Interns' Guide to Rotations at VUMC

VUMC: Vanderbilt University Medical Center Rotations

General Internal Medicine

Morgan (1 –  6)

  • Team: 1 Res, 1 Intern with patient cap of 10
  • Pick up list at 6 - 6:30 AM, admit until 5:30 PM, sign-out 6 PM
    • Admitting: Teams 1-3-5 & 2-4-6 alternate admitting days (just like VA)
    • Non-admitting teams can sign-out at 2PM on weekdays and 12PM on weekends
  • Rounds at 8 AM, teams usually meet at 8N Nursing stations; coordinate with attendings
    • Workroom: team-specific rooms on hall behind 7N Nursing station (Code 24300)
  • Review: read about each pt as you admit them, you will see a variety of different diseases
  • Tips: Call consults as soon as possible; keep a column on your pt list for Labs and New Notes easily track updates without entering chart to check; Your team pharmacist is a valuable resource, get her/his number the first day; Close communication with your team SW and CM help with discharges (upper level’s responsibility); Enter meds-2-beds ASAP

 

Geriatrics:

  • Team: 1 Res, 1 Intern with patient cap of 10
  • Rounds at 8 AM, team meets in the Round Wing workroom 7434
    • Workroom: 7434
  • Review: Geriatrics Section, Altered mental status (Neuro), genitourinary infection (ID)

 

Rogers (Subspecialty Services)

All Rogers services

  • Team: 1 Res, 1 Intern with patient cap of 10
  • Pick up list at 6 - 6:30 AM, admit daily until 5:30 PM, sign-out 6 PM
  • Each HPI usually requires special info about the patient’s subspecialty diagnosis (See Tips)

Rogers Hepatology

  • Rounds typically at 8 AM, team meets on 6MCE
    • Work room: 6MCE, 6755 – north end (No Code)
  • Review: Hepatology Section, Paracentesis (Procedures)
  • Tips: Present pts as “Cirrhosis secondary to ____ decompensated by ___ (EVs, Ascites, SBP, HE, HRS)”; use the MELD-Na dot phrase; almost never should give cirrhosis patient crystalloid, consider albumin instead (25%, not 5%), consult procedure service during rounds to get your pts on the list for therapeutic paracenteses

Rogers ID

  • Rounds typically at 8 AM, team meets in Resident Library (8N)
    • Work room: 6 Round Wing, 2nd door on left after coming out of elevator (No Code)
  • Review: Infectious Diseases Section, specifically HIV and ART General Concepts
  • Tips: Each HPI for pt with HIV should include most recent CCC provider, CD4/Viral Load, prior AIDS-defining illnesses and compliance to ART; Use ‘Notifications’ tab on main screen in Epic to keep track of lab orders as patients can have long stays with send-out labs that can take up to two weeks to result (can also hit ‘Notify Me’ in dropdown box of Order); consider doxy in lieu of Azithro for CAP in HIV/AIDS (MAC Coverage)

Rogers Pulmonology

  • Rounds typically at 8 AM, team meets at 8N nursing station
    • Workroom: 8South 8216 (Code 2430)
  • Review: Pulmonary Section, specifically Home Oxygen Therapies
  • Tips: Each HPI should include most recent PFTs (FEV1%most important, include other relevant data or recent changes); For CF, Use the CF admission order set, know typical organisms in patient’s sputum (ex: MDR Pseudomonas, Burkholderia, MRSA) and consult CF team; for PH know the therapies they are on (typically Flolan or Veletri)

 

Rogers Renal

  • Rounds typically start 7-7:30 AM, team meets at resident/fellow work room on 6MCE
    • Workroom: 6MCE 6772, behind nursing station with renal fellows (No Code)
  • Review: Nephrology section, specifically Renal Transplant
  • Tips: Each HPI should have renal transplant history with year, type of tpx, PRA, Ag MM, CMV D/R; 6MCE charge nurse can get pts transferred there; alert the night resident to patients with renal biopsy and low threshold to contact renal fellow; transplant pts should have daily tacro level one hour before AM tacro dose (5:00 am), regardless of pt’s home schedule and be cautious with first dose timing of IS to keep things on schedule

 

Cardiology Services (CHF & Harrison)

CHF - Heart Failure (1 & 2)

  • Team: 1 Res, 2 Interns on one team with pt cap of 8 per intern (16 total)
  • Pick up list at 6 AM, admit until 5PM (alternate admissions, resident to help assign)
  • Rounds typically at 7 AM, team meets at 7MCE nursing station
    • Workroom: 7N 7024 right before bridge to 7MCE. (Code 145)
  • Review: Advanced heart failure; RHC and swan numbers (useful in assessing volume status in hard to examine pts, and CCU transfers), post-cath care, valvular disease
  • Tips: Know each patient’s dry weight (usually found in outpatient cards notes or at last discharge), Know current outpatient diuretic regimen and most recent TTE (weight at the time helps too); order strict I&Os; Daily Standing Weights, and fluid restriction of 2L/day; Always assess JVP before rounds

 Harrison (1 & 2)

  • Team: 1 Res, 1 Intern on each team with patient cap of 10
  • Pick up list at 6 AM, admit until 5 PM (Long) or 2 PM (Short) alternating with other team
    • Weekends: Only long team admits new patients
  • Rounds typically at 7 AM, team meets at 7MCE Nursing station
    • Workroom: 5MCE 5181 (Code 0701); hard to hear stats so keep door propped
  • Review: post-cath care, ACS, chest pain, valvular disease, arrhytmia’s, PE’s.
  • Tips: To order heart cath, must be in the cardiology context in Epic “VUMC Cardiology VIR” (order listed as “Case Request Cath Lab” and use provider “Surgeon, Generic”)

 

Hematology (Brittingham) & Oncology

Hematology (Brittingham)

  • Team: 1 Res, 2 Interns with patient cap of 8 per intern (16 total)
  • Pick up list at 6 AM, admit until 5 PM (alternate admissions with second intern)
  • Rounds at 8 AM, team meets on 10T
    • Workroom: 7MCE Conference Room
  • Review: Neutropenic Fever, TLS, DIC, Acute Leukemia, Lymphoma, Plasma Cell Dyscrasia
  • Tips: Each HPI should include malignancy history (dx, prior tx, current tx); know the febrile neutropenia algorithm; if possible, enter orders/write notes while the other intern and attending are at bedside; low threshold to work any complaints up as bleeds and infections are common and can be rapidly lethal.

Oncology (A & B)

  • Team: 1 Res, 1 Intern on each team with patient cap of 10
  • Pick up list at 6 AM, admit daily 6 AM until 5 PM, sign-out 6 PM
  • Rounds at 8 AM, team meets on 11N at nursing station
    • Workroom: No assigned room, typically library, 11N or 10T, or 7MCE Conference room
  • Review: Opiates (Pain & Palliative Care), Oncologic emergencies, Paraneoplastic Syndromes, Chemotherapy Toxicity/Side Effects
  • Tips: Each HPI should have Onc history (Dot Phrase “.onchist”) including dx, prior treatments, most recent imaging; 10T and 11N charge nurse can get pts transferred there, you can write delayed admission orders for pts seen in infusion clinic (ask your resident)

MICU & Nights

VU MICU

  • Team: 3 Res, 3 Interns, no specific patient cap (typically 10-12)
  • Day Intern: 8 AM - 10 PM; Night Intern 9 PM - 11 AM; MICU is on 8T
  • Review: ARDS, Vent Settings, Modes of Oxygen Delivery, Sepsis, Management & Types of Shock, MICU/CCU Drips, ABGs (Pulm) Stress Dose Steroids (Endo), Cirrhosis, ACLS
  • Tips: Night intern presents all the old patients in the morning and signs the notes. The day intern owns the A&P of the notes by keeping them updated. Trust the nurses and never hesitate to relay info to your resident overnight if you’re concerned (wake him/her up!)

VU Nights

  • Start on Sunday night for interns, Wednesday night for residents; Off Saturday night
  • Team: 1 Res, 2 Interns with patient cap of 10 for Morgan/Rogers admitting; 1 Res + 1 Intern w/ cap of 10 for Harrison/Heme/Onc (Res and Intern split admissions)
  • Harrison/Heme/Onc: Start at 6 PM, admit until 5 AM, sign-out by 6 AM
  • Morgan/Rogers: Start at 6:30 PM, admit until 5:30 AM, sign-out by 6:30 AM
  • Cross cover: Start at 6 PM (Be on time!) sign-out 6:30 AM
  • Tips: ensure you communicate all orders and plans with the resident; Writing “To do” boxes on the first pages of each printed H&P might help you communicate the important aspects of each plan to the day intern when they arrive the next morning; cafeteria closes at 2 AM. For cross cover, make sure to document any significant events in Epic. Useful to follow-up on pts admitted previous nights to reflect on your diagnosis and workups

 

VA: Veterans Affairs Rotations

VA General Wards (1A – 6B)

  • Always make sure that your VA login works a few days before you are scheduled to start!
  • Team: 1 Res, 2 Interns with patient cap of 8 each (16 total)
  • Pick up list by 6:30 AM; Admit every other day; Can sign-out on non-admit days at 2 PM
  • Rounds alternate at 7 AM on admitting days, 8 AM on non-admitting days, meet at workrooms; night admitting team presents to attendings at 7 AM (depending on team)
    • Workroom:
      • Teams 1 – pulm & ID fellow workroom outside MICU on 2G
      • Teams 3 on 2N
      • Team 4 at 2nd floor main elevators
      • Team 5 on 3N
      • Team 6 – 2N hallway (Old team 1 workroom)
  • Review:  Geriatrics, chest pain, CHF, ACS/NSTEMI, syncope , COPD exacerbation, Pneumonia, Skin and Soft Tissue Infections, diabetic foot infections, AMS
  • Tips: Admission days can be very busy and anything you can get done on the non-admitting days will make your life easier (especially DIPNs for people leaving the next day); start your own patient list in a word document to use as your pre-rounding sheet as well as sign-out; Roll your pagers via Vanderbilt operator (same as at VU); ensure all orders on patients still in the ED are “Delayed” or they will disappear once on the floor (ask your resident); All consults must be accompanied by page to the covering fellow (see synergy for medicine subspecialties, TVHS website for surgery/other)

 

 

VA MICU

  • Team: 3 Res, 3 Interns, no specific patient cap (typically 10-12)
  • Combined CCU and MICU; 7AM CCU rounds followed by 8AM MICU rounds
  • Day Intern: 7 AM - 9 PM; Night Intern 8 PM - 10 AM; MICU between 2N and 2G (2nd floor)
  • Review: ARDS, Vent Settings, Modes of Oxygen Delivery, Sepsis, Management of Shock, MICU/CCU Drips, ABGs (Pulm) Stress Dose Steroids (Endo), Cirrhosis (Hep), ACLS
  • Tips: Night intern presents all of the old patients in the morning and signs the notes. The day intern owns the A&P of the notes by keeping them updated. Never hesitate to relay information to your resident overnight if you are concerned (wake him/her up!)

 

VA Nights

  • Team: 1 Res, 2 Interns, total of 10 admissions overnight
  • Start at 7 PM, Admit until 5:30 AM, present new patients to teams at 7 AM, leave by 8 AM
  • Start Sunday night for interns, Wednesday night for residents; Off day is Saturday night for interns/cross-cover resident (covered by clinic resident), Friday night for admitting resident (covered by BMT resident)
  • Tips: Admissions typically bolus at the start of shift and stop later in the night, so worry about seeing pts, formulating plans with resident and putting in orders as notes can be finished once it slows down; cafeteria at VU closes at 2 AM; communicate everything you do with your resident who is supervising a second intern as well; ensure all orders on pts still in the ED are “Delayed” or they will disappear once on the floor (ask your resident)