Welcome to�University of Alberta Hospital�General Internal Medicine

Division of General Internal Medicine

** CTU ROTATION (SENIOR RESIDENTS)**

CTU Orientation

• Please review these orientation slides prior to starting your rotation

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• Dr Caity Collins will be available between 0845-0930h on the first Monday of your rotation to answer any questions that you may have about the rotation ahead
• Please use the orientation link sent out by Carrie Hlady

GIM Structure at UAH

• 8 GIM Ward Teams
• CTU A – 5D2
• CTU B – 5D3/iCare
• CTU C – 4A7 **(5D4 closed since July 2025 for flooding)
• Med D – 5E2
• Med E – 5E4/off service
• Med F – off-service
• Med H – off service; Med I - off service
• GIM ED Consults
• triages all admissions during the day
• Med G staff, ED consults back up when consult #s are high
• GIM Inpatient/Ward Consults
• ward consults, ICU transfers, UAC (in KEC) and PAC

The Junior Resident is in-charge of their patients.��The Senior Resident (or Jr Attending) is a consultant to the Junior Resident, and the Attending is a consultant to the Senior Resident (or JA)

Weekday Schedule �– CTU Senior Residents

• ??? – 0810h
• Pre-round on sick or dischargeable patients
• 0810 - 0830h (double-check timing with your unit)
• Rapid Rounds – interdisciplinary rounds with unit manager, charge nurse, transition coordinator and representatives of allied health team (PT/OT/SW)
• Run through all the patients to ensure plans are in place and being executed

Weekday Schedule (Mon – Thurs)

• 0830 – 0845h
• Morning report for senior residents and staff
• 0845 – 0900h
• Senior resident teaching (RC scenarios/hot seat)
• **Please prepare and decide amongst yourselves who will do the RC scenario
• See next slide
• 0900 – 0930h
• Junior resident teaching by senior residents
• **If you were on the “hot seat” you are RESPONSIBLE FOR junior resident teaching that day

Morning Teaching

• Who is responsible for each day:
• Monday – CTU-A senior
• Tuesday – ED or Ward consults team
• Wednesday – CTU-B senior
• Thursday – CTU-C senior
• Return to In-Person Teaching (refer to Carrie Hlady’s email re: location due to flooding)
• Senior Resident RC scenario - ~0845 – 0900h
• Junior Resident teaching – 0900 – 0930h
• Taught by senior residents

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Weekday Schedule (Friday)

• 0800 – 0900h
• Hybrid U of A Medicine Grand Rounds (Zoom link sent via email)
• 0900 – 0915h (Friday, Saturday, Sunday)
• Morning report

Weekend Schedule when doing parachute shifts in ED

Arrival Time for Daytime, Evening, and Night Float ED Residents

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• Weekend daytime shift
• 0750 – 0800h – arrive to get handover from the night float senior
• Evening shift:
• 1600 – 0000h (midnight) Monday to Friday
• Night Float shift:
• 2330 – 0830h Monday to Friday
• 2000 – 0830h Saturday and Sunday

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Virtual Morning Report

• In Nov 2020, MR moved over to Zoom
• Essentially acts as a 'virtual 5D classroom’, Zoom link provided by Carrie Hlady to be used Mon to Sun for MR handover
• **Goal of MR is to get handover from the ED team on the new patients admitted to your ward

Teaching Schedule

• Orientation on the first Monday of the block
• The next slide has an overview of all of the teaching sessions as a guide, however, as please refer to Carrie’s email for the details and times as this is in the process of being updated on a divisional level.

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CTU JOURNAL CLUB (PREVIOUSLY CRITICALLY-APPRAISED TOPICS)

What?

• 30-minute PowerPoint team/group presentation of an appraisal of a study that is relevant to inpatient GIM. [20 mins for the presentation; 10 mins for Q & A]
• Only one journal club presentation per CTU block (4 weeks)
• Presented to all the learners (residents and students) and GIM attendings on service for all inpatient medicine teams. Attendance in-person is mandatory for all learners on CTU.
• Presented by Team A, B, or C, based on rotating schedule (the team will be notified at the beginning of the block)

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CTU JOURNAL CLUB (PREVIOUSLY CRITICALLY-APPRAISED TOPICS)

When? Where?

• Last Tuesday of the CTU block [unless otherwise specified]. 12:00 – 12:30 pm
• Meeting room 5D1.06. In-person only

Why?

• To provide CTU learners an opportunity to gain skills in critical appraisal of studies relevant to practice, and to develop tools to do this efficiently during busy clinical practice while providing clinically-useful information to attendees

How?

• The group PowerPoint presentation will be led by the Sr resident (or Jr Attending), who will assign team members (Jr residents and students) various parts of the presentation. The team will present jointly on the day of
• The team responsible to present will be contacted at the beginning of the block with more specific guidance

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Senior Role

• Responsibilities:
• Pre-round on sick or dischargeable patients
• Lead rapid rounds
• Assign patients to students and junior residents
• Ensure the students and junior residents know their expectations including pre-rounding, documentation, case presentations

Senior Role

• Responsibilities cont’d:
• After Jr resident teaching (~0930h) please ensure Jr residents and students present the new patients admitted to your ward overnight to you and staff
• This provides you with the opportunity to give feedback on learner presentations and do some teaching
• Note: goal is to have junior residents leave by 1000h post-call (so not to go over their 26-hour rule)
• Lead the team in conjunction with your attending
• Allot time for teaching students and juniors during rounds and in the afternoons

**IMPORTANT**

If you are sick or going to be away from service THAT HAS NOT BEEN APPROVED, it is YOUR responsible to contact:

· Your preceptor

· Switchboard outside of 0830-1430 (780-407-8822)

· Carrie Hlady (chlady@ualberta.ca)

· Your home program

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GIM UAH Call Schedule

• All changes MUST be brought to Carrie Hlady’s attention (carrie.hlady@ualberta.ca).
• If a junior resident is cross-covering for another team, this will be clearly indicated on the call schedule with a red X beside their name. Please ensure good handover is provided to cross-covering residents!
• Stat days must be taken within the same block as per PARA
• it is up to the resident to find a day which works with their team and to notify Carrie Hlady what day will be taken in lieu

Team Pagers for Call

• Team pagers for MED-A, MED-B, MED-C
• ED Consults has a pager app/smartphone
• Pager number is first-call
• Team pagers listed as first-call in ROCA 24/7, please decide within your team as to who carries the pager during the day
• Please ensure the pager is given to the appropriate resident/student on-call for your ward at ~1700h
• It is SOLELY the on-call resident's responsibility to hand off the team pager to the daytime team the following morning
• For ED consults, phone and pager to be rotated amongst residents
• can be forwarded to the elective resident while residents are at AHD

i-Care (5D3) / Telemetry

• i-Care and telemetry beds – allocated to CTU-B
• General indications: severe DKA, ACS (non-cath), signif lyte disturbances, hemodynamic/neurologic instability, syncope w/ high risk features, meds req monitoring, respiratory failure (severe hypoxia/hypercarbia)

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• i-Care – Up to 4 beds on 5D3 – please review i-Care and telemetry guidelines (in GIM Rotation Guide)
• 2:1 patient to nurse ratio
• Patients requiring: continuous cardiac monitoring, BiPAP
• Isolation capabilities

i-Care (5D3) / Telemetry

• i-Care and telemetry beds – CTU-B
• Capability for 2 additional telemetry beds, in addition to the 4 iCare beds on 5D3

ICU calls

• Medical Emergency Team (MET) call – sick deteriorating patient, impending deterioration
• 5 to 15 mins for ICU to arrive
• No overhead call
• Code Blue – respiratory arrest or cardiac arrest
• ICU arrives within 5 minutes
• Overhead call

Last Few Things (QI!)…

Please be mindful about lab test ordering

• Is it necessary and will it change management?

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Oxygen Therapy: Shifting Our Culture

• Evidence showing liberal/overuse of oxygen therapy in hospital can cause harm¹
• Important to gain awareness of new provincial approaches to guide the safest use of oxygen therapy
• Key points to remember throughout your rotation:

o Minimum acceptable SpO2 is dependent on patient’s age, pulmonary status, and clinical diagnosis

o As soon as possible, an order for an SpO2 target range should be obtained and the reason for hypoxemia determined

o In those at risk of hypercapnia (known CO2 retainer) and in those with suspected acute coronary syndrome (ACS) and stroke, oxygen therapy must be carefully applied, and only when patient is hypoxemic-usually below SpO2 of 90%

o Maintain patient on the lowest oxygen dose required to keep them within their ordered SpO2 target range

o Write weaning orders (nursing communication) as soon as possible

Questions?

• Please contact me (Dr Caity Collins) at cacollin@ualberta.ca if you have any questions throughout your rotation