img survival guide - The Wright Center

IMG SURVIVAL GUIDE
WCGME
IMG SURVIVAL GUIDE - TABLE OF CONTENTS
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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
2
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
3
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!
4
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 .
1
Adopted from Mercy Hospital’s Website at http://www.mercyhealthpartners.com/facilities.asp
5
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
6
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
7
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.
8
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
9
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.
10
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
11
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
12
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
13
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.
14
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
15
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.
16
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
17
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.
18
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.
19
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.
20
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
21
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.
22
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
23
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.
24
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
25
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
26
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)
27
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
28
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.
29
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.
30
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
31
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.
32
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)
33
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
34
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.
35
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
36
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/
37
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.
38
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
39
(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
40
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
–
-
Day Nursery Association
332 Jefferson Avenue, Scranton, PA – (570) 342-9397
41
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.
42
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.
43
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.
44
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.
45
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.
46
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.
47
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.
48
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.
49
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.
50
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.
51
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
52
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.
53
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.
54
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.
55
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.
56
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.
57
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.
58
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]
59
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.
60
© The Joint Commission, 2010. Reprinted with permission.
61
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
63
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].
65
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
66
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.
67
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.
70
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.
71
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.
i
(Mercy Hospital 2010)
(Moses Taylor Hospital 2010)
iii
(Community Medical Center Healthcare System 2010)
ii
72