IMG SURVIVAL GUIDE

WCGME

IMG SURVIVAL GUIDE - TABLE OF CONTENTS Use links (CTRL+Click) to navigate through guide; use CTRL+Home to return to Table of Contents.

Section I Welcome Message……………………………..…………………….…….4 About the Hospitals ..………………….……………………………….......5 Message from the President and CEO…………………………..………6 Message from the Program Director……………………………..….…...7 Section II Advance Preparation Costs & Pre-Departure Shopping……….…………………………....….8 Section III Getting Settled Local Information and Contacts……………………………….………....9 Housing…….……………………..........................................………….10 Cars……..………………………………………………………........…....14 Driver’s License……….……………………………………………….…16 Social Security Card………….………………………………………….18 Shopping for Basics…………………………………………............…...20 Eating Out………………………………………………………….……...22 Mail (Post) Post Offices……….…………………………………………..…..…...24 Shipping Services ……….……………...………………………........26 Formatting Addresses ………………………………………….........27 Utilities …………………………….………………………..……….…….29 Mobile Phones ……….………………………………………..….…..….30 Furniture……….……………………….………………………...……….32 Financial Matters Banking…………………………………………………………...…….....33 Credit Cards……….…………………………………………………........35 Sending Money Abroad……….…………………………………………36 Taxes……………………………………………………………..………...37 Family & Personal Considerations Schools……………………………………………………………..….…..38 Child Care………………………………………………………………….41 Leisure Workout / Exercise Facilities……………………………………………..42 Libraries…………………………………………………………....……….43 Volunteer Opportunities……….………………………………………….44 Newspapers……….……………………………………………………….45 Organizations or Interest Groups………………………………………..46 Recreation …………………………………………………………..……..47 Sports……………………………………………………………………….48

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Just for Partners & Spouses Local Colleges……….….…………………………………….…….........49 Spouse Groups……………….…………….……………..………….…..50 Activities……….…………….……………………………….…….……...51 Section IV VIPs……….…………………………………………………………….….....52 The Health Care Team……….………………………….……………..…...53 Attire……….…………………………………………………….…………....54 Equipment & Ready References…………………………………………..55 Communications……….…………………………………………….……...56 Admitting Orders…………………………….…………………………….…57 Discharge Orders………………………..………………………...………...58 Abbreviations………………………………………………….…….…..…...60 Signouts……….…………………………………………….……………….62 Difficult Situations……….……………………………….……………….…64 Section V Conclusion……….……………………….….…………………………........65 Appendix A - Websites of U.S. English Idioms, Slang & Expressions Appendix B - An Annotated Suggested Reading List for IMGs, IMG Applicants, and Spouses

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WELCOME MESSAGE

Welcome to WCGME. We hope this journey will be a very successful experience for you and we wish you all the success here. As much as the program will be contributing to your growth as a physician, you will be contributing to the growth and success of the WCGME program. We are very excited to have you as a member of our team. Conveniently located in the northeastern part of Pennsylvania, Scranton has lots to offer you, your spouse or partner and family. This guide is intended to ease your transition to the culture of the hospital and city. We hope this will be helpful in making your experience here very rewarding and fruitful.

Again, welcome!

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ABOUT THE HOSPITALS Mercy Hospital This 265-bed full service inpatient and outpatient healthcare center has served the residents of Northeastern Pennsylvania for more than 100 years. Located in Scranton, PA, Mercy Hospital is a short drive away from all residents in Lackawanna or Luzerne counties. Mercy Hospital is an acute care facility and serves a network of more than 600 physicians in more than 40 specialties of medicine and employs over 1,000 men and women. Mercy Hospital specializes in tertiary, cardiovascular, oncology and orthopaedic care. A personalized, special care facility for Long-Term Acute Care patients is also available at Mercy Hospital, Scranton, and offers the same comprehensive special care for medically complex patients as the larger 1i Nanticoke program . Many of the WCGME administrative offices are also located at the Mercy Hospital. Moses Taylor Hospital In 1892, a New York City merchant, banker and industrialist named Moses Taylor founded the Moses Taylor Hospital. Its mission was to care for the railroad workers and coal miners of the region. The main campus of the hospital remains at this site located at 700 Quincy Avenue, Scranton, PA. The acute care hospital has 173 beds, 22 geropsychiatric inpatient beds, 32 skilled nursing beds and a 14-bed inpatient rehabilitation unit. Moses Taylor Hospital has emergency, medical and surgical specialty services. In addition, Moses Taylor is the only hospital in Scranton, PA that provides OBGYN care and has Family Birthing Suites. It includes a private room Neonatal Intensive Care Unit and provides state-of-the-art services for our tiniest and most fragile patients. The newest additions to the scope of care provided at Moses Taylor Hospital include a Wound Care Center, an MRI/CT Center, and VNA Hospice & Palliative Care Center. With over 400 physicians on staff, Moses Taylor Hospital employs more than 1,200 people who are dedicated to providing quality and cost effective health care that is patientfocused. Moses Taylor Hospital is part of an integrated delivery system known as Moses Taylor Health Care System, comprised of Mid-Valley Hospital and Physicians Health Alliance, Inc., a 44member, multi-specialty physician group. The Hospital is fully accredited by the Joint Commission ii on Accreditation of Healthcare Organizations (JCAHO) . Community Medical Center Community Medical Center Healthcare System is a not-for-profit corporation located in Scranton, PA. CMC offers a complete continuum of educational, diagnostic, therapeutic and rehabilitative services and programs. CMC is a 297-bed full service hospital with an emergency medicine department that is accredited as the regional Trauma Center. The partners of the CMC Healthcare System include Mountain View Care Center, a 180-bed long term care facility; as well as Abington Physical Therapy and Green Ridge Physical Therapy. The Ronald McDonald House of Scranton is located only a block iii from the hospital. CMC also provides complete cardiac services, including open heart surgery .

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Adopted from Mercy Hospital’s Website at http://www.mercyhealthpartners.com/facilities.asp

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LETTER FROM THE PRESIDENT & CEO, DIO Welcome to WCGME. We want to share our excitement about graduate medical education in Northeast Pennsylvania. Our program has provided career fulfillment to our faculty, our staff, our residents and private practicing physicians in this region. We are most energized by the development of The Commonwealth Medical College which has accepted its first class of medical students to begin on August 9, 2009. The Medical College was an idea that was first proposed at a WCGME Board Planning retreat on October 25, 2004. It has already been approved as by the Pennsylvania Department of Education and accredited as an allopathic medical school by the Liaison Committee for Medical Education. I also want to share with you our enthusiasm about our affiliation with Community Medical Center (CMC). WCGME has been affiliated with Mercy and Moses Taylor Hospitals since 1977. Beginning in July '08, we had 3 residents rotating at Community Medical Center (CMC) at all times. Our program will be greatly enhanced this year by increasing our resident complement to 10. WCGME has added 3 full-time and 3 parttime faculty to fulfill this mission. We are making great progress in developing additional residencies and fellowships. We intend to apply for accreditation of fellowships in cardiology and palliative care during the coming academic year. Our office for research support has helped with 39 ongoing projects. WCGME is participating in an internationaly sponsored study for acute coronary syndrome this year as one of the major contributing sites. Our Institutional Review Board has seen an increase in submissions as a result of the interest of our faculty in clinical research. We are also busy planning residencies in Surgery and Obstetrics & Gynecology to provide opportunities for students and graduates of The Commonwealth Medical College and students from other affiliated medical schools whose support we have enjoyed over the past years. And so it is with great enthusiasm that I invite prospective internal medicine residents to seize this once in a lifetime opportunity to pursue training in a setting with such dynamic potential. I hope you find this website to be effective in communicating the enormous opportunity being on the WCGME presents. Robert E. Wright, M.D., F.A.C.P. President and CEO, DIO

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MESSAGE FROM THE PROGRAM DIRECTOR WCGME is transforming. For the past 33 years we have focused on training internal medicine residents to become primary care physicians. During the last 12 years we have noted that our graduates have chosen additional career options in the arenas of hospital medicine or various subspecialties. What we learned from this experience was that the training we provided prepared them very well for any future career choice. We pride ourselves on patient-centered, accessible, safe care delivery to our current patients and to those who will be served by our graduates. Explore our curriculum and you will appreciate our learner centeredness, our emphasis on principles of adult based learning and commitment to the nurtured development of internists skilled in the ACGME competencies. Look at our research site and you will see how we are integrating quality improvement into systems based practice and promoting reflective practice based learning and improvement skills. If you access the section on our graduates you will note their notable board pass rate reflecting our commitment to medical knowledge. The challenge in the new millennium is to find continuous career development and professional fulfillment. The way to do this is through life- long learning, and the best way to do that is by being engaged in the cycle of growth that comes from the integration of new information. We at WCGME are committed to work continually with our stakeholders to renew and improve ourselves, our organization and our community. We embrace educational change and organizational development based on valued feedback from our partners, our faculty, our residents, our medical students and most importantly, from our patients. We are excited to maintain a significant role in the development of the Commonwealth Medical College with shared faculty and the shared vision of promoting the health of Northeastern PA through the promotion of medical education. WCGME is also being challenged to build upon our success by stimulating additional local graduate medical education residencies and fellowships. Please visit our site often for new and continuing information for residents, students, faculty, applicants, partners in our research and education programs and stakeholders in our community. Linda Thomas-Hemak, M.D. Director, Internal Medicine Program

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ADVANCE PREPARATION: INITIAL COSTS AND PRE-DEPARTURE SHOPPING New residents are expected to arrive in one week prior to the residency start date. You can expect to begin receiving your paycheck approximately 2 weeks after the pay period end date. To cover initial costs, you might want to bring cash or a credit card. Examples of these initial expenses are listed below. Sample budget for moving to Scranton, PA: ITEM ESSENTIAL Taxi from airport Security deposit for apartment + 1 month advance Weekly groceries for 3 weeks Rental Car (if necessary)

Taxis Bank deposit (minimum $ to set up account) Down payment for car MISCELLANEOUS / OPTIONAL Basic appliances Basic furniture Kitchenware & house-ware Mobile phone Cable TV / Internet Landline phone TOTAL

ESTIMATED COST $ 35-50 $ 500-1200 $ 80-200 $ 200-300 (Double if purchasing insurance) $ 2 – 3/ mile $ 50 $ 500 - 1000 $500 $500 $300 $100 $60 $30 $2875-4290

Some IMGs have discovered that the cost of living in the United States is more expensive than what they are accustomed to at home. Prior IMG residents have recommended that new residents shop for items such as work clothes, accessories, and over-the-counter medicines before departing for the United States.

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LOCAL INFORMATION AND CONTACTS LIST OF IMPORTANT CONTACTS IN SCRANTON, PA Category Hospitals

Name Mercy Hospital Moses Taylor Hospital

Fire Department Police

Community Medical Center Scranton Fire Department Scranton Police Department Lackawanna County Sheriff

Social Security Department of Transport

US Social Security Administration Driver’s License Center

WCGME

Wright Center for Graduate Medical Education

Address 746 Jefferson Avenue, Scranton, PA 700 Quincy Avenue, Scranton, PA 1800 Mulberry Street, Scranton, PA 340 North Washington Avenue, Scranton, PA 100 South Washington Avenue, Scranton, PA 200 North Washington Avenue, Scranton, PA 409 Lackawanna Avenue, Scranton, PA

Phone # 570-348-7100 570-340-2100 570-969-8000 570-348-4260

570-348-4130

570-963-6719

570-342-8062 570-963-4246

Mercy Hospital 746 Jefferson Avenue Scranton, PA

570-343-2383

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HOUSING One of the most critical issues is finding a suitable place to live. Where you choose to live for the next few years may have a major impact on your new lifestyle. Buying a house or other property upon first arriving in the United States is probably not the best option. A better choice might be to rent a house or apartment first before selecting a more permanent housing option. There are several options for housing. The most common initial living arrangement for newly arriving IMGs is a rented apartment or house. Information on these and other housing options may be obtained directly from our residency program office and fellow residents in the program. Since you will spend a great deal of time at the hospital and commuting back and forth, you might want to consider choosing a property relatively near the hospital or at least convenient to roadways or public transportation. If you have school-age children, be aware that public schools are directly connected to the school district in which you reside. If you prefer a particular public school district, you might want to consider a house or apartment within that school district. Your fellow residents or program staff who have children could be a source of advice on this issue. The quality of life in and safety of a neighborhood are other issues to consider when choosing a place to live. Certain areas may have particularly high crime rates or may be dangerous for residents coming or going late at night. Many rental apartments and houses come already furnished. If yours is not, consider buying second-hand furniture from residents who are leaving the program. You can also purchase furniture from stores such as Target, Walmart, etc. While looking for a place to live, if you don't have a friend with whom you can stay, you might need to stay at a reasonably priced hotel.

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LOCAL INFORMATION AND CONTACTS 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 Scranton lifestyle. The main concern is to pick accommodation that suits you. There are many options available in downtown Scranton and the areas directly surrounding the hospital or other areas and suburbs. Other areas you might consider to live in include nearby areas of Clarks Summit (5.4 miles away), Kingston (15.8 miles), Wilkes Barre (16.6 miles), Edwardsville (16.8 miles), Stoudsburg (34.8 miles), East Stroudsburg (35.4 miles) and Delaware Water Gap (40.2 miles). According to the Greater Scranton Chamber of Commerce website (Greater Scranton Chamber of Commerce 2010) : Apartment Rentals in Greater Scranton Unfurnished, one-bed, one-bath apartments (750 to 900 square feet) in suburban apartment complexes are typically offered for between $500 and $800 per month. Unfurnished, two-bed, one-bath apartments (850 to 1,150 square feet) in suburban complexes are offered from $600 to $900 per month. These rents often include water, sewer, trash removal and pest control and sometimes include heat and cable TV. Many locals choose apartments in large, older homes in safe, established neighborhoods, where rents often fall into the $375 to $500 per month range. Distance of Various Areas in Northeastern Pennsylvania Communities from Downtown Scranton Old Forge

6 miles

Clarks Summit

8 miles

Pittston

12 miles

Moscow

14 miles

Carbondale

16 miles

Wilkes-Barre

20 miles

Tunkhannock

24 miles

Nanticoke

28 miles

Honesdale

30 miles

Hawley

34 miles

Hazleton

45 miles

Stroudsburg

46 miles

Berwick

48 miles

Delaware Water Gap

50 miles

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Milford

53 miles

Lehighton

54 miles

Jim Thorpe

58 miles

Bloomsburg

62 miles

Tamaqua

62 miles

Pottsville

71 miles

List of apartment complexes around the area: Summit Pointe 108 Summit Trl Scranton, PA 18508 Morgan Manor 117 Mountainview Way Scranton, PA 18508 The Apartments at 317 Linden 317 Linden St. Scranton, PA 18503 Tel: (570) 344-1750 Tall Trees 2000 Tall Trees Dr Scranton, PA 18505 Mill 800 James Ave Scranton, PA 18510 Summit By The Lake Apartments 105 Skytop Manor, Dunmore Pennsylvania 18505 Tel: (570) 346-7571 | (570) 963-0724 Oakmont Garden Apartments Incorporated 7 Laurel Dr Scranton, PA 18505 Tel: (570) 347-9460 Renaissance at 500 The Scranton Life Building Suite 618 538 Spruce Street Scranton, PA 18503 Phone: (570) 344-1500

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Brooks Building 436 Spruce Street For Leasing information: Nick Carlini, Tel: (570) 348-1010 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.

HILTON SCRANTON & CONFERENCE CENTER (570) 343-3000 138 Adams Ave, Scranton, PA 18503 Radisson Lackawanna Station Hotel (570) 342-8300 700 Lackawanna Ave, Scranton, PA 18503 Red Carpet Inn & Suites (570) 346-7061 320 Franklin Ave Frnt, Scranton, PA 18503 Econo Lodge (570) 348-1000 Stafford Avenue & Kane St, Scranton, PA 18503 Clarion Hotels (570) 344-9811 300 Meadow Ave, Scranton, PA 18505

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CARS After arriving in the United States, you might consider buying a car. There are several issues related to having a car, such as insurance, maintenance, parking, etc. If you choose to buy a car, you should be aware that new cars are expensive and you may want to consider buying a used car. You may be able to find information about used cars for sale on a hospital bulletin board. Newspaper ads and on-line sites such as Craigslist (www.craigslist.org) will list cars for sale. You can also try used car dealers or used cars sold by new car dealers. Whatever source you use, it is important to have a mechanic or someone who knows about cars check the car to see if it is in good condition before you buy it. Purchasing a car on your own may require a good credit history, which most newcomers do not have. In this case, a co-signer may be necessary to purchase a car. A close relative or a good friend may prove to be helpful. When you buy a car, you must register it and get car insurance. The registration and proof of insurance should always be kept in the car when you drive it. Liability insurance is intended to cover the cost of medical care for anyone you might injure and the cost of any property you might damage in the events of car accidents. The cost of insurance will vary based on a number of factors, including where you live and your driving record. If you have difficulty getting auto insurance because you do not have an official driving record, you can ask an insurance agent about state insurance programs for people who are considered "high risk" drivers and cannot get private insurance policies. It is an expensive alternative, but after some time of safe driving, you may have a record that enables you to get cheaper insurance. If you do not want to buy a car, you can rent a car when necessary. There are many local car rental agencies that can provide information about renting a car. The cost will vary based on a number of factors, including location and the type of car.

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LOCAL INFORMATION AND CONTACTS For a list of local new and used car dealerships, please visit the following websites: http://directory.the570.com/scranton+pa/auto+dealers.zq.html www.mattburnehonda.com www.tomhesserbmw.com www.dicksoncityhyundai.com www.scrantondodgechryslerjeep.net www.gibbonsford.com www.santocars.com http://www.automotive.com/usedcardealers/33/pennsylvania/lackawanna/scranton/index.html And here is a list of car rental agencies available in the area: AVIS Rent-a-car: www.avis.com Budget Rent-a-car: www.budget.com Enterprise Rent-a-car: www.enterprise.com Sensible Car Rental: www.sensibleautogroup.com The Scranton Parking Authority operates garages and parking lots around the Scranton downtown area, for garage locations, rates and hours, please visit their website at: http://www.scrantonparking.com/rates%20&%20hours.html. The average monthly rate for the parking garages is $100. For auto insurance in Scranton, you may visit these following websites: www.gilmartinagency.com allstateagencies.com www.grebbinsuranceagency.com www.nationwide.com www.unitrindirect.com nepainsurance.net www.jerrydonahue.net

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DRIVER'S LICENSE

A valid driver's license is required to legally operate any motor vehicle, including motorcycles and scooters. Driving without a license can result in significant penalties. Driver's licenses that contain photos are also the most common form of identification used in daily activities. An international driver's license can be used for a limited period of time. Each state agency has a website that provides detailed information on how to obtain a license and what kinds of documents are necessary. Usually they will require a valid passport, a visa with a current form I-94, and proof of residence within the state, such as utility bills. Obtaining a license requires the following procedures: written examination regarding traffic regulations and safety issues; eye examination, which requires that corrective lenses (contact lenses or eyeglasses) be worn for the exam if they are used for driving; and road test.

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LOCAL INFORMATION AND CONTACTS For further information on driver’s license, you may visit the Pennsylvania DMV website at http://www.dmv.state.pa.us/ The closest PennDOT photo and exam center is located in Dunmore, PA. Their address is 81 Keystone Industrial Park, Dunmore, PA 18512. To contact the Dunmore photo and exam center you may call at (570) 963-4052. For office hours and other exam center locations, please follow this link: https://www.dot4.state.pa.us/locator/AmsServlet.jsp#top?2010070112041858=20100701 12041858

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SOCIAL SECURITY CARD A Social Security card is one of the most important documents you will need. A Social Security card includes a Social Security Number, necessary for receiving a salary, opening a bank account, and obtaining a credit card. In order to apply for a Social Security card, you must submit the following documents:  Form SS-5 (application for Social Security Number),  Passport,  Visa with a current form I-94,  DS-2019 for J-1 exchange visitors,  Original copy of your residency/fellowship contract. Forms must be completed and submitted in person with the appropriate supporting documents at any local Social Security office. It will take between 3060 days to process and receive the official Social Security card with your Social Security Number. The application process itself should not be started until at least 10 days after entry into the country. Applying before that time may actually increase the delay in obtaining a Social Security Number. When the card is received, it should be presented to the program administrator, but should be retained in a safe place by the card holder. For security reasons, your Social Security Number should not be disclosed to anyone other than those having legitimate need for it, and then only the number should be reported. The card itself need rarely be displayed.

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LOCAL INFORMATION AND CONTACTS  Social Security Administration office (Toll-free number to locate offices: 1-800-772-1213)  The application form including detailed instructions can be downloaded from the Social Security website www.socialsecurity.gov. Apply for your SSN as soon as possible. Until you have this, it would be difficult to obtain many documents like a driver’s license, credit cards, mobile phone lines etc. You may apply for your SSN at the Social Security Administration Office. This is located at the Oppenheim Building, First Floor, 409 Lackawanna Ave., Scranton, PA 18503. For your application, you will need the following documents: A Completed Application for a Social Security Card form (Form SS-5) Immigration status documents; Work eligibility documents; Document showing your Age; and Identity. In general, you will need to bring with you your Employment Contract, Passport and Original Visa (stamped). Please ensure that all the documents are either originals or copies certified by the issuing agency. The Social Security Administration Office will not accept photocopies. 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 (570) 347-5312.

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SHOPPING It is important to know where and how to get groceries, ingredients for preparing your favorite foods, and clothes. Many hospitals offer membership in large buying clubs where food and other household goods can be purchased more cheaply in bulk. Shoppers who frequently go to a particular supermarket can obtain a free discount card for use in that market; this card can easily be applied for in the supermarket. If you are interested in buying ethnic food or other items, you might check with fellow residents from your own home country or region. There are several kinds of places to buy food: Supermarkets - for every kind of food. These large grocery stores usually include a butcher, a deli, a bakery, a seafood counter, etc. Farmers' markets - offering fresh produce at low prices Ethnic specialty shops - sell ethnic food and other items Shopping options for food, groceries, and clothing: Discount stores - department stores or drug-stores that emphasize low prices on everyday clothing and practical items for the home. Examples: Walmart, Target, and Kmart Outlet stores - sell factory seconds—goods that do not meet the manufacturer's specifications but are still in decent condition—at a lower price. Convenience stores - small stores that sell a basic selection of snack foods, beverages, motor oil, medications, tobacco products, newspapers, and milk. Some are open 24 hours a day and may be combined with a gas station. Because convenience stores tend to be more expensive, they should not be used for regular shopping. Shopping malls - convenient places to hunt for the best prices and select from several different retailers. Thrift shops - often run by charitable organizations, they accept donations of clothing, furniture, and other houseware and resell them, usually at very reasonable prices. Internet - most retail chains have websites that allow you to order merchandise on-line with a credit card or debit card.

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LOCAL INFORMATION Local supermarkets: Wegmans - Dickson City Rt 6 Bell Mountain Village, Scranton - (570) 383-8721 Price Chopper 1400 Montroe Avenue, Scranton, PA – (570) 343-1201 Gerrity’s Supermarket – Also offers online shopping and delivery. Visit Website for detailes 320 Meadow Avenue, Scranton, PA – (570) 961-9030 Wal-Mart Supercenter 900 Commerce Boulevard, Dickson City, PA – (570) 383-2354 Giant Food Store - #305 1600 Nay Aug Avenue, Scranton, PA – (570) 343-5997 Redner’s Warehouse Markets 550 North 7th Avenue, Scranton, PA – (570) 347-8550 Schiff’s Restaurant Services Inc 3410 North Main Avenue, Scranton, PA – (570) 343-1294 Turkey Hill Minit Market 1429 Mulberry Street, Scranton, PA – (570) 342-9333 Price Rite 611 Luzerne Street, Scranton, PA – (570) 341- 5769 Convenient Food Mart 300 Cedar Avenue, Scranton, PA- (570) 346-7700 Brunetti’s Shur-Save Super Market 441 North Main Avenue, Scranton, PA – (570) 961-8620 Shopping malls: Mall At Steamtown www.themallatsteamtown.com - (570) 343-3400 Shoppes At Montage www.theshoppesatmontage.com - (570) 344-3757 Dickson City Crossings Viewmont Drive & Viewmont Dr Dickson City, PA 18519

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Viewmont Mall www.shopviewmontmall.com

Outlet mall in the area: The Crossings Premium Outlets 1000 Route 611 Tannersville, PA 18372 (570) 629-4650 http://www.premiumoutlets.com/outlets/outlet.asp?id=59

EATING OUT

Because your schedule may sometimes make it difficult or undesirable to cook meals at home, you should get familiar with some local places to eat and how to get "take out" food to consume at home. While at the hospital, there is a cafeteria/dining room where you can get your meals, or you can bring food from home, which might be cheaper. There are many options for eating out, including places that offer ethnic food from a variety of countries and cultures. Eating out can become expensive and even residents living on their own should probably consider preparing at least some of their own meals. Be aware that some restaurants require special dress codes. Your fellow residents are a great source of information regarding good restaurants and restaurants where you can find ethnic dishes. Unlike many countries, tipping is the norm in the United States. Tipping is expected in all restaurants with table service (not in fast-food restaurants or selfservice buffets). In most areas, 15% to 20% of the amount of the bill is customary for tipping. The tip may be left on the table in cash or, if you are paying by credit card, simply written on the credit slip when you sign for the transaction.

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LOCAL INFORMATION AND CONTACTS  Hospital dining area  Local restaurants, including ethnic restaurants

Residents on call will be provided with meals at the hospital cafeteria according to hospital regulations. For a list of local restaurants available in the area, you may visit this website where a list is compiled by the Greater Scranton Chamber of Commerce: http://www.scrantonchamber.com/pdfforms/DiningGuide.pdf#page=1&zoom=75, 0,0

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POST OFFICES The United States Postal Service (USPS) operates six days a week (Monday – Saturday) with the exception of federal holidays and offers a variety of mailing services. You may choose to have your mail delivered to your home or to rent a Post Office Box, which is a lockable box at the Post Office. Some of the mailing options offered by the USPS include: Express Mail, which guarantees overnight delivery to most locations. For an additional charge, you can arrange for Sunday or holiday delivery. Priority Mail is used to ensure two- or three-day delivery. Express and Priority are more expensive than First Class Mail, which is usually used for items that are not urgent. Domestic delivery usually takes two or three days for letters and small packages. First class rates are dependent upon size and weight. Examples of domestic rates: Post cards: 28¢ Letters: 44¢, up to 3.5oz; 17¢ per additional oz. Large envelopes: 88¢, up to 13oz; 17¢ per additional oz. Package parcel: $1.13, up to 108‖ length + width and 13oz; 17¢ per additional oz. Parcel Post is the slowest but cheapest service for packages. USPS will not deliver packages heavier than 70lbs, or if the two largest dimensions (length and width) are greater than 108 inches combined. For larger packages, you will need to use FedEx or UPS. For more information on locations, hours and additional services, consult www.usps.com.

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LOCAL INFORMATION AND CONTACTS

WCGME internal medicine residents will be assigned mail slots in the WCGME residents’ lounge on the 6th floor of Mercy Hospital. Local Post offices: US Post Office 127 South Main Avenue, Scranton, PA (570) 342-4279 US Post Office 2800 Stafford Avenue, Scranton, PA (570) 969-5128 US post Office 100 The Mall at Steamtown, Scranton, PA (570) 941-0502

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SHIPPING SERVICES Federal Express (FedEx) and United Parcel Service (UPS) make nationwide and international deliveries of urgent letters and packages. They are direct competitors of the United States Postal Service (USPS) when it comes to express mail and package delivery services. These companies do not use U.S. mail boxes at residential and commercial destinations. They operate out of retail locations, which also sell packing supplies. To find out more information, such as rates, hours, and locations, consult their websites.  FedEx: www.FedEx.com  UPS: www.ups.com

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FORMATTING ADDRESSES ON ENVELOPES When addressing an envelope or package for domestic delivery, keep the following points in mind: Line 1 Line 2 Line 3

Name of recipient Street address or P.O. Box City, State, and ZIP Code (postal code)

Example: Mr. John Doe 112 Green Street Minneapolis, MN 02119 The ZIP Code is a five-digit postal code that aids in an efficient sorting and delivery of mail. You might encounter a ZIP Code that has four extra digits after it, which looks like this: 02119-7869. These extra numbers are used to determine a more precise location than the ZIP Code alone; use of these four digits is optional. Below are state abbreviations for the 50 United States: Alabama (AL) Alaska (AK) Arizona (AZ Arkansas (AK California (CA) Colorado (CO) Connecticut (CT) Delaware (DE) Florida (FL) Georgia (GA) Hawaii (HI) Idaho (ID) Illinois (IL) Indiana (IN) Iowa (IA) Kansas (KS) Kentucky (KY) Louisiana (LA) Maine (ME) Maryland (MD)

Massachusetts (MA Michigan (MI) Minnesota (MN) Mississippi (MS) Missouri (MO) Montana (MT) Minnesota (MN) Nebraska (NE) Nevada (NA) New Hampshire (NH) New Jersey (NJ) New Mexico (NM) New York (NY) North Carolina (NC) North Dakota (ND) Ohio (OH) Oklahoma (OK) Oregon (OR) Pennsylvania (PA) Rhode Island (RI)

South Carolina (SC) South Dakota (SD) Tennessee (TN) Texas (TX) Utah (UT) Vermont (VT) Virginia (VA) Washington (WA) West Virginia (WV) Wisconsin (WI) Wyoming (WY)

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SAMPLE Return Address Postage Stamp Mailing Address

Sender’s Name Sender’s Street Address City, State ZIP Code

Recipient’s Name Recipient’s Street Address City, State ZIP Code

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UTILITIES The basic utilities are electricity, water, and gas (if your home or apartment uses it). You may need to have these turned on when you move in. Many apartments include basic utilities in the rental fee. If this is the case, you do not have to concern yourself about these utilities. You can wait a few days or weeks to set up other utilities, such as landline telephone, cable TV, and Internet access. Inquire at the business office of your apartment about what companies are available to serve you. Utilities may require that you put down a deposit. This can either be paid at the utility office or will appear on your first bill. You may be billed for these utilities on a monthly basis. You may have the option to receive a paper bill or electronic bill. Generally, your bill can be paid through your bank checking account or through the website of the utility provider. You may also be able to arrange to have your bills paid automatically from your bank checking account.

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OBTAINING A MOBILE PHONE Mobile or cellular phone (cell phone) use is generally may not be allowed in certain areas within the hospital because of potential interference with medical monitoring devices. Outside of the hospital, cell phones are helpful for emergency calls and keeping in touch. Many providers offer plans that include free long distance during weekends and weeknights. Depending on your landline plan, cell phones can often be a more affordable way to keep in touch with family and friends. Because you may not yet have been able to establish credit history in the United States, you may need to put down a deposit when you apply for a cell phone. Another option is to buy a prepaid phone, which is usually more expensive. You can then convert to a regular cell plan after a few months. As people are become increasingly mobile, many choose to use cell phones instead of landlines.

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LOCAL INFORMATION AND CONTACTS

At& T 809 Scranton Carbondale Highway, Scranton, PA – (570) 344-0700 At&T 100 Viewmont Mall, Scranton, PA – (570) 348-4980 At&T 1041 Shoppes Blvd, Moosic, PA – (570) 961-1157 Verizon Wireless 1504 Scranton Canrbondale Highway, Scranton, PA- (570) 489-0142 WOW Mobile 1101 Paul Avenue, Dunmore, PA – (570) 499-7732 Verizon Wireless 300 The Mall at Steamtown, Scranton, PA – (570) 941-0944 Verizon Wireless 100 Viewmont Mall, Scranton, PA – (570) 343-1240

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FURNITURE Many residents may be moving out and selling their furniture at very good prices. The classified section of the local newspaper and Craigslist (www.craigslist.org) are also often good resources for used furniture. When purchasing used furniture, there is usually room for price negotiation. New furniture can be found at local furniture stores such as Target and Walmart. Furniture purchased from these places will likely require some assembly. It is also possible to locate used furniture on the bulletin board postings at the hospital.

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BANKING Setting up a bank account is one of the first things you may want to do when you arrive. Having checks at your disposal is helpful for paying bills and making deposits on utilities or housing. Your salary can be automatically transferred to your account via direct deposit. Banking options create efficient and secure ways to streamline and manage your finances. A Checking Account is a deposit account established to frequently access funds on demand, through different channels. This type of account generally is not used for savings, as it typically does not earn interest. Checking accounts will allow you easy access to Internet banking, cash machines (ATMs), or telephone banking. Savings Accounts are better for saving money because they often earn interest. Banks offer several different options when it comes to account types. Speak with a bank officer about various savings and checking account plans offered. Direct Deposit means that your payroll checks are placed directly into your account each pay period. If you have a savings and checking account, you may designate that a specific amount be directly deposited in each. Credit Unions are cooperative financial institutions that are owned and controlled by members. These institutions provide checking and savings accounts, and credit at reasonable rates, as well as other financial services. Many hospitals offer residents the opportunity to join. Check with your program director if you are interested in this option. On-line banking is offered by most commercial banks (and some credit unions). This gives you the ability to manage your finances on-line, such as paying bills and viewing real-time account transactions. Personal finance software is available for both PC and Mac and allows you to track and manage your finances from your home. An example of a popular product is Quicken. Documents typically required to open a bank account: Visa documents Passport Current valid driver’s license Social security card Proof of residency (utility bill, lease)

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LOCAL INFORMATION AND CONTACTS PNC Bank 210 Penn Avenue, Scranton, PA – (570) 961-7116 Wachovia Bank 330 Meadow Avenue, Scranton, PA – (570) 342-6901 Fidelity Deposit & Disc Bank 338 North Washington Avenue, Scranton, Pa – (570) 504- 8001 Bank of America 507 Linden Street, Scranton, PA – (800) 432-1000 Penn Security Bank& Trust Co 150 North Washington Avenue, Scranton, PA – (570) 346-7741 First National Community Bank 102 East Drinker Street, Dunmore, PA – (570) 346-7667 Pennstar Bank 130 North Keyser Avenue, Scranton, PA – (570) 341-8100

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CREDIT CARDS Rather than carry large amounts of cash, most residents make purchases by debit or credit card. Credit cards grant a line of credit, which you repay with interest through a monthly bill cycle. You might have to experience the frustration of being turned down for a credit card if you haven’t established credit history yet. When using credit cards, the amounts add up and you are expected to pay a portion each month. These are different from debit cards because the money is not taken from your bank account. When using debit cards, the money is taken directly from your bank account. Many credit cards charge annual fees, some of which can be high. It is possible to shop around for the best rates. There has been controversy surrounding the issue of hidden costs. Be aware of this and read the fine print. Interest rates can be quite high and do add up. If you have not paid an invoice during the billing cycle, these amounts can quickly become unmanageable. Be VERY CAREFUL with debt! It is best to pay as much as possible on the monthly bill, as debt can quickly accumulate. If you have difficulty paying your monthly bill, you can call the credit card company to discuss and it will usually work with you. Late fees are charged to overdue accounts and can add to the debt. Many stores offer store credit cards, which may appear attractive and are usually associated with store discounts. Before opening this type of credit card account, read the application carefully. Store credit cards often carry higher than average interest rates. Many medical societies such as the American College of Physicians (ACP) offer credit cards. You would first have to become a member of ACP. You may want to check with your program director about these offers.

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SENDING MONEY ABROAD The ability to transfer money back home might be a point of concern for you. We want to make sure you are aware of the options in order to avoid difficulties or overpayment. You might want to check first with your bank for suggestions. There are three major approaches to International Money Transfers: 1) Cash Transfers – Western Union or MoneyGram; allows customer to transfer money via telephone, on-line, or through exchange agents; costs vary by country and amount of transfer. 2) Money Orders – obtained through U.S. Postal Service or banks: U.S. Postal Service – limit is $700 per money order, but can purchase multiple money orders up to $10,000 per day; fees range from $3-$10. Banks – most banks issue money orders; maximum is $1,000; fees are approximately $10. 3) Banking Transfers Sending Checks Abroad – can take four to six weeks to clear; recipient may have difficulty cashing check; fees are approximately $50. Foreign Drafts – processing time can range from a few days to a week; money is deducted from your account when the draft is processed; recipient must have access to the corresponding bank, therefore it is important to investigate this first; fees are approximately $25. Wire Transfers – you do not have to be a customer of the bank to conduct wire transfers; must pay in cash; processed almost immediately; recipient must have access to corresponding bank; fees are approximately $65, but are less expensive if you are a customer of the bank. Helpful websites: http://www.usps.com/money/sendingmoney/sendmoneyinternationally.htm

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TAXES Tax structures and procedures differ from country to country. Be aware that under the complex U.S. tax system, your income will be taxed on the federal level, and may also be taxed on the state, city, and/or county level. Additionally, you will need tools and information for filing annual tax returns at the federal and possibly other levels. For federal taxes, the U.S. tax system requires that employers deduct a portion of each employee's income for payment directly to the Internal Revenue Service (IRS). In addition to federal taxes, there may also be deductions for the state in which you live and work, as well as city and/or county deductions. Be aware that if you work in a state that differs from the one in which you live, you may need to file tax returns in both states. At the end of the year, you will receive a detailed invoice listing your earnings and withholdings for that year. This form is called a W-2 form. You will need it to file your tax returns. April 15th is known in the United States as Tax Day. This is the date by which all taxes for the prior year must be filed, in order to avoid penalties. Depending upon your tax withholdings, you may either receive a refund or be required to pay more money. Tax Services – several helpful on-line resources exist for calculating and filing taxes via the Internet; you can also get assistance with taxes through private accountants or H&R Block, a walk in service. Please be aware that fees are associated with these services. Be wary of tax preparation services that set their fees based on the size of your return since they may use calculations that are questionable and could get you in trouble.

LOCAL INFORMATION  IRS e-File: http://www.irs.gov/efile/index.html  Turbo Tax: http://turbotax.intuit.com/  H&R Block: http://www.hrblock.com/

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SCHOOLS If your children will be living with you, school options will need to be considered. In the United States, children of compulsory age are required by law to be enrolled in school; compulsory age varies by state, but is commonly 5-18. You should be aware that public schools are organized into districts, meaning that where you live will determine for which public school your child is eligible. For residents with children, this will likely become an important factor for deciding on an area in which to settle. Types of schools: Nursery Schools / Preschools – optional form of schooling, for children younger than compulsory age Public Schools – free, supported by taxes; location of residence determines eligibility for a particular public school Vocational Schools – offer distinct curriculum for those not preparing to continue to higher education Magnet Schools – offer specialized curriculum such as arts, foreign languages, or science Charter Schools – publicly funded, privately operated; many benefits of private education without tuition Parochial / Private Schools – some closely associated with a church or religious denomination; do not receive tax funds, more expensive; some are highly selective and may require an interview process Immunization Requirements You will need to provide the school with a copy of your child’s immunization record. Check with the school to determine which immunizations are required. Any immunizations needed may be obtained through the child’s pediatrician or a local health department.

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LOCAL INFORMATION AND CONTACTS List of public schools in the Scranton School District as adopted from www.greatschools.org: ELEMENTARY Schools: Charles Sumner #18 North Sumner Avenue & Swetland Scranton, PA 18504 (570) 348-3688 Frances Willard #32 1100 Eynon St Scranton, PA 18504 (570) 348-3692 George Bancroft #34 1002 Albright Ave Scranton, PA 18508 (570) 348-3667 John Adams #4 927 Capouse Ave Scranton, PA 18509 (570) 348-3655 John F. Kennedy #7 Prospect Avenue & Saginaw St Scranton, PA 18505 (570) 348-3673 John G Whittier #2 700 Orchard St Scranton, PA 18505 (570) 348-3690 John J. Audubon #42 1801 Mulberry St Scranton, PA 18510 (570) 348-3665 John Marshall #41 North Lincoln Avenue & Oram St Scranton, PA 18504 (570) 348-3677 Lincoln-Jackson #14 public · K-5 · 256 students Academy Street & Hyde Park Ave Scranton, PA 18505

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(570) 348-3675 McNichols Plaza 1111 S Irving Ave Scranton, PA 18505 (570) 348-3685 Neil Armstrong #40 North Lincoln Ave & Clearview Scranton, PA 18508 (570) 348-3661 Robert Morris #27 1824 Boulevard Ave Scranton, PA 18509 (570) 348-3681 William Prescott #38 Prescott Avenue & Myrtle St Scranton, PA 18510 (570) 348-36 MIDDLE Schools: Northeast Intermediate School Adams Ave & Gibson St Scranton, PA 18510 (570) 348-3651 South Scranton Intermediate School 355 Maple St Scranton, PA 18505 (570) 348-3631 West Scranton Intermediate School Fellows Street & Parrot Avenue Scranton, PA 18504 (570) 348-3475 HIGH Schools: Scranton High School 63 Munchak Way Scranton, PA 18508 (570) 348-3481 West Scranton High School 1201 Luzerne St Scranton, PA 18504 (570) 348-3616

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CHILDCARE If you have young children in your household and plan to be away from the home (either daily or occasionally), you will likely need to seek outside services. Childcare Centers – also called ―daycare centers‖ can be public or private. Religious institutions run some services. Daycare facilities may be subject to state licensure requirements. You can check to ensure that the facility is licensed. Babysitter / Nanny services – usually childcare that takes place at your home. It can often be helpful to look within a local university for students who speak a common language. It is perfectly acceptable to ask the babysitter or nanny for references from past employers. This practice is normal in the United States and a good way to make a decision regarding with whom you will leave your child. Taxes for Household Employees – be aware that taxes must be paid for domestic help under certain circumstances, although usually not for babysitters; consult a Certified Public Accountant if you have concerns or questions. LOCAL CONTACTS Lackawanna County Day Care Centers: Progressive Center 414 Olive Street, Scranton, PA – (570) 207-4950 Fricchion Day Care Center 2300 Adams Avenue, Scranton, PA – (570) 961-4701 Treasure house Child Development Centers 611 Ash Street, Scranton, PA – (570) 961-1345 Little People Day Care School 254 Meridien Avenue, Scranton, PA – (570) 961-0900 Lackawanna County Day Care Centers: Freckles & Frills Nursery School 101 Pittston Avenue, Scranton, PA – (570) 346-8719 Creative Critters Childcare Center 234 Mifflin Avenue, Scranton, PA – (570) 207-7900 Green Ridge Day Care Center 1917 Boulevard Avenue, Scranton, PA – (570) 961-2224 Treasure House Child Development Centers –

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Day Nursery Association 332 Jefferson Avenue, Scranton, PA – (570) 342-9397

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WORKOUT / EXERCISE FACILITIES Exercise is an important stress reliever and a great way to meet people. A gym, short for gymnasium, is an exercise and workout facility. If your hospital does not offer gym services, you may want to seek a gym in the community. If time does not permit you to become a member of a gym, you may want to consider purchasing home exercise equipment such as a stationary bike. To go to most gyms, you must purchase a membership. Membership fees may be payable on a monthly or annual basis. Some gyms require that new members sign contracts, committing them to a block of several months or a year of membership. Gym etiquette is taken seriously in the United States. It important to wipe down equipment or machines before the next person uses it. Most gyms offer group exercise classes such as aerobics, Pilates, and yoga. If the group classes are your primary interest, you may explore the option of joining a yoga or Pilates studio or a freestanding group exercise class that does not involve gym membership costs. Trainers may be available at an extra cost and provide personal instruction, personalized workout plans, and often nutritional advice. Some gyms feature indoor or outdoor swimming pools and sauna facilities. Some also may offer massage services.

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LIBRARIES Community libraries are a great resource for you or your family. Many provide programs such as English as a Second Language (ESL) classes, activities for children, and guest speakers. These are great resources for current newspapers and periodicals. Please note: Community libraries focus on general interest reading and activities. If you need access to medical materials, you should use the library at the hospital. Many local colleges and universities grant public access to their campus libraries. The library card is your membership card to the library. It is necessary for borrowing books or other materials. Obtaining a library card is a fairly simple process. You will need to first fill out a membership form, which can be found at the front desk. Most libraries require that you be able to show proof of your address and a photo ID. Generally accepted forms for proof of address are a driver’s license, utility bills, a bank check or statement, a magazine subscription, a mobile phone bill, etc. Library etiquette is appreciated by the other patrons. This means using low voices in the library to respect others who are reading. Many libraries offer the use of computers and the Internet free of charge.

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VOLUNTEER OPPORTUNITIES Many people in the United States volunteer their time either independently or as part of a group to make life better for the less fortunate or to better the community. Although you will likely not have enough time for involvement in volunteer activities, they are a great way for other family members to meet people and to get involved in the community. Volunteer opportunities exist for hospitals, schools, clinics, welfare projects, parks/playgrounds, museums, libraries, community centers, soup kitchens, etc. Participating in these activities does not require citizenship.

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NEWSPAPERS Staying aware of local current events will enable you to feel like a part of the community. In addition to the local newspaper, many towns or cities also circulate free weekly newspapers, which are helpful sources of information, especially about local community events, movie listings, theater offerings, sporting events, and other forms of entertainment. In larger cities, it may possible to find newspapers from your home country or in your native language at newsstands. Many libraries provide access to international newspapers and periodicals. The classifieds section of the newspaper is a useful resource for buying or selling items. While circulation of newspapers varies, you can find copies for sale in newspaper vending machines or the newsstands. Newspapers can also be delivered to your home if you purchase a subscription. This can be done either on-line or by placing a phone call to your local newspaper provider. The same is true for larger scale newspapers. Depending upon subscription structures, it may be possible to subscribe only to the weekend edition of the newspaper.

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ORGANIZATIONS / INTEREST GROUPS If you or your family members are members of international or ethnic organizations that have local affiliates, you may want to check for local branches of these groups. Membership in a familiar group and connections made in the community can greatly assist in your adjustment process. Many towns or cities have national group organizations, which can be found in the phone directory or by contacting the consulate. If you are unsure about the existence of local branches in your area, it is best to consult with current residents or physicians from your home country at your hospital to identify these sorts of opportunities.

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RECREATION We understand the importance of having a place outside the home to relax and spend time with your family or in a group setting. Parks and playgrounds usually contain age-appropriate recreation equipment. Many parks provide picnic facilities, such as grills and tables, so that you can bring food and cook onsite. Be aware that alcohol is restricted in some parks. Swimming pools may be available through neighborhood clubs, local gyms, and parks. Some of these are private, requiring membership, while some are simply pay-per-use. Amusement or theme parks can provide a full day of fun and recreation for the whole family. There is usually a single charge for entry, which allows access to all attractions in that facility.

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SPORTS Some sports will be new and perhaps interesting to you, while others may already be a part of your culture. Depending on your location, professional league sports may play a large role in the local culture. SPECTATOR SPORTS: International matches – many televised international sports events, such as cricket or soccer matches, are shown at certain pubs. Local professional teams – many of your co-workers and patients will be interested in the local professional teams. Popular sports in the United States are football, baseball, and basketball. College sports – you may encounter many people who follow college sports teams, usually football and basketball. SPORTS FOR RECREATION: Community-sponsored sports leagues – often available for both adults and children. This is a good way to get your children involved with the community as well as make new friends. For yourself, check with your hospital or gym to learn about any sports league opportunities such as softball, soccer, or football. This is a great way to get to know your peers. If you have children in school, sports will play a major role in the school culture. *Important Conversation Topics – knowledge of local sports will make for easy exchanges with patients and members of the hospital staff.

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FOR THE SPOUSE OR PARTNER: AREA COLLEGES OR UNIVERSITIES If your spouse or partner is not able to work due to visa restrictions, he/she may be unaccustomed to an abundance of free time. Perhaps he/she would like to take this time to improve his/her English or learn a new skill. Many area colleges offer continuing education classes or non-credit classes, which provide great opportunities to meet people and make new friends. Be sure to take advantage of what your new city has to offer in the way of personal enrichment. Local colleges generally have large international student populations and therefore host language chats, clubs, and festivals. You and your spouse or partner may also be interested in using college libraries, which are often open to the public. Here, you can usually find international newspapers and magazines.

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FOR THE SPOUSE OR PARTNER: MEET UP GROUPS As you adjust to changes brought about by navigating a new city, transitions in your lifestyle, and supporting your spouse/partner though this stressful period, it is important to remember that you are not alone! You may find it very helpful to talk with other spouses/partners who are also in your situation and can provide valuable support or advice. A proven method for effective adjustment to a new culture is developing social connections with current housestaff physicians and their spouses or partners. If you have children attending local schools, you may also want to network with parents at these schools.

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FOR THE SPOUSE OR PARTNER: ACTIVITIES

Moving to a new place can offer new opportunities! In the Scranton area, you can take advantage of many activities, events, and interesting classes offered by the community. In addition to any personal enrichment you will gain, this is also a wonderful way to get to know new people while becoming more familiar with the area. Throughout the years, many partners and spouses of medical residents here at WCGME have enjoyed [art classes and lectures, cooking classes, and knitting groups], which take place in at different venues throughout the area. Many of these opportunities are available through local colleges, as non-credit courses, such as foreign languages, photography, or music. Others are available though libraries, art associations, private studios, or community associations.

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VIPs – VERY IMPORTANT PEOPLE IN OUR PROGRAM Although most of your daily interactions will be with your attending physicians, other residents, nursing staff, and patients, there are several people who ensure that our residency program (fellowship) is working to provide you the best education and meet all requirements. These people include the program director and his/her associates or assistants and the administrative program staff. From time to time, they may ask you to provide information or complete paperwork. They are also people who can answer your questions regarding things like board certification, visas, and medical licenses as well as provide information about your pay, benefits and related items. It is important to get to know them by name, where they are located, and how to contact them. You should also get to know core faculty and the Chair of our department. Finally there is an office of Graduate Medical Education responsible for the training program which you may have some contact. President, CEO and DIO o Dr. Robert E. Wright Program Director o Dr. Linda Thomas Internal Medicine Program Administrator o Mrs. Marlene Karam Director of GME o Mr. John Marcico o Business & GME director Administrative program staff o Ms. Laura Jones WCGME telephone number: 570-343-2383 The following section is just a guide, for detailed information on WCGME rules, regulations and guidelines, please refer to the Housestaff policy manual on the WCGME website at http://www.WCGMEweb.org/housestaff/HousestaffPolicyManual.pdf

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THE HEALTH CARE TEAM You should quickly come to realize that patient care is not provided solely by you and your fellow physicians but that there are a great number of other medical professionals that you can and will be working with. By learning who they are, what they do, and how and when to get them involved with caring for your patients, you will provide the best possible care, make your work a lot easier, and even learn a lot! Remember that all these people are professionals like you with extensive training and expertise and should always be treated with respect and acknowledged for their help and advice. You can get more detailed information on these and many more medical professionals on-line through ECFMG’s Interdisciplinary Health Care Team (IHCT), available on the ECFMG website at www.ecfmg.org/acculturation.

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ATTIRE—LOOKING LIKE A DOCTOR One of the things that determines patients’ satisfaction with their doctors is having their expectations met. And one of their most basic expectations is that a doctor look like.…a doctor! Patients expect you to appear neat and professional at all times. Men should wear shirts with collars, and should avoid bizarre colors or prints. Pants can be casual, but no jeans or shorts. Also, no sandals or open-toed shoes. Socks should be worn. Women should wear blouses and skirts or professional-looking pants. Pants can be casual, but no jeans, shorts, or capri pants. Also, no sandals or open-toed shoes. Traditional ethnic apparel such as turbans, head scarves, or saris are quite acceptable as long as they are neat and clean. Men and women doctors generally wear white coats as their outer garment. Be sure to change them as necessary when they become stained or dirty and try to keep all of the items that you must carry in the pockets as neat as possible. Depending on your location in the hospital and your duties on any given day, you may be permitted to wear scrubs. Again, if you do, make sure that they are clean and unstained. A final critical piece of your attire is your name tag, which should be prominently displayed. Patients encounter many people in hospitals and clinics and are often unsure which ones are doctors. Wearing your name tag and introducing yourself as a doctor will be appreciated by your patients. Finally, in addition to what you wear, be aware of personal hygiene and cosmetics. Also avoid exceptionally strong colognes, aftershaves, or perfumes as well as extremes of jewelry.

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EQUIPMENT, GEAR, SUPPLIES, AND READY REFERENCES There are many items that you will want to have on your person or in your coat pockets when you begin working on the floors and clinics. These include medical equipment, some simple supplies, devices to stay in touch and to store and organize information, and some ready reference materials, both hardcopy and electronic. You also need to be able to keep track of all your patients and up-to-date information about them. Finally, there are some items you need to have to get around in the hospital and do important things like eat! Carrying all these items in the pockets of your white coat can make you look sloppy so try to organize them as neatly as possible.

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COMMUNICATIONS It is critical that you can be reached immediately by nursing staff or other physicians or providers at all times when you are on duty. The most effective way to do this is by cell phone. You will be issued a cell phone, which you must have on your person and turned on at all times. Memorize the cell phone number and be sure it is working and that it is fully charged. When your cell phone goes off, it will display either an extension within the hospital or a phone number. Call that extension or phone number and tell whoever answers your name and that you just received a page. Have the cell phone numbers of individuals you are most likely to call available with you at all times. You may also be paged via the hospital overhead paging system. The message will usually include your name and an extension to call or a request to call the hospital operator. There may also be emergency pages such as ―Code Blue‖ for a cardiac arrest and a location. If you are on the Code team or have a patient in that location, you should proceed there immediately. You also may need to place phone calls outside the hospital and send or receive fax materials. You should familiarize yourself with these procedures and know the location of fax machines.

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ADMITTING ORDERS One of your primary responsibilities when admitting a patient to the hospital will be to write the initial admitting orders. In order to be sure that you have not omitted anything important, it is useful to follow a standard format for these orders. It would also be wise to have your senior resident review your admitting orders as soon as possible for your first several admissions to be sure that they are acceptable and find out if he/she or your attending have any particular preferences about how the orders should be written. Always be sure to sign, date, and time the orders and, if your signature is not legible, print it or use a stamp. Also include your contact number so nurses can contact you with any questions about the orders.

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DISCHARGE ORDERS You will be responsible for writing the discharge orders once a patient is ready for discharge (as per attending approval). Issues like the need for home health care are usually based on the evaluation of the physical therapist or the case managers. This is one reason why you should refer your patient to physical therapy (PT) or occupational therapy (OT) for evaluation or discuss it with the case managers as early as possible (earliest would be as soon as the patient gets admitted). Bear in mind that discharge planning begins upon admission. You also should check with the attending or primary care physician regarding when they want to see the patient for follow up and also see if consultant follow ups are indicated. Nursing staff will appreciate your writing discharge orders as early in the day as possible.

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SAMPLE DISCHARGE ORDERS Discharge patient to: home (vs. nursing home) with home health care (if indicated). (Specify the reason for ordering home health care (i.e. medical compliance, for home safety evaluation, for PT/OT needs). Follow-up with Primary Care Doctor by name in two wks – (Ask the attending how soon he/she wants to see the patient in the clinic.) Follow-up with: Consultants (if indicated; also ask the consultant if the patient needs to follow up him/her) Discharge Medications: (You are required to list all home-going meds. Provide scripts for new medications or changed medications, except in cases where medications were changed due to formulary unavailability [i.e. irbesartan changed to valsartan]. Be mindful of these changes to avoid sending a patient home on two medications of the same class.)  Irbesartan 75mg PO daily  Metoprolol 50 mg PO BID  Aspirin 81 mg PO daily Special instructions such as: Do not take amlodipine at home. For outpatient chest x-ray, CBC, INR, etc. on [date]

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ABBREVIATIONS AND MEDICALESE Whether you are writing in a medical record, on a prescription, or anywhere else, it is important to be careful that what you write cannot be misinterpreted by another reader. There are a few sources of error that can create problems. One very obvious one is your handwriting, so you must make it as clear as possible. If necessary, you can print important words or even all of your notes. Another source of error is the use of abbreviations. There are some abbreviations that should never be used. They are on a list that is published by The Joint Commission and is included here. There are also many informal terms that are used in hospitals, which may be new to you. You can view many of them in the ―Medicalese‖ glossary, available on the ECFMG website at www.ecfmg.org/acculturation.

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© The Joint Commission, 2010. Reprinted with permission.

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SIGNOUTS Care of hospitalized patients is obviously an ongoing process, continuing 24 hours a day, seven days a week. This means that you must turn over care of your patients to other residents and teams at the end of your shift, and that at the beginning of your shift you may be assuming care for the patients of those same other residents and teams. It is critical that accurate and up-to-date information be communicated in these signouts. Multiple studies have shown that this is a key point in patient care where significant errors leading to adverse outcomes can occur. Since this is such an important activity and one that occurs at the end of a shift when the whole team may be tired and anxious to go home, a number of acronyms have been proposed to help ensure that all important elements are covered in the signout. Obviously the acronyms are only a guide, but they may be useful and worth trying.

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ACRONYMS AND LISTS FOR SIGNOUTS ANTICipate: (www.psnet.ahrq.gov) Administrative data (e.g., patient's name, medical record number, and location) must be accurate. New clinical information must be updated. Tasks to be performed by the covering provider must be clearly explained. Illness severity must be communicated. Contingency plans for changes in clinical status must be outlined to assist cross-coverage in managing the patient overnight. SBAR Situation Background Assessment Recommendation

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DIFFICULT SITUATIONS You may encounter situations in which you are not sure how to proceed, to whom to talk, or what to do. Some examples: If you become aware of a medical event that might raise a concern for patient safety or liability, you should report it directly to your supervising attending physician. If you believe you have reason to question another physician’s order or action, you should report it to your supervising attending physician. If you become aware of behavior by anyone that you believe might present an immediate risk for harm or danger, you should notify the program director. If you suspect a fellow house officer or any other professional staff person is behaviorally impaired (alcohol, drugs, emotional stress, etc.), you should report it to the program director. If you find yourself in debt or unable to pay your bills, you should discuss your situation with your program director. If you have to leave the hospital suddenly due to a personal emergency or if you will be unable to come to work as scheduled, you should notify your attending physician, clinic staff, and program office.

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CONCLUSION

We hope this guide was useful and helpful. This ―WCGME’s Intern Survival Guide‖ was produced with assistance from a Survival Guide Template provided by the Educational Commission for Foreign Medical Graduates Acculturation Program (www.ecfmg.org/acculturation) and modeled on An Intern’s Survival Guide developed by St.Vincent Charity Medical Center in Cleveland, Ohio. Comments or suggestions would be welcome at [email protected].

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Appendix A WEBSITES OF U.S. ENGLISH IDIOMS, SLANG & EXPRESSIONS You may find it useful to become familiar with popular English idioms and slang to improve your communication skills in both medical and social settings. These websites can help you better understand some of the terms and words you will hear from patients, colleagues, and friends.  English Daily - Slang http://www.englishdaily626.com/slang.php?012 On this site, hundreds of idioms and slang are provided with cartoon pictures, definitions, and examples. Pictures may make your study more interesting. Also, the homepage is updated with a "slang of the day" each day.  Commonly Used American Slang http://www.manythings.org/slang/ Nineteen pages of slang collected on this site where you can see a list of sentence examples with highlighted slang. The meaning of each slang word or phrases is hidden until you click on the meaning button. It is a good site to test your knowledge of slang and learn new slang.  English-Zone - Idioms http://english-zone.com/index.php?ID=3 On this website, you can take a quiz about categorized idioms and practice using them.  Paint by Idioms http://www.funbrain.com/idioms/ This is a good website for you to learn idioms by playing games. In this game, you help the painter finish his paintings by identifying the correct expressions.  Pocket English Idioms http://www.goenglish.com/Index.asp This website lists popular key words in English idioms and phrases. You can learn them by clicking a key word and getting the idiom with an example sentence.  Proverbs in English http://www.manythings.org/e/proverbs.html This is a fun study site to learn commonly heard proverbs and old sayings.  Slang City http://www.slangcity.com/ This site provides U.S. slang, including explanations of popular songs and movies, bad words, pronunciation, and more.  Self-Study Idiom Quizzes http://a4esl.org/q/h/idioms.html

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This site divides verb phrases and slang into medium and difficult levels with different kinds of tests. You can go to your own level to learn new slang and phrases.  Dictionary of American Idioms http://www.sky-net-eye.com/eng/dictionary/english/idioms/american There are more than 8,000 idiomatic words and phrases of U.S. English on this website. This is primarily a reference site and not as useful as the sites above for practice and learning.

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Appendix B AN ANNOTATED SUGGESTED READING LIST FOR IMGs, IMG APPLICANTS, AND SPOUSES

GUIDES Alguire, P.C., Whelan, G., & Rajput, V. (2008). The International Medical Graduate's Guide to US Medicine & Residency Training. American College of Physicians. International medical graduates entering into a U.S. medical training program can be overwhelmed by the applications, education, and cultural experiences. Written in cooperation with the Educational Commission for Foreign Medical Graduates (ECFMG) and the American College of Physicians (ACP), The International Medical Graduate's Guide to US Medicine & Residency Training is a practical guide featuring information and guidance on the application process, residency training in the United States, the U.S. medical culture, certification, and beyond. Providing an overview of residency training and life in the United States, this book breaks down the education process, focusing on such key areas as: Selecting and Applying to Residency Programs Language and Communication Administrative, Financial, and Regulatory Issues Patient Care Assessment, Certification, and Licensure Up-to-date information, strategies, resources, and reference tools further assist the reader in the U.S. medical training process. An additional section is devoted to acclimating to U.S. culture, providing information on culture, finances, day-today living, and much more. Chandler, K. (2002). First Aid For The International Medical Graduate. New York, NY: McGraw Hill. Perhaps because this book was written by an IMG, it contains some of the most practical and down to earth advice of any of the IMG guidebooks. However, the reader should be aware that a great deal of the information about USMLE examinations, ECFMG Certification, ERAS, and the Match is quite dated and has many errors; those organizations and their websites should be referred to directly for up-to-date information. Nonetheless, the sections on obtaining visas, strategies on where to apply, tips for interviewing, and advice on practical issues and getting settled make this quite a valuable resource. It also contains a fair amount of clinical material that might be better referenced from standard clinical texts. Finally, it contains a good bit of information about progressing through a 68

residency and career plans following training. Overall, recognizing that this book is sometimes unbalanced, perhaps reaching too far in its clinical aspirations, and contains outdated and erroneous information regarding examinations and applications, it is still, on balance, worth reviewing for the positive sections noted. It is probably most useful for the IMG with the least familiarity with the issues; others may find it too basic. Livingston, M. (2005). Newcomer's Handbook: For moving to and living in the USA. Portland, OR: First Books. This book is not specifically directed at IMGs and therefore contains no information about adjusting to U.S. medical education or healthcare, but nevertheless is a valuable resource for anyone who has arrived recently in the United States. Math, K. (2008). Surviving Residency: A Medical Spouse Guide to Embracing the Training Years. IUniverse. The author and founder of the International Medical Spouse Network addresses the challenges faced by couples during the time of residency. This book provides practical tips for dealing with residency schedules and demands, managing finances, work-from-home jobs, raising children, and locating a medical spouse network in the local area. Also included are helpful websites and outside sources. Sotile, W.M. & Sotile, M.O. (2000). The Medical Marriage: Sustaining Healthy Relationships for Physicians and Their Families. American Medical Association Press. This book is a useful tool for helping families proactively create a successful medical marriage and family relationship. Along with tools for self assessment and case narratives, the author provides explanation of key issues and potential challenges that typify marriage and family relationships in which one or both partners are physicians.

REFERENCES American Medical Association. Graduate Medical Education Directory. Chicago, IL: AMA Press. Best known as the ―Green Book,‖ this is the definitive hardcopy source of accurate information about graduate medical education (GME). Published annually, it includes general requirements for GME programs as well as special requirements for each individual specialty and a listing of all accredited GME programs. The listings provide information about the number of positions, 69

institutional affiliations, contact information, and program identification numbers for use in the NRMP Match. This book is generally available in most medical libraries and even in some larger public libraries. McMahon, G. (2004). Coming to America - International Medical Graduates in the United States. New England Journal of Medicine. 350(24), 2435-2437. In this article, the author shares his account of his experiences as an IMG in the United States. Contributions of IMGs to the U.S. medical community are examined, as well as aspects of language barriers and adjustment to life in the United States.

Sorti, C. (1994). Cross-Cultural Dialogues: 74 Brief Encounters With Cultural Differences. Yarmouth, MA: Intercultural Press. Cross-cultural differences are explored in this work as the author examines the following 10 cultures: Arab/Middle Eastern, British, Chinese, French, German, Hispanic, Indian, Japanese, Mediterranean/European, and Russian. This book is a good resource for locating ways that cultural norms are breached though a series of conversations.

APPLICATIONS Association of American Medical Colleges. Roadmap To Residency: From Application to the Match and Beyond. Washington, DC: AAMC. Created to provide information to all applicants to U.S. medical residency programs, this invaluable publication is updated annually. It is used as a primary source of information by almost all U.S. medical students and their advisers and includes a description of candidacy requirements, factors involved in specialty choice, possible criteria for residency selection, and information about matching processes, program visits, and potential application outcomes, as well as about the transition from medical school to residency. Although it is directed primarily toward U.S. students, it does provide some specific and useful information and advice for IMGs. Iserson, K.V. (2003). Iserson’s Getting Into A Residency: A Guide For Medical Students. (7th ed.). Tuscon, AZ: Galen Press. Now in its seventh edition, this book is a highly useful and reliable source of both information and advice about obtaining GME positions. Probably the most practical of the available guides, it contains a small, but helpful section on IMGs.

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PERSONAL ACCOUNTS Baer, L.D. (2003). Doctors in a strange land: The place of international medical graduates in rural America. Lexington Books. Drawing from the author’s study of IMGs in two small, rural communities, this work highlights the significance of gender, religion, race, and language in rural America’s reaction to and acceptance of IMGs as physicians in their communities. Collins, M. (2005). Hot lights, cold steel: Life, death and sleepless nights in a surgeon's first years. New York, NY: St. Martin’s Press. This memoir of the author’s residency at the Mayo Clinic offers insights into peer relationships and patient empathy. Although the book is centered on the patients the author treats and the lessons he learns along the way, the seriousness is balanced with humor about his family life. Fadiman, A. (1997). The Spirit catches you and you fall down. New York: Farrar, Straus and Giroux. This anthropological study of a Hmong refugee family's experiences with the U.S. health care system is a brilliant illustration of the clash between two fundamentally different belief and social systems. This account provides examples of successes and failures at communicative attempts by all parties involved including the patient, doctors, and social workers. The author shows the reader the views and assumptions of both the Hmong family and the U.S. health care workers, which led to stereotyping and misunderstanding. Jauhar, S. (2008). Intern: A doctor's initiation. New York: Farrar, Straus and Giroux. This book is a popular read in the United States. Narrated by a cardiologist, this work outlines many of the crises faced during his residency at a New York City hospital. This honest perspective provides the reader with a glimpse into the humanity of medicine when the author himself becomes a patient. Marion, R. (2001). The Intern blues: The timeless classic about the making of a doctor. New York: HarperCollins. This book is comprised of diary entries from three residents. It provides a thought-provoking account of the daily life of the medical resident. Also included are narratives concerning their impressions of medical encounters, burn out, and fatigue.

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Transue, E.R. (2004). On call: A doctor's days and nights in residency. New York: St. Martin. An internal medicine resident’s transition from intern to physician is traced in this work through a series of patient journals. This book might prove helpful in understanding patients’ thought processes. Verghese, A. (1995). My own country: A doctor’s story. Random House Books. Reading Group Guide http://www.readinggroupguides.com/guides/my_own_country.asp The story of an IMG’s journey through U.S. training and practice, Dr. Verghese writes of his experience as an infectious disease specialist in rural America just at the time that HIV-AIDS began to appear. Well-written and very readable, it is a personal story with a lot of insight into the process of entering into U.S. medicine and becoming comfortable with a very new and different culture.

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(Mercy Hospital 2010) (Moses Taylor Hospital 2010) iii (Community Medical Center Healthcare System 2010) ii

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