Intern Survival Guide 2013-14 - the UNC Department of Medicine

UNC Department of Medicine Intern Information Guide 2014-2015On behalf of the Department of Medicine, we would like to welcome the 2014-2015 Intern Class to UNCHospitals. We have assembled this guide to assist you in transitioning to internship and “le arning theropes” of a new hospital and a new Department of Medicine. UNC is committed to fostering a healthylearning environment where we provide service to patients regardless of financial background, educatefuture leading physicians, pursue scholarly work and maintain the ‘UNC way’ in all aspects of practice.We hope that this guide will start you off running. Please know that we are always available to help you.Sincerely,“Esse Quam Videri” – To Be Rather Than To SeemSarah Carroll, MD - Ambulatory Chief Resident, UNC HospitalsMaureen Dale, MD - Chief Resident, Wake Medical CenterStephanie Davis Cardella, MD - Chief Resident, UNC HospitalsJulia Hughes, MD - Chief Resident, UNC HospitalsKiran “Venky” Venkatesh, MD – Class of 2012

ContentsServiceo CommunicationEmailPagersImportant Numberso Computer Programso The WardsStructureCall ScheduleWho’s your backupDaily Routine, Responsibilities / Tips for efficiencyo MICUo CCUo Ancillarieso ClinicEducationo Online Curriculumo Conferenceso Teaching Roundso Libraryo Online ResourcesScholarly Worko Subspecialty Contactso Department Informationo Clinic Quality ImprovementPersonal Health/Information/Misco Important personal work infoo Cafeterias and freedom payo Call Roomso Employee Discountso Gyms / Intramurals

COMMUNICATIONEmail: You must use your UNCH email account for allwork/hospital related issues. This is mandatory. Youremail limit is 40 MB, which goes fast so be aware of thesizes of attachments when sending to co-residents. Noone likes to be locked out of their email. This can besynced to smartphones as well with the followinginformation:Email: xxxxxxxx@unch.unc.eduServer: webmail.unch.unc.eduDomain: UNCHUsername: xxxxxxxxPassword: ********Use SSL: OnS/MIME: OffWeb Address: http://webmail.unch.unc.eduPhones:The three prefixes (starting with area code 919) at UNC are 966-,843- and 445- (the latter being the wireless phones that nurses carrywith them). When inside the hospital you only need to dial the last 5digits (6-xxxx for 966-xxxx, etc). If there are extra nurses’ phones,then they can be checked out at the Head Unit Coordinator (HUC)’sdesk to have for calling consults on rounds, etc. Do NOT take thesehome. They are extremely expensive and work only on the UNCintranet.Each ward team now has a Sprint cell phone, which can be used toreturn pages, call consults, etc. during rounds. These phones areresponsibility of EACH TEAM. If lost, replacement cost isresponsibility of interns and resident on team.There’s usually an important numbers handout posted in nursesstations and the KICKU. Here’s some notable numbers, of which allcan be found in in Web Exchange- Hospital Operator: 6-4131 (966-4131)- Clinic: patient line 966-1459 ; physician line 6-6989- House Supervisor: 347-1922 (pager)- alert of level of care changesfloorto ICU)- Hospital Bed Control 6-2041 - when admitting a patient from clinic- Home Infusion Nurses: 123-4280 (alert of anyone that will needhome IV meds at discharge, always let them know DAYS inadvance)- Inpatient Pharmacy: 6-2376- Core Lab: 6-2361- IT Help Desk: 6-5647

- KICKU numbers: 6-5644, 6-8587PagersEveryone is assigned an alpha pager with accompanying pager number for the entirety of residency. Inaddition to these pagers there are also team “virtual pagers”. These latter pagers are not tied to aphysical pager, but instead the numbers are signed over / forwarded to the appropriate coveringresident at EVERY shift change. The reason for doing this is to simplify communication between nursesand fellow providers and residents covering particular services and/or patients. Virtual pagers exist forjust about every service in the hospital, from house supervisors, pediatrics, surgery, and the medicineservices.Paging Tips and Good Pager Etiquette:1. How do I send pages? For the most part you’ll be using Webexchange, the hospital’s directoryand paging system. The address is http://directory.unch.unc.edu or simply ‘directory’ into theURL line only from within the hospital.2. Do not page someone to a pager number, page to a physical phone number where you can bereached. Doing so is poor form.3. Include the callback number! And who you are when sending pages.4. Listen! for the return call. Be aware that some floors do not page overhead.a. These floors have designated direct lines for doctors (examples: 8BT and 4ONC). Ifuncertain, ask your resident or the HUC (they sit at the front of every nurses’ station).5. What’s the way to type a page? Here’s the perfect page. You gotta try to be short, sweet, andsuccinct:“Re: pt name, MR#, reason for page, your name callback # * pager number”o ie: Re: Smith 5552424, upper GIB needs scope - amann 6-3131 * 2163311.o ie: Re: Leach MR1234456. 57yo M with recent STEMI and new ARF and bloody urine.Foley out. Rm 3734. Telloni (Cards) 65421*2161234o ie: Re:James MR 98765432. c/s for subdural hematoma. 86yo F with afib s/p fall withLOC and new L sided SDH. VSS AOx3. Johnson (MED A) 68801*21654986. When typing the page, don’t hit the “Enter” or “Return” key on the keyboard if you want tocreate a new line because if you do so, you’ll actually send the page. Instead, just keep typingyour entire page and when ready to send it, click send or hit “enter” or “return” on thekeyboard.7. My pager is broke, now what? Go to the Hospital Telecommunications office on the groundfloor of the Old Clinic. There’s near the GME office and they can replace or repair your pager.8. I accidentally lost or deleted an important page, can I get it back? Yes and No. If you call theUNC main number, 6-4131, you can talk to an operator who has access to all pages you’vereceived and sometimes you can find a list of old pages. They’re usually kept in a database forabout 24hrs and then deleted.9. I need new batteries, where do I find them? The Medicine Housestaff office has batteries aswell as Hospital Telecommunications. Occasionally HUCs also have batteries and will give you

one. Changing the battery in some pagers will cause you to lose all your pages, so make sureyou’ve jotted down the information you need before doing so.10. I’m receiving garbled pagers, what’s up with that? These are normal system errors, but if this isa persistent problem, talk to someone in communications as it could be due to your pager.11. I’m not receiving pages? What’s up with that? The paging system does rarely go down, but thisis a seldom occurrence.12. Signing in and signing out your pager. When working on a service, remember to SIGN INTOyour pager using the telephone pager system in the mornings. It is your responsibility as anintern or resident to do this in the morning. This is KEY to maintaining a steady flow ofcommunication for staff throughout the day. When signing out, you or the nightfloat can SIGNOUT your pagers. You can call 966-1100 or 6-1100, and follow the automated prompts to attachyour number to a virtual pager (“2” and then “8” to assign coverage of a pager; “2” and then “9”to make your personal pager unavailable, “2” and then “4” to make your pager available again).13. How do I call pagers other than using WebExchange?a. Call the pager directly. For 216- pagers (ours) outside of the hospital. Dial 919-216-xxxxand enter your call back number. Don’t forget that you can also tag your pages andpress the star key and then enter your pager number, which is one way of identifyingyourself (e.g. 38073*2163516). To end the call, either press the “#” button or just hangup.b. For 123 pagers (like the virtual pager numbers): call 919-966-PAGE and enter the pagernumber (ex. 123-1234) followed by your call back number. If you would like to includeyour pager number, enter your call back number followed by *, then your beepernumber, then press #.c. Page via the Medicine Housestaff website. Here you can page just medicine-relatedpersonnel (residents, fellows) or to page multiple residents at once from anywhere:https://clipper.med.unc.edu/impager/pagerlist.cfm?dept=IM

WebExchange/WebXchange/DirectoryWebexchange is the hospital’s centralized directory of all personnel and phone numbers, pagers, etc. forhospital staff. To access this, either type http://directory.unch.unc.edu or simply ‘directory’ into theURL line only from within the hospital. There’s also a phonebook icon on most desktops that will linkyou to the application.- You can of course use it to page just about anyone in the hospital.- Type in the "last name" box for just about anything (ie "6west", "pulmonary clinic", “bonereading room”, etc...). This can save you 100s of calls to the operator, where wait times can beseveral minutes.- After a few minutes, your current session in Webexchange will expire, so make sure you refreshyour screen if you’ve been idle for a whileComputersComputers, particularly desktops and laptops are located throughout the hospital. Mobile computers,or as they were formerly known, Computers on Wheels (COWs), are sometimes also available which canhelp you to make rounds run more efficient. The computers are Windows based and they are always awork in progress. At the time of writing this current guide, the hospital is slowly replacing old machineand updating some to run Windows 7. Here’s some tips and highlights:- Computers with “Clinical Workstation” in the background are clone or dummy computersmeaning they all essentially the same and you cannot install any programs on these. They arefairly limited in their programs but if you need PowerPoint or Word, you can access these if youright click on a small red button in the lower right hand corner of the screen on the Taskbar. Beaware that you CANNOT save anything on these machines either. But you can on the machineswith CD ENABLED in the background. These computers provide you a little more freedom toinstall and run programs to a limit.- Apple computers. UNC does not have Apple based systems or computers for access, but youcan use these and get access to UNC’s WiFi services. WebCIS can be buggy on Apple computers.CPOE in EPIC- I forgot to order XYZ lab tests. Should I re-stick my patient? Well, try not to. Here’s how, youcan ADD ON labs for a lot of tests, unless they require special tubes or assays. Adding on labsbasically allows you to use the sample of blood taken from the patient that is stored in the lab,to run more tests. So, if a patient had a chemistry panel in the morning but you forgot to orderliver function tests, well you can add those on.- Can’t Find a test? Search for it at the Mclendon Labs Website athttp://labs.unchealthcare.org/labstestinfo

- Who draws my labs? You must specify in the header of your order whether you want to have“nurse draw” or “phlebotomy draw” labs. In general, patients with central lines (PICCs, ports,tunneled or non-tunneled CVADs) should be nurse draw and everyone else is phlebotomy draw.The exception to the rule is in the CICU, where nurses like to draw all of their labs.- What actually happens when I write my orders? Now that all orders are computerized, errorsstill occur. Please use good communication and inform your nurse and other involved staff ofthe orders that have been placed, particularly in the case of “stat” or other time -sensitive issues.- Why do I always get paged about certain medications I ordered by a pharmacist? Don’t get toostressed out here. Remember, pharmacists are here to help and to make sure that the right medicationis being ordered at the right dosage, interval, and route and for the right patient. They how ever do nothave all of your clinical acumen, so be mindful and discuss why you want to use XYZ med in such a way ifit deviates from the norm. Certain medications must be approved for usage in certain patients, whereasothers are in short supply or are only indicated for certain patients based on UNC protocols.EPICYou have 3 whole days of training devoted to this. We will spare you the details here!AmionWe use Amion for our scheduling and it’s located online at http://www.amion.com. ‘uncmed’ for themedicine schedule.MuseMuse is our EKG database. You can get to it online by typing “musedb” into the URL or by clicking thedesktop icon of a Dog titled “Muse.” To logon, use your webmail userid and password, but for the logonyou have to do the following:- Login with: unch\email ID- password: email passwordThe easiest way to search for patients is by name and not MR number. Even though patients have hadan EKG done, it takes some time before it makes its way into the muse system online.IMPAX:High-res radiology studies. These programs are on the high res viewing stations in the ICUs and in theresident workroom (KICKU). The login for Impax is your email userid and password. Otherwise imagescan be pulled up from links in WebCIS or you can use Webpacs (“http://pacs.unch.unc.edu” or just type“pacs” in the hospital) however Webpacs requires its own separate password.CitrixCitrix is offered at UNC as a way you can access EPIC, Pacs, and other UNC programs/databases remotely(e.g even at home). You can access the login at http://csg.unch.unc.edu. There, you can download

Citrix to your computer which will allow you run citrix. You can also login as UNC with password heels1for a general list of applications including remote IMPAX.

Spanish InterpreterHere’s how to request a Spanish Interpreter. Go to https://servicehub.com/RWeb/unchSubmit the request through ServiceHubIf you are within the UNCH firewall, you willnot be prompted to log in.If you are outside of the UNCH firewall, loginwith the following information:Username: supportPassword: tmwork!Company Code: unchMouse over Requests, Mouse overNew Request and click onInterpreter RequestClick next to HospitalChoose from the drop down menuMove cursor to Clinic fieldClick SelectChoose from drop down menuFill in remaining fields and ClickStore RequestView your pending request bymousing over Requests, and clickon Interpreter Requests, Youmay also edit or cancel yourrequest from this pageIf ServiceHub is down or the internet is not working, please page (919) 347-1877 for an interpreter.If you have any additional questions on the use of ServiceHub, Please call Juan Reyes-Alonso at (919)843-2616.Spanish interpreters are available onsite 24 hours a day, 7 days a week.If you need a sign language interpreter for a Deaf or Hard of Hearing patient:Call Patient Relations at (919)966-5006 or email interpretsvs@unch.unc.eduIf you need an interpreter for a patient speaking a language other than Spanish:Contact our vendor, Pacific Interpreters by using the green dual handset phones or by calling 855-456-5224.Access code: 842994If you anticipate the need for an interpreter to be present in special circumstances, please emailinterpretsvs@unch.unc.edu to schedule a contract interpreter in advance.If you need a document translated:

Send a Microsoft Word, Publisher or PowerPoint file as an attachment to transrequests@unch.unc.edu.The WardsThis is the core of our residency. You’ll quickly get acquainted to the terminology and naming structuresof our teams. Here’s a quick run-down of each team and generally where most patients are generallyhospitalized. The caveat to that is that geographically we try to house pts close to their team “home”but because UNC often runs at or near capacity, it’s not often the case:A. Med A- Geriatrics [8 Bedtower]B. Med B- Nephrology [3 West]C. Med C/D- Cardiology/CCU [3 Anderson]D. Med E1- Hem/Onc [4 ONC]E. Med E2- Hem/Onc [4 ONC]F. Med G- Pulmonary [6 Bed Tower]G. Med K- Infectious Diseases [6 Bed Tower]H. Med U- General Medicine (Burnett) [8 Bed Tower]I. Med W- General Medicine (Welt) [8 Bed Tower]J. Med I- MICU [4 Bed Tower]K. Med M- General Medicine Consult and Procedure Service [6 West and KICKU] – Staffed by an upperlevel and attending only.L. Wake Medicine--Directions to Wake Medical Center and first day instructions can be downloadedfrom our website(http://medicine.med.unc.edu/education/internal-medicine-residency-program)“Sister Teams” – The eight medicine ward teams are paired in the following way to help with coverage.A/W, E1/E2, G/K, U/B (Anderson 1 and 2 are also sister teams, similar to E1 and E2).Med M does not have a sister team.Each team is comprised of two interns, one resident, attending with the exception of Med M. There areusually 1-2 students in non-summer months. Sister teams share a pharmacist, case worker, and residentassistants. MED H, L, and J are hospitalist services.

Admissions / Call Structure for UNC-based Ward ServicesYour team is on call every other day. You and your co-intern alternate being on call, resulting in callevery 4th day.- Your call starts at 7 am and goes through 8 pm. You can start the day out with 2 floats, orpatients that are admitted overnight by the nightfloat (see below). During the day from 7AM to8 PM you can admit a maximum of 5 patients. If you do not admit all 5 by 8 pm, the nightresident will continue admitting to you through the night to a maximum of 5 (7 with floats, seebelow) and present them on rounds the following morning. These will be your patients eventhough you did not admit them. Expect to always get your 5 and you will have a happierresidency.- In addition to your 5 intern admissions, you are allowed 2 pre-call ‘float’ patients. Thesepatients are admitted by your night resident on the night preceding your call day and arepresented to your team on morning rounds by the night float. This totals 7 new patients per callday. If your night resident admits more than 2 patients prior to your call day, all patients overtwo count towards your 5 for the day.- Every now and then, the admission rate exceeds available spots on medicine services. In thesesomewhat rare occurrences, your team may be asked to take a postcall float in addition to yourcall numbers. This is not a frequent occurrence.- Post call day hours are again 7 am to 8 pm. Once all clinical duties have been completed for theday, both your co intern and your resident will sign out the entire team to you to cross coveruntil the night team arrives. You ARE NOT ALLOWED to sign out to you sister team who is oncall if you get done before 8pm and leave early. For patient continuity and safety, this is NOTallowed.- The following day and your pre-call day both end when you have completed your clinical dutiesfor the day so you can leave early. 2-3 times per month you will have a clinic on one of thesedays if you are a categorical resident. On these days, you will sign out remaining clinical duties(other than notes) to your co-intern prior to going to clinic. You are not expected to return tothe wards after clinic.- Days Off: You will have four days off in all four week blocks. Five days off in 5 week blocks. Theweekend day that your co-intern is on call is a mandatory day off. This usually accounts for 2 ofyour quota. The remainder is divided per your team’s discretion early in the rotation and if youneed other days off, then you should arrange for coverage.

- Back Up: Who do you turn to for help when help is needed?o In order:• Before 8 PM – Your Ward Resident• On weekends when your resident has a day off, the sister team resident is yourbackup (ex. Med U for Med B).• On-Call Fellow - applicable on Med A, E1/E2, ICUs, Anderson 1/2• Ward Attending• The MICU Resident; the CCU Resident• Chief ResidentsAdmissions / Call Structure WakeMed1. This is a one resident / one intern team, so you both have the same call cycle. You and your team takelong call every 4th day. You are typically given two float patients on the morning of your call. You canreceive up to 5 new patient encounter, 2 of which could be consults. Typically there is a time cap aswell-- you must receive 3 admissions by 3pm and the 2 by 5pm. You take crosscover from all theremaining teams as they sign out for the day. At 8 pm the night float arrives and you sign out crosscover for all 4 teams. As the intern you should leave no later than 9 pm. Your resident should be theone to stay later if necessary so that you do not break the 10 hour rule to return the next morning forprerounding.2. The Post call day. You will receive 2 post call float admissions on most mornings. Otherwise your dayis over when your clinical duties are finished and you can sign out to the on call team.3. The Short call day: The third day in the call cycle you will take admissions for an abbreviated period.You will receive 1 short call float on weekdays. You will admit up to two admissions by 4pm.4. Pre call day: No floats or admissions!4. Days Off: You and your resident will discuss and divide days off. One of you must take of f weekenddays when you are not on call or post call (You should never take a day off on an on call or post call day).The intern often needs to take the short call day off that falls on a weekend. Decide early in the month,otherwise you may miss necessary days off.5. Weekends: The call schedule is slightly different on the weekends. On Call: No floats, Up to 5admissions (and 2 consults). Post Call: No floats. Short Call: 3 floats with no admissions. Pre call: Still nofloats or admissions!6. Clinic occurs on your Post call day- average of 2 short clinics (starts at 2 pm) during the month.7. Back Up:Most days, all day: Your resident.

Med B/Nephrology- Nephrology is for patients with ESRD requiring hemodialysis, glomerulonephritis, vasculitis,rheumatological conditions such as SLE, and those with renal transplants- Dialysis patients - know when, where and by what access (fistula, line) they get their dialysis andtheir dry weight. They need a full discharge summary at discharge and it needs to be faxed to theirdialysis center at discharge.- For transplant patients, know exactly what time they take their immune meds and what the specificdoses are. Take extra care putting these in the admission orders.- For patients who require immunosuppression for vasculitis or rheumatological conditions,attendings have to write chemotherapy orders on paper and have these faxed to the pharmacy- Concepts to be aware ofo Acute renal failureo Nephrotic and Nephritic Syndromeso SLEo Vasculitiso Sclerodermao Hemodialysiso Renal Transplanto Vitamin D deficiencyo Anemia in CKDMed E1/E2, ONC- Oncology is a challenging service and often changing due to the service remaining fairly busy.Except changes in the service throughout your residency.- You have a fellow on this service, however they can be tied up with consults at times. E1 also nowhas a nurse practitioner who carries 2-3 patients and reports to the upper level resident.- There is a great cancer network through the nurse navigators. These nurses are assigned toparticular tumor types and attendings and handle things like arranging outpatient chemotherapy,follow up labs, PCP appointments, etc. Use them!- There are several lists posted in the resident workrooms to help you navigate the navigators. If youcan’t find one, ask the fellow.- Simple tips to know for your patient: What chemo are they on (more advanced, what have they everhad) and what did their last imaging/staging work up show.- There is an order set for cancer patients which includes routine replenishment of electrolytes. Thisis not available on other services and patients must have a central line (TLC, hickmann, or port) tohave this available.- Neutropenic patients are often quite sick and require your utmost attention. Febrile neutropenia isconsidered a medical emergency and requires prompt IV antibiotics, blood cultures, CXR, andurinalysis and source identification, which is seldom found at times.- Stepdown cancer patients are currently managed by the MICU team in the MPCU.

- We are generally much more liberal with opioids medications for patients with cancer related pain,especially in those with solid tumors or metastatic disease. Consult the palliative care early for helpwith such patients.- End of life care is often encountered on this service so expect to have a lot of discussions withpatients and their families- Patients with sickle cell disease, ITP, TTP, and hemophilias are managed by the hospitalist serviceand MED M- Concepts to be aware ofo AML and chemotherapy regimens (7+3 = cytarabine for 7 days and idarubicin for 3 days,5+2)o Lymphomao Neutropenic Feverso Fungemiao Acute spine cord compressiono Solid tumor malignancies – Lung cancer, pancreatic, colonic, rectal, head and neck,melanoma, brainMed G/Pulmonary- You often will take care of post MICU patients on this service so expect to take care of complicatedpatients with complicated dispositions- This is where you will take care of CF patients most often.o UNC is a big CF center and patients are often admitted from home and clinic and seldomfrom the ED. Thus, their primary pulmonologist is in contact with the team for thetreatment plan which includes antibiotics, pulmonary toilet, and continuation of theirchronic medications.o Make sure they are getting their ADEK vitamins and Creon supplements.o Ask them about hemoptysis daily and then be patient. They typically stay for some timeo Urgent ABGs are drawn by the residents. Less urgent ABGs can be drawn by respiratorytherapy which is a separate order in CPOE.- Concepts to be aware ofo CFo Bronchiectasiso COPDo Asthmao Tuberculosiso Chronic Respiratory Failureo SepsisMed K/ID:- MED G being your sister team, you often have ID pts, but also CF and MICU transfer patients

- Know your HIV patient’s home HIV meds / prophylactic meds and if they are taking them. Don’tassume they are. Know their last CD4 count and viral load AND if this was on or off of HAART. Ifyou get an HIV patient on a service other than Med K, always let the ID consult team know they arein house, even if you don’t have a question for them. Doing so is the official policy of the ID service.- As soon as you know someone will need IV antibiotics at home, page the home infusion team sothey can start making arrangements. Many a discharge has been delayed because this was notdone. You will quickly learn the heartbreak of a delayed discharge as an intern.- To go home on antibiotics, patients often must have medical insurance, a central line of some sort(Port or often a PICC)- Concepts to be aware ofo HIV/AIDS, AIDS defining illnesseso Toxoplasmosis, Cryptococcuso Lumbar punctureo Endocarditiso Line infectionso Meningitis and Encephalitiso Pneumoniao Abscesso Tick borne illnesseso InfluenzaMed U / W (GEN):- You will get the majority of your GI experience on these services, along will other general medicinehence you will be in regular contact with a hepatology or GI luminal fellow.- Designate someone from your team to “run the list” with GI a couple of times per day to make thisrun more smoothly.- MED U has a nurse practitioner which is a great help and is staffed by usually one of the hospitalists.- MED W is usually staffed by one of the clinic attendings or others.- Concepts to be aware ofo Cirrhosiso Hepato-Renal Syndromeo Ascites and paracentesis procedureo PBC, PSCo Pneumoniao Renal Failureo Alcoholism and detoxificationo Upper and lower GI bleeding

Typical Intern Day/Expectations/Tips:1. Pre-round on your patients (time when you arrive depends on the number of patients and theircomplexity; typically around 6:30).2. BEFORE 7 AM: Visit the night resident in the KICKU you signed out to the previous night to learnabout cross cover issues that arose. If they are not there they are likely admitting a patient or takingcare of a sick patient on cross cover. Go ahead and head to the floor and send them a page. Once youchat with them, sign your pager back over to yourself.3. Pre-round on your patients (this should be completed by 7:30):- Check and record vital signs- inquire of patient if there were any problems with his/her night- perform directed physical exam- Run labs and review radiology reports (not all important lab information can be gleaned fromthe rounds report! You have to look in webcis.)*** Work out a system for organizing this information for rounds, and use it every morning, everypatient. It is more information than any of you are used to processing. Every successful intern has asystem. Period. Some people carry a folder/binder, some carry the H&Ps of each patient and write dailyinformation on the backs everyday and have a running tally of the hospital course at discharge. Somehave devised print outs that they fill in each morning so that their information is always organized in thesame concentrated format. This will improve your presentations drastically. If you don’t know where tostart, ask your resident what system they use. Then modify it to fit your brain.4. 7:30 - 7:45: Team Huddle. You should have pre-rounded on your patients by this time. Meet withyour resident and discuss any immediate concerns from the morning. This is the time for the team toidentify consults needed / those ready for discharge as long as the team is stable. This way the internscan start work in these areas during morning report.5. 7:45 - 8:30: Morning report. For interns: call consults discussed with your resident, ready discharges,etc. If your service is light and there is no work to be started on, you should attend morning report.6. 8:30 - 10:30: Work Roundsa. Give report to your resident about each of your patients in the following format:- Patient’s subjective report overnight- Vital signs- Pertinent physical examination- Relevant labs and studies and medications (esp antibiotics and day in regimen e.g. CeftriaxoneDay 5 of 7)- Assessment and plan by problem list

. You should be assertive and make your plan for your patient each day; however, this is your resident’sservice. Respect their leadership and ask questions when decisions are not clear to you.c. Keep your presentations brief, aim for 2-3 minutes for old patients, 5-10 for new patients. Keepingyour presentation problem-oriented will help with concision.d. While your co-intern is presenting patients: Enter the appropriate orders into CPOE for the day foryour fellow intern while he/she is presenting. He/she should do the same for you when you arepresenting. Grab a COW (computer on wheels) if available prior to rounds to help this cause. The moreorders and consults you can place on rounds, the better the work- flow will be for the rest of the day.i. Order x-raysii. Order medication changesiii. Order the next morning’s testsiv. Sign verbal ordersv. Sign discharge orders – as a hospital we are trying to speed up the discharge process. If you think apatient may be discharged later that day or the next day, please write an “anticipate discharge” orderwith the date and time included to notify the nursing staff ahead of timevi. The most savvy of interns will learn to do all of the above, start or even finish their own progressnotes and have a nurse’s phone on hand for calling consults on rounds. This is advanced interning at itsfinest. Be sure you are not doing all of this at the expense of catching all orders and inputting the mCORRECTLY.*** Keep track of every planned task on your patients. Nearly everyone uses the ‘checky box’ system atleast through their first year. Trust us, you will NOT remember it all without keeping track on paper.When you forget, your resident will not be pleased and a patient may suffer. It is YOUR responsibility tomake sure these orders were put in, NOT your co-interns responsibility even though they are puttingthem in on rounds. Double check Double check Double check.3. After Rounds: There is a lot of work to be done after rounds. You must be able to triageappropriately. The following ORDER of tasks is strongly recommended.1. Sick Patients First. If you have any unstable patients, complete all of their consults, orders and urgentprocedures first. When your mind is spinning from so much to do, think sick patients first and things willstart to organize....2. Call consults early/next (Web Exchange to find out whom to page, under call schedule at thebottom, type in the service then click “on call now”). See paging etiquette above to send the ‘perfectpage’ and have happier consult on the other end of the line. Also, if you have a nursing phone availableon rounds, there is ample opportunity to call consults on rounds, which makes everyone’s day better(you, the consultant, the patient).

- When the consultant calls back, they want to know: pt name and medical record number (evenif its in the page, just repeat it), your attending, reason for consult ( be as brief / specific aspossibleo E.g. requesting colonoscopy, do NOT recite the HPI- this will irritate the fellow), andwhom to contact with recommendations.o E.g. Do not start out by saying, “This is a 57yo M with COPD, CAD, HL…” and 5 minuteslater mention that you are calling about an evaluation for renal failure. Instead say, “Hi,I’m calling about a 57yo with renal failure that we think is ATN vs AIN. He has a historyof COPD, CAD…and we have done the following…”o The same goes true for calling your upper levels from the ED, which usually follows likethis as Kiran Venkatesh, MD aka Venky demonstrates:What the heck isthis page about?HmmmThey want to admitfor what?!?Are they kidding?!*&@#^(*&$^#*!!!3. Get Discharges out the door (hopefully the ‘anticipate d/c’ or d/c order was put in on roundsalready....)4. All other orders5. Any procedures6. Notes- You must write a progress note on every one of your patients EVERY day, even if there is amedical student following. It is not acceptable or legal to co-sign a student’s note or to allow a studentto write a note under your log-in. This is, among other things, Medicare FRAUD. Also, if a patient wasadmitted overnight they may or may not need a note for the new day. If the H&P was signed (notstarted) before midnight they need a note. If the H&P was signed after midnight they do not. Forexample, if the overnight resident started the H&P at 11:59pm and then signed it at 1am, the pt doesNOT need a note for the day. If the overnight resident began the note at 11pm and signed then note at11:59pm, the patient DOES need a note for the day.7. Update Rounds Report.8. Sign out to either your co-intern if you are not on call / postcall, or to the night resident at 8 pm.- Good Sign Out includes the following:

o 1. 4 word liner on each patiento 2. Stable / Unstableo 3. Anything to follow up (pending labs, check their blood pressure 1-2 times tonight,radiology, etc...)o 4. What to do with the pending information. This is something you team should havediscussed when ordering said information.o 5. Definite Pertinent to tell night float: Any issues with blood pressure or oxygenation,including their current baseline O2 need. Mental status baseline on those with alteredmental status. Any procedures performed that day to anticipate complications. Certainmedications you would like them to avoid (no pain medications, no benadryl, etc...)- Bad sign out: Just telling the nightfloat “Nothing to do” or “I don’t know who this is”9. Related, your day for the ICUs has a similar basic structure and the same tips apply as above. Thereare some key differences with call schedule and the way rounds are run......MICUThis is the rotation where boys become men and girls become women. That may seem foreboding, butit is a tough rotation, but usually one of the highest rated in our residency as you will obtain a great dealof learning and procedural training.1. Structure: The MICU consists of 4 teams, each comprised of one resident, one intern and +/ - amedical student. While the teams rotate call schedule and have their own patient census, the MICUrounds as a whole every morning at 8 am starting with radiology rounds, then work rounds,followed directly by education rounds.2. Call Schedule:1. Long Call. every 4th day:a. Arrival before 7amb. Complete pre-rounds on all team patientsc. Roundsi. Start at 8 am with teaching rounds.2. Present in their entirety3. Active participant in all patient presentations (take notes for cross cover)4. Do not depart rounds for codes, rapid responses, or admissions5. Post-Rounds to 11ama. Participate in teaching, radiology roundsb. Complete notes, patient carec. Depart no later than 11am6. Breaka. Leave no later than 11amb. 2. Do not return until 10 hours after departure (9 pm)7. Admittinga. ~9pm-7am; accept on-call intern pager

. Receive sign-out from departing short call internc. Complete further admissions with long-call resident8. Post-Calla. 7am-8am: pre-rounds; forward admission pagers/lanyardb. 8am: round with entire MICU, present all team patients firstc. Rounds = sign-out to the long call team; DO NOT sign out again After each post-callpatient is seen, the long-call resident, long-call intern, and short-call intern should knowthe daily plan and follow-up plans9. ~9:30-10am: post-roundinga. Complete all notes and departb. Do not stay for teaching, radiology roundsc. Do not complete proceduresd. Upon departure, complete the ‘to-do’ sheet and hand to the long-call resident10. Short Calla. Arrivali. Before 7am, transfer on-call intern pagerii. selected/complimentary pre-rounds with short-call residentb. Roundsi. Present in their entiretyii. Active participant in all patient presentations- you need to know these patientsfor cross-coverage.11. Pre-calla. Arrive at 7, pre-round and present your patients in their entiretyb. You should put orders in all on other teams patients as rounds progress. This isEXPECTED in the MICU as rounds run longer than the wards. Speak up at the end ofeach patient, recite the orders you caught for verification / check for missed orders.The short call intern can help with some of these, but it is primarily your responsibility.On your day off, your resident will complete this task.12. Admissions: There is no cap to admissions in the MICU. You are limited to 5 new admissions asan intern. You may participate in the care of all additional patients over 5 once admitted byyour resident.13. Back Up: Your ICU resident is your backup on call at all times. If for some reason you cannotcontact your resident (which should never happen) and you have immediate concerns about apatient, contact the CCU resident or the night floats for immediate help. The ICU fellows arealso on call for crisis, as well as the ICU attending. AFTER the patient is taken care of using theabove resources, you should alert the on call chief of the lapse in appropriate back up/s upport.*** IF a patient is crashing and you need help NOW, pick up the red phone and immediately say:“Code Blue, MICU. Code Blue, MICU”. No need to dial, this is a direct line to the hospital overheadvoice system. You will get help within the minute. Take a shot at your ACLS until then.

7. Days Off: The ICUs are extremely tight as far as possible days off are concerned. Therefore these willbe scheduled in amion. Your mandatory day off per month is the Friday your team is on short call. It is anecessary evil to get you your days off. The other days may be rearranged between you and yourresident as desired, but do let the chiefs know if you are rearranging.8. Lines and Such. The MICU is where you will become a master of all things line s. Central lines are aimportant component of critical care medicine and some interns are new to the UNC system thus ourequipment may appear different than those you encountered at your home medical schools.Cardiology:A great, but busy rotation where you will learn all about EKGs, heart failure, valvular problems,arrhythmias, and more.1. Assigned Roles: CICU Day: One Resident, Two Interns CICU Night: One Resident Cardiology Floor Team (Anderson 1) Day: One Resident, Two Interns Cardiology Floor Team Day (Anderson 2): One Resident, Two Interns Cardiology Floor Night: One Resident Heart Failure: One Intern2. CICU Day: Resident:o Arrives by 6:30 am, receives sign out from CICU Night Residento Pre-rounds, rounds, and completes daytime work and admissionso Leaves by 7:30 pm after sign out to the CICU Night Resident Interns:o Arrive by 6:30 am, receive sign out from CICU Night Residento Pre-round, roundo One Intern will be on-call for admissions, responsible for daytime admissions andstaying until 7:30 pm (leaves after sign out to the CICU Night Resident)o One Intern is post-call and is free to leave in the mid-afternoon at a time that isdeemed appropriate by the resident and Cardiology Fellow• Post-call Intern may have clinic on the post-call/non-call dayo Interns will rotate call/staying until 7:30 pm on a every other day (ie q2 basis)o CICU Intern will take their Post-Call/Non-Call weekend day off3. CICU Night: Resident:o Arrive at 7pm, receive sign out from CICU Day Resident and Interno Cover admissions, cross-cover from 7pm-7amo Briefly round with attending at 7:30 am, presenting overnight admissions andcritical patients, to take no longer than 30 minutes

o Leave at 8am4. Cardiology Floor Team: On Call Resident (q2 call schedule):o Arrive by 7am, receive sign out from Cardiology Night Float Residento Pre-round, round, complete daytime work and admissionso Leave by 7:30 pm after sign out with the Cardiology Night Float Resident On Call Intern (q4 call schedule)o Arrive by 6:30 am, receive sign out from Cardiology Night Float Residento Pre-round, round, complete daytime work and admissionso Leave by 7:30 pm after sign out with the Cardiology Night Float Resident Post-Call Intern:o Arrive by 6:30 am, receive sign out from Cardiology Night Float Residento Pre-round, round, complete daytime worko Leave by 7:30 pm after sign out with the Cardiology Night Float Resident Post-Call Resident:o Arrive by 7am, receive sign out from Cardiology Night Float Residento Pre-round, round, complete daytime worko Leave when daytime work is complete Pre-Call Intern:o May be day off or clinic day Night Float Resident:o Arrive by 7pm, contact on-call team and post-call intern for sign outo Provide cross-cover for Cardiology Floor team and cover admissions from 7pm to7amo Sign out to Cardiology Day teams by 7 am; leave after sign out, you do not have tostay for rounds unless your attending would like to hear about a specific patientdirectly from you5. Heart Failure: Heart Failure position may be covered by an intern, Family Medicine Resident, orCategorical Medicine Residento Arrive by 7 am, receive sign out from Cardiology Night Float Residento 7am-5pm: Pre-round, round, complete daytime worko You will write notes and orders on floor patients only; you will also likely round onthe Heart Failure patients in the CICU but you do not write notes on CICU patientso Leave at 5pm after signing out to long-call resident and intern6. Notes:ED interns: Every Wednesday morning the ED interns have a mandatory morningconference. They can miss this conference once per month and this should occur ontheir post call day that falls on a Wednesday. Be very careful with days off onWednesdays if there is an ED intern on the team (unless something is worked out aheadof time with the Chief Residents).Night to Day Switches for Residents: On most Thursdays, a floor night float resident willswitch to a day team

o Resident should stay through rounds and ensure that all plans are “tidied up”and then go homeCardiology AdmissionsACGME’s requirements:1 resident, 2 intern teams can carry no more than 20 patients at any one time.Interns may carry no more than 10 patients at any given timeInterns may admit no more than 5 new patient admissions in a 24 hours period (the DayIntern may admit up to 5, and the Resident may admit an additional 5).Interns may admit no more than 8 new patients in a 48 hour period (the “8 in 48 rule”)An Upper Level Resident may admit no more than 10 new patient admissions in a 24 hourperiod (see above). They may accept up to 4 additional in house transfer patients (ie. Rapidresponses, Codes, transfers from other services).Chez, one of the CICU nurses notes that residents should not turn off any alarms on any monitoringequipment. If it’s beeping constantly, INFORM a nurse but DO NOT turn off the alarms yourself.

Cardiology EquipmentThe cardiologists have a wide bevy of equipment that you will eventually interact with. Here’s a few:Swan Ganz Monitoring EquipmentIntra Aortic Balloon Pump (IABPThe “Box” Swan Ganz continuous monitoring device

Artic Sun for hypothermia treatmentLVAD External Monitoring EquipmentInpatient Ancillary Staff- Resident Assistants. Can’t tout this resource enough. Ask your resident how to get in touch withthem. They are good at scheduling appointments, getting OSH records, and faxing dischargesummaries.- Social Work. You will share a Clinical Care Manager (social worker is old term with your sister team.Your resident will round with the case manager most days. However, on your resident’s morningclinic days, YOU must round with case management on your patients. Things they are interested inknowing: Anticipated discharge date, needs on discharge including Oxygen, IV antibiotics, PT/OT,hospital beds, financial assistance, skilled nursing facility, or hospice.- Home Infusion: Numbers can be found on webexchange. As soon as you know someone will need IVanything at home, call them. They have to find a company, arrange line education and meetingtimes, etc.- Phlebotomy: Performed by Phlebotomy Services 7 days/week hourly between 4AM and 2200 PMQuestions? Phlebotomy Services- 6-2446

7. Clinic (Categorical interns only)Structure:- 1. Clinic schedule: You will have approximately 3 afternoon clinics per month. During CAR, you willhave anywhere from 6 to 8 half-day continuity clinics during the month. You will have slightly fewer,shortened afternoon clinics on MICU, CCU, and Wake Med. You should sign out your patients toyour co-intern and resident prior to reporting to clinic.- 2. Preclinic conference: Starts at 1:10 PM. All interns and residents are expected to attend, unlessyou are on MICU, CCU, or Wake Med.- 3. Patient panels: After the orientation weeks are completed, you will have see both new andreturn patients (ideally from your own patient panel).• Presentations: These differ from the wards. Please use a problem-based format, rather thana SOAP format for your presentations For each problem, you should give the pertinenthistory, exam findings, and data and your assessment and plan.• Clinic notes: Can be dictated with dragon or written, whichever you prefer.- Clinic notes must be completed on the same day of the patient encounter.- Follow Up and Patient Correspondence: You are responsible for following up on the results ofall labs and studies that you order on your clinic patients. These results will show up as alerts inyour EPIC inbasket. You should be checking your inbasket daily, even while in the ICUs or atWake Med. For critical lab results, your patients should be notified immediately. For nonurgentlab results, your patients should be notified of the results within one weeks. You caneither call your patient and document the correspondence (as an addendum to your clinic notebefore it is signed, in a telephone encounter that gets finalized to the record, as a patientcorrespondence note, etc.). Alternatively, you can send your patients a letter in the mail or viamychart or email with the results.- Back Up: If you do not know what to do with a test result or need hel p with deciding the nextstep in management, contact the attending who precepted the visit.- Patient messages: Patients will often call our clinic with requests for refills, questions aboutmedications, lab results, etc. These will show up in your “inbasket,” and you should respond tothese promptly.EDUCATIONCurriculum: The medicine department and its associated subspecialty departments have eachdeveloped a list of core topics and in some cases recommended readings. These comprise the expectedobjectives for each rotation and are located at the following link:http://medicine.med.unc.edu/education/internal-medicine-residency-program/resident-informationThe curriculum is currently under expansion / editing. Updates should be available in the firs t fewmonths of the year.

Conferences1. Core Curriculum: Monday, Tuesday 12:00-1PM [4th Fl Aud. -Old Clinic]2. Lecture format on core topics. Lunch usually provided.3. Intern Conference: Wednesday 12:00PM [2035 Bondurant] Lunch provided. Residents take internpagers for uninterrupted teaching time.4. Grand Rounds: Thursday 12:00 PM [4th Fl Aud.-Old Clinic] Lunch provided.5. Evidence Based Clinical Practice: Friday 12:00-1:00PM [133 MacNider] Lunch provided.6. AM Report: Monday, Tuesday, Wednesday, Friday 7:45-8:30 AM [133 MacNider] (this may soon beextended to Thursday as well)7. Ambulatory Care Conference: Every Wednesday at noon in the ACC building.8. Wake AM Report: Occurs daily at 8-9 am. Mandatory for upper level residents. Attend when yourworkload is light / you finish pre-rounding in time.9. Subspecialty Conferences: Each of the subspecialty departments have several weekly conferences.These conferences can usually be found on their websites. If you are interested in a subspecialtycareer you are encouraged to attend these conferences on elective months or when ward timeallows.10. There is a running compilation of lecture PowerPoints loaded onto the housestaff website. If youcan’t make it to conference (which should be the exception not the rule), you can review thematerial.http://medicine.med.unc.edu/education/internal-medicine-residency-program/conferencesGoogle doc spreadsheet of conferences11. There is also loads of EBM help material on the housestaff website.

http://medicine.med.unc.edu/education/internal-medicine-residency-program/evidence-basedclinical-practice12. Want to see the experts of years past giving Grand Rounds? Check out the streaming videoarchive:http://medicine.med.unc.edu/whatsnew/grand-rounds-video13. Health Care Library: This is located right outside of MacNider (where orientation is). You can checkout medicine text books, locate papers in the archives and perhaps most importantly the librarianscan help you with difficult literature searches for clinical based questions or research.14. Resources: There is a slew of online references through the health science library. These will beextremely helpful. You can access most of these references from home using your Onyen (seebelow in personal work info). This includes access to Up To Date, Electronic Journals, Online Texts,etc.15. The following books can be obtained at the Health Affairs Bookstore. You may want to ask toborrow these from other residents and then decide if they fit your style of learning before buyingthem. Most resources can be found online through the library :http://www.hsl.unc.edu/resources.cfm16. UNC Department of Medicine Homepagea. Address: http://medicine.med.unc.edu/education/internal-medicine-residency-prograb. Or it's the first link in google after typing "UNC internal medicine"17. Become very familiar with our House Staff web page. Many useful databases can be accessed here,including archived “AM report” case based presentations, core curriculum lectures, board reviewlectures, and EBCP guidelines and tutorials. This should be your first stop when looking for help.Below is a list of frequently used resources. The bolded are those that current residents tend tokeep on their person at all times.- Pocket Medicine. Fourth Edition 2010, Sabatine, M. Massachusetts General Hospital. It’sgood to take notes in the margins and continue to refer to this through residency.- Netter’s Internal Medicine. Runge, Marschall; Greganti, M. Andrew. Excellent textbookwritten by UNC faculty, many of whom you will be working with on a daily basis.- On Call: Principles and Protocols, 2nd Edition Marshall SA, Ruedy J. WB Saunders Co.- usefulfor addressing frequent on call scenarios you will handle this year.- The 2006 Tarascon Pocket Pharmacopoeia- you will use it daily (vs. epocrates)- The Tarascon Internal Medicine and Critical Care Pocketbook- The Sanford Guide to Antimicrobial Therapy 2012- Facts and Formulas (a pocketbook)- most residents carry this daily.- Diagnostic Strategies For Common Medical Problems- Editors Black, Bordley, Tape andPanzer. (available in Housestaff Library)- The Washington Manual, 31st Edition - most residents carry this daily, keep notes in themargins throughout residency.

Scholarly Work / Career GuidanceFinding a career path is the first part. If you are not certain what you would like to do on matriculation,you are not alone. The fellowship match has recently been moved to December of your third year,which gives you 6 more months of planning and preparation. Once you are ready to get your feet wet,all of our departments are very welcoming and eager to have residents involved in research. It is fairlyeasy to get involved in research once you send out the first email. We understand it’s hard to know whoto email. Many of our upper level residents and fellows would be glad to meet with you to discuss thisprocess. They can help introduce you to the receptive faculty or those geared towards your interests.2. Related, the faculty within our division is extremely receptive and can help guide your choice in fieldsand help you navigate any chosen path. Dr. Deb Bynum, MD, Associate Professor of Medicine, Program Director C. Lee R. Berkowitz, MD, Professor of Medicine, Associate Program Director, Vice Chair ofEducation. E. Paul Chelminski, MD, MPH, Assistant Professor of Medicine, Associate Program Director Cristin Colford, MD, Associate Professor of Medicine, Associate Program Director F. John E. Perry, III, MD, Associate Professor of Medicine, Director Wake AHEC Internal Medicine Christopher A. Klipstein, MD, Associate Professor of Medicine, Third Year Clerkship Director3. Part of your outpatient clinic rotation (CAR - for categorical residents) includes a qualityimprovement project. These are geared towards improving the clinic experience. The faculty canprovide as much guidance as needed.Personal Work Info / Personal Health / MISCImportant Personal Identifiers / Numbers (there are a LOT of them)Keep these on your person (in your smartphone or on a card in your wallet), handy for reference. Youwill need some of them daily (easy) and others at seemingly random q 6month intervals. Just enoughtime for you to forget them in between.1. Physician ID (the “p number”): This is a 6 digit UNC identifier. It is used for WebCIS Login (e lectronicmedical records) and for identifying you as the ordering physician. This is the number used to log intopreclinc conference as well. Otherwise no one will recognize it.2. DEA: same for all residents at UNC (will be given to you)3. PID (personal ID number): This is a 9 digit University identity number useful for gaining access to allthings UNC run (outside of the hospital), ie: gym, some library resources....

4. EID (Employee ID number): This 7 digit number denotes you as a UNC Hospital employee A lot ofyour passwords will default to this. You will need it for employee health as well. This is also the numberyou will need for completing LMS online training at the beginning of each year.5. UPIN: Medicare identification number6. NPI: National Provider Identifier. This is a unique identifier used by the Federal Government(Medicare, HIPAA, etc) and will be obtained for you. This should be placed on all prescriptions andbilling forms. You will keep this number for the rest of your practicing career.7. ONYEN: This is an account that you set up and is linked to your PID that grants you access to thehealth science library online resources (including uptodate) as well as our Internal Medicine ResidencyWebsite off campus. It can be managed at onyen.unc.edu .*** Empty your mailbox-located on the first floor West Wing. Do this monthly.*** Remember to renew your license before your birthday. If this is not completed by your birthday,your pay will be docked for each day it is not complete: http://www.ncmedboard.org/renewals/Cafeterias:The first four options accept your work provided freedom pay card.Overlook Café: 2nd Floor Neurosciences 11am-6pm - brick oven pizza, fresh salad, paninisStarbuck’s Coffee Shop: Cancer Hospital, ground floor, 24 hours/ dayChildren’s Hospital Café: 1st Floor Children’s Hospital; Everyday, 6:30am-9 pm- grill, daytimefresh sushi / stir-fry, southern comfort food, pasta/pizza, refrigerated selection of mealsCorner Cafe: Children’s hospital, ground floor down hall past the kinetic sculpture. M-F 7am-2pm. Hospital famous burrito bowels, deli. The Beach (NOT a hospital restaurant, hence does NOT take your blue freedom pay card!). M-F: 7:30am-3pm; Closed S/S. 2nd floor old clinic, across from cath lab, walk outside double doorsand across walkway. Chick-fil-a, Quiznos, coffee shopFreedomPay: You will receive a FreedomPay card from the housestaff office during orientation.This can be used to purchase meals in the hospital. You will be given $120 at the beginning ofthe year for the entire year and will receive $14 for every 24 hour shift (for upper levels) and $7for every shift over 12 hours throughout the year. You can check your account balance at thefollowing link by inputing the number at the back of the card:https://www.freedompay.com/balance.Call Rooms: Med A/B Intern Room – 4 Anderson Call Rooms Med E1/E2 Intern Room – (3 ONC) Med G/K Intern Room – M6315 (6 Bed Tower, next to room 6314)

Med U/W Intern Room – 8056 (8 Bed Tower A) Med C/D Interns/Residents Room – 3021, Rm B and C (3 Anderson), code 5-1-3 MICU Intern/Resident Room – Physician’s Room (MPCU, next to room 4301) Night Resident’s Rooms – 4 Anderson Call Rooms and KICULounge (aka the “KICKU”):KICKU 5 EW- code 5-1-3 (across from the lockers on the 5th floor)Any issue with locked call rooms not amenable to your keys --> call security in a non-urgentfashion.Keurig machine w/ K cups supplied by fellow residents and interns (CONTRIBUTE if you’reconsuming!)DiscountsUNC has relationships with several businesses. When signing up for contracts, always ask if there is aUNC discount. Phone companies nearly universally offer up to 15%-20% off for UNC staff includingwireless service for AT&T and Verizon.

Gyms / Intramurals:A membership at the UNC gym is extremely affordable (150/year). The hours are less flexiblethan some gyms for holidays and the summer, but it boasts pools, racquet ball/squash courts,etc...Several residents are members at other gyms around Chapel Hill and Durham. If you’reinterested, just send out an email asking for recommendations. The medicine department fields several intramural teams each year, including softball (twiceper year), football and basketball. A couple of our residents are also involved in ultimatefrisbee and tennis leagues. If you’re bold enough, Raleigh boasts a full -on Roller Derby league.Alert emails tend to come around just prior to the start of each season.Employee HealthLocated on the first floor of old clinic. Used for vaccinations, PPDs, etc.If you have made it this far, you have amassed a great deal of information. We are thankful andhumbled to have you join us at UNC in the coming months. While you are walking in the footsteps ofgiants, UNC prides itself on compassionate, collegial, and scholarly patient care. Please note that we areall available at any time, so please come to us with any questions. We look forward to a great year!All Best,Sarah, Maureen, Steph, and Julia