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Intern Survival Guide The University of Tennessee Health Science

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Intern Survival Guide The University of Tennessee Health Science Powered By Docstoc
					Internal Medicine Housestaff
Survival Guide &
Quick Reference



2010-2011
13th Edition


The University of Tennessee
Health Science Center
Internal Medicine Residency Program
                        Index I
3    Medicine Ward Expectations and Survival Tips
5    Night Float Expectations and Survival Tips
              The Night Float System
8    Cross-Cover Guide for Common Problems On-Call
             Acute Chest Pain
             Acute Shortness of Breath
             Altered Mental Status
             Fever On Call
             Falls Out of Bed
20   Death Pronouncement
21   Prescription Numbers
21   Dictation Information
22   Regional Medical Center at Memphis (MED)
             Phone Numbers
             Computer
             Dictation
             Discharge
25   Baptist Memorial Hospital
              Phone Numbers
              Computer
              Dictation




                        ~1~
                                        Index II
     General Program Information, Policies, and Requirements

29            Campus Training Lessons
29            Clinical Evaluation Exercise
30            Conference Attendance
30            Core Competencies
32            Curriculum and Syllabi
33            Duty Hours
34            Email Policy
34            Evaluations Policy
35            Fatigue Policy
36            Housestaff Manual
36            Internal Medicine In-training Examination
36            Internal Medicine Website
37            Leave Policy
38            Mail
38            Medical Records
39            Moonlighting Policy and Requirement
40            Non-teaching Patients
40            Pagers
41            Paychecks
41            Portfolio
41            Procedures
42            Professional Conduct
44            Research Rotation
44            Stipend
45            Supervision Policy
46            SVMIC Conference
46            TB Testing
47            Teaching Responsibilities
47            Travel to Meetings
49             Mini-CEX forms
* This is not a complete list of policies. You should review all program policies on the
program website.

                                        ~2~
Medicine Ward Expectations and Survival Tips

   All patients should have notes written by an intern daily.
   All notes have to be written and on the chart by 9-10am.
   The hour between 9 and 10am will be used for pre rounds with
    the resident and for discharging.
   All new patients are to be seen immediately after intake
    rounds.
   All new patients should have an order to change the team and
    provide pager numbers once assigned to you.
   Each note should keep track of antibiotic days (if applicable).
   Check each patient’s MAR daily to make sure appropriate
    meds are still given and inappropriate meds are not.
   Each note should address the current active issues and plans
    for discharge.
   The orange “Anticipate DC tomorrow” note should be placed
    on the charts with pertinent information addressing the things
    that we will need to have done in order for the DC to happen.
   On days off, the interns are to check out their patients to the
    other intern the day before so that ALL patients are covered
    the next day.
   All interns and medical students are to go to Morning Report.
   Once noon conference starts, all team members are to attend.
   Once your clinic starts, all patients have to be seen and notes
    written prior to your clinic if time permits. If not, check on any
    critical pts and check the rest out to the resident and/or other
    team members (intern or JI) prior to leaving for clinic. This will
    obviously be easier for those who have Methodist clinics, but
    we must work together to get all pts seen.
   All tests (Cxs, special labs, images, etc) ordered need to be
    personally followed up. If time permits, go to the CT room or
    Echo lab, etc and review images with the STAFF or Fellow! Do
    not wait for results to show up in the computer; that may take
    days!
                             ~3~
   The patient list is to be updated daily. That means all new
    pertinent information (meds, test results, room numbers, etc.)
    needs to be on the list by check out.
   When discharging a patient, make sure to know who/where
    they are following up and have the unit secretary make the
    appointment prior to DC. Also, make sure the patient
    understands all DC meds, especially if there are changes in
    doses, amounts, new medications, etc., so that duplicate meds
    (classes or the same med) aren’t taken, and explain that in
    your dictation.
   All dictations are to be done the same day. Sign your
    dictations!
   Each intern/JI should check out his/her own patients face-to-
    face at the end of each day.




                           ~4~
Night Float Expectations and Survival Tips

The goal is to work effectively together to get the pts seen and
orders written in a timely fashion and not compromise pt care.
Show up on time so that the day team can check out before we start
getting admissions.
If you switch with another Intern, please inform the operators so the
floors know who to call for each team.
Once you get an admission, if you are not taking care of a critically
ill patient, proceed immediately to the ER because it’s easy to get
behind once you’re down there.
Try to write some basic orders soon after you see the pt. If there is
time, you can finish up with the complete orders and then write your
note. If a bed hasn’t been ordered or you want to switch bed
assignments, please let the charge nurse know ASAP.
Orders should be written clearly and concisely. An example would
be as such:
       “ADC VAAN DIMLS”
       A – Admit to “team”, attending, resident, intern (pager #), to
       floor (tele, medicine, PCU, etc.)
       D – Dx. First list what the pt is being admitted for (primary),
       then list secondaries (e.g. HTN, DM2, obesity, etc.)
       C – Condition. No one’s condition is “stable”. It’s either good,
       fair, guarded, or critical.
       V – Vitals. Please don’t write routine unless they’re going to
       the ICU. Write what you want, Q4 or Q6, etc. Here, also write
       telemetry orders, neurochecks, etc.
       A – Allergies
       A – Activity. Remember that if you want I/Os, they cannot have
       BRP.
       N – Nursing orders. Parameters if you chose, precautions,
       Accuchecks, etc.
       D – Diet. Specify what type and how many calories
       (sometimes not needed).

                              ~5~
       I – IVFs. Please write duration of fluids or amount to be given.
       You don’t want the pts to mistakenly get IVFs when they don’t
       need them. You can always restart if you fall short.
       M – Meds. List them in numerical order so that it is VERY
       CLEAR what you want and when! Don’t forget prophylactic
       meds if applicable.
       L – Labs. I usually write one line for Stat/Now Labs, then
       another line for AM labs. Please date and time the labs so they
       know when to draw them (e.g. 8/23 0600).
       S – Special Orders (you don’t have to write Special Orders)
       but here you would write orders such as consults (If emergent,
       we call our own consults, even in the middle of the night),
       imaging studies (x-rays, USG, CTs), EKGs, old charts,
       vaccinations, counseling, etc.

Please TIME/DATE and SIGN your orders! You would be amazed
at how you can forget simple things like this when you’re 3 pts
behind.

Night Float System
MED
Sunday-Thursday
Long Call - 7:30am-4:30pm- The long call team admits.
Day Float - 4:30pm-7:30pm- The dayfloat resident admits.
Night Float*-7:30pm-7:30am- The night float team admits the
patients. These patients are distributed to the ward teams the
following morning.
*For Friday-Saturday, residents & interns on electives take call as the night float team.

MUH
7 Days A Week
Short Call-7:30am-2:00pm (5 pt cap)-The short call team will admit
until 2:00 pm or until 5 patients are admitted, whichever occurs first.


                                        ~6~
Long Call-2:00pm-7:30pm-The long call team will start admitting
patients at 2:00 pm or once the short team reaches its cap of 5.
Call will end at 7:30 pm when the night float team arrives. The long
call interns will provide cross-cover until 7:30 pm and will receive
check-out from the other teams.
Night Float**-7:30pm-7:30am-The night float team will admit
patients between 7:30 pm and 7:30 am. These patients will be
distributed to the ward teams upon admission; the team with the
fewest patients will be the first team to receive new admissions.
The night float interns will provide cross-cover overnight and will
receive check-out from the long call interns.
**For Friday-Saturday, The long call resident will act as the night float resident on the
weekends. Interns on electives will provide night float coverage at this time.

VAMC
7 Days A Week
Short Call-7:30am-3:00pm (4 pt cap)-The short call team will admit
until 3:00 pm or until 4 patients are admitted, whichever occurs first.
Long Call-3:00pm-7:30pm-The long call team will start admitting
patients at 3:00 pm or once the short team reaches its cap of 4.
The long call interns will provide cross-cover until 7:30 pm and will
receive check-out from the other teams. One Intern from the day
team stays overnight. The second Intern from the on call team
covers from 4 pm – 7:30 pm and is relieved by the Night Float
Intern. Call will end at 7:30 pm when the night float team (1
Resident and 1 Intern) arrives.
Night Float***-7:30pm-7:30am-The night float team will admit
patients between 7:30 pm and 7:30 am. The night float intern will
provide cross-cover overnight and will receive check-out from the
long call intern who left at 7:30 pm.

***For Friday-Saturday, residents & interns on electives take call as the night float team.

Medicine consults during the evenings are taken by the night float
resident and passed to consult team in the morning.
                                        ~7~
                   “In the Midnight Hour”
           Cross–Cover Guide for Common Problems
                    Encountered On-Call

This guide serves to assist you in taking care of some very common
cross-cover calls you may receive while on call. It is very important
for a physician to learn and master the skill of clinical problem
solving while on call. This is not a comprehensive guide and thus
you may need additional sources to assist you in your management
of a particular patient.

General Keys to Managing a Patient on call:
When the nurse calls you regarding a patient, always use a
pleasant tone when speaking with them, regardless of the time or
situation.

You will get the majority of the history from the patient and the
chart, so do not spend a great deal of time trying to obtain the
complete history from the nurse.

 Go and see the patient before making a decision regarding his
care.

If at any time during your cross-cover call you do not know what
to do, call your resident to assist you. Remember we as physicians
are to first DO NO HARM!

Always document what you did on the chart, include the reason you
were called to see the patient, your physical exam, and your
assessment/plan.

Communicate with your resident if you plan to order further testing
or procedures. All intern procedures need to be supervised by a
resident until you have completed the requirements. Also discuss

                              ~8~
with your resident and/or attending your management plans for the
first few months of internship, ESPECIALLY IF THE PATIENT
NEEDS TO BE TRANSFERRED.

If this is a private patient (The patient IS NOT on a medicine/ICU
team, rather his admitting physician is a private physician-at
METHODIST for example), notify the admitting physician of the
patient’s complaint and your physical evaluation. You will need to
discuss your plan with that physician prior to ordering tests,
procedures or transfers.

All patients who are to be transferred will need transfer orders.
These orders are to be written out; do not write “Continue all
previous orders and meds.”

Acute Chest Pain

The nurse calls and states that Mr. Ihurt is complaining of chest
pain

Questions to ask the nurse:
    The patient’s age and reason for admission
    Time, duration, and description of pain
    Vital signs (include O2 sat)
    Is the patient on a monitor?
    Has the patient been given any medicine for the pain?

Orders for the nurse:
    Place patient on a monitor (Note: The Emery House/Code
    Blue carts have monitors on them if there are no floor monitors
    available)
    Get EKG Stat
    Get PCXR (portable) stat
    O2 sat if not done

                              ~9~
     O2 by nasal cannula or face mask
     Cardiac enzymes (CK, Troponin)
     Sublingual NTG 0.4 mg x 1 (if chest pain is persistent), make
     sure BP is stable. Repeat in 2-5 minutes if needed.
     ASA 325 mg if no contraindication (Bleeding, Allergy)

Inform nurse:

I will arrive in ____ minutes (Do not delay in going to see the
patient!)

Important differentials to think about on the way
    Acute MI
    Pulmonary Embolus
    Aortic Dissection
    Pleuritis/Pneumonia
    Pneumothorax
    Unstable/Stable Angina
    Pericarditis
    Gastroesophageal Reflux-GERD
    Chest Wall Pain/Musculoskeletal
    Herpes Zoster
    Rib Fracture
    Esophageal Spasm

LIFE THREATENING CAUSES OF CHEST PAIN (DON’T MISS
THESE!!)

     Acute MI
     Aortic Dissection
     Pneumothorax
     Pulmonary Embolus




                             ~ 10 ~
Upon Arrival to floor:
Quickly that day, review the chart (PMH, medicine list, recent
procedures/tests, vitals and physical exam earlier that day, labs
earlier that day)

Evaluate the patient (location of chest pain, breathing pattern)
Review EKG, CXR , and labs( may take ½ to 1 hour, so do follow-
up on labs)

Call and discuss your plans with your resident (especially in the
beginning of the internship year)
Decide if patient needs to be transferred to a monitored bed or ICU;
if so begin to write transfer orders and have the nurse call for a bed.

If pain not relieved by 2 nitroglycerines then review precipitating
factors. Think of adding IV Beta-blockers, IV NTG, Morphine
(especially for pulmonary edema)and/or IV Heparin.
If considering thrombolytics, you will need a cardiology consult.
Make sure you discuss with resident first.

NOTE: Call your resident +/- attending for any EKG changes,
unrelieved chest pain, and malignant arrhythmias.

Acute Shortness of Breath
The nurse calls you and states that Ms. Wheezie is complaining of
shortness of breath

Questions to ask the nurse:
    The patient’s age and reason for admission
    How long has the patient been short of breath
    Sudden onset or gradual
    Vitals sign (include O2 sat)
    Is there any accompanying chest pain
    What has been done so far?

                             ~ 11 ~
Orders for the nurse:
    O2 sat if not already done
    Stat ABG
    Stat EKG
    Stat PCXR (portable)
    Stat CK /Troponin I
    O2 by BNC or face mask

If patient is wheezing, order stat breathing treatment (Albuterol unit
dose breathing treatment; if patient has already has already had an
albuterol treatment, consider ordering a combined
Albuterol/Atrovent 1 hour long unit dose breathing treatment)

Inform nurse:
I will arrive in ____ minutes (Do not delay in going to see the
patient!)

Important Differentials to think about on the way
    Congestive Heart Failure (CHF)
    Pulmonary Embolus (PE)
    Pneumothorax
    Asthma/ COPD Bronchospasm
    Acute MI
    Massive Pleural Effusion
    Cardiac Tamponade
    Pneumonia
    Post-Op Atelectasis
    Upper Airway Obstruction
    Anxiety
    Massive Ascites (Liver patients)




                             ~ 12 ~
Upon Arrival to floor:
Quickly review the chart (PMH, medicine list, recent
procedures/tests {Ex. central line placement}, vitals, O2 sat, and
physical exam earlier that day, labs earlier that day, etc)

Evaluate the patient

Review EKG, CXR, ABG and labs( may take ½ to 1 hour, so follow-
up on labs). Go and see the CXR yourself, don’t just go by the
preliminary report

Decide if patient needs airway protection/crashing, if so, call an
EMERY HOUSE/CODE BLUE.

Other options include IV Lasix if pt is CHF/volume overoloaded,
scheduled breathing treatments, 100% face mask ventilation.
Re-evaluate patient after above intervention. If patient is not
improved, decide if patient needs to be transferred to the ICU for
either Non-invasive ventilation (NIPPV) or conventional mechanical
ventilation (CMV). Remember to call your resident for any concerns
or questions. Please discuss any plans of transfer with your resident
and/or the attending
CT chest per PE protocol (make sure pt has a normal creatinine
before ordering.) If pt has renal failure, get V/Q scan instead of CT
chest. Of note, if the patient has an abnormal CXR, the V/Q scan
may not be helpful. Consider giving IVF’s with bicarbonate prior to
the CT if pt has a borderline creatinine or is a diabetic.

Note: If PE is a moderate to high probability and there are no
contraindications, consider start either Heparin or Lovenox prior to
the CT chest or V/Q scan. Decide as to whether to continue
treatment based on clinical suspicion and results of imaging studies.
Discuss your plans with the resident and/or attending prior to
ordering the above studies.

                             ~ 13 ~
Altered Mental Status

The nurse calls and states that Mr. Bonkers is confused

Questions to ask the nurse:
    The patient’s age and reason for admission
    Vital signs
    Is the patient a diabetic or an alcoholic?
    Has the patient been recently started on new medicines
    (especially in the elderly)
    Any recent trauma

Orders for the nurse:
    Vitals, fingerstick blood glucose, O2 sat

Inform nurse:
I will arrive in ____ minutes (Do not delay seeing the patient!)

Important differentials to think about on the way
    CNS infections
    Hypoglycemia/Hyperglycemia
    Increased intracranial pressure
    Hypoxia
    Seizures
    Arrhythmias
    Toxins/Delirium Tremens
    Metabolic (Hypercalcemia, Hyponatremia, Hypernatremia,
    Metabolic Acidosis, Uremia/Renal failure)
    Drugs (Think about morphine, benzodiazepines, steroids,
    tricyclic antidepressants. In the elderly, do not forget aspirin,
    beta-blockers, H2 Blockers, Antihistamines, Anticholinergics)
    Depression/Schizophrenia
    Endocrine: Hypothyroidism, hyperthyroidism, adrenal crisis
    Constipation (especially in the elderly)

                             ~ 14 ~
Upon Arrival to floor:
Quickly review the chart (PMH, medicine list, labs earlier that day,
vitals and physical exam earlier that day)

Evaluate the patient (include the neuro exam)

Consider ordering the following:
    BMP, CBC, ammonia, CK, Troponin, EKG, ABG
    O2 by BNC (Start with 2Liters)
    EKG
    Thiamine (especially if pt is alcoholic, also order before giving
    glucose (D5 IVF’s, or amp of D50 )
    Narcan if pt is receiving opioids
    Lactulose if pt has hepatic encephalopathy or is elderly with
    constipation
    Amp of D50
    Insulin if pt is hyperglycemic
    Haldol or Ativan if pt is extremely agitated or having
    hallucinations
    IVF’s for metabolic & infectious causes
    IV antibiotics for infection (Refer to Sanford guide)
    Non-contrasted CT Head to evaluate for intracranial bleed
    LP tray to bedside - especially in immunocompromised
    patients (HIV, cancer)
    Call your resident if LP is needed
    Evaluate pt for improvement after above intervention
    Decide of patient needs to remain on the floor versus being
    transferred to the ICU




                             ~ 15 ~
Fever On Call

The nurse calls and states that Mrs. Hottie is running a fever.

Questions to ask the nurse:
    The patient’s age and reason for admission
    How high is the temperature and which route was used to
    measure the temp (Oral, Axillary, Rectal- Remember that 37°C
    oral = 37.5°C rectal =36.5°C axillary)
    Vital signs, include O2 sat
    Is this fever new?
    Is this a postoperative patient? If so, what type of surgery was
    done

Orders for the nurse:
    IVF’s (especially if the patient is febrile and hypotensive)
    Blood cultures X 2 from 2 separate sites, 5 minutes apart. If
    patient has a central line, PICC line, or Port-a-Cath, get one
    set of blood cultures from the line
    Urinalysis with urine culture & sensitivity (UA w/ C&S)

Inform nurse:
I will arrive in ____ minutes (Do not delay in going to see the
patient!)

Important Differentials to think about on the way
    Infection (especially in HIV patients)
    Pulmonary Embolism
    Drug Induced Fever
    Delirium Tremens (alcoholic patients)
    Post-op Atelectasis
    Connective Tissue Disease
    Neoplasm



                             ~ 16 ~
LIFE THREATENING CAUSES OF FEVER
 (DON’T MISS THESE!!)
    Septic shock
    Meningitis

Upon Arrival to floor:
Quickly review the chart (PMH, medicine list, recent
procedures/tests, vitals (fever curve), O2 sat, physical exam earlier
that day, and labs that day, etc)

Evaluate the patient –complete physical exam including surgical
wounds, joints, sacral region and rectal exam. Inspect ALL IV
SITES for signs of infection. Inspect Foley catheter bag urine as
well.

Consider ordering CBC with differential, BMP, portable CXR (if pt
with pulmonary complaints-wheezing, decreased breath sounds),
sputum cultures, and LP tray to bedside if patient has signs of
meningitis. Call resident if LP is needed.

Once source of fever is identified, treat accordingly

Infection/Septic Shock- Broad spectrum antibiotics (refer to
Sanford guide and hospital biograms-a list the hospital’s antibiotic
resistance patterns). Aggressive IVF hydration. Call surgery if there
are signs of post-op wound infection.

Drug Induced Fever- Stop the offending agent
Delirium Tremens-Benzodiazepines
Tylenol (PO or Rectal)

Decide if the patient needs to be transferred to a monitored bed or
an ICU bed. IF PATIENT HAS SIGNS OF SEPTIC SHOCK,
TRANSFER THE PATIENT TO THE ICU.

                             ~ 17 ~
Falls Out of Bed

The nurse calls and states that Mr. Ive Fallen was found on the floor
beside the bed and now needs you to evaluate him

Questions to ask the nurse:
    The patient’s age and reason for admission
    Did anyone witness the fall?
    Is the patient injured?
    What are the vitals signs, include O2 sat
    Is the patient on any anticoagulants or anti-epileptics?

Orders for the nurse:
    Please page me back immediately if there is a change in
    consciousness before I arrive to the bedside

Inform nurse:
I will arrive in ____ minutes (Do not delay in going to see the
patient!)

Important Differentials to think about on the way
    Cardiac causes: MI, Arrhythmias, Orthostatic hypotension
    Vasovagal Syncope
    Confusion (Could be 2° to drugs, metabolic disorders,
    dementia, TIA/stroke or seizure)
    Environmental hazards: wet floor, call button out of reach, lack
    of assistance when transferring from bed to chair or vice-
    versa, or a dark room

Upon Arrival to floor:
Quickly review the chart (PMH-any history of falls, medicine list,
vitals, labs, etc).



                             ~ 18 ~
Evaluate the patient (check mental status and tilt vitals). Look for
tongue lacerations, evidence of a fracture, bruises, or hematomas.
Do a complete physical examination.

If patient is a diabetic, check fingerstick blood glucose.

If patient is on anticoagulants, check INR and PTT. If patient is on
anti-epileptics, get a drug level.
Decide on reason for fall. If possible treat the underlying cause
(holding sedatives, volume repletion for the hypovolemia, holding
oral hypoglycemics for hypoglycemia, giving additional anti-epileptic
medicine for a seizure, or turning on the light for a dim room).

Decide if any imaging is necessary (CT head for head trauma or
mental status change or X-ray for localized pain)
If patient has head/neck injury or is on anticoagulants, consider
placing these patients on frequent neuro checks (Every 1-2 hours)
If patient needs more intensive monitoring, discuss the option of
transferring the patient with your resident and/or attending.




                              ~ 19 ~
Death Pronouncement

     Identify the patient
     Examine the patient
     Check for verbal stimuli
     Auscultate for heart sounds
     Inspect for spontaneous breath sounds
     Check for pulse
     Check pupils for dilation
     If family at bedside, express sympathy/empathy

Write the death pronouncement on the chart as follows:
     Called to pronounce patient. No response to verbal or tactile
     stimuli, pupils fixed and dilated, no spontaneous respirations,
     no heart sounds auscultated, and no pulse. Pt pronounced
     dead at _____hrs. Cause of death: Cardiopulmonary failure
     secondary to underlying disease.

Consider discussing with the family and attending whether an
autopsy is needed. If autopsy is ordered, notify the nursing staff.
Write orders as follows:

     Notify attending
     Notify family
     If no autopsy:
           D/C lines/tubes/meds
           D/C to morgue

After you write the orders, the nursing staff will take care of getting
the paperwork to the family, calling the tissue bank, calling the
organ donor services, etc.




                              ~ 20 ~
Prescription Numbers:
DEA Number Your Suffix
NPI ___________________________________


Baptist Hospital AB8546004   ______________
VAMC AV4580014               ______________
MED AC5611000                ______________
LeBonheur AL0397643          ______________
Methodist AM0395168          ______________


Dictation Information:
Hospital Specific Phone Number Dictation ID#


Baptist Hospital 226-5092    _______________
VAMC 523-8990 x3600          _______________
MED 205-9673                 _______________
Methodist 516-7054           _______________
Regional Medical Center at Memphis (MED)
OPERATOR : 545-8400
PHONE PREFIX: 545-_______

Inpatient medicine:
5B Lo-side     57173        5B Hi-side       57560
5C Lo-side     58150        5C Hi-side       58100
4D MICU        58334        4C PCU           57060
4D NICU        58390        Adams Prison      57470
Rout OB ICU 56996

Labs:
Cath Lab      448-6122      Chem             57744
CT Scan       58345/57294   Echo             448-4767
EEG           57881         Heme             57767/56344
Immunology    56528         Micro            52178
MRI           58499         Trauma Lab       87192
U/S           57281         X-Ray (Trauma)   57771

Miscellaneous:
Admissions     57688        Bed Control      57133
Computer Help 57480         ER front desk    57826
ER MD area     57859        Health Dept:     544-7600
Interventional 57476        TB               544-7616
MMHI           524-1200     STD              544-7552
Mphs Path      405-8200     Newborn Ctr      87366
Pathology      448-6300     Pharmacy IP      57937
Psych Holding 57944         Surg A           790-9849
Surg B         790-9858     Trauma           57857

MedPlex Phone Numbers:
GI Lab       58311          Lab              57964
Mammogram 5636              Pharmacy         57970

                          ~ 22 ~
Promark (800) 762-2299         TLC     725-7100 #3300
X-Ray:U/S         57281
MED Clinics:
Adult Special Care 57446      Allergy            57185
Derm                 57486    Med A              57130
Med B                57285    Neurology          57285
Optho                57257    Oral Surgery       57273
Ortho                57259    Neurosurgery       57486
Sickle Cell Clinic   58535    Surg/Urology/Vas   57486
Wound care           58999

MED Computer:
Meditech

USERNAME: ____________________________________

PASSWORD: ____________________________________

MED Dictation:

Step 1: Dial: 205-9673

Step 2: Your Physician ID# is ________________. Enter your
5-digit ID number. (If less than 5 digits, enter your ID number
followed by the # sign).
Step 3: Enter the Service Number followed by the # sign:
1 – Surgery                 9- Neurosurgery
2 – Medicine               10-Thoracic Surgery
3 – Plastic Surgery        11-Neurology
4 – ENT                    12-Orthopedics
5 – Urology                13-Trauma
6 – Oral Surgery           14-Rehabilitation

                             ~ 23 ~
7- Ophthalmology            15-Newborn-Pediatric
8- Ob-Gyn

0 – History & Physical      4 – Letter
1 – Operative Report        5 – Progress Note
2 – Discharge Summary       6 – Out-Patient Note
3 – Consult                 7 – Physician Action Line

Step 5: Enter the patient’s 8-digit account number (or press # for
PAL)

Step 6: Press 2 to begin dictating. When finished, press 5 to
begin a new dictation or press 9 to obtain a job confirmation
number and disconnect. Begin dictation by stating:
     Your Name
     Service
     Patient’s Name and Spelling
     Medical Record Number
     Admission and Discharge Dates
     Copy Distribution

To indicate STAT dictation, press the * key any time during
dictation
Follow Touch Tone control function on last page of manual.




                           ~ 24 ~
MED Discharge Summaries:
1) Physician’s Name
2) Patient’s Name, Age, Sex, Race
3) Unit Number, Service
4) Hospital Area
5) Date of Admission
6) Date of Discharge
7) Pertinent History
8) Pertinent Physical Findings
9) Pertinent Lab Findings
10) Hospital Course (TX, Complications)
11) Final Diagnosis (Primary, Secondary)
12) Operative Procedures
13) Instructions to Pt for future care
14) Name and Address or Fax # for copy distribution

BAPTIST MEMORIAL HOSPITAL
PHONE: 226-5000

Internal dialing use 6 as the prefix then the extension, red phones
starting with suffix 2 can only be dialed while in the hospital

Phone Numbers: (226- _ _ _ _)
Cath Lab 65196       Medical Records         65088
CT       65159       Pathology               65600
ER       63010       Pharmacy                65750
GME      61350       Radiology               64000
Hem      65647       Recovery Room           65710
MRI      62808

X-Ray Reports: 226-3800          2             #
(push 5 for prev report)


                           ~ 25 ~
BMH Computer System:

Codes will be assigned by Gina Rogers in the Baptist GME office.
226-1350.

USERNAME: _____________________________________

PASSWORD: _____________________________________



BMH Dictation:

East: 226-5092
Step 1: Enter Doctor I.D. #
Step 2: Enter Hospital Admission Number
Step 3: Enter worktype I.D. #

0= H&P                  4= Letter
1= OP                   5= Cardiac Cath
2= DS/Transfer          6= Monroe Clinic STAT DS
3= Consult              7= Misc

Follow Touch Tone control function on the next page.




                          ~ 26 ~
Generic Touch Tone Phone Functions




                ~ 27 ~
Campus Training Lessons

You are responsible for completing the following on-line training
modules. Modules should be completed before you start your
training or within the first month.

         HIPAA Security Training
         Medicare Compliance Training Lesson 1
         Medicare Compliance Training Lesson 2
         HIPAA Privacy Training Lesson 1
         HIPAA Privacy Training Lesson 2
         Sexual Harassment Avoidance Training
         FERPA Training
         General Store Internet Training
         HIPAA Privacy Training Update 2007
         Billing Compliance Update 2007
         Resident Fatigue Training Module

To complete the lessons go to the University website.
http://www.uthsc.edu Click on the iLogin link on the top menu bar of
the website. Enter your User Name and Password. (UT Net ID and
Password) Open the Administration folder and then open the
Campus Training Lesson folder.

Clinical Evaluation Exercise

All PGY-1 housestaff (except preliminary) are required to perform a
minimum of five (5) Mini-Clinical Evaluation Exercises during their first
year of training. Forms are provided at the back of the guide.


                              ~ 29 ~
An attending physician, chief resident, or senior resident can
complete the form. You may request an evaluation on any rotation
but you must include one evaluation from a general medicine ward,
medicine clinic, and the ICU or ER.

Note: It is your responsibility to ask your attending or senior resident
to complete this evaluation.

Conference Attendance

All residents are required to attend a minimum of 60% of the
housestaff noon conferences and grand rounds. The only excused
months are Night Float and MICU. Missed conferences can be made
up online. All PGY-1 categorical housestaff are required to attend a
minimum of 75% of the MedStudy conferences. A link and required
information is located on the program website.
http://www.uthsc.edu/Internal/conferences.html

Core Competencies – Competency Based Education

The following ACGME core competencies will be used to evaluate
you as a resident physician.

     1.   Patient Care
     2.   Medical Knowledge
     3.   Practice Based Learning and Improvement
     4.   Interpersonal and Communications Skills
     5.   Professionalism
     6.   System Based Practice


                              ~ 30 ~
You should be able to list and define these six competencies. A very
simple breakdown is listed below. Please visit the ACGME website
at: http://www.ACGME.org for detailed information on the
competencies and various teaching methods.

 Patient Care                   What you do
 Medical Knowledge              What you know
 Practice Based Learning        How you get better
 Interpersonal and              How you interact with other
 Communications Skills
 Professionalism                How you act
 Systems Based Practice         How you work within the
                                system

Patient Care – demonstrate patient care that is compassionate,
appropriate, and effective for the treatment of health problems and the
promotion of health. It is the basis of our profession so all the other
competencies will improve patient care.

Medical Knowledge – demonstrate an investigatory and analytic-
thinking approach to clinical situations, and know and apply basic and
clinically supportive science of their discipline. The basis of physician
training which consist of specific knowledge needed to treat patients.

Practice Based Learning and Improvement – requires residents to
investigate, evaluate, and improve their patient care practices, and
appraise and assimilate scientific evidence into their practice. It is a
method to monitor, reflect, and improve performance.

Interpersonal and Communication Skills- skills that result in the
effective exchange of information and collaboration with patients, their
                              ~ 31 ~
families, and other health professionals. One of the most important
skills a physician can master as communication problems may
negatively affect patient management and outcomes.

Professionalism – demonstrate a commitment to carrying out
professional responsibilities, adherence to ethical principles, and
sensitivity to a diverse patient population. Patients are more
compliant to treatment recommendations when they trust their
physician. Trust is large part of professionalism. You must
demonstrate, integrity, honesty, and morality in your work and daily
life.

System Based Practice – demonstrates an awareness and
responsiveness to the larger context and system of healthcare, as
well as the ability to call effectively on other resources in the system
to provide optimal healthcare. The utilization of the health care
system as a whole to provide quality care as the patient’s advocate.

Curriculum and Syllabi

Housestaff and teaching attendings must review the curriculum at the
beginning of each rotation. The review will clarify learning objectives
and competency assessment methods. The curriculum for each
rotation is listed on the website at:
http://www.uthsc.edu/internal/curriculum.html

Program goals, general objective, and progressive learning objectives
are listed at the beginning of the curriculum page.

The following syllabi require a password for access.


                               ~ 32 ~
     Ambulatory Care Syllabus – Password: Ambulatory
     Consult Medicine Syllabus – Password: Consult
     Ward Medicine Syllabus – Password: Ward
                *Click Submit after entering the password.

Duty Hours

Duty hours must be entered into New Innovations quarterly (August,
October, January, and April) and must be completed by the 4th of the
following month. The internal medicine residency program adheres
strictly to the RRC guidelines. Duty hour rules are summarized below
and the entire policy can be viewed online at http://www.acgme.org
under resident duty hours.

         one 24-hour period away from the hospital averaged over a
          four week period for a minimum of four days off per four
          weeks
         hours are limited to 80 hours per week
         10 hours off between shifts
         no more than 30 continuous hours

Post-overnight call residents must leave the hospital premises
promptly at 12 pm or earlier if they started the previous day before 6
am. Teamwork is essential in order to comply with the RRC
guidelines. Following an overnight call, housestaff must not care for
any new inpatients.

NOTE:    YOUR AVAILABLE EDUCATION AND/OR TRAVEL FUNDS WILL BE
SUSPENDED/FROZEN UNTIL THE NEXT DUTY HOUR REPORTING PERIOD IF YOU
FAIL TO ENTER YOUR DUTY HOURS. IN ADDITION, YOU WILL RECEIVE A
REDUCTION IN THE AREA OF PROFESSIONALISM ON THE YEARLY AMERICAN
BOARD OF INTERNAL MEDICINE EVALUATION.

                              ~ 33 ~
Email Policy

All residents are required to have a UT email address. You can
contact the Computer Help Desk at 448-2222 to set up your account.
Important information from the Chiefs, Program Coordinators, and
Program Director will be communicated through UT email.

Note: If you have a personal email account you may forward your UT
email to that account. If you need instructions on how to do this
contact the Computer Help Desk at 448-2222. Check you email
frequently!

Evaluation Policy

Residents will be evaluated following each rotation. Residents must
ensure the program office is provided with the correct attending
physician/supervising faculty by the 15th of each month. Upon
completion of a rotation, the program office will send evaluation forms
to the faculty member(s) who has supervised the resident during this
period. Completed evaluations will be returned to the program and will
be reviewed by the program director. The program office will verify
that all evaluation forms have been returned and assemble the
information for each resident. Each resident will also anonymously
evaluate their peers and their faculty on a monthly basis.
Constructive comments for anonymous feedback should be provided.

Each resident has an assigned faculty advisor who reviews all new
evaluations with the resident on a quarterly basis. The Faculty Advisor
Committee meets quarterly to review each resident's progress and
make suggestion for improvement.

                             ~ 34 ~
A resident having problems will be referred to the Clinical
Competence Committee, a small group chaired by an Associate
Program Director. The committee studies the problems, contacts
residents and staff for additional insights, allows the resident to
appear before the group, and passes on its recommendations in
written form to the program director. The program director then meets
with the resident to review findings, make recommendations for
improvement, and/or reformulate goals and objectives as indicated.
The resident will be requested to sign the evaluation summary which
will then be placed in the resident's file. The resident will receive a
copy of the signed summary. Residents may review their files upon
request.

Fatigue Policy

Faculty and residents should be alert for signs of fatigue among
housestaff. These signs include falling asleep, irritability, apathy, and
careless medical errors. When faculty and residents observe these
signs, the houseofficer should be questioned about sleep loss and
fatigue. Brief counseling should be provided if a sleep deficit is
identified. This counseling may include information about naps, use of
caffeine, and good sleep hygiene. If the symptoms continue, referral
to the chief residents or program director should occur.

If the houseofficer's fatigue symptoms at any point are sufficient to
jeopardize patient care, the houseofficer or attending physician
discovering the problem should consult immediately with other
members of the team or with the chief resident or program director so
that the houseofficer may be immediately relieved of duty. Patient
care should then be delivered by other members of the team or by

                              ~ 35 ~
another houseofficer designated by the chief residents. All
housestaff must complete the “Resident Fatigue Training Module”.

Housestaff Manual

The Housestaff Manual is located on the website at:
http://www.uthsc.edu/Internal/hmanual.pdf It is your responsibility as
a resident to read this manual.

Internal Medicine In-training Examination

The Internal Medicine In-training Examination is administered yearly
to all categorical and combined medicine/pediatric housestaff in
October for self-assessment. It is a timed national examination
consisting of two books.

Sharing of test information before, during, or after testing is prohibited
and is a violation of professionalism. Irregular or unprofessional
behavior during the exam will be reported to the testing agencies. The
Clinical Competency Committee will be convened to investigate any
irregularities and recommend appropriate disciplinary action up to and
including termination from the training program.


Internal Medicine Website

The program website located at http://www.uthsc.edu/internal is an
excellent source of information. Conferences, call schedules,
curriculum, housestaff manual, program documents and polices are
listed on the site.


                              ~ 36 ~
Leave Policy

Paid annual leave of three (3) weeks, consisting of twenty-one (21)
days with a maximum of fifteen (15) “working days” (Monday-Friday)
plus six (6) “weekend days” (Saturday-Sunday), may be given per
twelve month period. Annual leave is granted at the discretion of the
Program Director and must be approved, in writing, by the Program
Director (or his/her designee) in advance.

**All vacation and sick days must be entered into the New Innovations
  system under Duty Hours.**
You may take an extended (more than one week) vacation during
back to back electives with prior approval. However, for those
two week vacations housestaff must ensure that they are back to
work on time. For those that arrive late one extra night call will
be assigned for each day late plus one week of back-up call. A
minimum of two extra calls will be assigned.

    Educational leave is granted at the discretion of the Program
     Director, but may not exceed ten (10) days per twelve month
     period.
    Sick leave - Twenty-one (21) working days of per twelve month
     period.
    Maternity leave - All available sick and annual leave days up to
     the maximum of six (6) paid weeks duration may be used by
     female housestaff members for the birth of a child. With prior
     approval, additional unpaid maternity leave may be granted by
     the Program Director. Extended leave due to complications may
     be covered under the resident’s disability policy after the 90 day
     waiting period.


                             ~ 37 ~
      Paternity leave - 7 days with a possible extension using vacation
       days. With prior approval, additional unpaid parental leave may
       be granted by the Program Director.

***Due to APDIM rules, taking additional time off will delay completion
   of the residency.***

Mail

Any mail received for you at the program office will be placed in a mail
slot near the program office. Journals should be mailed to your home
address not the program office. Please check for mail on a regular
basis.
Medical Records

One of the major components of “quality assurance” is timely
completion of the medical record; specifically, an appropriately
detailed discharge summary dictated on the day of the patient’s
discharge. At the time of discharge the house officer should make a
quick review of the chart and co-sign any verbal orders, consults, or
student notes. The summary should be dictated on the day of the
patient’s discharge. If this is impossible, the dictation must be done
within two weeks of discharge. If the summary has not been
completed within two weeks, it is deemed delinquent and disciplinary
action may be taken against the assigned resident. Extra guest call
may be assigned during selective/elective months and documentation
of poor professional behavior may be filed in the house officer’s
permanent GME record. Additionally, the resident may be suspended
from clinical duties until all charts are completed, which may result in
an extension of training time. Failure to complete medical records


                                  ~ 38 ~
within the allotted time has an adverse impact not only on
reimbursement for physician services but also on patient care.

Moonlighting Policy and Requirement

All moonlighting requests must be submitted and approved by the
program director. A link for requests is location at the bottom of the
training program website. Residents are not required to moonlight.
The performance of residents' moonlighting will be monitored and any
adverse effects will lead to withdrawal of permission.

    PGY-1 residents may not moonlight/sunlight.
    No moonlighting/sunlighting during medicine wards or any ICU
     months.
    No moonlighting/sunlighting pre-call, post-call or when on back-
     up call.
    During ER months, any moonlighting/sunlighting must be
     separated by at least 10 hours from any ER shift.
    Moonlighting/sunlighting shall not occur more frequently than
     twice per week and for a maximum duration of 24 hours per
     week.
    Moonlighting/sunlighting cannot interfere with scheduled
     afternoon or weekend rounds.
    No moonlighting/sunlighting during sick leave or maternity leave.
     No sunlighting during leaves of absence.
    Residents who plan to moonlight outside of the system must
     notify the program director of this intention in writing. They will
     then need to notify the program director of the location, type and
     schedule of moonlighting by the first of each month.



                              ~ 39 ~
    Any resident who wishes to moonlight on this campus (i.e. Med
     ER) must obtain a signed moonlighting approval form from the
     Program Director.
    All moonlighting/sunlighting by residents is ultimately subject to
     the program director's approval.
    Moonlighting hours combined with residency work hours must
     not exceed 80 hours per week when averaged over a 4 week
     period.
    Each resident is responsible for maintaining the appropriate state
     medical license where moonlighting occurs (see GME Policy
     #245 – Licensure Exemption) and separate malpractice
     insurance. The Tennessee Claims Commission Act does not
     cover residents who are moonlighting.

Non-teaching Patients

Housestaff are occasionally asked to render care to patients not on
the teaching service. This care must be limited to emergent situations
only with the primary physician expected to assume care
expeditiously after the housestaff are called.

Pagers

We are using Comserv Alpha Numeric Pagers. Text messages can
be sent from http://www.pagememphis.com. If your pager
malfunctions contact the program office at 448-5814 for a
replacement. There is a $75.00 charge for lost pagers and a $50
charge for pagers with damage.



                             ~ 40 ~
Paychecks

Paychecks are received the last working day of each month. All
paychecks must be set up for direct deposit (University Policy). Direct
deposit verifications are emailed each month.

Portfolio

The Portfolio in New Innovations is to assist you with keeping a record
of scholarly activity. All residents must enter any presentations,
posters, journal club materials, abstracts, research projects, or
publications you produce.

Procedures

All residents must maintain a procedure log to comply with
specifications of the American Board of Internal Medicine (ABIM) and
the Residency Review Committee and to assist residents with
obtaining hospital privileges in the future. All procedures must be
logged into the New Innovations computerized system and confirmed
by supervising faculty.

The following is a list of required procedures:
Breast Exam (5), Rectal Exam (5), Pelvic Exam (5)
Paracentesis (3), Arthrocentesis (3), Thoracentesis (3), Lumbar
Puncture (5), Central Line (5), Arterial Blood Gas (5), and Nasogastric
Intubation (3)




                             ~ 41 ~
Professional Conduct

House officers are expected to maintain a high level of professional
conduct. Professionalism is one of the six clinical competencies in
which residents must demonstrate proficiency in order to successfully
complete residency. Professionalism includes maintaining a
professional appearance as well as demonstrating a high standard of
moral and ethical behavior. Some examples of expected behavior that
should be maintained throughout a physician’s career are listed
below. Other examples are given in the Academic Appeals Process
section.

Communication:
   • Discuss treatment plans or changes in status with patients and
   families daily
   • Personally call all consultants at the time the consult order is
   written
   • Call the patient's primary care provider upon admission and
   discharge and send a copy of the discharge summary to the
   physician’s office
   • Discuss issues concerning patient management with fellow
   colleagues personally and in a professional manner. Do not write
   inflammatory or disparaging remarks about colleagues in the
   chart.
   • Notify the appropriate personnel including hospital paging
   operators immediately about any call schedule changes




                            ~ 42 ~
Confidentiality:
     • All residents and staff must comply with federal HIPPA
     guidelines. GME requires all housestaff to complete an online
     course documenting knowledge of the policy.
     • Respect patient privacy at all times. Avoid using patients’
     names and personal information in public places. Shred all
     documents with personal information, including patient census
     lists.

Honesty:
    • All information written in the chart must be accurate and true.
    Any medical errors or adverse patient outcomes must be
    documented honestly and disclosed to the patient and/or family.
    • Honesty must be use when taking any program related
    examination or course.

Appearance:
    • Project a professional, confident, and caring image.
    • Be well-groomed, professionally attired, and practice good
    hygiene.

Dedication:
    • Possess a sound work ethic
    • Judiciously use the back-up call system
    • Follow a diligent reading regimen
    • Ensure proper follow-up of inpatient and outpatients
    • Develop a good working relationship with colleagues and
    consultants
    • Teach fellow residents and medical students
    • Comply with the 80 hour work week and 30 hour continuous
    duty rule

                             ~ 43 ~
Respect:
    • For all hospital and UT employees regardless of position
    • For all patients and their families
    • Respond sensitively to patients' and co-workers culture, age,
    gender, and disabilities

Research Rotation

At the end of any research rotation all residents must submit to the
program office a minimum three-page paper summarizing work
performed during that rotation. This paper must be put into resident’s
file and entered into New Innovations under the Portfolio option.

Stipend (Educational)

    MedStudy books for PG1 categorical and medicine/pediatric
     housestaff
    UpToDate access for all residents
    Pocket PC (if needed) from Graduate Medical Education office.
    You will be notified when additional funds are available.
Additional funds can be used toward purchase of the following:

Medical textbooks, medical instruments, computer software, journal
subscriptions, board review books, membership dues, and exams.

All receipts must be given to the Program Coordinator, Susan
Andrews, by May 31 for reimbursement each year. Please contact her
at 448-5704 or sandrew8@uthsc.edu if you have any questions.
MedStudy DVDs, Multimedia Primary Care Procedures, and MKSAP
questions are available for checkout in the program office.

                             ~ 44 ~
Supervision Policy

Implementation of the Resident Supervision Policy (RSP) and
Guidelines occurred October 1, 2006. They have been incorporated
into the housestaff manual and placed on the program website under
Documents and Syllabi.

1. The RSP states supervisory expectations in inpatient and
outpatient settings, for consultations, and for bedside and other
procedures. Please review the RSP carefully since resident and
attending documentation are significantly affected. Both residents and
attendings need to document their interactions on the chart. Attending
physician and resident interaction should be encouraged in all
situations.

2. For inpatient, non-critical care admissions, the admitting resident is
expected to notify the attending physician promptly (within minutes
after full patient assessment) in the following situations: a. any
questions about patient care; b. clinical instability; c. need to move to
a higher level of care; d. any major change in patient status; and e.
need to make DNR.

3. For critical care admissions, the critical care fellow (either
pulmonary or cardiology) is expected to see these patients promptly
after admission. The fellow is expected to notify his attending
physician if there are any questions about patient care.


                              ~ 45 ~
4. For inpatient consults, the resident is expected to notify his
attending promptly in the following situations: a. any questions about
patient care; b. any patient going soon to the operating room; c.
clinical instability; d. need to move to a higher level of care; e. a
recent major change in patient status; and f. patient to be discharged
prior to attending seeing patient.

5. While attending physicians and housestaff are required to adhere
carefully to the RSP and guidelines, attending physicians may wish to
provide even closer supervision (i.e., prompt notification after every
admission and consultation). This is left to the discretion of the
attending physician.

See web page for specific information:

http://www.uthsc.edu/GME/policies/supervision_pla2008.pdf

SVMIC Conference

This is a mandatory conference that covers malpractice issues. The
State Volunteer Mutual Insurance Conference must be attended each
year. Specific dates for 2010 are September 2 & 3.

TB Testing

Residents are required to have a TB test every year. PGY-1s must
have the test done before they start training. PGY-2 and 3s can have
testing completed at University Health (448-5630), 910 Madison
Avenue, 9th Floor. TB results must be faxed to the Graduate Medical
Education Office at 448-6182.


                             ~ 46 ~
Teaching Responsibilities

An integral part of the learning experience is the ability to teach
others. Residents in charge of a ward service are expected to
present at least one oral presentation weekly to the interns and
students on the service. Additional bedside teaching is expected as
part of the daily ward activity.


Travel to Meetings

Approval for travel to meetings is contingent upon the requirements
listed below.
       An Internal Medicine Travel Request Form MUST be
      completed for travel to meetings and submitted to the Program
      Coordinator four (4) weeks before the meeting.
      No more than eight (8) residents will be allowed to attend the
     same meeting. Permission to attend will be given on a first
     come-first served basis.
      The abstract(s) must be submitted to the Program Director for
     approval before submission to the meeting.
      You must be the 1st author or presenting because the 1st
      author cannot attend the meeting.
All requirements must be met to receive approval. No exception will
be made.

Publications and presentations must be entered into the New
Innovations Portfolio.


                             ~ 47 ~
Internal Medicine Travel Request Form (program website)

If travel funds are available, the training program will provide support
for one (1) Regional, State, or National meeting.
       If support funds are provided, the program will pay for one
      (1) poster.
         The poster MUST be made at the UT Print Shop.

A GME Travel Form must be reviewed and signed by the Program
Coordinator then submitted with a meeting brochure and original
receipts to Lisa Shinall in the Graduate Medical Education Office
when you return from your meeting for travel reimbursement to be
processed.

To ensure you have the required documentation necessary for
reimbursement, review (and perhaps take with you) the GME Travel
Reimbursement form before leaving on your trip.

GME Travel Reimbursement Form
(http://www.uthsc.edu/GME/policies/travel.pdf)




                              ~ 48 ~
Mini-Clinical Evaluation Exercise (CEX)

Evaluator: __________________________ Date: ______________

Resident: ___________________________            R1     R2    R3

Setting:    Ambulatory      In-patient      ED   Other

Medical Interviewing Skill
 1       2     3     |     4     5      6    |   7      8     9
  Unsatisfactory           Satisfactory              Superior

Physical Examination
  1      2    3     |      4     5      6    |   7      8     9
   Unsatisfactory          Satisfactory              Superior

Humanistic Qualities/Professionalism
  1    2      3      |    4      5      6    |   7      8     9
   Unsatisfactory          Satisfactory              Superior

Clinical Judgment
   1      2    3     |     4     5      6    |   7      8     9
    Unsatisfactory         Satisfactory              Superior

Counseling Skills
  1     2     3      |     4     5      6    |   7      8     9
   Unsatisfactory          Satisfactory              Superior

Organization/Efficiency
  1     2     3      |     4     5      6    |   7      8     9
   Unsatisfactory          Satisfactory              Superior

Overall Clinical Competence
  1      2      3    |    4     5      6     |     7     8    9
   Unsatisfactory         Satisfactory               Superior
___________________________________________________________
___________________________________________________________
___________________________________________________________
Resident Signature                       Evaluator Signature
             Mini-Clinical Evaluation Exercise (CEX)

Evaluator: __________________________ Date: ______________

Resident: ___________________________            R1     R2    R3

Setting:    Ambulatory      In-patient      ED   Other

Medical Interviewing Skill
 1       2     3     |     4     5      6    |   7      8     9
  Unsatisfactory           Satisfactory              Superior

Physical Examination
  1      2    3     |      4     5      6    |   7      8     9
   Unsatisfactory          Satisfactory              Superior

Humanistic Qualities/Professionalism
  1    2      3      |    4      5      6    |   7      8     9
   Unsatisfactory          Satisfactory              Superior

Clinical Judgment
   1      2    3     |     4     5      6    |   7      8     9
    Unsatisfactory         Satisfactory              Superior

Counseling Skills
  1     2     3      |     4     5      6    |   7      8     9
   Unsatisfactory          Satisfactory              Superior

Organization/Efficiency
  1     2     3      |     4     5      6    |   7      8     9
   Unsatisfactory          Satisfactory              Superior

Overall Clinical Competence
  1      2      3    |    4     5      6     |     7     8    9
   Unsatisfactory         Satisfactory               Superior
___________________________________________________________
___________________________________________________________
___________________________________________________________
Resident Signature                       Evaluator Signature


                              ~ 50 ~
             Mini-Clinical Evaluation Exercise (CEX)

Evaluator: __________________________ Date: ______________

Resident: ___________________________            R1     R2    R3

Setting:    Ambulatory      In-patient      ED   Other

Medical Interviewing Skill
 1       2     3     |     4     5      6    |   7      8     9
  Unsatisfactory           Satisfactory              Superior

Physical Examination
  1      2    3     |      4     5      6    |   7      8     9
   Unsatisfactory          Satisfactory              Superior

Humanistic Qualities/Professionalism
  1    2      3      |    4      5      6    |   7      8     9
   Unsatisfactory          Satisfactory              Superior

Clinical Judgment
   1      2    3     |     4     5      6    |   7      8     9
    Unsatisfactory         Satisfactory              Superior

Counseling Skills
  1     2     3      |     4     5      6    |   7      8     9
   Unsatisfactory          Satisfactory              Superior

Organization/Efficiency
  1     2     3      |     4     5      6    |   7      8     9
   Unsatisfactory          Satisfactory              Superior

Overall Clinical Competence
  1      2      3    |    4     5      6     |     7     8    9
   Unsatisfactory         Satisfactory               Superior
___________________________________________________________
___________________________________________________________
___________________________________________________________
Resident Signature                       Evaluator Signature


                              ~ 51 ~
             Mini-Clinical Evaluation Exercise (CEX)

Evaluator: __________________________ Date: ______________

Resident: ___________________________            R1     R2    R3

Setting:    Ambulatory      In-patient      ED   Other

Medical Interviewing Skill
 1       2     3     |     4     5      6    |   7      8     9
  Unsatisfactory           Satisfactory              Superior

Physical Examination
  1      2    3     |      4     5      6    |   7      8     9
   Unsatisfactory          Satisfactory              Superior

Humanistic Qualities/Professionalism
  1    2      3      |    4      5      6    |   7      8     9
   Unsatisfactory          Satisfactory              Superior

Clinical Judgment
   1      2    3     |     4     5      6    |   7      8     9
    Unsatisfactory         Satisfactory              Superior

Counseling Skills
  1     2     3      |     4     5      6    |   7      8     9
   Unsatisfactory          Satisfactory              Superior

Organization/Efficiency
  1     2     3      |     4     5      6    |   7      8     9
   Unsatisfactory          Satisfactory              Superior

Overall Clinical Competence
  1      2      3    |    4     5      6     |     7     8    9
   Unsatisfactory         Satisfactory               Superior
___________________________________________________________
___________________________________________________________
___________________________________________________________
Resident Signature                       Evaluator Signature


                              ~ 52 ~
             Mini-Clinical Evaluation Exercise (CEX)

Evaluator: __________________________ Date: ______________

Resident: ___________________________            R1     R2    R3

Setting:    Ambulatory      In-patient      ED   Other

Medical Interviewing Skill
 1       2     3     |     4     5      6    |   7      8     9
  Unsatisfactory           Satisfactory              Superior

Physical Examination
  1      2    3     |      4     5      6    |   7      8     9
   Unsatisfactory          Satisfactory              Superior

Humanistic Qualities/Professionalism
  1    2      3      |    4      5      6    |   7      8     9
   Unsatisfactory          Satisfactory              Superior

Clinical Judgment
   1      2    3     |     4     5      6    |   7      8     9
    Unsatisfactory         Satisfactory              Superior

Counseling Skills
  1     2     3      |     4     5      6    |   7      8     9
   Unsatisfactory          Satisfactory              Superior

Organization/Efficiency
  1     2     3      |     4     5      6    |   7      8     9
   Unsatisfactory          Satisfactory              Superior

Overall Clinical Competence
  1      2      3    |    4     5      6     |     7     8    9
   Unsatisfactory         Satisfactory               Superior
___________________________________________________________
___________________________________________________________
___________________________________________________________
Resident Signature                       Evaluator Signature


                              ~ 53 ~
             Mini-Clinical Evaluation Exercise (CEX)

Evaluator: __________________________ Date: ______________

Resident: ___________________________            R1     R2    R3

Setting:    Ambulatory      In-patient      ED   Other

Medical Interviewing Skill
 1       2     3     |     4     5      6    |   7      8     9
  Unsatisfactory           Satisfactory              Superior

Physical Examination
  1      2    3     |      4     5      6    |   7      8     9
   Unsatisfactory          Satisfactory              Superior

Humanistic Qualities/Professionalism
  1    2      3      |    4      5      6    |   7      8     9
   Unsatisfactory          Satisfactory              Superior

Clinical Judgment
   1      2    3     |     4     5      6    |   7      8     9
    Unsatisfactory         Satisfactory              Superior

Counseling Skills
  1     2     3      |     4     5      6    |   7      8     9
   Unsatisfactory          Satisfactory              Superior

Organization/Efficiency
  1     2     3      |     4     5      6    |   7      8     9
   Unsatisfactory          Satisfactory              Superior

Overall Clinical Competence
  1      2      3    |    4     5      6     |     7     8    9
   Unsatisfactory         Satisfactory               Superior
___________________________________________________________
___________________________________________________________
___________________________________________________________
Resident Signature                       Evaluator Signature


                              ~ 54 ~
~ 57 ~

				
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