Outside Rotation Gouge

Please contact the Rotation Director and Rotation Coordinator at least 3-4 weeks prior to the start of the rotation. Points of contact may be found below or under Rotation Information.

Recommended Apps for rotations: 

• WikEM: wikipedia for EM workups and procedures  

• MDCalc: suggested favorites NIH stroke scale, HEART, MELD, Wells, PESI

• MobilEM: Con: costs money Pros: works offline, all EMRA books included (ABx, PEM, Pain meds, Tox, Ortho, Vents, etc) 

• Suture, Nerve Block, Fracture Apps: all related to WikEM app. All free. Direct recommendations and instructions. 

• AOCD Dermatology App: Free. All derm diseases and diagnoses. 

• PediStat: Con: costs money. Pro: pretty much pocket Broselow tape with all med management for peds by weight/height.

Scripps Memorial and Green ICU 

POC: 

Stephanie Lozano (Lozano.Stephanie@scrippshealth.org). Submit your paperwork at least 3-4 weeks before rotation start date.

Check In:

In the week prior to your shift, check in and receive your badge, computer access and parking access. 

Location: 

• Scripps Green Hospital is in La Jolla next to Torrey Pines golf course. This is a small boutique hospital with an Urgent care clinic (UCC) but no ED. You will be handling patients that are admitted through the UCC, direct admits from outlying clinics and patients transferred from the ward floors to the ICU. 

• Scripps Memorial (La Jolla) is down the street on the other side of the highway. This is a high-speed facility with a large ICU spanning 2 floors of the new hospital building. It has a large volume ED and the hospital is a trauma center with a large interventional cardiology/ECMO service.

Schedule: 

Interns will work a shift schedule. M-F 0630-1900. With a half day (0630-1200) alternating on Saturday/Sunday with the other intern/med student and your other weekend day off. 

Typically you will split the month at both Scripps Memorial and Scripps Green however it will change depending on the block. Sometimes you work at Scripps Memorial, others only work at Scripps Green. 

What to Expect:

You and the team must respond to code blues. You can respond to respiratory calls when they come through because they tend to turn into codes. Remember, if you're the first doctor there, you're running it until your senior or attending shows up. 

The service consists of post-op patients which are taken care of by the surgical service who operated on them primarily with ICU serving as a consult service. The staff may or may not ask you to follow these patients depending on how big the list is. Just go with the flow and be sure to know whom the team is expected to follow. Other patients are direct admits from the outside and transfers from the ward (house staff patients). The ICU is primary on them and they usually have the more interesting problems (sepsis, liver bombs, etc.).

Typical ICU days. Show up at 0600 for patient assignment and pre-rounds. 

There is a specific dot phrase used for pre-rounds here, ask your senior or steal from prior resident on this rotation. You round with a WOW so just copy forward prior notes, add in pre-round information. Handoff from the night team is typically at 0700. 

On days with new x-rays, we do x-ray rounds with attendings. Be ready to read your patient's CXRs. (Rotation, penetrance, then A-E) 

After which you will do walking rounds starting with the patients that are covered. Grab a WOW if you can, should have haiku on your phone as well. Usually, two staff are on during the day and split up the patients. 

After rounds, consults and discharges take priority. You can epic chat most providers. If there is no one listed, call the operator on the landline and ask for who is on call. 

There are dot phrases to use for admission notes, progress notes, and procedure notes. Just ask your senior for these dot phrases. If there are med studs, you will be expected to sign off on their notes as well. 

At the beginning of the rotation, you will receive rotation information that will highlight the maximum amount of patients you can carry depending on the block rotation (earlier rotators are required to hold less patients) as well as admit limits and time limits for which you can admit patients (i.e you are not required to admit a patient within 2 hours before end of day.) Learn these requirements and stick to them. 

Food

At noon everyday there is catered lunch in the resident room. The Scripps resident will have grand rounds or conference but we are not expected to attend this. There is usually a grand rounds or conference (in various rooms in the hospital depending on the day) with food that you are expected to go to.  If you find it totally non-applicable to emergency medicine, you can leave and get back to the unit to do work and look for procedures.

For Green: Make sure you put your pager number on the white board each day and let the staff know you are available and interested. You should also call the hospital operator when you first start to let them know your schedule and pager number so you can be reached.

Rady Children's Hospital ED

If you like working with kids, then this is the rotation for you! Each intern will spend four weeks working in the Emergency Department at the only San Diego area children's hospital.

Point of Contact: 

Rady's Resident Coordinator Office 

POC for All things Radys

Phone: 858-966-8036

Fax: 858-966-7433

RadyEDRes@rchsd.org 

Marian Toscano

GME Administrator

mtoscano@rchsd.org

Ph: (858) 576-1700 ext 6138

Fax: (858) 966-7477

Check In: 

Make sure to complete and send your onboarding paperwork at least 6 weeks prior to the start of your rotation. EPIC credentials will be emailed to you as well as training to complete. Before you start your rotation, you will receive an email from the RadyEDRes@rchsd.org with onboarding information and details on how to pick up your badge and proximity card. You must make an appointment at least one day in advance to receive the proximity card and test your EPIC access. 

Office hours: Monday through Friday, 7:30am-3pm.

Office address is: 7960 Birmingham Drive, San Diego, CA 92123 (Building #14 – EOB). 

Parking: You will need to find street parking or park in the visitor lot. Another option is to shuttle to campus (more info attached).

When you get to the lobby, have security send you up the elevators or please call (858)966-8036, as the elevators are badge activated.  

Scheduling:

Scheduling is completed through QGenda. If you have any issues accessing, email the above contact. If you are taking leave, email prior to start of the rotation when you submit onboarding paperwork so the scheduling team can ensure that you are working a reduced number of shifts. You place requests directly into Qgenda when you receive access. 

In the past, there have been issues with having to flip from days to nights while at Rady's. Our program, our chiefs and Rady's scheduling team has been more attentive to this. When you receive your schedule, make sure to review it as soon as possible and pay close attention to how many times you must flip to nights. If there are multiple flips (as in 2 or more times you must flip from days to working a full night shift) or any violation to our residency duty hours, reach out to the Chiefs. 

Parking

There are 2 staff parking decks across from the hospital and access is free with your hospital badge and proximity card. When you report to the office to retrieve your badge and proximity card, test your badge access at the ED and the proximity card access at the parking garage before you leave the campus. You will receive a parking garage ticket with your proximity card. On the last day of your rotation, there is a bin in the ED workroom to submit your proximity card. Submit your card there, then take your parking garage ticket for release out of the parking garage on your last day. 

What to Expect

Interns work 14-16 shifts during the course of their four weeks at Rady. The shifts are slightly different from those at NMCSD and are nine hours long; set up into 8+1 where you will see patients actively for eight hours and then work on notes/disposition of those left for the last hour while the next team starts seeing new patients. 

On your first day, show up early and pay attention to the shift color you are assigned to as that dictates the pod you work in. Ask for the ED resident workroom and you should be guided back easily. There should be at least one other resident in addition to your attending who can show you the ropes.

Turnover is essentially the same as well, but takes place with a computer and writing an accept note as you take turnover. 

Wear whatever scrubs your heart desires.

Depending on the season, certain things will be more or less common; expect a lot of croup/bronchiolitis during the winter months. Study up on the universal complaints, like asthma and gastritis/gastroenteritis. Know your pathways. Know your emergencies (i.e. anaphylaxis) There are ample opportunities for procedures like lumbar punctures and laceration repairs during this rotation, log your procedures. 

There is an iphone microphone app you can download when you get to the site. Ask one of the attendings/residents there for a guest log in so you can dictate your notes. 

Consults occur through a web paging system and Epic Chat mainly. Unfortunately, chat can occur slowly so don't be afraid to call consults directly. Nurses will epic chat you with updates and questions. Epic chat has its pros and can be convenient for small questions, but we all know the ED is hectic and a messaging app does not cut it. Always take ownership of your patient and see your patient and nurse directly. Make sure to follow up on your patients. Make sure orders and actions are being done correctly. 

Food

There is a cafeteria open for breakfast, lunch and dinner, and if there is some down time, you may be able to get some food, though there is no free food available unless you go right before closing at 0200. There is also a Subway across the lobby from the ED. Sometimes a food truck will show up at night as well. There is a small coffee stand outside around the corner from the Subway. 

Pearls

• Have a resident or attending show you the web paging system the first day so you don't spend time hunting for phone numbers.

• Use the order sets.

• Bring your quick sheets and pocket guides or have them ready and available offline. There are pediatric pocket guides available in the ED workroom. 

• Pediatric trauma and medical resuscitations are not super common, so go to all when possible and log any, even if you are only peripherally involved to get your numbers.

Scripps Mercy Trauma

Point of Contact: 

• The GME coordinator and a point of contact is Shivani Patel (Patel.Shivani@scrippshealth.org).

Check-In

• Try to email Shivani Patel about a month prior to the rotation to make sure she has all of the correct paperwork and vaccination records, and ask for the email of the trauma surgery chief resident at that time; you will also have to do some online training modules before you can get hospital access. Do the EPIC training modules ASAP, it takes 3-4 days to receive EPIC access once you complete the training.

• Stop by the hospital a few days before to pick up your badge at security and check in with Trauma Administration located on the first floor for your orientation. Points of contact as of April, 2024 are:

Rotation education coordinator: LuAnn Walker (LuAnn@mercyvascular.com)

Administrative coordinator: Lindsay Binns (Binns.Linsay@scrippshealth.org)

• When picking up your badge and checking in, you can park in visitor parking next to the hospital. Once you get your badge, security will give you a pass to get out of the visitor parking for free.

• Try to also stop by the 10th floor (badge access required) and ask to see one of the Trauma NPs to introduce yourself and get a tour; they can show you all of the important stuff, and depending on when you drop by, maybe your schedule for at least part of the upcoming rotation. 

First Day

• On the first day, I would arrive to the work room located in 914 (door code: 6019) at 0500 so the outgoing call intern can give you a little orientation to the paperwork. The NPs will also help you the first day. Dr Bansal (the head of the department) will often give a brief overview of expectations and procedures at some point during the day as well.

Typical Day

• You will work with 2 to 3 other interns (surgery and/or TY) and maybe 1 or 2 PA students. Currently, there are day shifts (D), 24-hour shifts (C), post call (P) and off (O).  You will not be allowed to take leave or step 3 during this rotation. 

• Days officially start at 0530, when the interns and PA students meet in 914 to divide up the floor patients. Pre-rounding is fast as you quickly record vitals, labs, meds, incentive spirometry, chest tube output, and I&O’s on a progress note template (just fill in the blanks) and read the prior day’s note. At 0730, you meet with the nurse practitioners for the day and resident in the Doctor’s Lounge (next to the cafeteria) on the first floor to quickly go over key data and plan for patients. Prior to meeting at 0730 is a great time to grab breakfast as items in the Doctor’s Lounge are free! The overnight intern will then divide his/her patients up amongst the day personnel and leave (this is usually around 0800), so make sure you know his/her patients well since you will present them to the attending later. 

• At this point after discussing the plan with the NPs, you all split up, write orders (Epic), work on discharge summaries, follow up on labs, imaging, and get to know the night interns’ patients while the attending, residents, and NPs see the SICU patients. Once they have rounded on all the SICU patients, the interns, PA students, resident, NP, and attending will conduct table rounds in the morning conference room (usually around 0900 or 1000). Immediately following table rounds you will, as a group, walk round on patients. After walk rounds, you carry out the plan of the day, which for interns is mostly about writing orders and dictating discharge summaries. 

• The intern assigned to the 24-hour call shift will carry the trauma pager to deal with or delegate any floor issues that arise. Ideally, when “Code Trauma” is called the 24-hour call intern and a PA student should go directly to the trauma bay to run the trauma. At this point they can pass off the pager to another intern if able. If however, the 24 hour call intern is behind on notes or in the middle of attending to something, another intern can be tapped to go to the trauma. There will be enough traumas to go around. If the day was slow enough, then most or all of the interns would end up going to observe/help out if needed.     

Nights

• Turnover occurs sometime in the afternoon, generally around 1700, though on a good day can be as early as 1500. Be sure to take good notes about who needs what overnight or the next day so that information can be passed on the next day. You will generally have several tertiary exams or post ops to do overnight, otherwise you deal with issues on the floor and respond to trauma codes. There will always be a PGY2+ covering the SICU and available to you should you have any questions or concerns with the floor patients. They’ll likely hang out in 914 with you during the night. The night nurses on the tenth floor are awesome and do great work, do not be afraid to ask them for help as you are getting acquainted. In the morning (around 0430), you will need to print the rounding sheets for the oncoming day team members. Make sure that all the new patients overnight are added to this sheet before printing. Until 0730 you are the one who responds to trauma codes, not the day interns. After pre-rounds, hand the pager to the next 24-hour call intern and leave!

Trauma Codes

• When running a trauma, you will need to put on the lead shield, gown, gloves, and goggles as it can sometimes get messy. The person not running the trauma will scribe on an H&P template. The H&P is relatively easy to fill out and is much shorter than your typical history from internal medicine.

• Run through your primary and secondary assessment. Airway, Breathing, Circulation, GCS/Disability then Secondary Survey. Call out confidently. Don't scream. Don't interrupt or move people. 

• There is always an Emergency Medicine attending and resident who completes a FAST exam. The EM resident technically gets first dibs to an intubation but don’t be shy to ask the resident if you could do it! You will also have many opportunities to suture, staple, splint and do other basic procedures like pull chest tubes and NG tubes, and pack wounds.

NPs - Emilee, Amy, Nancy, Jordan, Katie, Jenn 

• This service is very multidisciplinary. The attendings work very closely with the NPs and nurses, especially the TNTLs and ICU nurses; play nice in the sandbox. The attendings will back the nurses and NPs up 100% as they have known them for years, and you will have a miserable rotation if you do not get along. Trauma is very algorithmic, and, in some cases, repetitive. When the NPs tell you how they normally handle a situation or case, listen to them! If you are honestly concerned about the patient, or have question for your own learning, then by all means, respectively ask your question. Be a TEAM player, not a know-it-all, and this rotation will be much more pleasant. Plus, most of the NPs have a great sense of humor, don’t be afraid to show your funny side.

Attendings - In general all are very low-key for surgeons.

• Dr Bansal is the head of the department. Rounds are very fast and he does not need an attending note for rounds.

• Dr Peck likes to teach on rounds and will ask a lot of questions. She is nice.

• Dr Krosner is really nice. Takes a long time to round and is very particular about the holes in the sheets lining up (USE THE GRAY HOLE PUNCHER). You should also know all of your post-op, post-injury and hospital days, and micro results. Also, hearing him call the restroom “the little surgeon’s room” never gets old.

• Dr Yang is very low key. Short rounds. Likes to teach and very approachable.

• Dr Sise is retired Navy. Likes to tell stories (good ones) and pretend he is the Fonz. Long rounds.

• Dr Tadlock is an active-duty Navy surgeon who moonlights with the program; he can be particular about the notes being properly filled out (if you have a medical student, make sure to sign their note).

•  Dr Benfield is also active duty and seems to work mostly nights only. I never rounded with him.

• Dr Simpson is very nice, middle ground on rounding length and amount of detail needed during rounds.

• Dr Kryzaniak is a Navy Trauma surgeon who moonlights at Scripps Mercy occasionally. Very laid back, but generally likes a little more information as he is not there often. If a patient has head bleed, report their GCS.

Pearls

• The SICU is on the 2nd floor near the OR. You almost never need to go there.

• Most of your patients will be either drunk, on drugs (meth is popular), or crazy in some form. Enjoy the sane patients.

• SHP is the preferred consult medicine team.

• Language barriers are common. Try to get the Cyracom Translation phone number saved to your phone for easy access to translators.

• Surgical consultants are like ghosts; the notes just magically appear in the charts despite you not having seen a surgeon anywhere near the patient (so make sure to check the charts).

• There is another doctor's lounge on the 2nd floor; it is usually better stocked. Have one of the residents show you.

• Trauma Administration provides you with a $40 gift card to the cafeteria. Don’t forget to pick this up.

• Patients will die on your service as well as in the trauma bay. We had at least 7 patients die during my rotation. One of them was a code blue on the floor. We also had several RRTs on the floor as well. Don't hesitate to call for help if you need it.

• Room 1020 is called the "safe unit." It is a mini step-down unit, usually for traumatic brain injury patients. The charts for those patients are in the room.

• The NPs love to cite how many steps and the assistive device patient’s used from the Physical Therapy note. You’ll look like a pro if you know this during NP and formal rounds as it helps with disposition planning. Also good to know how the patient did in PT/OT the day prior to compare progress.

• You still need to shave during the rotation, but it is OK to wear scrubs to and from the hospital. You can also wear a jacket instead of a white coat if you prefer.

UCSD Burn

Points of Contact

Julie Hancock, Administrative Assistant Christina Richardson Division Admin Breanna Carmichael GME Admin

(In Charge of Scheduling Rotators) (Back Up for Julie) (POC for UCSD paperwork)

jthancock@health.ucsd.edu C3richardson@health.ucsd.edu becarmichael@health.ucsd.edu

619-543-7200 619-543-7162 619-543-8253

Burn Clinic Coordinator:

Eli Strait

estrait@health.ucsd.edu

Main Clinic Providers: Clinic Phone: 619-543-6505

Catherine Ridgway PA         Brian Piatkowski, NP           Fa Tangtamnu, NP      Julia Thrasher, NP

cridgway@health.ucsd.edu bpiatkowski@health.ucsd.edu    rtangtumnu@health.ucsd.edu       jthrasher@health.ucsd.edu

Check-In

There are several required forms that are required to rotate at UCSD, the onboarding process is relatively convenient and is completed using a link provided to you in an email. If you have not heard from them 1 month prior to your rotation, make sure to reach out. You will have to have some form of TB test (either PPD or Quantiferon) within three months of rotating through UCSD; most choose the Quantiferon as it is a single blood draw that does not have the same follow up at a PPD. Contact Breanna Carmichael at least two weeks ahead of the rotation start date to verify that they have all of the paperwork necessary. For your first day, park in the visitor parking lot (15$/day) and meet at 0800 on the 5th floor of the inpatient tower. 

What to Expect

EM interns spend one week in the Burn Clinic at UCSD Medical Center. Both the clinic and the ICU are located on the fifth floor of the hospital and the typical day goes from 0800-1630. Make sure to go to the clinic and not the Burn ICU (many have made that mistake and many will continue the trend). Clinic is closed from 12-1300 for lunch. The cafeteria at UCSD is like any other hospital cafeteria and unfortunately there are no other good options within close walking distance of the hospital. There is a lounge on the 5th floor that has a fridge if you want to bring your own food.

The burn PAs and NPs (Catherine Fa, Brian, Julia and Carrie) run the clinic service. They are very helpful and will teach you everything you need to know about initial burn care. Most of what you will do in clinic is taking a basic H&P, learning how to describe burns, and learning how to clean and dress them; it is not an intellectually challenging rotation. If they call a Burn Trauma while you are there, try to go since you won’t see burn on your Mercy rotation. The providers also get lots of burn consults in the ED, so make it a priority to go see those patients. Also, ask if one of the APP’s will go through some of the Burn ICU patients with you that way you can get some experience seeing more complex, critical burn patients. Most importantly learn what they want to hear from you when you refer patients over to UCSD for burn care. 

Parking: 

Unfortunately, there are no parking passes available and no Navy reimbursement plan in place. Parking options are the visitor parking lot, rate is about $15/day or street parking. 

Tips:

• If they call a Burn Trauma while you are there, try to go since you won’t see burn on your Mercy rotation. 

• Ask if one of the PAs or NPs will go through some of the Burn ICU patients with you that way you can get some experience seeing more complex, critical burn patients. 

• Most importantly learn what they want to hear from you when you refer patients over to UCSD for burn care. 

NHCP Anesthesia

The two week anesthesia rotation for EM interns, second years, and EMPA fellows takes place at Camp Pendleton and is the farthest away of any rotation during intern year. Depending on the number of trainees there at any given time, it can be more or less useful as there are also CRNA students training there as well.

Points of Contact:

CDR Paul Johenk

paul.d.johenk2mil@health.mil

517-303-3088

Location

Naval Hospital Camp Pendleton is located at Camp Pendleton in Oceanside, CA directly North of San Diego when taking I-5, and is right off Exit 54-B. Once you get to the exit continue straight to reach the main gate. After going through the gate, the hospital will be straight ahead on the right side of the road. Park on the North side of the hospital in the visitor parking deck. To get to the OR/PACU, take the North elevators to the 3rd Deck; the fastest way to the PACU is on your left as you get off the elevator. It can take between 45 minutes and an hour to get to Pendleton so you have to leave pretty early to make it on time.

Check-In

Email CDR Paul Johenk (paul.d.johenk2mil@health.mil) to let him know the dates that you will be at Camp Pendleton completing your rotation. If you cannot reach him by email then you can send him a text at 517-303-3088.

On the first day of the rotation, try to arrive by 0700. Give the anesthesia floor walker a call (Phone: 760.685.1296) to let you into the anesthesia offices adjacent to the PACU. Depending on who is available at the time, you will get a brief tour of the offices/OR and start the check-in process, though this is far less formal than when officially checking in to NMCSD. You will need a CAC and a copy of the Anti-terrorism online training certificate to get an access card from Security on the 1st deck of the hospital. Make sure to have the NMCSD command badge with you as well. You can wear NMCSD scrubs and a white coat or a jacket when you get there the first day and the Floorwalker can show you where to get NHCP OR scrubs (there is no longer a scrub machine, so no need for a scrub card).

What to Expect

Rotators should arrive at 0700 every day except Wednesday (when the OR opens at 0800). Grab a copy of the OR schedule from the desk and review to see which rooms would be best for potential airway opportunities. The SRNA's will manage their own room, so avoid that one, and there are some CRNAs who only rotate through the OR once a week and prefer not to work with trainees, but for the most part, all of the anesthesiologists and CRNAs are great about letting rotators float through the rooms; Mike Lynn is particularly good about teaching trainees and likes to pull you out of your comfort zone, so try to work with him when you can. Introduce yourself to those providers in the rooms prior to the start of the first case to avoid any issues. After you find out that the provider is alright with having you in the room, head out to pre-op to introduce yourself to the patient and do an airway exam to see how easy/difficult the airway will be. The first cases start at 0730 in all of the open ORs everyday except Wednesday when they begin at 0830. If there are other trainees overlapping with your rotation, consider alternating days so you do not end up fighting for airways.

When you roll back to the OR with the anesthesiologist/CRNA, it will be your job to ventilate the patient with the mask. You don't really need to worry so much about the meds or gases that are being used, but try to discuss the RSI meds chosen and for what reason. It is pretty amazing what pre-oxygenation will allow you to do when intubating and there is often time for multiple attempts if necessary. You should try to use a variety of blades/sizes when you are intubating and it is a controlled environment so there is time to get a little comfortable with both the Miller and Mac blades. Once you get the airway and confirm placement, you are free to float away to another room or back to pre-op. Most everyone only cares about intubations, but place a few LMAs while you are there as well for practice as they are on the difficult airway algorithm and don't be shy about placing airway adjuncts like oropharyngeal or nasopharyngeal airways. Unfortunately, NHCP is not the busiest hospital and the number of available ORs exceeds the number in use every day. With the number of trainees there, it is somewhat difficult to get a decent number of tubes while at Pendleton. 

The rotators typically hang out in the pre-op area when not doing airways. This way, you can see the next patient come in to introduce yourself and do an airway assessment. Take advantage of IV start opportunities. The providers there prefer smaller gauge access in the back of the hand, which is a little different from practice patterns in the ED, but still a useful skill to have. There will also be opportunities to practice nerve blocks or epidurals.

The vast majority of cases are scheduled for the morning, and you should try to leave by 1300 to 1400 to avoid traffic headed back to San Diego if you can. Sometimes, if there is not really much going on, you can leave earlier; the providers up there will not mind, and often will not even notice. 

Food

If you have some down time before you peace out, there is a NEX and a galley on the 1st deck of the hospital for food options. The NEX is basically right below the pre-op area and the galley is located on the South side of the hospital.

Helpful Topics to Review

• Basic airway anatomy: Adult vs. Pediatric

• Airway evaluation

• Airway management equipment

• Airway management/induction drugs

How to Succeed

• It’s a numbers game; get as many airways as you can. Get the airway, get out and find another room! 

• Become an expert in ventilation. Be able to bag, use oral airways, optimize positioning, etc.

• Try different airway blades and adjuncts. This is a controlled environment. Try the various LMAs, intubate through an LMA, video laryngoscope, Miller, Mac, fiber optic intubation, nasal intubation, you should see and do as many different approaches as possible!

• You can do IVs, blocks, and epidurals. If you ask, show interest and are helpful, the staff are very willing to let you be involved.

• Avoid rooms that have a SRNA, dental student or any other learner/rotator.  That being said, you may be able to snag an airway if the SRNA is in his/her second year. Play it by ear, depends on the student and ultimately the staff that is supervising them.

• NHCP is relatively small; they are running five to seven ORs, but some days, there are two SRNAs, dental student, and an ED resident. This can lead you not getting a lot of airways. Realize there will be days when you only get a couple airways, but there will also be days you get a lot. 

VA CCU

This is a four-week required rotation in the Coronary Care, Telemetry, and combined Cardiovascular and Medical Intensive Care Units at the Veterans Affair Medical Center. 

POC: 

Catherine DiMagiba

(858) 552-8585 x1458 

catherine.dimagiba@va.gov

The senior chief will reach out to you with starting information. You can text the resident on the rotation prior to you for their information as well. You will receive several emails prior with information regarding badge pick up. Make sure to come in at least a day early and test your EMR access. 

Location

3350 La Jolla Village Dr, San Diego, CA 92161 near UCSD campus

Parking:

Parking pass will be provided. You cannot park in the parking garage. There are large parking lots past the parking garage that are labeled. There is always plenty of parking in the designated resident parking area. Make sure to print your parking pass (which will be emailed to you with 

Food:

There is a cafeteria with limited hours. Food options are more limited. Generally bring your own lunch. Depending on your senior you can run out to briefly get lunch if the ICU is not that busy.

What to Expect:

• Your day usually starts around 6:30am for pre-rounding. You will have another intern on service with you who is usually from UCSD. The attending will arrive at 8am for formal rounds. Medicine and cardiology alternate who rounds first. You will most likely not have a WOW for rounds. You can print your note to the printer in the workroom which is helpful. 

• You and the other intern alternate short and long call days. The short call intern can take new admissions up until 3:00pm and the long call intern can take new admission up until 5pm. You will alternate which weekend day off you have.

• The EMR is incredibly inefficient. On your first day, come early to learn how the EMR works. It will take a lot of time and is not intuitive.

• It is the ICU so expect longer days. It is between you and your other intern to decide when you can go home on your short days so work with each other to get each other out early.

• As an intern you can take up to 6 patients at a time, but this is rare in the VA ICU.

• Expect to present your new admissions to the attending with a plan.

• On the weekends be ready to present up to 6 patients as you cover for your co-intern on their day off. So, make sure you at least have an idea of what is going on with their patients.

• Can wear your own scrubs. 

• You will not get many procedures here. Most of the fellows and senior residents have not performed procedures (like intubations, lines, etc.) so they will try to take the procedures that come up. You can still perform the procedure if you speak up but it is very rare you will be able to do any of these procedures at the VA.