Your first day

Before day one

A short email a week or two ahead saves you a frantic first morning. The goal is to arrive already credentialed, already able to log in, and already knowing where to stand.

Email your coordinator or the chief resident and ask the four questions that matter: what time and where the team meets in the morning, how you will get a badge and scrubs, whether your PowerChart access is set up, and who your direct contact is for the first day. Everything else can be sorted once you are there.

The day-one checklist

Seven things to have working before rounds on your first morning. Most can be done the day before if you arrive early.

• Get your photo ID badge. Badging or ID office Your hospital badge is also your door access, and at many sites it unlocks the scrub dispenser and parking gates too. Wear it where it is visible. If a door will not open on day one, your access for that unit may not be active yet, so flag it early.
• Confirm your PowerChart login. IT service desk, 505-272-3282 The hospital runs on Cerner PowerChart. Log in once before day one so you are not locked out during rounds. If your username or password does not work, or access has not been provisioned, call the service desk. This is the single most common day-one snag.
• Find out how you draw scrubs. OR locker rooms Most ORs use a badge-linked dispenser that issues a set and credits you when you return the used ones. Learn where the locker rooms are, how many sets you are allowed, and where dirty scrubs go, before you need to change in a hurry.
• Sort parking or transit. Parking and Transportation Services The hospital sits on the university's north campus and parking is tight. Arrange a permit or a transit plan in advance, and build in extra time on day one regardless.
• Set up contact with the team. Ask your senior Find out how the team communicates: pager, secure messaging inside PowerChart, or the senior resident's phone. Give them your number too. Being reachable and responsive is half of being useful as a junior.
• Clear OR and isolation access. Student or employee health If you will scrub or see patients in airborne isolation, make sure N95 fit testing and OR onboarding are done. A respirator you were never fitted for is not protecting anyone.
• Confirm the schedule. Coordinator Know your rounding time, where to meet, and whether day one is an OR, clinic or consult day. Walking in knowing the plan signals that you take the rotation seriously.

If you are a resident

Interns and rotating residents carry more than students do, so a few extra things are worth settling in the first 24 hours.

• Get the sign-out times and format. When and where morning and evening sign-out happen, and which tool the service uses for its written handoff. What a vascular sign-out needs.
• Learn the call structure. Who holds the vascular pager overnight, who your backup is, and which calls go straight to the senior or attending. When to call.
• Know the numbers you will dial. OR front desk, the angio suite or hybrid OR, the vascular lab for urgent duplex, the CTV ICU, and the ward charge nurses. Save them in your phone on day one.
• Check your order and note access. Make sure you can place orders, use the service's PowerPlans, and sign notes. Build your patient list and your Auto Text phrases before your first call. Working faster in PowerChart.
• Find the OR schedule. Know where to see tomorrow's cases so you can read the operation, check the consent and the pre-op labs, and know which patients go to the CTV ICU afterwards.

Getting into PowerChart

PowerChart is where you will live: vitals, labs, notes, orders, imaging and the patient list. The faster you are fluent in it, the more useful you are on rounds.

On your first login, do three things before rounds. Find the vascular service patient list or build a custom list of the patients you are following. Open one chart and find where vitals, labs, ins and outs, medications and notes live. Practice opening the most recent imaging so you are not fumbling when an attending asks for the CT angiogram.

Patient list

Find the service list, or make a custom list of your patients so you can pre-round efficiently.

Flowsheets

Know where the vitals and the ins and outs are documented by nursing; these are the numbers you report first.

Results

Pull the morning labs and learn to view a trend rather than a single value.

Imaging

Practice opening duplex, CTA and angiography reports and images quickly.

Notes

Read the team's note style and write yours to match. Do not copy forward stale data. Templates are on History, exam and charting.

Orders

As a student, understand the orders being placed before you ever pend one. Your order access depends on your role.

Scrubs and the OR

The operating room has its own rules of dress and movement, and getting them right on day one earns quiet credibility.

• Drawing scrubs. Badge in at the dispenser, take only what you need, and return used sets so your account stays in credit. Carry a spare set for the day a case runs long or messy.
• Changing and storing. Change in the locker room, not the hallway, and keep your coat, phone and badge somewhere you can reach between cases.
• OR attire. Scrub top tucked in, hair fully covered, mask on before you enter a room with an open field, and a fresh mask for each case. Shoe covers and eye protection as the hospital requires.
• Moving in the room. Once sterile, keep your hands above your waist and in front of you, do not turn your back to the field, and say so immediately if you think you have contaminated.
• Before you scrub. Introduce yourself to the scrub tech and the circulating nurse, tell them it is your first day, and ask where to stand. They run the room, and they will help you if you are respectful.

Where to be, who to find

Knowing the shape of the team tells you who to ask for what, and where you fit in the morning.

A vascular service usually runs as a layered team. The attending sets the plan and operates. The chief or senior resident runs the list, the OR and the consults. Junior residents and interns carry the floor patients and the notes. Students and sub-interns follow a handful of patients closely, pre-round on them and present. There is often an advanced practice provider who knows the floor and the systems better than anyone, and a coordinator who owns the schedule. Patients in the CTV ICU are co-managed with the intensivist team.

• In the morning, find the workroom where the list is reviewed, get there before the stated round time, and have your patients pre-rounded and ready to present.
• For clinical questions, ask the junior resident or APP first; save the chief for decisions and the attending for teaching, unless something is urgent.
• For logistics, the coordinator and the APP are your people. They have answered every first-day question before.
• When you do not know, say so plainly and offer to find out. Confident guessing on a vascular service can hurt a patient.

What to carry

A vascular trainee's pockets are slightly different from everyone else's, because the exam runs on one small device.

Handheld Doppler essential

The vascular exam lives on the continuous-wave Doppler. Know where the team keeps one, and learn to describe a signal as triphasic, biphasic or monophasic.

Skin marker essential

Mark the pulses you found by Doppler (dorsalis pedis and posterior tibial) so the next person checks the same spot.

Shears and tape useful

For taking down and reapplying dressings on wound and ulcer checks, plus a pen and a printed list.

This guide useful

Quick reference is built to be screenshotted: ABI cutoffs, Rutherford categories, endoleak types and the numbers attendings expect on demand.