Link to Seizure Presentation by Dr. Sabetian!!!!!!!!!!!!!!!!! https://drive.google.com/file/d/0B1pWeEVI68OycWRQLVh1V3hzM1E/view?usp=sharing

Links below are educational points from M&M conference and QA lecture given by Dr. Ragland; Please Review. Thank You, Sukhpreet Sidhu

https://drive.google.com/file/d/0By4Sxq4DvrhbQmZFclY4SmlpZXJwNk9Ob0RaSkQyeHA3T0hn/view?usp=sharing

https://drive.google.com/file/d/0By4Sxq4DvrhbaU1mdGpsZlpHSm1jNlhnRm9YMHZZdjJHdTM0/view?usp=sharing

Please check the below schedule for the Internal Medicine In-Training Exam. Make sure to sign out to the cross covering resident before your exam. Cross covering residents, please carry the pager of the person you are covering while he or she is taking the exam. Inform your attending of the days you will not be available, it is a full day exam.

Exam Date: 9/4/2015	Exam Date: 9/11/2015
Ahmed-NF	Ghafarizadeh _ER
Chen-Wards	xxxxxxxxx
Gill- ICU	Abukamleh- Pulm
Arutyunov -Elective	Talwar- Wards
Ritam Sidhu- ICU	Gholam- ER
BenPerlas - VAC	Kaur- ICU
Agarwal- AC	Lee- Elective
Hammami- Wards	Ammar- Wards
Chahine- Renal	Sukhpreet Sidhu - Neuro
Parekh-AC	Chahal -Wards
Aguirre -NF	Avetisyan - GER
Azizi -Wards	Gupta- ICU

Nightfloat coverage:

Abukamleh cover night of 9/3, tell attending wont be present 9/3 and 9/4

Gholam cover night of 9/3, tell attending won’t be available 9/3 and 9/4

Wards coverage

-Sukhpreet Sidhu cover Azizi's team on 9/4

- Ghafarizadeh cover Chen's team on 9/4

- David will cover Ammar/Talwar's team on 9/11

ICU Coverage:

-ICU coverage on 9/4 (as per Schedule on Amion)

-ED resident to take care of all patients on 9/11/2015. 

http://www.acponline.org/education_recertification/education/in_training/

Thank You,

Sukhpreet Sidhu

The procedural service, runned by Pulmonary and Critical care division is now available to perform bedside procedures  from 8 am to 4:30 pm , Monday to Friday.

 

This procedures include:

 

Lumbar puncture, Thoracentesis, Paracentesis, Central line placement (or HD catheter), arthrocentesis (Knee or elbow).

 

The goals are to train residents in the Department of Medicine, expedite turn around to have the procedures done, save cost by improving patient safety and complications, and decrease the "load" of referral to IR to perform them.

 

 

 

Thank you

 

 

 

Ralph Garcia-Pacheco MD

Pulmonary and Critical Care

Medical ICU Director

 

TO ALL RESIDENTS and especially to INTERNS,please add your pager number or team color to imaging orders. Also, when you get a critical report from radiology please close the report by pressing 1.

Procedure Note Template

Hey ladies and gentlemen,

This will be my last blog post.

Please add the following template to the bottom of your procedure notes per Dr. Johnson.

Supervision:

Attending of record for procedure___________ [ ]  Direct     [ ] Indirect (authorized and aware)

Supervising resident (direct only) when applicable:_________

Primary Proceduralist:______________


It's been a pleasure serving you guys this past year. New chiefs, please tell all the new interns to sign up for the blog.

Thank you,

Sarah & Avi

Indications For Special Blood Product Transfusions

Hey Guys and Gals,

Below is a link to download the presentation and short quiz Dr. Ragland gave on ordering special blood products. The education is required to be given to all residents by the California Dept of Public Health.

Blood Products Presentation

QUIZ

There will be no GI Coverage starting Saturday, 6/6 7 AM until Monday, 6/8 at 12 noon.

Per Dr. Ragland, all GI bleeds for the weekend should be transfered to a level of higher care unless surgery is willing to provide emergent diagnostic scoping. Lower GI bleeds and PUD can then be surgical treated if needed and invasive IR can perform emergent TIPPS for varicial bleeding since sclerotherapy will not be available. 

OnCallAdvisors: Transition to Attending

Next week OnCall Advisors will be hosting four free webinars designed to help residents and fellows prepare for their transition to attending.  The "cram session" is designed to fill in the gaps on topics they need to know more about before leaving training:

• Knowing the parts of their employment contract that are most likely to cause a termination event.
• Avoid costly misunderstandings about their income.
• Ideas to help control work/life balance.
• How physician can keep more of their money and effectively handle debt and taxes.
• Learn physician-specific financial strategies for protecting their assets and loved ones.
• Knowing the most important steps to take to build a strong financial foundation in the early years of their career.

You can sign up using the link below:

Graduating residents/fellows, click here to sign-up

OnCall Advisors has educated residents and fellows all across the country on these topics and we don't want yours to miss this last chance to learn what they need to know on these topics.  

Matthew J. Wiggins | Lead Advisor & PartnerOnCall Advisors 888.848.0786 x. 103(f) 402.507.4477 MWiggins@OnCallAdvisors.com

Summary of today's Noon Conference

• Please note the Department of Medicine has agreed to pay for your taxi ride home and back to work if you are too fatigued to drive. Just save your receipt and turn it into Renee

Below links can be accessed easily by clicking on labels on the right side of the blog (when accessed on a computer)

• CLICK HERE to download Dr. Ragland's powerpoint from today

• CLICK HERE to download Resident Policy Manual (also give to you at orientation)

• CLICK HERE to download CIR MOU (contract) for 2014-2015 (also give to you at orientation)

• CLICK HERE  for Review of ACGME Duty Hour requirements as given in handout today

• UCLA Employee Assistance Program  phone number 1-800-730-3859

New Pulmonary & Critical Care Medicine Faculty

We have some exciting news. Kern Medical Center has hired 2 pulmonary and critical care physician for the intensive care unit.

Stay tuned to officially welcome our new faculty!

National Patient Safety Goals

Below are the National Patient Goals for 2015 as stated by The Joint Commission, previously known as JCAHO (Joint Commission on Accreditation of Healthcare Organizations).


1. Identify patients correctly: Use at least two ways to identify patients.

2. Use medicines safely: Before a procedure, label medicines that are not labeled. Take extra care with patients who take medicines to thin their blood. Record and pass along correct information about a patient’s medicines. Update home med lists

3. Use alarms safely: Make improvements to ensure that alarms on medical equipment are heard and responded to on time

4. Prevent infection: Use the hand cleaning guidelines from the Centers for Disease Control and Prevention or the World Health Organization. Use proven guidelines to prevent infection of the blood from central lines. Use proven guidelines to prevent infection after surgery. Use proven guidelines to prevent infections of the urinary tract that are caused by catheters

5. Identify patient safety risks: Find out which patients are most likely to try to commit suicide.

6. Prevent mistakes in surgery: Make sure that the correct surgery is done on the correct patient and at the correct place on the patient’s body. Mark the correct place on the patient’s body where the surgery is to be done. Pause before the surgery to make sure that a mistake is not being made. TIME OUT

Rotation Goals and Objectives

Ladies and gentlemen,

Please download the updated Rotation Goals and Objectives (previously on evalue).
The goals and objectives are PGY level specific for those rotations you do more than once in residency. They also reflect the ACGME 6 Core Competencies.

The Journal Club Curriculum and Research Curriculum have also been updated and uploaded.

This post will always be available under the resources and acgme labels. We also added it in the link box on the right of the website

Click Here for Goals and Objectives

Patient Care
Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.

Medical Knowledge
Residents must be able to demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care.

Practice-Based Learning and Improvement
Residents must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices.

Interpersonal and Communication Skills
Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, patients’ families, and professional associates.

Professionalism
Residents must be able to demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.

Systems-Based Practice
Residents must be able to demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value.

Transition of Care- Patient Signouts

Acronym for Effective Signouts 

Senior residents: you must observe your interns method for signouts at least twice a rotation and provide constructive feedback afterwards. Additionally, you are responsible for signing out all sick patients to the on call senior.

It is stongly encouraged for interns and seniors to identify sick and new patients and consider joint evaluation at bedside during signouts.

SIGNOUT?

o S: Is this patient particularly Sick or DNR
o I: Identifying data and demographic info about patient
o G: General hospital course for the patient
o N: New events or occurrences of the day
o O: Overall Health status
o U: Upcoming possibilities and things to watch for
o T: Tasks that need to be completed prior to next handoff
o ?: Any questions?

Call day holllaaaaaa

Pitbull 

New Rotation Announcements - Sub-Specialties, Sepsis, and more.

Attention Residents:

The following were discussed during the faculty meeting today, please pay close attention:

• If as a primary team it is decided that you will not institute the recommendations of a specialist, please document the reason. 
• ex: nephrology consulted and recommends diuresis but as a primary team you decide that this may not be beneficial to the patient due to hypotension, please note it in your progress note.
• Antibiotics are recommended within 1 hour of recognizing sepsis. When evaluation patients in the ED and recognizing sepsis, place your first dose of antibiotics in the ACTIVE ORDERS, not the delayed orders. Contact the nurse and inform them as they don't get automatic print outs of orders.
• When placing critical orders (imaging, labs, medication, etc) in ED patients. Place them in the ACTIVE orders so they are available to nursing staff immediately.
• There will be a specialty evaluation committee on 2/24/15. The objective is to evaluate the medicine specialty services. If you have any recommendations, suggestions or concerns regarding any of the medicine sub-specialties, please post (anonymously if you'd like) in the comments below.
• Please make sure that there are Internal Medicine Consults placed when seeing patients.

ACGME Core Competencies & Milestones

• ACGME has 6 core competencies for every resident physician to meet prior to graduating. 
• The ACGME milestones are used as a system for programs to evaluate residents and promote residents based on the 6 core competencies. 
• The Clinical Competence Committee (CCC) meets semi-annually and evaluates each resident's progression through the milestones
• Milestones are graded on a 1 - 5 scale with 1 being "critically deficient" to 5 being "aspirational."

Click links below for more details

ACGME SIX CORE COMPETENCIES

Patient Care (PC)

Medical Knowledge (MK)

Practice Based Learning and Improvement (PBLI)

Interpersonal and Communication Skills (ICS)

Professionalism (PROF)

Systems Based Practice -working with health care system (SBP)

ACGME 22 MILESTONES & HOW YOU ARE EVALUATED 

1. Gathers and synthesizes essential and accurate information to define each patient's clinical problem: monthly eval, chart review, miniCEX 

2. Develops and achieves comprehensive management plan for each patient: monthly eval, chart review 
3. Manages patients with progressive responsibility and independence: monthly eval, chart review
4. Skill in performing procedures: Met 5 required procedures
5. Request and provides consultative care: monthly eval, chart review
6. Clinical Knowledge: monthly eval, Peer review
7. Knowledge of diagnostic Testing and procedures: monthly eval, chart review
8. Works effectively within an interprofessional team: peer eval, nursing eval, patient survey
9. Recognizes system error and advocates for system improvement: monthly eval
10. Identifies forces that impact the cost of health care, and advocates for, and practices cost effective care: monthly eval
11. Transitions patients effectively within and across health care delivery systems: montlhy eval
12. Monitors practice with a goal of improvement: self eval
13. Learns and improves via performance audit: quality data (i.e. pap smears, mammograms, diabetes checklist, pcoft)
14. Learns and improves via feedback: monthly eval, peer review
15. Learns and improves at the point of care: monthly eval
16. Has professional and respectful interactions with patients, caregivers and members of interprofessional team: monthly eval, nursing eval, patient survey
17. Accepts Responsibility and follow through on tasks: monthly eval, patient survey
18. Responds to each patient's unique characteristics and need: monthly eval, nursing eval
19. Exhibits integrity and ethical behavior in professional conduct: monthly eval, peer review, nursing eval
20. Communicates effectively with patients and caregivers: monthly eval, peer review, patient survey
21. Communicates effectively in interprofessional teams: monthly eval, peer review, nursing eval, patient survey
22. Appropriate utilization and completion of health records: PCOFT, Problem/Med List, unapproved abbreviations, delinquent records

Continuity Clinic Evaluations

Many of you already know this but for those who don't, please note the following ways you are evaluated in continuity clinic:

• Mini-Cex which includes faculty bedside evaluation of residents
• Nursing evaluation
• Chart Audits
• Dan Burke Bedside Behavioral Science evaluation

Diagnostic Cardiac Catheterizations at KMC

Please note that we do have the ability to perform diagnostic cardiac caths at KMC and have for quite some time. Of note there were 50 caths done last year.

 Our cath lab has receive a makeover is  fully operational for at least 3 weeks now.

A Message From Glenn Goldis, Chief Medical Officer

From: Glenn Goldis, MD, CMO
Date: February 5, 2015
Subject: Confidential Communication 

In response to ACGME process improvement recommendations, I would like to begin extending my availability to any of our Residents who wish to have a “safe place” to discuss sensitive issues or topics that affect the learning environment and your experience as a Resident at KMC.

Therefore, please know that effective immediately, I am available to discuss any personal or professional issues you may wish to share. I hope to use any learning from our discussions to improve the process, operations, or function of our facility and the Residency program itself. Any topic is “fair game” and held in the strictest of confidence.

Thank you in advance for your willingness to work with me toward improving the academic and clinical services we offer here at KMC.

If you would like to arrange a time to speak with me, please contact Tracy Subriar:
Office: 661-326-2718 or
E-mail: subriart@kernmedctr.com

Glenn Goldis, MD, MMM
Chief Medical Officer
Chief Academic Officer/DIO
Kern Medical Center
1700 Mt. Vernon Ave.
Bakersfield, CA 93306
Goldisg1@kernmedctr.com
(949) 445-4758 (cell)
(661) 326-2123 (office)

Weekend Call Schedule and Dr. Duggal Endocrine

Ladies and gentlemen,

Please note the weekend call schedule has been updated on Amion to reflect the changes.

Additionally for those of you on ambulatory care, pay attention to the subspecialty schedule regarding the Endocrine rotation with Dr. Duggal.
No longer are the days set for Tuesday and Friday.
Each week the endocrine rotation days are different so that we can accommodate the Family Practice Program.

New Weekend Call Schedule Trial

We will be "beta" testing a new call schedule for the weekend to ensure that residents don't work for more than 24 hours.

The following will only apply to residents and NOT interns:

Old Schedule:
Night float Thursday 9pm - Friday 7am
Wards Friday 7am - Saturday 7am
Wards Saturday 7am - Sunday 7am
Wards Sunday 7am - Sunday 9pm
Night Float Sunday  - 9pm - Monday 7am


New Schedule
Night float Thursday 9pm - Friday 10am (13hour call)
Wards Friday 10am - Saturday 10am (24 hour call)
Wards Saturday 10am - Sunday 10am (24 hour call)
Wards Sunday 7am - Sunday 9pm (12 hour call)
Night float Float Sunday 9pm - Monday 7am

Sunday night throughout Thursday morning, The scheduling will remain the same


What does this mean?

• There will be a 3 hour window where you'll be on call WITHOUT your intern while you admit to the incoming team.
• Example: Night float is on until 10am on Friday morning. A consult comes in at 9am. The senior resident is not available yet but the intern from Platinum team is there already. The night float senior will take the consult information, triage the patient appropriately, then supervise the ward intern during the encounter with the patient. The admission will be to platinum. Once the senior arrives at 10am, there will be a senior to senior sign out.
• Example: Platinum team is now on 24 hour call from Friday 10am to Saturday 10am. A consult is called on Saturday at 8am. The Platinum senior will take the consult, triage the patient appropriately, then supervise the incoming ward intern (Purple) to see the patient. Once the next team senior (Purple) arrives at 10am, there will be a senior to senior sign out.
• We will be using a consult pager that will be passed on from senior to senior. The pager number is 307-2191. This will simplify the process for the hospital to know who to contact for medicine consults.
• This new schedule means you will come 3 hour later on the 24 hour calls so you can leave by 10am and not hit the 24 hour mark.
• We understand this sounds complicated but the alternative more simple approach to avoid  >24 hour call is to extend night float from 5 nights to 6 so we can cover friday nights and then have residents that are on non call rotations (Cards, ID, AC, Neuro, etc..) Saturday night float. ---This means you will give up 1-2 weekends off while on non call rotations

If you have any questions or confusion, please don't hesitate to call us or ask questions in the comments.

Endocrine Round Table Discussion - Dr. Ettinger Schedule Change

Please note the Endocrine lecture has been changed to 1 pm tomorrow 1/14/2015 in the platinum room so that more people can make it.

We will schedule more lectures during noon conference from now on.