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 5 8 Medicine Ward Expectations and Survival Tips Night Float Expectations and Survival Tips The Night Float System 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 Death Pronouncement Prescription Numbers Dictation Information Regional Medical Center at Memphis (MED) Phone Numbers Computer Dictation Discharge Baptist Memorial Hospital Phone Numbers Computer Dictation

20 21 21 22

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Index II
General Program Information, Policies, and Requirements 29 29 30 30 32 33 34 34 35 36 36 36 37 38 38 39 40 40 41 41 41 42 44 44 45 46 46 47 47 49 Campus Training Lessons Clinical Evaluation Exercise Conference Attendance Core Competencies Curriculum and Syllabi Duty Hours Email Policy Evaluations Policy Fatigue Policy Housestaff Manual Internal Medicine In-training Examination Internal Medicine Website Leave Policy Mail Medical Records Moonlighting Policy and Requirement Non-teaching Patients Pagers Paychecks Portfolio Procedures Professional Conduct Research Rotation Stipend Supervision Policy SVMIC Conference TB Testing Teaching Responsibilities Travel to Meetings Mini-CEX forms

* This is not a complete list of policies. You should review all program policies on the program website.

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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 patients 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

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not wait for results to show up in the computer; that may take days! 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) arent 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-toface at the end of each day.

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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 its easy to get behind once youre 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 hasnt 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 ones condition is stable. Its either good, fair, guarded, or critical. V Vitals. Please dont write routine unless theyre 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.

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D Diet. Specify what type and how many calories (sometimes not needed). I IVFs. Please write duration of fluids or amount to be given. You dont want the pts to mistakenly get IVFs when they dont 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! Dont 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 dont 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 youre 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

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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. 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.

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Medicine consults during the evenings are taken by the night float resident and passed to consult team in the morning. In the Midnight Hour CrossCover 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.

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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 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 patients 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 patients 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

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Get PCXR (portable) stat O2 sat if not done 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 (DONT MISS THESE!!) Acute MI Aortic Dissection Pneumothorax Pulmonary Embolus

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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 to 1 hour, so do followup 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 patients age and reason for admission How long has the patient been short of breath Sudden onset or gradual Vitals sign (include O2 sat)

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Is there any accompanying chest pain What has been done so far? 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)

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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 to 1 hour, so followup on labs). Go and see the CXR yourself, dont 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 IVFs 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.

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Discuss your plans with the resident and/or attending prior to ordering the above studies. Altered Mental Status The nurse calls and states that Mr. Bonkers is confused Questions to ask the nurse: The patients 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

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Endocrine: Hypothyroidism, hyperthyroidism, adrenal crisis Constipation (especially in the elderly) 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 IVFs, 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 IVFs 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

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Fever On Call The nurse calls and states that Mrs. Hottie is running a fever. Questions to ask the nurse: The patients age and reason for admission How high is the temperature and which route was used to measure the temp (Oral, Axillary, Rectal- Remember that 37C oral = 37.5C rectal =36.5C 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: IVFs (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

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LIFE THREATENING CAUSES OF FEVER (DONT 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 hospitals 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.

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

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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.

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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.

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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 5C Lo-side 58150 4D MICU 58334 4D NICU 58390 Rout OB ICU 56996 Labs: Cath Lab CT Scan EEG Immunology MRI U/S 448-6122 58345/57294 57881 56528 58499 57281 5B Hi-side 5C Hi-side 4C PCU Adams Prison 57560 58100 57060 57470

Chem Echo Heme Micro Trauma Lab X-Ray (Trauma) Bed Control ER front desk Health Dept: TB STD Newborn Ctr Pharmacy IP Surg A Trauma Lab Pharmacy

57744 448-4767 57767/56344 52178 87192 57771 57133 57826 544-7600 544-7616 544-7552 87366 57937 790-9849 57857 57964 57970

Miscellaneous: Admissions 57688 Computer Help 57480 ER MD area 57859 Interventional 57476 MMHI 524-1200 Mphs Path 405-8200 Pathology 448-6300 Psych Holding 57944 Surg B 790-9858 MedPlex Phone Numbers: GI Lab 58311 Mammogram 5636

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Promark (800) 762-2299 X-Ray:U/S 57281 MED Clinics: Adult Special Care 57446 Derm 57486 Med B 57285 Optho 57257 Ortho 57259 Sickle Cell Clinic 58535 Wound care 58999 MED Computer: Meditech

TLC

725-7100 #3300 57185 57130 57285 57273 57486 57486

Allergy Med A Neurology Oral Surgery Neurosurgery Surg/Urology/Vas

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

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7- Ophthalmology 8- Ob-Gyn 0 History & Physical 1 Operative Report 2 Discharge Summary 3 Consult

15-Newborn-Pediatric 4 Letter 5 Progress Note 6 Out-Patient Note 7 Physician Action Line

Step 5: Enter the patients 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 Patients 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.

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MED Discharge Summaries: 1) Physicians Name 2) Patients 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 CT 65159 Pathology ER 63010 Pharmacy GME 61350 Radiology Hem 65647 Recovery Room MRI 62808 X-Ray Reports: 226-3800 (push 5 for prev report) 2 65088 65600 65750 64000 65710 #

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

Follow Touch Tone control function on the next page.

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Generic Touch Tone Phone Functions

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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.

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

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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 Medical Knowledge Practice Based Learning Interpersonal and Communications Skills Professionalism Systems Based Practice What you do What you know How you get better How you interact with other How you act 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 analyticthinking 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.

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Interpersonal and Communication Skills- skills that result in the effective exchange of information and collaboration with patients, their 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 patients 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.

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The following syllabi require a password for access. 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

1 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

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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.

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

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Committee meets quarterly to review each resident's progress and make suggestion for improvement. 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

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that the houseofficer may be immediately relieved of duty. Patient care should then be delivered by other members of the team or by 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,

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curriculum, housestaff manual, program documents and polices are listed on the site. 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

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the Program Director. Extended leave due to complications may be covered under the residents disability policy after the 90 day waiting period. 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 patients 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 patients 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 officers permanent GME record. Additionally, the resident may be suspended

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from clinical duties until all charts are completed, which may result in an extension of training time. Failure to complete medical records 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 backup 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

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then need to notify the program director of the location, type and schedule of moonlighting by the first of each month. 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.

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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)

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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 physicians 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 physicians 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

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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

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 Comply with the 80 hour work week and 30 hour continuous duty rule 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 residents 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.

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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.

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 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.

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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. 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

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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. 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.

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All requirements must be met to receive approval. No exception will be made. Publications and presentations must be entered into the New Innovations Portfolio. 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)

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Mini-Clinical Evaluation Exercise (CEX)

Evaluator: __________________________ Date: ______________ Resident: ___________________________ Setting: Ambulatory In-patient ED | R1 R2 R3

Other 7 8 9 Superior 8 9 Superior 8 9 Superior 8 9 Superior 8 9 Superior 8 9 Superior

Medical Interviewing Skill 1 2 3 | 4 5 6 Unsatisfactory Satisfactory Physical Examination 1 2 3 | Unsatisfactory 4 5 6 Satisfactory

Humanistic Qualities/Professionalism 1 2 3 | 4 5 6 Unsatisfactory Satisfactory Clinical Judgment 1 2 3 Unsatisfactory Counseling Skills 1 2 3 Unsatisfactory | 4 5 6 Satisfactory 4 5 6 Satisfactory 4 5 6 Satisfactory

Organization/Efficiency 1 2 3 | Unsatisfactory

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

___________________________________________________________ Resident Signature Evaluator Signature

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Mini-Clinical Evaluation Exercise (CEX)

Evaluator: __________________________ Date: ______________ Resident: ___________________________ Setting: Ambulatory In-patient ED | R1 R2 R3

Other 7 8 9 Superior 8 9 Superior 8 9 Superior 8 9 Superior 8 9 Superior 8 9 Superior

Medical Interviewing Skill 1 2 3 | 4 5 6 Unsatisfactory Satisfactory Physical Examination 1 2 3 | Unsatisfactory 4 5 6 Satisfactory

Humanistic Qualities/Professionalism 1 2 3 | 4 5 6 Unsatisfactory Satisfactory Clinical Judgment 1 2 3 Unsatisfactory Counseling Skills 1 2 3 Unsatisfactory | 4 5 6 Satisfactory 4 5 6 Satisfactory 4 5 6 Satisfactory

Organization/Efficiency 1 2 3 | Unsatisfactory

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

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Mini-Clinical Evaluation Exercise (CEX)

Evaluator: __________________________ Date: ______________ Resident: ___________________________ Setting: Ambulatory In-patient ED | R1 R2 R3

Other 7 8 9 Superior 8 9 Superior 8 9 Superior 8 9 Superior 8 9 Superior 8 9 Superior

Medical Interviewing Skill 1 2 3 | 4 5 6 Unsatisfactory Satisfactory Physical Examination 1 2 3 | Unsatisfactory 4 5 6 Satisfactory

Humanistic Qualities/Professionalism 1 2 3 | 4 5 6 Unsatisfactory Satisfactory Clinical Judgment 1 2 3 Unsatisfactory Counseling Skills 1 2 3 Unsatisfactory | 4 5 6 Satisfactory 4 5 6 Satisfactory 4 5 6 Satisfactory

Organization/Efficiency 1 2 3 | Unsatisfactory

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

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Mini-Clinical Evaluation Exercise (CEX)

Evaluator: __________________________ Date: ______________ Resident: ___________________________ Setting: Ambulatory In-patient ED | R1 R2 R3

Other 7 8 9 Superior 8 9 Superior 8 9 Superior 8 9 Superior 8 9 Superior 8 9 Superior

Medical Interviewing Skill 1 2 3 | 4 5 6 Unsatisfactory Satisfactory Physical Examination 1 2 3 | Unsatisfactory 4 5 6 Satisfactory

Humanistic Qualities/Professionalism 1 2 3 | 4 5 6 Unsatisfactory Satisfactory Clinical Judgment 1 2 3 Unsatisfactory Counseling Skills 1 2 3 Unsatisfactory | 4 5 6 Satisfactory 4 5 6 Satisfactory 4 5 6 Satisfactory

Organization/Efficiency 1 2 3 | Unsatisfactory

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

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Mini-Clinical Evaluation Exercise (CEX)

Evaluator: __________________________ Date: ______________ Resident: ___________________________ Setting: Ambulatory In-patient ED | R1 R2 R3

Other 7 8 9 Superior 8 9 Superior 8 9 Superior 8 9 Superior 8 9 Superior 8 9 Superior

Medical Interviewing Skill 1 2 3 | 4 5 6 Unsatisfactory Satisfactory Physical Examination 1 2 3 | Unsatisfactory 4 5 6 Satisfactory

Humanistic Qualities/Professionalism 1 2 3 | 4 5 6 Unsatisfactory Satisfactory Clinical Judgment 1 2 3 Unsatisfactory Counseling Skills 1 2 3 Unsatisfactory | 4 5 6 Satisfactory 4 5 6 Satisfactory 4 5 6 Satisfactory

Organization/Efficiency 1 2 3 | Unsatisfactory

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

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Mini-Clinical Evaluation Exercise (CEX)

Evaluator: __________________________ Date: ______________ Resident: ___________________________ Setting: Ambulatory In-patient ED | R1 R2 R3

Other 7 8 9 Superior 8 9 Superior 8 9 Superior 8 9 Superior 8 9 Superior 8 9 Superior

Medical Interviewing Skill 1 2 3 | 4 5 6 Unsatisfactory Satisfactory Physical Examination 1 2 3 | Unsatisfactory 4 5 6 Satisfactory

Humanistic Qualities/Professionalism 1 2 3 | 4 5 6 Unsatisfactory Satisfactory Clinical Judgment 1 2 3 Unsatisfactory Counseling Skills 1 2 3 Unsatisfactory | 4 5 6 Satisfactory 4 5 6 Satisfactory 4 5 6 Satisfactory

Organization/Efficiency 1 2 3 | Unsatisfactory

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

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