he/she is off of probation and granted permission to moonlight by the ROC committee. Typically, the ban on moonlighting lasts for six months.
5. Moonlighters must have demonstrated satisfactory performance during code Blue situations. This determination will be made by the CMRs and program directors.
6. Moonlighters must have current ACLS certification.
7. Moonlighters must have the approval of the ROC committee for moonlighting.
1.
Telemetry: Weekends (Saturday - Sunday). Telemetry evening moonlighter will cover
Telemetry B-Service from
a)
The Telemetry PA’s will give
a written sign-out on their problem patients to the Telemetry Service
moonlighter.
b)
The Telemetry
moonlighter will admit all B-Telemetry admissions and provide cross-coverage
for all B-Telemetry patients.
2.
Intermediate Care Unit
(IMCU): Friday
a)
The IMCU staff will give
written sign-out on their problem patients to the IMCU moonlighter.
b)
The IMCU moonlighter
will admit patients as required to the IMCU and provide cross coverage for all
IMCU patients.
RESEARCH POLICY
GUIDELINES FOR APPLYING FOR RESEARCH TIME DURING INTERNAL MEDICINE RESIDENCY TRAINING
The residency program in internal medicine at
1. A written request for research time should be submitted to the Department of Medicine Research Committee.
2. Dedicated research time will generally be granted only for basic science research. It is expected that clinical research will be done without dedicated time. Exceptions may be discussed with the program director.
3. Residents engaging in research projects must be in good academic standing with satisfactory to superior evaluations during previous rotations. Residents who are on academic probation will not be able to qualify for research time.
4. The maximum duration of time allocated for basic science research will be two months. The resident must demonstrate to the program that the major component of the proposed research, including all of the laboratory work, can be completed during this time. Only data analysis and writing up of findings may be completed after this period.
5. Basic science research requires a faculty sponsor who is actively engaged in research in the specialty of interest. The faculty sponsor should have a research lab in which the resident will conduct his/her research. The sponsoring faculty should provide the department with a written commitment stating that the resident will be permitted to engage in the proposed research at his/her facility.
6. It is the responsibility of the resident to meet with the faculty sponsor and develop a formal outline of the proposed research. The outline should be structured to include:
-- Background and significance
-- Review of existing literature
-- Specific objectives of proposed research
-- Study design
-- Methods
-- Data analysis
-- Anticipated time commitment of the resident and the faculty.
This information should be provided in the form available through the Department of Medicine.
7. Be advised that it will likely take three to six months of preparation to meet with faculty, design a research project and prepare the proposal in the format specified by the department. The resident must be the person who conducts the major component of the proposed research with clearly specified goals. Time will not be allocated just to acquire basic science laboratory skills or to contribute time to a project already in progress.
8. All submitted research proposals will be forwarded to the research committee for review. The committee will be blinded to the names of the residents. The following guidelines will apply during the review process:
-- Significance of the proposed research
-- Completeness of the literature review
-- Clearly stated research goals
-- Demonstration that the resident will be conducting the major component of the
research under the supervision of the faculty.
-- Demonstration that most of the research project would be completed within 2 months.
-- Demonstration that the proposed methods would achieve the stated research goals
Resident whose research projects are approved will be granted the requested research time with the following stipulations:
1. A copy of the research outline will become a permanent part of the resident’s file.
2. The residents would be required to
develop a presentation of the research conducted and relevant findings within
two months of completing their research.
This presentation will be scheduled during a
3. A summary of the evaluations would be placed in the resident’s file.
4. The resident is also expected to submit his/her research findings for presentation at the Sinai-Grace Hospital Research Day.
5. The resident is required to submit a written report of the results to the Research Committee within six months of completing the research. A completed paper for publication is acceptable in place of this report.
6. The submitted report/paper will be evaluated by the Research Committee and this evaluation, together with the report, will be placed in the resident’s file. Failure to submit the report in the allotted time will be documented as such. Additional time will only be granted if the resident is able to convincingly demonstrate to the committee that a significant component of the research is ongoing and that additional results would become available with time. Additional time will not be granted for preparation of the report.
ORDER WRITING POLICY
All orders for patients on the teaching service should be written by the housestaff.
REWRITING ORDER POLICY
Objective
• Re-evaluation of medications is done on a regular basis in order to improving the quality of care and safety for the patient.
Responsibility
• All orders (medications and others) are to be reviewed and re-written regularly by the house staff.
TRANSFER ORDER POLICY
Objective
• Ensure that proper orders have been written.
• Ensure quality care and safety for the patient.
Responsibility
Units to Floors
• Before patients are transferred out of any unit (Telemetry, MICU, CICU, SICU, IMC), the unit resident must call the 5010 beeper before transfer to have the patient put on the transfer list.
• The attending physician must be notified of the transfer.
• A detailed transfer summary should be dictated by the unit resident or intern. A student’s note must be co-signed by the intern or resident.
• Transfer orders should be written on the order sheet by the resident, intern or the student. A student’s orders must be reviewed by the resident and co-signed by the intern or resident.
• An order to notify the receiving service with beeper number must be included in the transfer orders.
• The receiving resident should see the patient within 30 minutes of arrival to the floor and should review and co-sign transfer orders.
Floors to Units
• Before patients are transferred to any unit (Telemetry, MICU, CICU, IMC), the floor resident must call the unit resident or attending and discuss the case with them before transfer.
• Transferring resident or intern should write a detailed transfer summary including all current medications and other orders in the progress notes and not on the order sheet and communicate with the receiving unit residents.
• The unit intern or resident will write all orders, medications and others as soon as the patient arrives to the unit.
• All transfers from A-Medicine to B-Medicine must be approved by one of the CMRs.
• The transferring resident or intern on A-Medicine should write a detailed transfer note and all transfer orders including medications on the order sheet.
• The transferring resident or intern should verbally communicate with the receiving resident, PA or moonlighter if possible.
• The receiving resident, PA or moonlighter should see the patients within 30 minutes of arrival to the floor and should review and co-sign transfer orders.
• An order to call the receiving service with beeper number must be included in the transfer orders.
Non-Medical
Service (e.g. Surgery, OB/GYN, Ortho, etc.) to A-Medicine.
• A-Medicine resident or intern should evaluate the patient within 30 minutes.
• A-Medicine resident or intern must write acceptance note and orders.
THE MEDICAL RECORD
1. PGY-2/3s are responsible for dictating the admission history and physical examination and the discharge summary for each patient assigned to their service. Discharge summaries may be delegated to the PGY-1s or a WSU-4. However, the PGY-2 or PGY-3 is responsible for the discharge summaries not done by WSU-4s.
2. Discharge summaries should be dictated on the day the patient is discharged.
3. Residents with an excessive number of delinquent charts (e.g. awaiting discharge summary dictation) will be placed on the long-term resident “at risk” list and will have moonlighting privileges suspended.
4. REMEMBER: Charting is a very important responsibility that physicians must fulfill. The medical record is a legal document. The promptness and quality of your entries in the medical record are a reflection of your professional behavior. Prompt, high quality charting in the medical record and dictation of H&Ps all help to:
a. Improve patient care by providing useful information from previous hospital stays.
b. Prevent medical-legal problems; good records virtually always help physicians.
c. Keep the hospital financially solvent by facilitating hospital billing.
THE ADMINISTRATIVE
PHYSICIAN ON-CALL:
The Department of Medicine has a faculty attending assigned each day to be on call for administrative problems related to patient care. One of the most frequently encountered issues is difficulty contacting an attending physician about a hospitalized patient. In the event you are unable to reach a patient’s attending and need help you should contact the administrative attending on call for advice. The administrative attending is also available to resolve any disputes arising between the house-staff and the emergency department, private attendings, physician assistants and nursing personnel. The administrative call schedule is posted on the bulletin board in the Department of Medicine just outside the education office and on the department’s website (www.sgintmed.com) in the schedules section.
Dress Code Policy
All residents are expected to maintain an appropriate and professional appearance. Casual attire and surgical scrubs are not appropriate dress during normal business hours. We ask all residents to dress in a fashion that is in keeping with what our patients expect and deserve. Male residents are to wear shirts with collars and ties and white coats. Female residents are to wear professional attire with white coats.
1. Residents should not report to work in casual attire. In particular, blue jeans are not acceptable attire. We expect residents to dress in a professional manner.
2. Scrubs and tennis/gym shoes are permissible only on call days and post-call days.
3. Moonlighting residents can wear scrubs only during moonlighting hours. They should comply with the dress code at all other times.
4. Scrubs are not permissible attire in the medical clinic.
EVALUATION AND FEEDBACK
The purpose of providing evaluation and feedback on performance to housestaff, faculty instructors and the program directors is to promote learning, skills improvement and ensure that trainees are performing at an adequate level. Evaluations of the faculty and categorical residents are done using an Internet based system identified at the URL: www.MyEvaluations.com. Your user ID is your first initial + your last name (e.g. for Atul Singh the user ID is asingh). To prevent duplicate user IDs should two names generate the same ID (e.g. Atul Singh and Ahmed Singh would both generate “asingh”) the system assigns a number to the user ID such as in asingh1 and asingh2. Your user ID cannot be changed. The password for your first sign-on will be “sinaimed”. You will be directed, after signing on to the website for the first time, to change your password to one of your choosing. If you forget your password one of the system administrators can look it up for you (Drs. Feldman, Munasinghe or Siddique, Robin Pastorious and Carol Maurizio). At the end of each rotation you must sign-on at www.MyEvaluations.com and complete your assigned evaluations.
Evaluations done by teachers of learners (i.e. Faculty of a PGY-1/2/3 or a PGY-2/3 of a PGY-1) will appear, when the learners sign-on to the website, as needing to be “acknowledged”. Click on the link and you will see the evaluations for your review. Then select an evaluation to review. Review the evaluation and at the end of the evaluation form you have the opportunity to make comments back to the teacher. After making any comments you wish, “acknowledge” the evaluation by clicking on the acknowledge button. The evaluation will then be in the list of evaluations for the teacher to “acknowledge”. This affords the opportunity for the teacher to see the comments from the learners about the evaluation. So, the evaluation goes back and forth between the teacher and learner and the comments are seen by both of them.
The situation is very different when learners evaluate their
teachers. An evaluation done by a learner of a teacher (i.e. PGY-1/2/3 of a
faculty physician or a PGY-1 of a PGY-2/3) at www.MyEvaluations.com is done
anonymously. The teachers get a summary of the learners’ evaluations and
comments every four to five months without any identifying information that
would allow them to know how an individual learner rated their performance as a
teacher. The acknowledgement process described above does not occur when
learners evaluate their teachers. Therefore, the evaluations done by the
house staff of the teaching faculty are done in an anonymous fashion.
Evaluations will be assigned to teachers and learners for each rotation on a monthly basis. Learners will also complete an online evaluation of their assigned rotation each month. This evaluation will also be completed at www.MyEvaluations.com and is an opportunity to provide feedback to the program directors about the rotation itself (educational value, work load, etc.) and is not to be use to evaluate the teaching faculty. We pay great attention to this feedback from you about the rotations in planning adjustments to the overall training program.
Purpose: To define the consequences for the house officer who fails to successfully complete the performance requirements of a rotation.
In most cases, the house officer will be required to repeat the rotation and demonstrate adequate performance before he/she will be considered for:
· Reappointment
· Promotion
· The program’s recommendation for admission to the ABIM certifying examination
An appeal may be made to the Program Director to have the Residency Operation Committee (ROC) review the failing grade for the rotation. The ROC may take whatever action it deems appropriate including, but not limited to the following:
· Overturn the failing grade
· Retain the failing grade
· Require a repeat of the rotation
· Initiate due process for resident dismissal from the training program
An appeal of the ROC decision may be made to the Dean’s Council for Graduate Medical Education of Wayne State University. This body is the supreme authority with regard to disputes pertaining to decisions made by a ROC within the Wayne State University/DMC postgraduate medical educational system.
RISK MANAGEMENT
The primary purpose of risk management is to reduce the frequency and severity of medically related incidents that result in potential liability exposure (i.e. being sued for medical malpractice) to the physicians and/or hospital. It is essential that any incident of this nature be reported early so that we can evaluate it properly and respond appropriately.
The Risk Management staff can also offer assistance by suggesting ways of maintaining objectivity when documenting in the medical record when incidents do occur. The medical record is the physical property of the hospital. The information in the record is the property of the patient. Therefore, it can be reviewed by the patient or with written permission by his/her representative.
Risk Management staff also offer advice and assistance regarding guardianship issues, medical consent issues, HIV related legal issues and any other medical-legal concerns. You should contact the risk management office if you have question related to the above or if you feel that an event, related to your hospital/resident duties, has occurred that puts you or the hospital at “risk” for legal action.
Professional liability claims and lawsuits involving the hospital and/or DMC employees are the responsibility of the Risk Management Department. They will notify you directly if you are involved in claim. When investigating claims or lawsuits, it is necessary that risk management personnel meet with you to gather information to effectively defend you and the hospital. Residents are employees of the hospital and are provided professional liability coverage through The Detroit Medical Center. Therefore, it is imperative that you contact Risk Management whenever you are served with a claim or lawsuit of a professional liability nature. Not only is investigation essential for the defense of the case, but also maintaining the integrity of the medical record. Risk Management will sequester medical records involved in litigation to ensure their integrity throughout the litigation process.
Please call Risk Management whenever an attorney contacts you. We will contact the attorney and determine the nature of your involvement. A patient’s medical condition should never be discussed with an attorney or anyone else without signed authorization from the patient or his representative.
The Risk Management Department telephone number is 313-966-1954. There is an answering machine to accept calls and information during non-business hours. The Director of Risk Management can be reached on beeper 6925.
BENEFITS
Health, Dental and Vision Insurance
Health insurance is provided at minimal cost to each resident and his/her immediate family. Coverage is effective on date of appointment.
A dental program is available at no cost for all residents and their immediate families.
A vision insurance program is available at minimal cost to each resident and immediate family members.
Short-term illness and long-term disability plans are provided to all residents.
First year residents receive three weeks of vacation and one week of educational leave annually. Second and third year residents receive three weeks of vacation and one week for educational leave.
Life insurance equal to two times your annual stipend is provided for all residents without charge and is effective on date of appointment.
Professional liability coverage is provided while
participating in residency activities at any of the
White coats and laundering services are provided for residents without charge. Scrub clothes are provided for night call at each institution.
Residents receive meal tickets for meals during on-call duty only.
All WSU educational and recreational facilities including
the libraries, sporting facilities and theaters are available to
Apartment Search - 1-800-648-1357
This service will locate, free of charge to the renter, apartments, condominiums and town houses available for lease. It will save you a lot of time finding a suitable place to live.
As a full-time post-doctorate student at
The Department of Internal Medicine will subsidize travel expenses for any resident who is the first author of a scientific abstract and is invited to present the work at a regional or national meeting (in the continental U.S.).
Social gatherings are an important aspect of a resident’s experience. The Department of Internal Medicine sponsors a social committee that arranges for a range of social activities. Some are resident only gatherings and others are for residents and their families as well. Every summer the house staff, faculty and their families are invited to attend a picnic.
The annual graduation dinner dance is held at the end of each academic year. This is a semi-formal event held at a local hotel and is quite a nice evening. Several awards are given out at this function such as: Intern of the Year, Resident of the Year, and teaching awards for faculty and non-faculty attending physicians.
LISTENING
Have you ever asked for directions and then a few blocks down the street forgotten which way to turn -- left or right?
Have you ever given permission to a child to do something and then forgotten what you had told them?
We hear well, but we don’t listen well.
We only utilize about 25% of our listening capacity.
Poor listening skills stem from bad habits. Bad habits abound because we have not trained ourselves to listen well.
We listen more than anything we do, except breathe.
A survey of couples having marital conflicts revealed:
37% cause was money 44% cause was sex
46% cause was kids 87% cause poor communication, poor listening.
The key to better listening is the desire to become a good listener!
Each of us must develop the art of concentrated listening.
a. Make it your goal to be a better listener
b. Desire for improvement is essential.
There is no correlation between I.Q. and listening.
Good listening is a mater of desire and concentration.
Why are some better listeners than others? They work hard to listen well.
Reasons to motivate yourself to listen more actively:
To be an interested, helpful manager
To obtain news, facts or other information
To form an opinion or reach a decision
To discover someone’s attitude
To obtain feedback or a response from someone
To be a friend
Good listening is simply a matter of elimination bad habits and developing good listening skills.
ADDITIONAL EDUCATIONAL
ACTIVITIES
INTERNAL MEDICINE EXAMINATIONS
Theses exams are given monthly and are mandatory for all
interns and residents. They are administered in lieu of morning report once a
month. Dr. Geetha Krishnamoorthy coordinates the examinations and discusses the
answers at
Board type, single best answer questions.
Cardiology
Infectious Diseases
Nephrology & Hypertension
Hematology/Oncology
Endocrinology
Gastroenterology
Rheumatology/Geriatrics
Neurology
Multimedia
Multimedia exams cover interdisciplinary areas. Photographs, x-rays, EKG’s, peripheral smears gram stains, etc. will be projected and questions will relate to the projected images.
This is a 100-question exam covering all the topics listed above. It is usually given in late May or early June.
ALL trainees are required to participate in the
All
All second year residents will give grand rounds on selected
topics at
All third year residents will give an update on selected subspecialties. They will be evaluated by fellow residents and faculty.
Each chief medical resident will give one grand rounds presentation in the ground floor auditorium toward the end of the chief residency year.
For some
Research (See Research Policy)
Each year residents from all departments participate in Sinai-Grace Hospital Research Day. Submitted papers are judged by a panel of physicians and researchers and recognition awards are presented.
This is a program run monthly for about 8 to 9 months per year that has residents seeing patients with interesting physical findings with bedside teaching done by the medicine faculty. The focus is on promoting excellence in physical examination skills.
OSCE (Observed Structured Clinical Exercise)
OSCEs, which focus on communication skills, are done yearly. Residents take a history from actors trained both to play standardized patient roles and to do evaluations of the interview skills of the residents. The encounters are video taped and transferred to CD. The residents have a small group debriefing session with a faculty facilitator to discuss and share their experience immediately after their OSCE sessions (usually four separate 12-minute encounters; the residents rotate through all four stations). The residents also receive a copy of their own interview sessions on CD. One of the faculty reviews the recorded sessions individually with any resident who has been scored poorly by the standardized patients to facilitate learning of better interviewing skills. This program is a joint effort of the SGH Dept. of Medicine and Wayne State University School of Medicine.
About The
The Detroit Medical Center (DMC)
is a comprehensive regional health care delivery system offering a full range
of services and a large number of specialty programs. Operating in concert with
Children’s
Detroit Receiving Hospital and
University Health Center, located in the medical center complex in
Hutzel Hospital, located in
the medical center complex in
Rehabilitation Institute of
Michigan, located in the medical center complex in
Veteran’s
The
The
ICU/TELEMETRY TRANSFER-OUT POLICY
1.
All MICU/ IMCU/Telemetry transfers will be
accepted by B Med 5010- 24 hours/day.
2.
B-Med
will enter the patient on to the transfer log.
3.
B-Med
will maintain this transfer log and periodically check on bed status of the
transfers.
4.
If the patient has not been transferred in 24
hours from ICU, B-Med needs to be re-informed about the transfer by the ICU
resident.
5.
B-Med
is allowed to triage transfers which require A-Med, to Short Call teams.
6.
Only when the patient is physically on the
floor, B-Med will triage this patient to A-Med, and take patient off the
transfer list.
7.
If
the transferred patient is unstable, B-Med will call A-Med resident on-call to
evaluate and A-med will manage patient till
8.
At
9.
B-Med
will review the ICU transfer list after picking up the beeper at
CARDIOLOGY ADMISSION
POLICY
.This policy
will go into effect on
•
ED will
call 6841(B-Tele) pager with all cardiology admissions.
•
6841 will
triage all cardiology patients from ED and floor to A-Telemetry or B-telemetry
•
A-Telemetry
resident will evaluate the patients assigned by B-Telemetry, address code
status and appropriately triage to ICU or A-Telemetry.
•
If ICU
admission is required, A-Telemetry resident will call the ICU attending (
•
Once
admission to ICU is accepted, A-Telemetry resident will write the H&P,
admission orders, call for an ICU bed, call the cardiologist and medicine
attending and finally the MICU resident.
•
MICU resident 9355 will be notified by A-Telemetry
resident about cardiology patients requiring ICU admissions.
•
All
patients determined not to need an ICU admission by ICU attending will be
accepted to A-Telemetry.
•
If MICU
has increased number of admissions, A-telemetry resident is required to help the
MICU resident with admissions and management till the duration of the call (
7am-7am) in the unit.
•
If there
are any controversies, please page the IMCU attending (pm)/Administrator
on-call/CCU Rounder/CCU Medical Director/CMRs.
•
All
transfers from the ICU to Telemetry need to go through 6841, who will triage
patient to A or B-Telemetry.
•
Exceptions
to this policy will be made only in consultation with the administrator
on-call.
n ICU ADMISSIONS
n On the Vent
n On pressors
n On Nipride/Labetelol/Fenoldepam drips
n On Nitro drip >/=35 mcg/min
n STEMI
n NSTEMI with TIMI>/=3 and ongoing chest pain
n
n Complete heart block/ 2nd Type II HB
n Patients on transvenous pacemaker
n Cardiogenic Shock
n Frank Pulmonary edema.
n A-TELE ADMISSIONS
n New-onset CHF
n NSTEMI with TIMI<3
n
n NSTEMI/USA with TIMI>/=3 and hemodynamically stable and symptom free.
n New onset Atrial Fibrillation
n Unstable Tachy/Brady arrythmia
n Pericardial Effusion with ?Tamponade
n New LBBB
n HF on Dobutamine drip
n Post-PTCA/ Post-device implantation
n Syncope with Tachy/Brady arrythmia
n All patients rejected by ICU
n B_TELE ADMISSIONS
n Atypical CP
n Stable Arrythmias
n Chronic, uncontrolled A.Fib
n S/P AICD discharge
n Stable tachy/brady arrythmia requiring permanent pacemaker and not on transvenous pacemaker
n S/P PTCA-Stable
n Stable pericardial effusion
n Syncope
n
ON-CALL POLICY
1.
Long
call starts at
2.
Short
call starts at
3.
ER
will call 5010 (B-Med) with admissions to medicine floors.
4.
5010
will distribute patients to short-call teams.
5.
Short
call team will cap at 5 patients (new or transfers)
6.
Short
call team will take no more than 2 patients after
7.
Long
call team will cap at 10 new patients.
8.
Long
Call team will take patients after the short call teams have capped/ after
9.
Long
call team will take patients till
10.
Between
11.
5010
will make every effort to distribute patients evenly to short call teams.
12.
Patients
admitted after long call team has capped or after
13.
The
post-call team is exempted from noon-conference, will sign-off in the chief
residents office and leave the hospital by
14.
The
post-call team will sign-out pending work to the on-call team at
15.
Change
to this policy will be made only in consultation with the administrator
on-call.
WSU/DMC
GME - REQUEST FOR APPROVAL OF OFF-SITE ROTATION (AT NON-WSU/DMC HOSPITAL*)
REQUESTING WSU/DMC PROGRAM:
________________________________________________________________
NAME OF TRAINEE:
________________________________________________________________________________
NAME OF NON-WSU/DMC
INSTITUTION: _________________________________________________________
ADDRESS: _________________________________________________________
FAX NUMBER: _________________________________________________________
PERCENT OF ASSIGNMENT AT
NON-DMC INSTITUTION: _______________
IF ROTATION IS AT SITE
OUTSIDE OF MICHIGAN, THE TRAINEE MUST CONTACT THE STATE LICENSING BOARD IN THAT
STATE TO DETERMINE IF HIS/HER MICHIGAN LICENSE IS VALID FOR THE ROTATION.
INDIVIDUAL WHO WILL
SUPERVISE WSU/DMC TRAINEE:
____________________________________
_______________________________
NAME TITLE
SPECIALTY OF
ROTATION:
______________________________________ START DATE: ____________ END DATE:
____________
Does rotation involve direct
patient contact: YES ________ NO
________
Is rotation available at a
WSU/DMC hospital: YES ________ NO
________
If yes, why is the WSU/DMC
setting not being utilized:
_____________________________________________________________________________________
_____________________________________________________________________________________
Goals and objective of
rotation:
_____________________________________________________________________________________
_____________________________________________________________________________________
How will the off-site
rotation be evaluated relative to meeting program objectives?
_____________________________________________________________________________________
_____________________________________________________________________________________
Will the WSU/DMC trainee’s
performance be evaluated? YES ________
NO ________
Malpractice: Please see attached regarding malpractice
coverage for off-site rotations.
SIGNATURE: _______________________________________
__________________________________________
Chairperson Program
Director
*WSU/DMC
hospitals include: Children’s, Detroit
Receiving, Harper, Huron Valley-Sinai, Hutzel, Rehabilitation Institute, Sinai-Grace
and
FOR GME OFFICE USE
APPROVED:
_________________________________________ DATE: _____________________
DATE FAX’D TO DMC CORPORATE
RISK MANAGEMENT: _____________________
APPLICATION FOR ROTATION
INTO A
Part
I and Part II must be completed by the applicant and the applicant’s program
director. If CIS access is being
requested, a Confidentiality of Information Statement will also need to be
completed by the applicant and will be enclosed with the Application for
Rotation.
THE
COMPLETED APPLICATION SHOULD BE FORWARDED TO THE WAYNE STATE UNIVERSITY/DETROIT
MEDICAL CENTER PROGRAM DIRECTOR/CHIEF OF SERVICE IN CHARGE OF COORDINATING
ROTATIONS.
INSTRUCTIONS FOR WSU/DMC DEPARTMENT – PART III
Part III is to be completed by the department and signed by the Program Director, and, when applicable, the Division Head/Chief.
If you are requesting CIS access for the rotating resident, please include a completed Confidentiality of Information State with the Application for Rotation.
PLEASE NOTE: IN
ORDER TO INSURE ISSUANCE OF CIS ACCESS CODES PRIOR TO THE START OF A ROTATION, THE
REQUEST FOR ROTATION ALONG WITH THE COMPLETED CONFIDENTIALITY STATEMENT MUST BE
RECEIVED IN THE GME OFFICE NO LATER THAN FOUR WEEKS PRIOR TO THE
START OF THE ROTATION.
APPLICATION
FOR ROTATION INTO A
Part I – APPLICANT
Applicant
Name: __________________________________________ Social Sec #: _________________________
PGY: o 1
o
2 o 3
o
4 o 5
o
6 o 7
o
8 o 9 Home
Phone #: _______________________
Rotation(s) being requested:
1 DMC
Department: ______________________________________ Dates:
FROM___/___/___ TO ___/___/___
2 DMC
Department: ______________________________________ Dates:
FROM___/___/___ TO ___/___/___
3 DMC
Department: ______________________________________ Dates:
FROM___/___/___ TO ___/___/___
4 DMC
Department: ______________________________________ Dates:
FROM___/___/___ TO ___/___/___
International
Medical Graduates ECFMG #:
_______________ MTH/YR Certificate Issued:
_______/______
Current
Training Program: ________________________________ Institution:
______________________________
Name
of Program Director __________________________________________ Phone #:
_____________________
Date
of Last TB Skin Test: ___/___/___
Results: o
Negative o Positive*
*If
TB skin test was positive, you will need to submit evidence that a chest x-ray
has been performed and reviewed by a physician.
Emergency
Contact:
Name:
__________________________________________________________ Phone #:
________________________
Address:
_________________________________________________________________________________________
Relationship:
______________________________________________________________________________________
I
hereby verify that the information and documents contained in this application
are accurate, authentic and complete.
Signature
of Applicant: ______________________________________________________ Date
___/___/___
PART II – PROGRAM
DIRECTOR (to be completed by trainee’s program director)
I
verify that:
(1) The above named Resident/Fellow is a trainee in good standing
in a program which I direct and there have been no licensing, liability,
disciplinary or other problems with the applicant.
(2)
The above named Resident/Fellow has received all
Hazardous Materials training and Universal Precautions training and exposure to
Blood Borne Pathogens training as required by State of
Please
estimate the percentage of time your Resident/Fellow will spend during the
requested rotation at:
I
understand that the
A
copy of this Resident/Fellow’s valid
Signature
of Program Director: ______________________________________________ Date: _____/_____/_____
Percent
of time Resident/Fellow will spend at DMC hospital:
Rotation
1 ____%CHM ____%DRH ____%Harper
____%HVH ____%Hutzel ____%Rehab
____%Sinai-Grace ____%UHC
Rotation
2 ____%CHM ____%DRH ____%Harper
____%HVH ____%Hutzel ____%Rehab
____%Sinai-Grace ____%UHC
Rotation
3 ____%CHM ____%DRH ____%Harper
____%HVH ____%Hutzel ____%Rehab
____%Sinai-Grace ____%UHC
Rotation
4 ____%CHM ____%DRH ____%Harper
____%HVH ____%Hutzel ____%Rehab
____%Sinai-Grace ____%UHC
Signature
of DMC Program Director:
__________________________________________________ Date: ______/______/______
Paperwork
checked by: _________________________________________
Program
Notified: ______/______/______
Database
input by:
_____________________________________________ Date: ______/______/______
CONFIDENTIALITY OF INFORMATION STATEMENT
[This document must be signed
by all employees of the
As an employee, resident
physician, student/intern, or individual assigned to the DMC or any affiliate
thereof, (faculty or staff at the Detroit Medical Center; or any professional
association or other entity associated with the Wayne State School of Medicine,
or any subsidiary or affiliate thereof.), I understand that information is
required for me to perform my duties. Some of this information may concern
patients being treated at the DMC or it may concern the operations of the DMC.
I understand that patient medical information belongs to the patient and that I
am only permitted to access patient medical information to the extent that it
is necessary to provide patient care or perform my duties. I also understand
that all medical and personal information regarding patients is confidential
and, unless directly related to the care of patients and authorized by DMC
policy, should not be revealed or discussed with other patients, friends or
relatives, or anyone else within or outside the
I also understand that other
information regarding the operations of the DMC is confidential. This includes
any information regarding employees, financial operations, quality assurance,
utilization review, risk management, research, procurement, contracting and
credentialing of staff. I understand
that I am only authorized to access this information if it is required for me
to perform my duties. This information should not be revealed or discussed with
others within or outside the DMC except to the extent that this discussion is
necessary to perform my duties.
I understand that I am
required to protect any DMC patient or operations information from loss,
misuse, unauthorized access, or unauthorized modification, and to report any
suspected breach of security policies.
I understand that I may be
given access codes or passwords to DMC computer systems. I will safeguard the
security codes and passwords given me. I acknowledge that I am strictly
prohibited from disclosing my security codes to anyone including my family,
friends, fellow workers, supervisors, and subordinates for any reason.
I understand that I may use
my access security codes to perform my duties only. I agree that I will not use
anyone else’s security codes to obtain access to any computer systems. I
understand that I will be held accountable for all work performed or changes
made to the system or databases under my security codes and that I am not to
allow anyone else to access the computer using my security codes, or leave my
computer unattended and permit anyone else to access the system through my
computer password.
I understand that failure to
follow the confidentiality of information statement is cause for termination of
employment, revocation of privileges, or revocation of access to the DMC, and
may be noted in my student or personal record, and may result in notice
to my educational institution or my agency or employer, if such a relationship
exists.
____________________________________________________
|
EMPLOYEE VERIFICATION
DATA – Please complete the following: Printed Name:
______________________________________________________ Employee No. ____________________ Print First, Middle and
Last Name (Legal Name) Department: Name: _________________________________ Name of Hospital Site/Division: _____________________ Your Mother’s maiden
name?
___________________________________________ The first school you
attended?
___________________________________________ Your
favorite animal/pet?
___________________________________________ |
|
11/98 |
WSU/DMC GRADUATE MEDICAL EDUCATION
MALPRACTICE COVERAGE DURING ROTATIONS TO AND FROM NON-DMC SITES
WSU/DMC RESIDENTS ROTATING TO NON-DMC SITES:
Malpractice coverage with limits of $200,000/$600,000 will be provided to trainees rotating to non-DMC sites only if the following conditions are met:
The rotation location is NOT a hospital. In most cases, the DMC requires that the host hospital cover the trainee rotating in their institution. Exceptions will be evaluated by DMC Risk Management on an individual basis.
The rotation site is located IN
A completed Request for Off-Site Rotation form, signed by the Program Director, has been submitted to the GME Office 6 weeks prior to the beginning of the rotation.
Request for Off-Site Rotation form has been approved and signed by Vice President, Graduate Medical Education.
OTHER RESIDENTS ROTATING TO DMC HOSPITALS:
It is the practice of The DMC to provide malpractice coverage for trainees who are rotating in a DMC hospital and are being supervised by WSU/DMC physicians. In most cases, an affiliation agreement will have been executed in which both the DMC and the non-DMC hospital have agreed to this arrangement reciprocally, i.e., DMC residents rotating to the non-DMC hospital are covered by the non-DMC hospital, and non-DMC residents rotating to DMC hospitals are covered by The DMC.
A completed Application for Rotation into a