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Tips for Interns

All the things we wish we knew at the start of internship. Come back to this list once you've got a handle on most things to see what extra tips you could learn. Add your own at the bottom!

A day on the wards

  1. Until your team rounds: prepare notes / complete outstanding tasks

    • ​On surgical teams, you are often asked to attend early and go through all the notes prior to the round as the registrars won't read the notes​​

    • If you round with a computer, do NOT print a patient list - save paper and write your jobs on a notes/to-do app on your phone (e.g. Google Keep)

  2. Ward round​​​ & write notes

    • Try to write clear plans for after hours (e.g. not for further IVF after this bag​

  3. Urgent jobs

    • Request consults (page registrars, Allied Health via Orders, Rehab registrar via Adhoc​ (top bar) > Rehabilitation Referral)

    • Imaging orders (depending on how urgent these are for your team)

    • Last-minute afternoon pathology orders

    • Discharge medications

    • Discharge summaries if transport booked soon

  4. 30min lunch​ break (read, play games , send messages, go for a walk)

  5. Non-urgent jobs

    • Go through your plans to make sure you haven't missed anything

    • If spare time:

      • For all patients, check: antibiotic approvals, DVT prophylaxis​, bowels opening (if recorded), blood results, prepare future discharge summaries

  6. Order Bloods for the next morning

  7. Claim your overtime for that day (including lunch if you didn't take it)

Discharge Summaries

  • Use the left bar to navigate, double click text with "==" to edit that section

  • Summary of Admission: fill in using the template, can do in Word first

  • Health Status: add relevant diagnoses

  • Results > General Results: right-click top bar > Admission date to current

    • Select admission results​ + last results + any other interesting testing

  • Results > Other results: copy all imaging, cultures, histopathology and operation reports

    • Pro tip: Highlight all the imaging on flowsheet, then Edit > Copy to get all the reports at once​

  • Once discharge medication reconciliation has been done, refresh while editing > untick all boxes except the top two and last one (and their subpoints)

  • Do NOT sign until patient is about to leave - every time it is signed it is emailed to the GP + consultant + uploaded to HealtheNet (myHealthRecord)

  • Just before signing, refresh to ensure the auto-generated dates are accurate + Note Details at bottom right > set time and date to current

Remote eMR Access

Before starting, download Citrix Workspace (Windows, Mac)

  1. Login to www.swras.health.nsw.gov.au

  2. Intranet under SESLHD

  3. Health Data Systems and Tools in the blue box in the left-hand panel

  4. Citrix Application Portal at the top

  5. Detect Citrix Workspace app

  6. Already Installed at the bottom

  7. Login and you're good to go

eMR: where to find non-obvious things

  • Language: Patient information > Patient Demographics

  • List of SESLHD inpatient/outpatient presentations (including which consultants they see): Patient Information > Visit List

  • Bowel chart: Flowsheet > Change "Level" to "Gastrointestinal"

  • ECGs (some, others in folder) and TTEs: Flowsheet > Cardiac Diagnostics

  • Urinalysis: BTF Observation Chart (change timeframe to 7 days)

  • NFR: Advance Care Documents (also in top bar)

  • Take home med packs from ED: Quick Orders > Discharge Prescription

  • Previous medication reconciliations: Medication List > Medication History Snapshot > All Visits

  • Recent medications: MAR Summary > Left arrow at top (or right-click top bar)

  • Search documentation: ContinuousDoc (adjust the timeframe, and note the filter stacks with every search, so if you want to start again you need to clear filter)

  • Past/booked appointments in SESLHD: Appointments

  • Filter notes: Documentation > Advanced Filters (recommended: Allied Health, Discharge Summary, ED, Operation Report, Pall Care)

  • History of edits

    • Notes: drag up grey bar at the bottom of the note​

    • Pathology/imaging reports: yellow filing cabinet button at top right

  • Letters (some) & ICU discharge summaries: Clinical Notes View

  • Fluid input/output: iView > Intake and Output

    • To change scale, Options (in top bar) > Select Time Scale​

  • myHealthRecord (discharges, pharmacy meds, investigations): HealtheNet​

eMR Tips & Tricks

  • If eMR is locked on someone else's login, right click the Citrix icon on the bottom right of the screen > Connection Centre > click the folder icon > Log Off

  • Create two side-by-side eMRs: Tear Off (button at top left)

  • If your eMR templates use underscores for information to fill in, then you can press F3 on the keyboard to jump to the next underscore to fill in the next blank

  • When doing ADDITs, press F5 to add the current date and time

  • When filling in a date and time, press "t" for today's date and "n" for now

  • When using the Census Task List on after hours shifts, go to Medical Task by List > Options (top bar) > Task List Properties > Patient List > expand All Locations > expand your hospital > expand Inpatients > select the wards you are covering

    • Note: some come under words, e.g. Extended Day Only is part of 1W, and there is Mental Health Unit and MHOPU Mental Health Older Person's Unit

    • You cannot select by Patient List, it does not work

    • Do NOT change the Time Frames - you may miss important jobs from several days ago that weren't rescheduled (e.g. chase potassium level over the long-weekend and treat if required)

    • After saving your wards, sometimes you need to quit eMR and reload for your list to update

  • When ordering investigations that you need to chase after hours (e.g. Hb if bleeding, troponin, imaging), use "MO Consult" to add them to the CTL for you to chase the results (or leave the original task on the CTL and add an Admin Note so other JMOs don't accidentally double up on jobs)

  • If you've accidentally ticked something off on the Census Task List, you can right-click and unchart it (you can find Completed Tasks under Options > Task List Display, but it takes literally forever to load)

  • To see the edit history of imaging/pathology, click the yellow filling cabinet symbol at the top of the result

  • To attach files, either:

    • Screenshot (Ctrl+Shift+S) and paste into a note​ - will usually accept up to 4-5 screenshots per note or it won't save

    • Save the file to your downloads, then at the top of a note: paper clip icon > Browse > This PC > Local Disk (with the numbers at the end) > Users > KUSR (with the same numbers) > Downloads > select file > Attach

Communication

  • From hospital phones/faxes, unless calling a five-digit extension, press 0 first

  • If calling a patient/family from your mobile, dial #31# first to make your number private

  • Prior to consults always know: relevant symptoms & exam (may need to do yourself), if known to a consultant from that specialty (chase letters if so), your question (may need to clarify with reg) - check out MedApp (see resources) for more information on specific consults

  • Save yourself from being on hold with Switch, check out rmoa.au/directory (or bit.ly/Network8Directory) for all the contact numbers a JMO could want

Imaging

  • For urgent imaging, call the radiology registrar to get approval first (unless the team has a relationship, e.g. neurology/neurosurgery with MRIs), then call the imaging department

  • To view echo reports before they're published to eMR, go to Intranet on Internet Explorer > Hospitals > St George > Cardiology > username: sgh, password: echo

  • Want to know when that scan is going to happen? Open medical imaging in SECTRA, and it'll appear at the top as a future date and time

    • If there is not time and date, it hasn't been booked (so if you want it urgently, call them)

    • If the patient hasn't had scans before, you can find the Patient Imaging Folder link at the bottom of Patient Summaries (middle column) in a purple box

  • For abdominal ultrasounds, patients need to be fasting (ideally overnight)

  • For renal tract ultrasounds, patients need to have a full bladder (encourage 1L oral intake 30min-1h before the scan, or give IVF if NBM)

Medications

  • To add a medication not on eMR, use Unlisted

  • When withholding a patient's home medications, chart them all and then suspend them (don't just stop them altogether) - otherwise, the home team may not realise they're supposed to be on that medication until preparing them for discharge

  • The hospital does NOT stock Panadol Osteo: either chart regular Panadol, or if the patient brings their own supply chart it as unlisted and tick "Use Patient's Supply"

  • When charting 

  • When charting steroids (or NSAIDs in the elderly), chart a PPI (e.g. pantoprazole 20-40mg daily) to prevent ulcers, and cease it when they cease the steroids/NSAIDs

  • The hospital stocks Novorapid Penfill (not Flexpen)

  • Hydromorphone must be co-signed by a registrar or higher (by that user editing and commenting "Co-signed by X"), as per local hospital policy

Wellbeing

  • It is normal to be stressed during and after work. Internship is a huge change in your life, and it will take a long time to become comfortable with how everything works. Everyone is different, but it's often not until Term 5 that people start to feel comfortable. 

  • It is normal to feel you're not as good as your peers. This is called Imposter Syndrome. It is not true, you're only seeing a snapshot of them and don't see all the mistakes they've made. You were the best person chosen to complete this role - there is no one better to fill it. Even the best among us get Imposter Syndrome.

  • It is normal to feel like you've made a poor consult. It is normal to feel like you've been inefficient. It is normal to make mistakes, and even have the occasional IMS meeting. It is important you learn from them.

  • It is NOT normal to be harassed or bullied in your workplace. If you feel uncomfortable, if jokes are being made at your expense and they're not humorous to you, if you feel like too much pressure is being put on you, please let someone know. Whether that's Dr Nicole Hersch (DPET), someone from the St George RMOA, or anyone else at work you feel comfortable talking to, it's important that you reach out and escalate as required.

  • It is important you debrief with your peers, to know that everyone has these crazy experiences and that we can laugh about them. JMO wellbeing is why we run all these social events, so you can talk to your peers, build supports and develop a sense of community. We are all exhausted after work, but it is still so important to come along to socials to break things up and build these relationships.

  • Share the load: If someone is called in for you when you're sick, message them and offer to take one of their future after hours/on-calls in return (unless you're feeling overwhelmed).

How to claim overtime

  1. Login to StaffLink's UROC JMO Dashboard (or use the UROC app)​

    • Without link: Google "​StaffLink" > menu at top left > NSW UROC Creator​​

  2. Add Unrostered Overtime Claim (top right)​

  3. Fill in the details

    • Legal Employer: ​South Eastern Sydney LHD

    • If started early, must be added as separate claim to staying late

    • If did not take lunch break, add to the end of your afternoon overtime

    • If the reason was completing jobs, select "Other" and name the registrar or consultant who was ok with you staying back to finish jobs

Miscellaneous

  • To find Policies & Procedures, go to the intranet > Hospitals > St George Hospital > Policies & Procedures at the top

  • Before intern teaching, give your pager to your reg or resident - the beeping is so loud on the recordings

  • SGH Intern Education only has to be attended by medical and surgical interns at SGH and Calvary (not ED/TSH, relievers on evenings/nights or ADOs)

  • Morning handover is attended by all medical teams (not surgical or ED) at 8am every day, except Thursday it's 7:45am because Grand Rounds is on 8-9am

  • Need to drop something at pathology (e.g. CSF, frozen section biopsy, bloods on ice)? Pathology reception at St George Hospital is in 3N (head towards 3E then turn left down the corridor). At Sutherland Hospital, it's in a building just outside and left of the Emergency Department.

  • In the new SGH building (Acute Services Building or ASB) lifts, double press the level button to de-select in

  • There are lockers at SGH next to the JMO Common Room
  • CDA/ANSW (ambulance) cannulas need to be replaced within 24h because they're associated with a much higher risk of infection (they say "Emergency" on the IVC dressing)

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