Danville Veterans Affairs Medical Center
http://www.va.gov/sta/guide/facility

Orientation

Students meet with Medical Service Administrative Officer, Mrs. Calhoun, at 7:45 a.m. for orientation to the VA. Her office is on the third floor of Building 58, Room 350. Orientation will include a short tour and introduction to staff and nursing.

Pagers

Second and third year residents carry U of I beepers routinely.

Meals

No meals are provided for the student. Quarters 35 is available and has facilities for cooking. Refrigerators are on the ward. VA Canteen is located in 104 and has a full menu. Hours of operation are 8:15 a.m. to 3:45 p.m.

Parking

Students will be issued a parking sticker that allows them to park in any space that is not restricted. Most parking is in the huge lot by the greenhouse, across from Building 58 – Lot E.

Mail

Mail should be directed to correspondence symbol (111). Wards have outgoing and incoming mail location.

Holidays

Students are not on call during holidays or holiday weekends. In most cases, students are excused from patient care for approximately one week during the December holiday season.

Call

Students will be assigned to night call approximately once every fourth night. Call is served with the resident that you are assigned to. If you have prior commitments on the day that you are scheduled to be on call, contact Mrs. Bowen who can rearrange the schedule. Students will be called for admissions and interesting cases. It is requested that you make rounds at the different nursing stations on 58-2, 58-3, and ICU during the evening to let the nurses know that you are available and that you will notify them before retiring to the house for the night.

Housing

Quarters 35 has been provided as a sleeping area for students who are on call or who would rather not travel back and forth from Champaign. When staying at the house, cars should not be parked directly behind the house but in the designated parking area. Clean linens are provided along with cooking utensils. Dirty linen should be placed in bags on the back porch for pickup. Repairs needed should be reported to Mrs. Bowen. There is no outside telephone at the student house. Incoming calls can be directed to the student house by dialing 554-4020. In case of emergencies parties should contact Mrs. Bowen who will get in touch with the student.

Telephones

Telephones are not to be used for personal business. When placing calls, the FTS line will be used. Please ask Mrs. Bowen or one of the secretaries to help you place your call until you are familiar with placing FTS calls.

Copyinging

There is a copy machine on 58-3, Room 311

Daily Schedule

Please see schedule section.

8:15 a.m. - 9:00 a.m.	Morning Report
9:00 a.m. - 11:00 a.m.	Ward Rounds
11:45 a.m. - 12:45 p.m.	Teaching Conference
1:00 p.m. - 2:00 p.m.	Teaching Conference
2:00 p.m. -	Work up patients, do summaries, go to library, etc.

Each student must have a written work up of two to three patients per week. The work up may be obtained from admissions, clinic patients, and/or consultations.

Each student will present at least ten patients at teaching rounds during the rotation. Physician Assistant students will be asked to present to one of the full-time PA's or to Dr. Marshall weekly.

Write-ups are to be reviewed by the recipient of the presentation. Each student is responsible for the history, physical examination, and progress notes. The student is also responsible for writing a set of orders. This may be accomplished by writing orders reviewed by:

· Staff Physician

· Resident

· Health Care Practitioner

· Special Care RN

If orders have been written prior to student finishing his work up, he is to write a suggested set of orders as part of his plan. This is done for a learning experience. Students are also responsible for reviewing the laboratory data including x-rays and EKGs.

It is expected that each student read a minimum of two references for each patient he works up. Students are encouraged to use standard texts and ask staff or residents for suggestions.

GENERAL INFORMATION

Library

The Medical Library is open 24 hours per day, 7 days per week. After hours, the key for entrance to the library is obtained from the senior resident on call.

Telephone Numbers

Rheta Bowen, Administrative Officer	554-5283
Dr. Marshall, Chief, Medical Service	554-5281
Sandy Calhoun, Program Assistant	554-4511
Student House	554-4020
Ward 58-3, Cardiology & Pulmonary	554-5477
Ward 58-2, General Medicine & Gastro	554-5518
ICU	554-5455
Nephrology	554-5507
GI/Neurology	554-3100
Resident Clinic	554-3100
Pulmonary Health Aid	554-5290
Imaging (Radiology)	554-4518
Medical Director	554-5072
Chief of Staff	554-5077
Laboratory Service	554-5534
Library	554-5607
Pharmacy	554-5581
Surgery	554-5451
VA Police	554-4507

Key Personnel

W. Marshall, M.D.	Chief, Medical Service
Rheta Bowen	Administrative Officer
Sandy Calhoun	Program Assistant
A. Robbins, M.D.	Staff Pulmonologist
R. Blum, M.D.	Staff Pulmonologist
P. Sivanesan, M.D.	Staff Nephrologist
V. Tazudeen, M.D.	Staff Neurologist
T. Laurence, M.D.	Staff Neurologist
S. Prabhudesai, M.D.	Chief of Staff
M. Gai, M.D.	Chief, Imaging Service
M. Prabhudesai, M.D.	Chief, Laboratory Service
S. Slovacek	Chief, Pharmacy Service
J. Reddy, M.D.	Staff Gastroenterologist
L. Bhatia, M.D.	Staff Gastroenterologist
S. Prabhudesai, M.D.	Chief, Psychiatry Service

D. DICTATING INSTRUCTIONS

All Dictations: 

#1:	Pick up the phone receiver in a quiet area. Dial 7 to access the machine. Dial 1 to dictate. You will hear a steady tone after dialing 7, once you dial 1 to dictate this steady tone will disappear.
#2:	State your name. State the type of dictation; i.e., history and physical examination, final discharge summary, transfer summary, progress note, consultation, clinic note (includes clinic follow up progress note). State the number of copies desired.
#3:	State and spell the patient's full name. Dictate the entire Social Security number (all 9 digits).

E. DISCHARGE SUMMARY

After STEPS 1 through 3 above, begin dictation with FINAL diagnoses--Diagnosis #1 should be the diagnosis responsible for the major part of the patient's stay; then, remaining diagnoses in order of clinical importance for which treatment was given.

List all operations/procedures performed during current hospital stay, including dental procedures and give dates for each operation/procedure. 

Body of summary should include the following:

Reason for hospitalization

Significant findings (brief history, pertinent physical findings)

Course in hospital

Treatment given

Condition of patient on discharge

Specific instructions given to patient and/or family (includes instructions relation to physical activity, medication, diet, and follow up care)

Date patient is able to return to employment (if applicable)

Medications furnished upon discharge

Competency opinion (if applicable--only for those patients with final psychiatric diagnosis)

Follow up care recommended

History and Physical Examinations

These dictations are automatically given priority transcription but it is up to the dictator to identify the dictation properly for expedition.

Consultations

The original referral consult should be sent to the Transcription Unit after dictation of the consultation with number of copies specified by the dictator.

Stat Transfer Summaries

As above--see Final Summaries.

When completing the transfer summary, DIAL "O" to alert Transcription Unit. WAIT until the operator in the Transcription Unit answers your call. Specify at that time what the dictation consists of; i.e., Transfer to VAMC Indianapolis, date of transfer, patient's name and ward location. The cassette will be retrieved from the machine immediately and transcription will begin

Please Note:

Residents: When dictating final summaries, please indicate the attending physician's name at the beginning of your dictation, as each summary must be co-signed.

Spelling is a very important factor in the quality of the transcription. If unusual dictations, drugs, names, treatments, etc. are dictated without spelling, these items will be left blank to be filled in upon receipt of the dictation. To facilitate our dictation/transcription, please remember to spell.

Please remember you are dictating to a person, not a machine. That person's ears are very precious. Courtesy is appreciated. Speak slowly and distinctly and enunciate for your transcriber.

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Procedures (Usually Without Operation Reports) To Be Listed on Final Summary

Nervous System Injection anesthetic agent into nerve Spinal Tap (lumbar puncture) Endocrine System Aspiration (biopsy) of any gland (specify) Percutaneous biopsy of any gland (specify) Eye Biopsy, any site (specify) Scraping of cornea for smear or culture Ophthalmoscopy Ear Otoscopy Biopsy, any site (specify) Suture of laceration, external ear Nose, Mouth, and Pharynx Control of epistaxis by Nasal Packing Cauterization Ligation Cardiovascular System Pericardiocentesis Insertion temporary pacemaker Removal/replacement pacemaker Injection of therapeutic substance into heart/pericardium Venous cutdown Phlebotomy (specify site) Insertion CVP catheter Hemic and Lymphatic System Biopsy, any site (specify) Aspiration biopsy, bone marrow (specify site) Digestive System Paracentesis Esophagoscopy Biopsy, any site (specify) Dilation esophagus Gastroscopy Endoscopy, small/large intestine (specify) Proctosigmoidscopy Anoscopy Percutaneous (needle) biopsy liver/gall bladder/bile ducts/pancreas Incision and drainage, abdominal wall Suture, laceration, abdominal wall Reclosure incision Injection therapeutic substance into cavity Urinary System Percutaneous (needle) biopsy, kidney/ureter (specify) Injection therapeutic substance into kidney Ureteroscopy Dilation, ureter/urethra (specify) Urethroscopy Cystoscopy Male Genital Organs Needle biopsy, any site (specify) Biopsy, any site (specify)

Rhinoscopy Biopsy, any site (specify) Aspiration, nasal sinus Forceps extraction, tooth Surgical extraction, tooth Root canal therapy Gingivoplasty Alveoloplasty Incision and Drainage, any site (specify) Pharyngoscopy Respiratory System Biopsy, any site (specify) Injection of larynx/trachea/thoracic cavity (specify) Temporary tracheostomy Tracheoscopy Laryngoscopy Bronchoscopy Suture, laceration chest wall Thoracentesis Chest tube insertion Musculoskeletal System Biopsy, any site (specify) Arthrocentesis Injection of therapeutic substance into joint/ligament/bursa/soft tissue (specify) Suture, tendon/muscle/fascia/bursa (specify) Aspiration of bursa Fitting of prosthetic limb device (specify) Integumentary System Percutaneous (needle) biopsy, breast Aspiration of breast/skin and subcutaneous tissue (specify) Injection therapeutic agent in breast Incision and drainage Biopsy, any site (specific) Debridement Removal nail, nailbed, nail fold Dermabrasion Suture, skin and subcutaneous tissue Excision/destruction of lesion/tissue, skin and subcutaneous tissue (can be by cauterization, fulgeration, etc.) Miscellaneous Diagnostic and Therapeutic Procedures Cholecystogram Retrograde pyelogram Cystogram/cystometrogram Arteriography/angiography (specify site) Cardiovascular stress test using treadmill Cardiovascular stress test using bicycle ergometer Other cardiovascular stress test Traction (specify type and site) Application of cast/splint (specify site) Replacement of cast/splint (specify site) Manual reduction renal/anal prolapse Removal of foreign body without incision (specify site) Transfusion of blood and blood components Chemotherapy Injection or infusion of therapeutic agent Conversion of cardiac rhythm (specify)

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CONFERENCE GUIDELINE

A.M. Conferences

Residents are required to attend and the students are invited to attend when possible. The teaching material will be aimed at the residents.

P.M. Conferences

All students are required to attend and residents are required to attend when they are the presenter. All other residents are invited to attend if possible. The teaching material will be aimed at the M-3, M-4 and PA student.