This document provides an orientation for new medical residents at MSKCC, summarizing: - The structure of medicine services and responsibilities of residents and interns. - Daily schedules including sign-outs, rounds, conferences and expectations for weekends. - Policies around admissions, consults, being on call and codes. - Expectations around teaching, documentation, dress code, and use of technology/resources. - Information regarding meals, housing, sick days and providing overall feedback.

1. Welcome to MSKCC!
Department of Medicine Orientation
2014 - 2015
KC Arbour
Anuja Kriplani
Brian West
Chief Medical Residents

2. Medicine LibGuide
• Internally:
type“mskway” into your browser
• Externally:
libguides.mskcc.org /medicinehousestaff

4. Medicine Services at MSKCC
• Medicine Housestaff Services:
– GI A, GI B: 2 residents , 3 interns
– Breast, GU, lymphoma green: 2 residents, 2 interns
– Leukemia A, leukemia B: 1 resident, 2 interns
– General Medicine: 3 interns
• Medicine Nurse Practitioner Services:
– Thoracic Oncology
– Bone Marrow Transplant
– Head/Neck, Melanoma, Sarcoma (HMS)
– Gynecologic Oncology
– Lymphoma Red (Multiple Myeloma)

5. SCHEDULE

6. Starting your day…
• Day starts at 7am
▫ Admissions are listed on the board
▫ Admissions done by nocturnalists are picked by
residents and presented on rounds
▫ Admissions with an “NF” are picked by the interns
▫ All patients must have a service care provider
assigned to them immediately (“add to your list”)
Everyone has breakfast!

7. Adding Care Providers

8. In the afternoon….
• Lunchtime Conference (1pm)
• Work (2pm-5pm)
• PM Attending Rounds
• Sign-out to NF (5:30pm or later)
– Don’t forget to forward your pager

9. Sign Out
• Interns MUST review hand-offs with your resident prior to
sign out
• Residents MUST be present to supervise intern-to-intern
verbal sign out
• Residents and interns should leave the hospital together
(every intern needs to have a back-up resident in house)
• Pagers:
• NF 1 (p 9132) SOLIDS: GI, GU, Breast, Gen Med
• NF 2 (p 9133) LIQUIDS: Leuk, Lymphoma Red/Green

10. Signing out new admissions
• All daytime admissions presented and discussed with
primary team attending can be added to the sign-out
list
• Admissions not yet staffed by an attending should be
signed out with a copy of the full admission note

11. Weekends
• Everyone works 6 days per week
– Either Sat or Sun off (no “golden” or “black” weekends)
– You will be “on call” or “rounding”
• If “on call,” you take admissions from 7am-7:30pm
• If “rounding,” you may sign out when your work is finished
to the “on call” person on your team (earliest 2:30pm)
*if it is very busy you may be asked to admit as well
– gen med signs out to GU-breast intern on call, earliest 5pm
– Half of the team will be on each day
• The resident will cover the missing interns’ list
• Except on leukemia:
– On days when the Leukemia resident if off, there will be a moonlighter backing up
the intern. If the intern is off as well, moonlighter will be backing up intern and
carrying an intern’s list

13. Patient Admissions
Home Clinic
UCC
Chief’s Office
Floor Team
(YOU!)
IR
OSH

14. Admissions Policy
• 7am-3pm: all admissions are paged to both residents on
the service to be done by any member of the team (to
be decided by the residents)
• 3pm-7:30pm: admissions are done by the on call team
members
* There are exceptions when residents not on call will be asked to help with
admissions after 3pm.
• If any service is particularly busy, teams may still be
asked to do admissions to other services

15. Being On Call
• Approximately Q4
• You may sign-out your list/new admissions earliest 7:00PM
• You must be done with your work and out of the hospital by 11PM
• Tip: if new patient is at a study (e.g. CT), feel free to go meet them
there
• You are on the code team and must attend all codes until 7:30PM
• All residents MUST stay until “buddy” intern signs out
• Residents and Interns are expected to leave the building together
• Electronic “free-to-go” meal cards are provided

16. AM-I-ON??
• www.amion.com; password - sloan2
–Review it to ensure that you are not on
call during a clinic day

17. AM-I-ON??
• www.amion.com; password - sloan2
–Review it to ensure that you are not on
call during a clinic day

18. AM-I-ON??
• www.amion.com; password - sloan2
–Review it to ensure that you are not on
call during a clinic day

19. On Call “buddy” teams
• “Buddy” teams:
• Leukemia A + Leukemia B + Lymphoma Green
• GI A +GI B
• GU + Breast + General Medicine
• All intern admissions will be supervised by a resident
• Residents must examine the patient, review the orders
and the plan with the intern
• Residents must also assist their “buddy” intern with
floor patients

20. Calling Consults
• Call your consults early!
– clarify with attending the urgency of the consult
• Consult via computer order and call the
consultant

21. Consults done by Residents
• Renal and General Medicine Consults (including urgent pre-ops)
• On Weekdays 5pm – 7pm
• On Weekends 7am - 7pm
• Distributed as an admission
• Only responsible for NEW consults of patients on a NON
house staff service
• Primary team residents will be responsible for consults on
their own services (contact consult attending directly).

22. Code Leader
• One “on-call” resident per day is designated as the Code
Leader
• You are the code leader from 7am to 7:30pm.
– Answer a test page at ~9:15am and 4pm by calling the
operator and telling them you got the test page
– Review your ACLS
• Check the Amion schedule ahead of time, check LibGuide
for further details on code leader responsibilities
• Document ALL code events and be sure to include
code rhythm.

23. Codes
• Call team is paged with all codes (7a-7:30p)
• Codes are attended by medicine team, ICU
team (NP/fellow), anesthesia
• Pediatric codes (M9) are run by medicine for
adult sized patients – we attend all codes!
• If there are enough people to help at the
code, check with code leader if you are
needed

24. Weekly Conferences
• Resident Report (medicine library): Monday and
Wednesday 11am
• Intern Report (medicine library): Thursday 11am
• Grand Rounds (Zuckerman Auditorium) :
–Friday 8am
• Lunch Conferences (medicine library):
–Monday – Thursday 1pm
• Professor’s Rounds (RRL-101): Friday 1pm

25. Morning Report
• Choose an interesting patient to present
• You will present the patient in an H&P format
to your co-residents
• Prepare 1-2 “key take away” teaching points
you want your colleagues to remember
• Chief resident and attending (med onc or IM)
will be present to facilitate MR

26. Patient Death Debriefing Sessions
• Goal: to focus on emotional reactions of
housestaff following a patient’s death
• 2-4 sessions per month
• Led by inpatient service attending
• Please remind your attending if needed
• If no deaths, the team should debrief on
patients that are nearing the end of life.
• Please see chiefs for a green pocket card reminder, also see
LibGuide for reference.

27. Teaching

28. Residents As Teachers
• All residents must teach interns and medical
students regularly
• In a 2 week period, residents will give at least
one 10 min talk on a topic of their choice
• Residents should inform chiefs re: when they
are planning to do formal teaching
– Chiefs and attendings may come to observe
sessions

29. MS3
• Care for 2-4 patients
– encouraged to take ownership and be the primary provider
(interviewing patients, calling consults, etc.)
• Present their patients on rounds
• Write an admission note and daily notes
– paper notes to be placed in paper chart (not electronic)
– these do not count for billing purposes so a complete
housestaff note must also be written daily
• Paired with the intern with whom they should
take call q4h (including weekends)

30. Sub-I’s
• Care for 3-5 patients
– encouraged to take ownership and be the primary provider
(interviewing patients, calling consults, etc.)
• Pick up their patients from night float
• Present their patients on rounds
• Write an admission note and daily notes
– paper notes to be placed in paper chart (not electronic)
– these do not count for billing purposes so a complete housestaff note
must also be written daily
• Write orders (co-signed by resident)
• Sign out patients to night float
• Paired with the resident with whom they should take
call q4h (including weekends)

31. Expectations

32. You are a team!
• Do not consider yourselves a divided service
• BOTH residents should know ALL patients,
supervise both interns and work as a complete
team
• Will need to cross cover on weekends

33. Dress
• Wear a white coat and MSKCC ID badge
• Business casual; men must wear a tie
• Proper footwear (no open shoes as per OSHA)
• You may wear scrubs on call days
• No green scrubs

34. Patients with Limited English
• All patients with Limited English Proficiency
should be spoken to in their native language
AT LEAST once daily
– Remote interpreters: Video cart, phone (by Vocera
or bedside phone)
– In person: interpreters@mskcc.org
– Order in CIS: “Interpreter Inpatient Request”. For
URGENT or non-business hour interpretation
requests: call the operator at 212-639-2000 to be
connected to Pacific Interpreters.

35. HIPAA
• Do not send Protected Health Information (PHI) over a
personal email account (gmail, yahoo, etc.)
• You may use your secure, institutional email account (chpnet,
downstate.edu, etc.) when necessary.
• Avoid work-related postings on social networking sites (no
matter how seemingly benign).
• Keep all MSK PHI (patient names, MRN, clinical info) onsite at
MSK (do not bring it home, store to thumb drive, etc)

36. Odds and Ends

37. E-medical Record

38. Imaging (PACS)

39. Chemo History

40. Active Medications

41. Dose History

42. Documentation
• Select note template: type “Medicine Inpatient Progress Note”
– Title your notes with your service (e.g. Breast Progress Note)
– Sign your note with your pager number, date, and time
• You should write an event note for any acute events for your patients
(such as RRTs, ACS, and Codes). End-of-life discussions should also be
documented.
• You do not need to write a discharge summary but pts MUST have at
least brief progress note on day of discharge
• Do NOT copy notes daily, especially from attendings/consults (the
attendings WILL read them)

43. Death certificates
• Go down to the Admitting Dept to complete
the death certificate. It must be completed by
the end of your shift!
• You need to create an account :
- DOH needs to send you a verification email
use your non-MSKCC account

44. Paging
• Tag your message with your own pager
– Example: call back number x6733 & your pager #9132
tag your page with “6733*9132”
• Vocera: if you get a page from 4646 * ####, a nurse
is trying to get in touch with you 
Call 4646 and follow the instructions
• Leave your pagers in the medicine library overnight

45. Feedback/Evaluations
• Praise/Concern cards are available on paper
and electronically in LibGuide under
“Communication/feedback” tab
• Completely anonymous
• We are available anytime for feedback
• Faculty evaluations will be sent to your
programs

46. Lockers on M21

47. Mealcards and Housing/Parking
• For Downstate and Methodist housestaff,
housing is provided based on availability OR
parking is reimbursed
• Meal cards are provided for everyone (for call
days)

48. Sick days
• If you cannot work…
• Please contact both your chiefs & us ASAP
• Call the main hospital number 212-639-2000
• Ask them to page the chief residents @ pgr 1030
• Chiefs Office:
212-639-6733 (x6733)

49. Have fun and enjoy the cookies!