Second year orientation

WELCOME TO THE WORLD OF ZIAC

The Wonderful World of Ziac

Most of the 2nd years are rotating outside

Most of the time… You will be with 3rd years (GP in, ACRs) If there are unresolved issues between

incoming 3rd years and 2nd years, better settle them now

The Wonderful World of Ziac

Rules of Ziac

Beds are reserved for post duty and duty, unless they don’t want to use it

Answer phone calls even if you are not duty SASOD

Minimize bags and clutter Food that is not labeled shall be assumed

to be for everyone’s consumption

The Wonderful World of Ziac

What you see, what you hear, when you leave, leave it there. (Unless agreed upon)

THE ART OF SASODSHIP

SASOD

Second Attending Senior On Duty 24 Hours duty

AM Post Still required to attend rotations On-call for other tasks

PM Post Reminders:

UPHS 9:00am to 5:00pm Lunch break 12:00 to 1:00pm Depends upon availability of consultant SASOD to accept consults starting at 5:00pm until

7:00am unless emergency/ urgent cases/ endorsed by consultants

SASOD

Primary Duties and Responsibilities1. Assists the ACR on pay wards

Answer phone referrals – forwards it to ACR

Assists on admissions IV, FC, NGT insertions Conductions

SASOD

Primary Duties and Responsibilities2. Responsible for CI patients during duty

hours3. Attends to employees/students/retired

employees consulting at AMBU Consultations Fit to work Admissions

SASOD

Primary Duties and Responsibilities4. Oversees the AMBU ROD

3* months in the AMBU Complicated cases Transferrable cases Mis-triaged cases Clears all AMBU patients before

discharge AMBU ROD shall endorse each patient to SASOD

before discharge RIV for meds

5. Checks on the DEM Rotator

SASOD

Secondary Duties and Responsibilites1. Maintains cleanliness/peace & order at

Ziac Check on water Dispose old/stale foods in the fridge Checks on Eman

2. Reminds CAGE officer for the next day CAGE cover

SASOD

Secondary Duties and Responsibilites3. Checks on the 1st, 2nd and 3rd year

outside rotators on duty (occasionally the Chief Res – SHO)

IM, Pedia, Toxicology, OB/Ortoll Food deliveries References

QUESTIONS/ CLARIFICATIONS?

Second Year Rotations

IM 3 months Pedia 2 Toxicology 1 Hospice 1 Trad & Integrative Med 1

(Wellness) Ortho/Rehab 1 Electives 1 FMC 2

IM Rotation

3 months 2 months straight wards 1 month POD (Physician on Duty) – ER

With ECG duties Day 1 to 10 – Service 1 and 4

(Team A) Day 11 to 20 – Service 2 and 5

(Team B) Day 21 to 30/31 – Service 3 and 6

(Team C)

IM Rotation

Teams 1 senior (3rd year), 1 to 2 1st year IM and 1 FM/ Derma/ Neuro

rotator i.e. 1 senior and 2 to 3 residents

Duties Every 3 days

Alternate between WAPOD and APOD WAPOD (Ward Attending Physician on Duty)

Alternate between Ward 1 and Ward 3 APOD (Admitting Physician on Duty)

2 Duty teams every 3 days, with only 1 senior on duty E.g. Dec 5

Service 1 - APOD (With senior) Service 4 - WAPOD (Without senior)

Dec 8 Service 1 - WAPOD (Without senior) Service 4 - APOD (With senior)

IM Rotation

Responsibilities You will have your own patients Know your patients well – Full history and PE up

to the smallest detail In-coming RIC notes

Complete history and PE Revise present working impression as needed Plans

Review and Revise med as needed Review and follow-up pending laboratories

Rounds patients DAILY Endorse patient to team mates / senior if and when

you will be out on leave

IM Rotation

Responsibilities Never rely on the students

In the end, everything is still your responsibility

Involve your senior Ask questions if you have any Document everything (they can always

retract everything that they have said or ordered unless you have documented it)

Attend rounds with senior/ consultants Know your patients well!

IM Rotation

Basic bedside procedures Thoracentesis Paracentesis Ask guidance from teammates or from

seniors

IM Rotation

POD-ship Accept patient initially seen AND stabilized by

DEM/FM resident Lab results are not absolute requirements prior to

accepting referrals Do your own history and PE Formulate your own assessment

May or may not be the same as with the first doctor who saw the patient

Formulate your own plans May or may not be the same… Scrutinize the previous plans well Correct what should be corrected

IM Rotation

POD-ship 12-hour duty every 3 days Endorse and leave and turn off cellphone Pre-duty /From AM Duty Status: Day

MHAPOD (medical holding area physician on duty) Receives patient from the post-duty PODs and

post-duty Night MHAPOD Carry outs orders/ Facilitate patients’ needs or

admission Endorses remaining ER patients to Night

MHAPOD

IM Rotation

POD-ship Usual cases

ACS STEMI – Refer to MICU, CVS ASAP

CHF Renal Failure Encephalopathies – Metabolic, Hepatic UGIB Septic shock CAP, HR

IM Rotation Mortalities

All of your patient mortalities from the 1st -21st day of the month.

Word Format, Table Form Submit to the MR/Audit senior-in-charge on

the 22nd day of the month WITHOUT FAIL!!! Mortality Review

Powerpoint report – include everything in the chart

With a service consultant, ± senior AUDIT!

IM Rotation

Who to refer to? Co-WAPODs/APODs/PODs/MHAPODs FM Batchmates FM Seniors – ACRs WAPODs

SAPODs (2nd year IM) Senior APOD (Senior of your sister team) MICU Senior

– GOD ALMIGHTY

IM Rotation

References Stash

IM Platinum Aherrera notes Blue book Harrison’s Guidelines ICD 10 Previous notes Internet

Cardiac meds Dobutamine, Levophed,

Dopamine

Anti-hypertensive meds Captopril, enalapril,

amlodipine, metoprolol, losartan

ACS regimens ASA, Clopidogrel, Simvastatin,

B Blockers, ISDN

Antibiotics Meropenem Piptazo

IM ROTATION

Things to review or take note of Formulas

Electrolyte correction ABG Cardiac meds computation

Dosages Antibiotics Renal dosing

Regimens ACS Insulin – 70/30 Sliding scale

IM Rotation

Meds You are NOT required to buy all these meds for your

patient Its good to have them on hand just in case you

need them BADLY Make sure to have them replaced Refer patient to MSS/ CAAP/ SAGIP

Procedures/ Labs You are NOT required and you SHOULD NOT

shoulder any expenses for your patient (but you may…)

You can ask your senior if you can avail SAGIP for your patient

IM Rotation

In case you bought meds or paid for the labs or procedures of your patient, always keep the receipt for possible reimbursements from IM chief res c/o SAGIP

Saturdays, Sundays, Holidays Ward: half day unless otherwise

announced Day MHAPOD (POD pre-duty/from duty) :

whole day (7am – 7pm)

IM Rotation

Being ready is just a perception You are ready when you are Always keep in mind, we are FM residents first and

foremost, although our competencies are different, it doesn’t mean that we are inferior to them, it’s just a matter of choice – they are IM and we are FM.

It also doesn’t mean that we should push ourselves as hard as they are pushing themselves.

Never lose your identity as FM residents – the identity that we want others to be reminded of FM

ANY QUESTIONS?

YOU ARE READY… YOU JUST DON’t KNOW AND FEEL LIKE YOU ARE

PEDIA

2 months 1 month wards

No definite structure Don’t expect it to be as structured as IM You just have to be visible and involved You just need to learn the essentials that

you will be needing for ER rotation IV Fluid computations Electrolyte corrections ABG interpretation Proper endorsement of patients

PEDIA

1 month ER Team duties unlike IM POD Under the guidance of Senior POD Part of decking or co-deck (at times) Duty

All new patients and your patients previously admitted by your team

Post-duty Endorse your own patients Endorse and leave

Pre-duty Triage Patients admitted previously by your team and the post-duty

team Saturdays, Sundays, Holidays – half day unless otherwise

specified

TOXICOLOGY

1 month Duty every 3 days, regardless of

number of rotators If you are paired with an outside

rotator (MMC, OsMak, etc), you have to trodat and sign their entries.

TOXICOLOGY

Duty 24 hours Receives endorsements from post-duty – roundtable

and bedside Sees referrals from ER (DEM, Sx, IM, Neuro, Pedia) Sees referrals from wards History, PE, Assessment and Plans Plans

Guided by the black book, pandora’s box, other referrences

You can ask the fellow or consultants for problematic cases

Updates fellow and consultants regarding patients

TOXICOLOGY

Post-Duty No post-duty status whole day Prints census Endorse patients – roundtable and

bedside Can do other tasks/ errands just ask

permission from the fellow Pre-Duty

Answers telephone referrals (including tox phone)

TOXICOLOGY

Saturdays – half day Sundays, Holidays – pre-duty off, post-

duty endorse and leave unless otherwise announced

Monday – case conferences Wednesday PM OPD – Duty and Post-

duty FM Service follow-ups, Thursday

conferences and other department activities – excused from Tox

Trad Med & Integ Med (WELLNESS)

Ever evolving rotation Historically

UPHS Traditional Med rotation

2 weeks with Dr Tan-Gatue, Dr Galvez-Tan

2 weeks with Dr. Pinky Baclig Integrative Medicine

WELLNESS

High risk of being pulled out Cover for consultants at UPHS Cover for CAGE officer Cover for students’ activities Attend conferences

ELECTIVES

1 month rotation Still with SASOD duties unless otherwise

agreed upon Please take into consideration the number

of inside rotators Subject for approval May be taken outside PGH

Subject for approval Proposal must be presented early (at least 2-3

months before) High risk for pull out if taken inside

ORTHO/ REHAB

OPD basis 2 weeks Ortho 2 weeks Rehab High risk for pull out

Directives from the Incoming Chief Resident

Proactive residents Engaged in learning

Conferences Student hours

Facilitate learning Not only of oneself More importantly, our juniors (including the

students) REQUIRED and EXPECTED TO ASK QUESTIONS

Support each other Biopsychosocially BRPs and internal BRPs

ANY PROBLEMS?

You can always text or call your seniors

Avi - 09228412361