University Of Utah General Surgery Residency Handbook
University of UtahGeneral SurgeryResidency HandbookRevised June 2020
Table of ContentsIntroduction . Page 3Section 1: Policies . Page 4Section 2: Clinical Responsibilities . Page 5Section 3: Educational Responsibilities . Page 8Section 4: Administrative Responsibilities . Page 10Section 5: Academic Actions . Page 12Section 6: Resident Assessments . Page 13Section 7: Leaves of Absence . Page 15Section 8: Professional Development . Page 20Section 9: Travel. Page 22Section 10: Pregnancy and Lactation . Page 24Section 11: Moonlighting . Page 27Page 2 of 27
IntroductionWelcome to the University of Utah General Surgery Residency. Over the next 5-7 years, you willparticipate in various aspects of the training program. The purpose of this handbook is toprovide you with information that will help you to navigate the program. This handbook isbroken down into sections to make it easier for you to find the information you need. It wouldbe impossible to address every aspect of being a resident, so if something is not included in thehandbook it still can be considered an important part of the program.This handbook is also meant to be a “living” document, so please provide feedback on itscontents to the Program Director’s office. If there are any questions regarding the handbook,please contact the Program Director’s office.Page 3 of 27
Section 1: PoliciesAs a resident at the University of Utah, you have two distinct roles. One is that of a learner,which is covered by most of this handbook. The second is that of an employee of the Universityof Utah. As an employee, you are bound by the policies of multiple entities, including: University of UtahUniversity of Utah School of MedicineSchool of Medicine Graduate Medical EducationUniversity HospitalIntermountain HealthcareIntermountain Medical CenterPrimary Children’s HospitalVeterans Administration Medical CenterEach of these entities has policies that describe what is expected of an employee, what isexpected of a trainee, grievance processes, etc. All of these policies are available online or fromthe Human Resources office of the given entity. It is your responsibility to know and complywith the policies as outlined. Where areas of this handbook differ from policy, it is usually in theform of being more generous. If you have questions regarding policy, please contact theProgram Director’s office, the Graduate Medical Education office, or Human Resources.Page 4 of 27
Section 2: Clinical ResponsibilitiesThere may be some variability with regards to the guidelines listed below, based on therotation expectations. If there is no listed expectation for the resident, then the guidelinesbelow apply.It is the resident’s responsibility to know the clinical responsibilities of a rotation. These aretypically located in the Goals and Objectives document in the Learning Management System(Canvas). For teams with multiple members, the most senior resident is the leader of the team.This person is responsible for orienting team members to the service, setting schedules forclinical work (rounds, clinic, operating rooms), and assuring that all patients are being cared forin the best way possible.Most services also have Advanced Practice Clinicians (APC) as part of the team. APCs may havedifferent roles on a service. It is the responsibility of all residents to establish a good workingrelationship with the APCs and to seek guidance from the APC with regards to the structure ofthe service. It is highly recommended that the resident meet with the APC when they start arotation to establish lines of communication, roles and responsibilities, and review howattending surgeons like to be notified about their patients.Admissions/consults: Patients can be admitted to Acute Care Surgery, a designated surgical service, or toanother service with consultation to general surgery Patients must be seen in a timely fashion. This can be either a medical student, juniorresident, or senior/chief resident The senior/chief resident must be made aware of all admissions/consults within onehour of them being seen by a student/junior resident Every admission must be staffed with an attending surgeono Residents do not have admitting privileges and thus must staff patients with theresponsible faculty membero Either the junior or senior/chief resident can review the patient with theattending surgeon Documentation must be completed within 12 hours of admission/consultationo An exception is patients who need urgent/emergent operative intervention;these patients need documentation completed prior to going to the ORDaily patient care: Every patient will be seen by a resident and/or a faculty member each day A progress note is required every day Any resident on the team can staff a patient with the attending surgeono If a resident operated on a patient, they are encouraged to staff the patient withthe attending surgeonPage 5 of 27
o The senior/chief resident is still responsible for knowing and approving the planfor the patientTests and consults: A senior/chief resident can initiate tests and consults at the discretion of the attendingsurgeon A junior resident should get approval of the attending surgeon before ordering tests orconsultsChange in patient status: The attending surgeon must be notified in a timely fashion if there is a change in thepatient status. This includes:o Transfer to a higher level of careo Potential for development of a life-threatening conditiono Need for urgent return to the operating room In a truly life-threatening situation (e.g. exsanguinating patient or respiratory failure), aresident may initiate transfer to an intensive care unit or operating room while at thesame time assuring notification of the attending surgeon.Documentation: Operative notes will be completed the day of surgery and will be signed by the residentwithin 24 hours History and Physical exams and Consults will be completed within 6 hours of admissionand signed by the resident within 24 hours of admissiono Exception being an urgent/emergent operation Daily progress notes will be completed by 7 PM and signed by the resident the day theywere completed Discharge summaries will be completed within 24 hours of discharge and signed within48 hoursCommunication with patient family members: Residents may be asked to update family members This can be done with the approval of the attending surgeon Please be aware of HIPPA rules and assure that those you are communicating with havethe approval of the patient or have a HIPPA exemptionHIPPA: There is policy to address all HIPPA questions and concerns Some that need to be stressed:o Do not talk about patients in public placeso Email communication with protected health information (PHI) should have PHI inthe subject line, with no identifiers in the subject linePage 6 of 27
o Text messaging is not HIPPA compliant and identifiable PHI should not be sentvia text Smart Web is HIPPA compliant and can be used to send PHIo PHI will not be placed on social mediao Photography that is sent to the cloud is a violation of HIPPA An exception is photography that has no PHI and is being used for clinicaldecision making (e.g. a wound for a faculty member to review).Electronic medical record (EMR) There are multiple policies that apply to the EMR Some that need to be stressed Do not look at charts where you are not a responsible provider Do not let others use your log in If you walk away from a computer, log offWhat to do if you have to miss clinical duties (e.g. illness) Everyone has the potential to get ill or have an emergency that requires them to miss aday or two of work If this happens to you, you have the responsibility to notify The residents on your team that you will not be at work The faculty educational lead of your service that you will not be at work If you will need to miss call, notify the administrative chief resident If you are going to miss more than 2 days,o You will need to notify the program director’s office and the administrative chiefresidento If you are going to miss 7 or more days, you will need to check with the GMEoffice to set up FMLA (per U of U FMLA policy)Page 7 of 27
Section 3: Educational ResponsibilitiesThe education program in general surgery is designed such that there is a rotation-basedprogram, a residency-based program, and your own personal program. It is your responsibilityto maintain and keep up to date in all three areas. As to specific parts of the program: Rotation-based programo Each rotation has goals and objectives for which you are responsibleo You will work with the rotation education lead to assure that you are meetingthese objectiveso It is important that you know what the objectives are, as you will be assessedbased on the objectiveso Each rotation has service educational activities in which you will participateResidency-based programo The weekly curriculum is an important part of the residencyo Each of the following are elements of the program: Grand Rounds M&M Indications Wednesday didactics Simulation Non-clinical sessionso Due to current circumstances with COVID 19, these sessions will be held using avirtual format.o You are expected to attend all of these sessions, unless a special dispensationhas been made based on a unique educational opportunity on a rotationYour personal programo There is no way that an education system can provide all of the information youneed to succeed academicallyo You will need to have a personal education plano This should be done in conjunction with your mentor and/or the ProgramDirector’s officeo Recommend updating plan every six monthso Things to consider when developing a plan Resident readiness assessment ABSITE Performance on rotations Performance in conferences Your own perceived needsOther education itemso In-Training Exam (ABSITE) Every resident is expected to take the ABSITE every year in training,including during the professional development yearo SimulationPage 8 of 27
oooo Simulation activities can be part of rotation or program-based education If a simulation is arranged, it is expected you will attendFundamentals of Laparoscopy (FLS) PGY-1 residents will complete FLS by November of their PGY-1 year The residency will pay for the first attempt at FLS If the PGY-1 fails the first attempt, (s)he is responsible for expensesrelated to retestingFundamentals of Endoscopy Curriculum (FEC) All PGY-2 residents will complete the FEC This includes the knowledge test and the Fundamentals of EndoscopicSurgery (FES) practical test The residency program will pay for the first attempt at FEC/FES Any expenses related to re-testing will be the responsibility of theresidentRobotic Surgery All residents will complete the basic program in robotic surgery Online course Basic simulation exercises Docking and bedside assist Residents who are interested in pursuing robotic surgery are expected tocomplete Phase 2 of the robotic curriculum Residents can receive an equivalency certificate from the residency, touse for robotic privileges Once the Fundamentals of Robotic Surgery (FRS) is implemented, it willbe incorporated into the robotic surgery curriculumFundamental Use of Surgical Energy Incoming PGY-1 residents are expected to complete the FUSE programeither prior to starting residency or during the first three months of thePGY-1 year There is no requirement to complete the FUSE exam, though residentsare highly encouraged to do soPage 9 of 27
Section 4: Administrative ResponsibilitiesAs a resident, you have certain administrative responsibilities as they relate to clinical care androtations.Work hours: The ACGME has outlined the policies as they apply to work hours and you are directedto their website for more information You will submit your work hours into the residency management site, Medhub, on aweekly basis Do not “pre-submit” your hours Work hours must be kept up to date, defined as no more than seven days past due Failure to log work hours, falsification of work hours, or repeated delay in reportingwork hours puts you at risk for receiving an academic action, as outlined in a separatesection of this handbookOperative Case Logs: The American Board of Surgery requires residents to keep a case log It is both the program’s and your responsibility to assure that you are on target to meetrequired graduation case numberso Residents should be familiar with the case requirements, which can be viewedon the American Board of Surgery website The residency program utilizes the ACGME case log system to generate case log reports Residents will log all cases into the case log system Expectations, based on the ABS requirements:o Residents will log a minimum of 250 cases by the end of their PGY-2 yearo Residents will log 40 critical care cases in the seven categories, as defined by theABS, by the end of their second yearo Residents will log all non-operative trauma cases in the case log systemo Residents will log a minimum of 450 cases by the end of their PGY-3 year Cases should be entered on the day they are performed The expectation is that the case log will be no more than 14 days out of date Failure to maintain and check your operative log puts you at risk for receiving anacademic action, as outlined in a separate section of this handbookEvaluations Evaluations are critical to both programmatic improvement and personal growth Residents are responsible for evaluations of rotations, faculty members, students, andother residents Evaluations must be completed within seven days of completing a rotation or workingwith a student We will be continuing an internal, anonymous evaluation every 6 monthsPage 10 of 27
Failure to complete evaluations puts you at risk for receiving an academic action, asoutlined in a separate section of this handbookSurveys There three required surveys each year, put out by theo ACGMEo U of U GME Officeo Division of General Surgery Program Evaluation Committee Each of these surveys are important to the program maintaining accreditation Failure to complete these surveys in a timely fashion puts you at risk for receiving anacademic action, as outlined in a separate section of this handbookPage 11 of 27
Section 5: Academic ActionsThe formal process for academic actions is provided in policy by the Graduate MedicalEducation office and can be found on Pulse. To summarize, there are various types of actionsand one does not have to follow another. Academic actions are decided upon by a vote of thefaculty members with the action and expectations authored by the Program Director’s office.Every academic action may have activities that need to be completed, suspension of othertypes of activities, limits on participation in extracurricular activities, or other items that aredeemed important to address. These actions, in order of seriousness, are: Informal email notificationo This is meant to put the resident on notice that something needs to be done,such as case logs or work hours.o This is not reportable to licensing agencies and medical boardsFormal email notificationo This is more serious action and is used if the activity or behavior is recurrent ormore serious, such as professionalism issues, including not logging cases, workhours or completing evaluations or surveys in a timely fashion.o This is not reportable to licensing agencies and medical boardsLetter of Concerno This is an action that is coordinated with the GME officeo It is reviewed by the GME committee lawyero There will be a case laid out as to why this action is necessaryo Defined expectations that are measurable will be includedo There will be a timeline associated with completing the action itemso This is included in your permanent file and may become part of the letter sent tolicensing agencieso It is not a reportable action when applying for a medical license or hospitalprivilegesProbationo Similar to a letter of concerno This is reportable for the rest of your career Every job Every credentialing request Every medical licenseDismissalo This can be a contract non-renewal, or it can mean being dismissed from theprogramo This is a reportable action, similar to probationDue Processo If you decide to appeal an academic action, there is a process outlined in theGME policy on academic actionsPage 12 of 27
Section 6: Resident AssessmentsAssessments are a way of receiving feedback on your performance. While assessments can bestressful, they are part of becoming the best surgeon you can be.Assessment Process: The assessment process is a combination of clinical, professional, and administrativeobservationso Clinical Based on rotation goals and objectives ABSITE Conference performanceo Professional Communication skills Leadership abilities Getting your work (clinical and administrative) done Showing a commitment to patients, where patient needs supersedeeverything except for critical family needso Administrative Completing all of your tasks based on the timelines in Section 4. Being prepared to teach on rounds and in conferences Completing activities to which you have volunteered or have beenassigned PGY-1 and PGY-2 residents will meet with a member of the Program Director’s officetwo times each year:o November and May PGY-1 and PGY-2 residents are expected to meet with their mentors at least twice eachyearo August and February PGY-3 and higher residents will meet with a member of the Program Director’s officetwice yearlyo November and May Formal Assessmento Residents will be assessed by the Clinical Competency Committee twice yearly November and Mayo Residents will be assessed for contract renewal and advancement at the end ofFebruary Informal Assessmento Residents will be discussed and reviewed at the Graduate Education Committee(GEC) PGY-1 and PGY-2 residents will be reviewed four times/year PGY-3 and higher residents will be reviewed twice/yearPage 13 of 27
Residents can also be reviewed more frequently based on their standingin the programAcademic actions can be given to a resident at any time, based on the residentperformance in the programo Please refer to Section 5 for academic actions and due processPage 14 of 27
Section 7: Leave of AbsenceThere are many different types of leave that you may require during your residency. There isUniversity of Utah policy for nearly all of them, and some are covered under the GME contractyou signed when you joined the residency. Some of the leaves described below are moregenerous than that provided by the University. If you have any questions about leave, FMLA,etc., please contact the Program Director’s officeTime requirements for the ABS: Per the ABS, there are specific requirements for time in trainingo During the first three year
The education program in general surgery is designed such that there is a rotation-based program, a residency-based program, and your own personal program. . As to specific parts of the program: Rotation-based program o Each rotation has goals and objectives for which you are responsible o You will work
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Jennifer S. Schwartz, MD Assistant Professor of Surgery Department of Surgery Division of General & Gastrointestinal Surgery The Ohio State University Wexner Medical Center Robotics in General Surgery Objectives Brief History of Robotics in General Surgery Robotic General Surgery
Jennifer S. Schwartz, MD Assistant Professor of Surgery Department of Surgery Division of General & Gastrointestinal Surgery The Ohio State University Wexner Medical Center Robotics in General Surgery Objectives Brief History of Robotics in General Surgery Robotic General Surgery
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