From the personal notes of vj and Giselle Velez, md



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AN INTERN’S

SURVIVAL


GUIDE

From the personal notes of

VJ and Giselle Velez, MD

St. Vincent Charity Medical Center

Department of Internal Medicine



Table of Contents


  1. Introduction

  2. About St. Vincent Charity Medical Center

  3. Message from the Program Director

  4. Advance Preparation

a. International driver’s license

b. Money/Credit card

c. Pre-departure shopping

d. Apartment reservations



e. Ethnic costume

  1. Moving In

    1. Apartment hunting

    2. Hotels

    3. Social Security Number application

    4. Cars

    5. Driver’s License application

    6. Furniture

    7. Utilities

    8. Credit Card application

    9. Opening a Bank Account

    10. Cellular phone application

    11. Tipping

  2. Shopping

    1. Grocery/Ethnic Stores

    2. Wet Markets

    3. Home Décor Shops

    4. Malls

    5. Factory Outlets

  3. Recreation

    1. Sports

    2. Theatre

    3. Music/Concerts

    4. Parks

    5. Museums

    6. Zoo

    7. Movie Theaters/Cinemas

    8. Cleveland Websites

  4. Dining out

    1. American

    2. Asian (Japanese, Chinese)

    3. Indian

    4. Italian

    5. Greek/Middle Eastern

    6. Spanish




  1. Just for kids

    1. Child Care Centers

    2. Schools

  2. Car Dealers

  3. Transportation Services

    1. Taxis

    2. Car Rentals

    3. Public Transportation

  4. Hospitals/Medical/Dental Clinics

  5. Who’s Who in the Internal Medicine Program

    1. Program Director, Core Faculty, Nicki, Linda and Chief Residents

    2. Attending Physicians, Consultants, and Senior Residents

    3. Allied Medical Professionals

  6. Gearing up for the floor/unit rotations

(Inside the average lab coat)

  1. Tips for the Floor

    1. Early Bird

    2. Develop a routine

    3. Floor Routine

    4. Technology

    5. Dress Code

    6. Admit Orders

    7. Paging

    8. Hospital Phone System

    9. Prescriptions

    10. Discharges

    11. Common night problems

    12. Rounds with Resident

    13. Rounds with Case Manager

    14. References/Books to read

    15. Sign-outs

  2. Golden Rules

  3. Conclusion


I. INTRODUCTION
Welcome to the Internal Medicine family of St. Vincent Charity Medical Center. At last, the long wait is over. After months of MLEs, residency applications, traveling for interviews, matching, and visa applications, you are finally here to embark on yet another grueling chapter of your life.
Predictably, the next few days will be filled with excitement, apprehension and uncertainty. Things may seem overwhelming. However, take comfort that a lot of the residents have been through the same experience and SURVIVED!!!
It isn’t easy being a stranger in a strange land. One can’t help but feel like a fish out of water, when all of a sudden; you have to be comfortable in your new surroundings, and fast! For some people driving on the right side of the road will be a problem. Those of us who have never seen snow will soon have to contend with blizzards. The health system is different. Definitely, patients and peers will have a different culture and will act in ways counter to what one may expect in your country of origin. All in all, being a foreigner in the US is big enough of a challenge. Being a foreign medical graduate doing residency will even seem worse.
Bear in mind, that none of the residents survived by going solo. What makes this residency program special is the spirit of comradeship and solidarity. Internship will be a breeze, with a little help from your friends.

II. ABOUT ST. VINCENT CHARITY MEDICAL CENTER
St. Vincent Charity Medical Center is a 480-bed, full service inpatient and outpatient healthcare center who has served the Greater Cleveland community for the past 140 years. Located in the heart of downtown Cleveland, St. Vincent Charity Medical Center is a model of urban healthcare - progressive, vital, meeting the changing needs of the community today and tomorrow.

As a Catholic Hospital, St. Vincent’s caregivers are dedicated not only to caring for the body, but also for the mind and the soul. This is a place where compassion is more than just a word - it is a vision. It provides tremendous vital medical, surgical and emergency care resource for patients. St. Vincent Charity Medical Center is owned in partnership between the Sisters of Charity of St. Augustine Health System and University Hospitals Health System.



III. MESSAGE FROM THE PROGRAM DIRECTOR

Welcome to the St. Vincent Charity Medical Center/Saint Luke's Medical Center Internal Medicine Residency. We have a great tradition of excellence in residency training in Cleveland, Ohio. We are training internal medicine residents to be responsive to the present and prepared for the future.

Medicine in the year 2007 and beyond will be exciting - new knowledge, new technology, new communication techniques. In addition, major social and economic forces continue to play a role in the healthcare arena. The challenge of providing excellent, up-to-date practical medical education as we provide high quality care to our patients is one that confronts academic centers everywhere.

At St. Vincent Charity Medical Center/Saint Luke's Medical Center, we believe in a practical approach that combines an academic approach with a community-oriented view. We keep a national view, evidenced by our 5 year accreditation by the ACGME, while integrating the Core Competencies into our everyday teaching and patient care. Patient Care, Medical Knowledge and Professionalism have long been central to medical training. We have placed major emphasis on Communication Skills for more than the past six years with a required Communication Skills Seminar each year of training. Patient-Based Learning and Improvement, otherwise called Evidence-Based Medicine and Quality Improvement, have been embraced and taught for the past five years. System-Based Practice has been part of our day life as we have continued to provide excellent patient care and resident training as our primary health system has been through major systems changes from not-for-profit to for-profit and back to not-for-profit status.



At St. Vincent Charity Medical Center/Saint Luke's Medical Center we believe there is great value in a practical philosophy that combines an academic approach with a community-oriented view. We do not have all the answers to the challenges that face medical practitioners of the future. However, we are working on understanding both the questions and the answers. Our purpose is to develop women and men with the skills to solve present and future clinical and health care system problems for themselves, their patients and those who follow in their footsteps.

Richard Christie, M.D.

IV. ADVANCE PREPARATION AT ORIGIN COUNTRY
a. Obtaining an International Driver’s license
It will take quite a while before you are able to obtain an Ohio driver’s license. The main culprit for this is social security number processing (approx 1 – 2 months) for those without one. It is highly advisable to find out how to obtain an international driver’s license from your country of origin. This has allowed most starting interns to drive (i.e. rental car) around Cleveland while waiting.
b. Money/Credit card
New interns are expected to be in Cleveland 2 weeks prior to the program start date for orientation. One will expect to receive your first paycheck at approximately a month from that date. Generally, newcomers had to come in with cash and/or a credit card (either yours or supplementary from parents) from your country of origin.
The following is an example of a newcomer’s budget checklist. This may give you clues as to what to expect.
Intern X’s Budget for moving into Cleveland

Item

Estimated Cost

Must




Taxi from airport

$30-50

Apartment Security deposit + 1 month advance

$1000-1500

Weekly groceries X 3 weeks

$150-300

Rent-a-car

$150-300/week (double if purchasing insurance)

Taxis

around $2-3/mile

Bank deposit

$50 minimum

Car down payment

$500-1000

Miscellaneous/Optional




Basic Appliances

$500

Basic Furniture

$500

Kitchen/houseware

$300

Cellphone Kit (i.e prepaid)

$100

Cable TV/Internet

$70

Land Line Phone

$40

TOTAL

$1880 - $4710


c. Pre-departure Shopping
The standard of living in the U.S. is definitely more expensive compared to where most FMGs come from. Some newcomers have advocated shopping for work clothes, accessories and over-the-counter medications beforehand.
d. Apartment reservations
After accepting a pre-match or match, make sure to arrange living accommodations or apartment reservations before heading back to your country of origin. This will spare you the hassle and uncertainty of arranging for a place to stay while grappling with orientation and work adjustment. Nicki Banks, our program coordinator, usually has a list of excellent apartments that offer discounts to SVCH employees.
e. Ethnic costume (for the Diwali party!)
When in America, dress like an American… well NOT necessarily. Be proud of your heritage and bring elements of it through your country’s traditional dress/garb. There will be many parties/gatherings, like the Diwali party where showcasing your culture is encouraged. There will be many opportunities to drop the usual business dress or coat-and-tie. The SVCH Internal Medicine Residency program has always been at the forefront of promoting harmony in diversity.

V. MOVING IN
Cleveland, Ohio is on the southern shore of Lake Erie, part of the Great Lakes Region, the country's largest fresh water resource. It is in the Eastern Standard Time Zone (EST). The winding Cuyahoga River partitions the city of Cleveland into two areas: the East and West sides.
a. Apartment Hunting
Get in touch with graduating residents who could give personal feedback on the places that they have lived. Occasionally, incoming residents have taken over the newly vacated apartments of outgoing residents.
Choosing a place to live for the next three years will define and dictate your new Cleveland lifestyle. There are a lot of wonderful apartments and homes in the area, so take your pick. The main question usually becomes a matter of whether to stay in downtown (where St. Vincent is located), the west suburbs, or the east suburbs. Choose accommodations that suit you.
Suburbs
The suburbs generally become excellent living choices for residents with children due to their proximity to the best school districts. Suburbs are considered closer to nature, not to mention closer to nearby malls, chain stores, chain restaurants and public parks. Rent is generally cheaper than downtown accommodations.
The disadvantage is obviously the distance from the hospital. As an intern, one may be inclined to think that those extra minutes spent in traffic may be better spent for some extra snooze time. Plus, winter blizzards may double travel time up to 45-60 minutes or worse with bottleneck accidents (unless you own a “bat mobile”).
West side suburbs offer a more efficient route to downtown Cleveland by way of easy freeway access. One interesting fact is that the west side generally receives fewer inches of snow compared to the east side. The more modern and efficient layout of this area is however offset by its lack of character and historic attractions. The appearance of the west side is way too typical of American suburbia.
East side suburbs harbor the homes of Cleveland pioneers. The east side definitely has historic appeal and unique places (Severance Hall, Blossom Center, Little Italy, Millionaire’s row) that the west side lacks. However, the route to downtown is equally antiquated, due to a lack of general access to expressways.
Downtown
Rain or shine, sleet or snow, the hospital is five minutes away. One will have great entrée to unique restaurants, nightlife and cultural/sports attractions. Downtown is also an excellent choice for those who will need more time before they can buy a car and may need to take public transportation. The average cost of a taxi ride to the hospital is just $5, tip included.
Downtown living is definitely upbeat and glamorous, especially with the emerging trend of New York Loft-style apartments, becoming quite ubiquitous at the old warehouse district.
The disadvantage of living downtown is mainly city noise: ambulance sirens (you can literally count the admissions from home).
Distance of Various Areas from Downtown Cleveland


Municipality (Cuyahoga County)

Bay Village

Beachwood

Bedford


Bedford Heights

Bentleyville Village

Berea

Bratenahl



Brecksville

Broadview Heights

Brooklyn

Brooklyn Heights

Brook Park

Chagrin Falls

Cleveland

Cleveland Heights

Cuyahoga Heights

East Cleveland

Euclid

Fairview Park



Garfield Heights

Gates Mills

Glenwillow

Highland Heights

Hunting Valley

Independence

Lakewood

Lyndhurst

Maple Heights

Mayfield Heights

Mayfield Village

Middleburg Heights

Moreland Hills

Newburgh Heights

North Olmsted

North Randall

North Royalton

Oakwood Village

Olmsted Falls

Olmsted Township

Orange

Parma


Parma Heights

Pepper Pike

Richmond Heights

Rocky River

Seven Hills

Shaker Heights

Solon

South Euclid



Strongsville

University Heights

Valley View

Walton Hills

Warrensville Heights

Westlake

Woodmere


Miles From Downtown

13 miles west

13.5 miles east

12 miles southeast

14 miles southeast

18 miles east

17 miles southwest

7 miles east

14 miles south

14 miles south

6 miles southwest

6 miles southwest

8 miles southwest

18 miles southeast

n/a

12 miles east



7 miles southeast

10 miles east

8 miles east

10 miles southwest

6 miles southeast

18 miles east

21 miles east

18 miles east

15 miles east

8 miles south

6 miles west

15 miles east

10 miles southeast

14 miles east

14 miles east

13 miles southwest

14 miles east

7 miles south

12 miles southwest

7 miles southeast

14 miles southwest

25 southeast

15 miles southwest

16 miles southwest

18 miles east

10 miles south

12 miles southwest

13 miles southeast

13 miles northeast

9 miles west

12 miles south

10 miles southeast

25 miles southeast

11 miles east

15 miles southwest

8 miles east

6 miles south

12 miles southeast

10 miles southeast

12 miles west

13 miles east




List of areas where SVCH residents have lived
Alba Villa

11115 Lake Avenue, Cleveland, OH

(216) 281-5999
Fairview Village

20000 Lorain Road Fairview Park , OH

1-888-5701093
Marine Towers West

12540 Edgewater Drive, Lakewood, OH

1-888-2560182
Parma Woods Apartments

5216 Knollwood Drive, Parma, OH

(216) 741-3134
Reserve Square Apartments

1701 E 12th St Cleveland,OH 


1-888-419-5564

Parmatown Apartments

6871 Ames Road, Parma, Ohio

1-877-6817393


Shaker Park Manor

19220 Van Aken Blvd., Shaker Heights, OH

(216) 421-8400

The Islander

7711 Normandie Blvd. Middleburg Heights OH

(440) 2436222



www.islanderapartments.com
The Grand Bay Brecksville

7001 West Cross Creek Trail, Brecksville, OH

(440) 526-5440
The Triangle

11457 Mayfield Road, Cleveland, OH

(216) 791-5959
West View Acres Apartments

9755 Westview Drive, Parma, OH



(216) 749-5822
The following websites add to the list of apartments in Cleveland:

www.clevelandrents.com

www.apartmentguide.com

http://www.apartmentcities.com/Cleveland%2DApartments/
b. Downtown Hotels (Where to stay while apartment-hunting)
While apartment hunting (ideally, months prior to actual move-in), you will probably need to stay in one of the hotels in Downtown. This strategic placement will locate you midway between the Eastern and Western suburban areas. This becomes even more convenient obviously if you intend to find a downtown loft in the first place.



Hotel

Address

Telephone

Embassy Suites Hotel Cleveland
Hampton Inn
Holiday Inn
Hyatt Regency Cleveland
Sheraton
Residence Inn
Radisson
Marriott - Key
Renaissance
Ritz Carlton
Holiday Inn

1701 East 12th Street
1460 E. 9th
1111 Lakeside Ave
420 Superior Ave
777 Saint Clair Ave
527 Prospect Ave
651 Huron
127 Public Square
24 Public Square
1515 W. 3rd
623 Euclid Ave.

216.523.8000
216.241.6600
216.241.5100
216.575.1234
216.771.7600
216.443.9043
216.377.9000
216.696.9200
216.696.5600
216.623.1300
216.443.1002


c. Social Security Number (SSN)
Apply for your SSN as soon as possible. Until you have this, it would be as if you DO NOT exist. All subsequent steps to your assimilation here will depend on this. Without an SSN, it will be impossible to obtain everything else (driver’s license, opening a bank account, credit cards, cellular phones, etc.)
During orientation, time will be allocated for SSN application at the Social Security Administration Office. This is located at the Federal Building Room 793, 1240 E. 9th St., Cleveland, OH (in Downtown). You need to bring with you your Employment Contract, Birth Certificate, Passport and Original Visa (stamped). The official social security card will take between 30-60 days to process. For more information, you can visit their website at: www.socialsecurity.gov or call 1-800-772-1213.
d. Cars
No Cleveland resident could get away with not ever needing to have a car. A car is a must! While it is known that having a car in New York, Tokyo or London will slow you down, urbanites in those areas could get around effectively and more quickly with public transport. However, as with most US cities, Cleveland has it the other way around. Public transportation will slow you down, rather than make things faster. Some bus stops are even visited by buses only hourly. This isn’t exactly the best way to get to the hospital quick when you are needed for urgent back-up.
Purchasing a car on your own will require a decent credit history which most newcomers won’t have. For such cases, a co-signer may be necessary to purchase a car. A close relative or a GOOD friend can prove to be helpful.
Buy a reliable car. Buying a hunk of junk will save you money up front. In the long run, you will end up spending additional time and money for car repairs that will cost more than the car itself (only in America!). This is not exactly how a busy intern would want to spend his free time. Definitely, buying a reliable second hand car will require some research. A brand new set of wheels in whatever shape or form is your best bet for efficiency and reliability.
e. Driver’s License
A Driver’s license is A MUST, and should be obtained at all cost. Not only will it allow you to drive the car that you sorely need, but your license card is among the most accepted forms of identification here. It will also afford you the chance to lie about your weight.
How to apply for your license:
Visit the nearest deputy registrar office where driver licenses are issued (visit http://bmv.ohio.gov/county/dx_locs.html). You must bring documentary proof of your age, identity and social security number. A certified birth certificate and social security card are normally required, but other documents may be acceptable. (For foreigners, bring your passport, letter of employment –you can get this from Linda-, approval notice, employment contract, birth certificate) After checking your documents, the deputy registrar will complete your application, collect a fee and give you a temporary permit application packet. This packet is not a driving permit. You may not drive (even accompanied by a licensed driver) until you have passed the vision and written tests.
The driver’s test
Applying for a driver’s license requires that you pass the vision, the skills (maneuverability and driving) and the driver knowledge test (written or computerized). You can visit the Ohio BMV website (www.ohiobmv.com) for details. You need to read the Digest to prepare for the driver knowledge test. You can obtain this manual either thru one of the licensing bureaus or print the actual manual from the website (http://www.bmv.ohio.gov/engdigest.pdf)

Already have an international driver’s license?
It is much easier if you have this already. Remember that you should also have with you your original driver’s license from your country of origin. If you are a holder of a valid international/foreign driver license and wish to convert to an Ohio driver license, you must take and pass all required tests (vision, driver knowledge, driving, and maneuverability). But you will have the benefit of being able to skip the learner’s permit step (where one will need to be accompanied by a licensed driver).
Tips to pass the driving test
The written exam will be a piece of cake especially if one reviews the rule book (handed out for free during application). However, the practical part of the exam, dubbed the “maneuverability test”, is where quite a few have faltered. For those with limited driving experience, it pays to practice this part on your own with your own set of “orange traffic cones”. If this fails, it may be time to recruit a driving instructor ($50/hour usually). For this, some residents contacted Ameristars Driving School at 216-2281125. Their address is as follows: 12611 Madison Ave. Lakewood, Ohio.
f. Furniture
Take advantage of residents who are moving out and are selling their stuff cheap. There may even be more room for price negotiation. Furniture from Target or Wal-mart is affordable too, although some assembly is inevitable.
g. Utilities
Cable TV, Telephone and Internet access will take a backseat to more important needs. However, these tools have a huge benefit in alleviating boredom and homesickness. Inquire at your apartment’s business office on options for what companies are available to serve you.
h. Credit Cards
You might have to endure the frustration of being turned down for credit card applications simply because you don’t have a credit history yet.
Try applying to MBNA as an associate member of the ACP (American College of Physicians). Explain your unique case to the credit analyzer during the phone application. You need to be a member of the ACP first before you could actually apply for this. Membership to ACP is $99 and is reimbursable from the resident’s educational fund. Visit the ACP’s website to learn more about membership application. http://www.acponline.org/
Spend wisely and do all you can to nurture a spotless credit history.
i. Bank Account
One of the first things that you want to do is open a checking account. Your salary would then get automatically transmitted to this account (direct deposit) and save you a lot of major hassles. Having checks at your disposal is extremely useful especially for paying bills. Banks typically require a minimum amount for initial deposit (average minimum is $50). Also, request to have personal checks starting in the four-digit numbers (example: check number 1004 or 5465). This is because a number of merchants will not take checks with 3-digit numbers (example: check number 105 or 405). St. Vincent Charity Medical Center banks with National City but you can always open your account elsewhere. The following are banks within the Cleveland area. You may wish to visit their websites for more information on interest rates and different account options for you.
Dollar Bank- www.Dollarbank.com

First Merit Bank www.firstmerit.com

Huntington National Bank www.huntington.com

US Bank www.usbank.com

Sky Bank www.skyfi.com

National City www.nationalcity.com

Fifth Third Bank- www.53.com

Charter One Bank- www.Charterone.com

Ohio Savings Bank- www.Ohiosavings.com

Key Bank- www.Keybank.com

Star Bank- www.Starbank.com
j. Cellular Phone
Cellular phone use is not allowed within the hospital because of their potential to interfere with the medical monitoring devices. Needless to say, for outside use, these gadgets are a necessity for emergency calls. Some plans have free long distance during weekends and night. Cell phones may be a more affordable way to keep in touch with friends and relatives.
Without a credit history, you’ll be obliged to put in a somewhat steep amount of money for deposit when you apply for a cellular phone line. One option is to get a prepaid phone line initially then convert to a regular line after a few months because prepaid phones are more expensive in the long run.
k. Tipping
Tipping may not be too common a practice in most countries. But in the United States, tipping is the norm and pretty much a big deal since most people in service sector actually make the bulk out of their earnings from tips! Travel experts from the official Cleveland visitors guide have come to a consensus as to how much to pay and for whom.



Hotel porters who bring luggage to the lobby

$1/bag

Bellhops who bring luggage to your room

$1/bag

Hotel chambermaids

$1-2/night

Short cab ride

20%

Long cab ride

15%

Restaurants

15-20%

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