DEPARTMENT OF SURGERY University of Kansas School of Medicine – Wichita

2014-2015

Surgery Manual

TABLE OF CONTENTS Residency Staff / Contact Information Current Residents Responsibilities Overview Unassigned Surgery Rotation Supervision Competencies Work Hours Leave Policy / Time off Resident Travel Moonlighting Educational Goals Research Call System

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THE DEPARTMENT OF SURGERY FOLLOWS ALL OF THE POLICIES AS DESCRIBED IN THE WCGME POLICY HANDBOOK. THE INFORMATION IN THE SURGERY MANUAL IS MEANT TO EXPAND ON THE POLICIES IN THE WCGME MANUAL AS THEY MAY PERTAIN TO THE DEPARTMENT OF SURGERY.

BRIEF WCGME POLICY MANUAL TABLE OF CONTENTS General Information / Benefits Requirements Other WCGME Staff KU – Wichita GME Policies

Section A Section B Section C Section D Section E

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IMPORTANT CONTACT INFORMATION

Alex D. Ammar, M.D.

Chairman

Jacqueline S. Osland, M.D.

Program Director

Jack L. Shellito, M.D.

Assistant Program Director

James Haan, M.D.

Assistant Program Director

Via Christi – St. Francis Campus:

316-268-5990 phone 316-291-7662 fax

929 N. St. Francis, #3082 Dawn Fountain Email: [email protected]

Residency Program Coordinator

Ashley Vopat Email: [email protected]

Assistant Program Coordinator

Steve Helmer, Ph.D. Email: [email protected]

Research Scientist Direct Phone Line 316-268-5457

Rachel Drake, M.Ed. Email: [email protected]

Research Associate Direct Phone Line: 316-268-6049

Wesley Medical Center:

316-962-2245 phone 316-962-7231 fax

550 N. Hillside Rhonda Franssen Email: [email protected]

Coordinator 3

RESIDENTS 2014-2015 PGY 1

PGY 2

Obi Agborbesong Jamie Ball Clint Gates Blake Spitzer Brandon Stringer Brady Werth Mitch Unruh

Omar Almoghrabi Sarah Corn Paige Harwell Omar Hasan Scott Stoeger Jered Windorski

PGY 3

PGY 4

Chris Gartin Eric Glendinning Tricia Hill Michelle McGuirk Aaron Nilhas Clint Rathje

Ben Johnston Ben Jordan Lance Larson Adam Misasi James Summers Mark Wolfe

PGY 5 Austin George Tanya Kajese Kendra Kamlitz Rey Morales PJ Stiles Brandt Whitehurst

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RESPONSIBILITIES OF SURGICAL RESIDENT Conference BE ON TIME FOR CONFERENCES and be sure to sign in. Dress professionally. No jeans, shorts, sandals, facial jewelry other than earrings etc.….. Attend conferences. When possible, place relevant x-rays for M&M presentations into a PowerPoint presentation. You should attend all conferences unless a patient’s critical or serious condition requires you presence. Education Read at least a major textbook of surgery in its entirety twice during a five-year residency period. The resident must take initiative for their own education; ask questions when appropriate. It is an expectation of the program that you score greater than 30th percentile on the annual ABSITE (American Board of Surgeons In-service Training Exam). If this is not met, a remedial program will be assigned for you. Failure to score above 30th percentile on a repeated basis may result in probation or termination. It may lead to a delay in your privilege to sit for the American Board of Surgery exam pending further remediation. OR/Patient Care Be on time for operations. The patient must be seen prior to going to the operating room for pre-op history and physical. You should have examined all available x-rays and data. Read about and have knowledge of the case pre-operatively - including the natural history, diagnosis, treatment options, anatomy, surgical technique, steps of the operation. Review the x-rays and other available tests and information prior to the operation or conferences. These tests should be available in the OR and for conferences. The senior resident must supervise the junior resident; i.e. the senior should personally make rounds daily on all patients. The senior resident must supervise the medical students; i.e. assign their cases the night before at the latest. Notify the attending surgeon of any significant change in the patient’s status. i.e. need for CT scan, hypotension, etc. After paging a staff physician, wait at least 3 minutes prior to leaving the line. Round on each patient each day before the operative schedule begins. Treat peers, students, nurses, secretaries and other personnel in a professional manner at all times. Intensive care patients need to be seen at least twice daily. Respect patients and their privacy. Ask patient’s permission prior to performance of an examination or procedure. (Note: This should include an explanation of a procedure if not previously discussed)

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Be available to scrub on all cases unless more than one case is going on at the same time. Addendum: If a major case cannot be covered on the service, the attending surgeon should be notified the evening before. In addition, if a major case (i.e. colon resection, esophageal surgery, stomach surgery, liver, spleen, mastectomy, endocrine and vascular) cannot be covered by the senior resident on the service, he or she should notify the attending surgeon the evening before and explain the reason. The junior resident should scrub on all cases on the service unless another case is going on at the same time or other responsibilities (conferences) supersede, regardless of whether the senior resident is also scrubbed on the case. If an attending surgeon contacts a specific resident, that particular resident should take care of the problem and report back to the attending surgeon. He should not ask a more junior resident to accept this responsibility, unless specified by the attending surgeon. The junior resident is encouraged to assist in the evaluation. The resident should be available to make rounds with the attending surgeon unless scrubbed or attending a required conference. Residents must participate in outpatient activity, including the unassigned clinics as well as outpatient surgery center cases, and participation in clinics at offices of various attending surgeons. The RRC requires ½ day per week of clinic for all residency years, with few exceptions based on service type. Medical Students Residents are important to the education of medical students and must participate in their education and evaluation. Medical students are to be notified of operations, traumas, or consultations while on call. Medical students are to round with residents before the operative schedule begins and as needed in the afternoon. They should be informed of their assigned cases, the night before at the latest. Timekeeping Timekeeping is done online using New Innovations (www.new-innov.org). You should try to keep track of your time online on a daily or weekly basis. All time must be entered in no later than the 1st of the following month. Medical Records Timely dictation of H&P’s, operative reports, and discharge summaries. (H&P’s 24 hours, operative reports - 24 hours, discharge summaries - one week) The resident discharging the patient is responsible for performing the discharge summary. Residents who have excessive delinquencies may have their paycheck held and/or be required to sit in front of the GMEC committee. Case Logs Record operative cases and outpatient activities in the ACGME Resident Case Log System. This is an internet-based data collection system that you can access at www.acgme.org. The system was designed to permit residents to enter procedures on a regular basis at their convenience. Cases need to be entered weekly. This is your affidavit to the ABS proving your candidacy for board certification. If you do not keep up with your case records, you will be placed on a remediation program. This is a professionalism breach. M&M Conference M&M’s should be submitted to Dawn ([email protected]) by Friday afternoon the week before conference. Please include the following information: Patient Initials / Age / Sex / Operation / Complication / Summary. Residents in each year have been assigned weeks which they will present M&M’s. PGY 4 & 5 residents should present a minimum on 2 cases and PGY 1-3 should present a minimum on 1 case on these weeks. If you do not have an important complications to present on these weeks, please pick your most interesting or educational case. This is a

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MINIMUM requirement, you are encouraged to turn in cases in addition to this requirement. Dr. Osland reserves the right to have you present again the next week if your presentation is not well-prepared. Step III WCGME policy states that you must have passed your Step III by June 30th of your PGY-2 year, therefore THE DEPARTMENT OF SURGERY REQUIRES THAT ALL PGY-1 RESIDENTS TAKE STEP III BEFORE THE COMPLETION OF THEIR PGY-1 YEAR. Bumping Rules Fifth year residents may bump residents in years 1 – 3 without limits. Fifth year residents may bump a fourth year resident for a maximum of 6 cases per rotation. Between 2 fifth year residents, the unassigned chief resident will have first priority in bumping a particular case. The resident being bumped must be notified by the chief resident bumping the case by 6pm the preceding day. The resident who bumps the case must perform all the perioperative care and check the patient out to covering residents only when necessary to comply with duty hour regulations. Evaluations Resident reviews with Dr. Osland are held twice a year (October / April) Please take time to fill out the on-line evaluations for your faculty, rotation and other residents. Your completion of evaluations is monitored bi-monthly by the residency office and also at the quarterly peer review meetings.

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UNASSIGNED ROTATION Unassigned surgery service is covered by the 5th year residents – with the only exceptions being end of June and the ACS meeting in October when all of the 5th years are gone. The 5th year is responsible for all decisions on these patients and all lines, ER visits, consults and admissions for the unassigned service must be discussed with the unassigned resident. Unassigned surgery patient designation includes any patient the referring primary doctor or ER doctor designates as unassigned. The chief resident is responsible for the unassigned service at all times unless specifically checked out to another 5th year resident. The 5th year will require assistance from other residents for line placements, ER patients, consults etc. however the patient should not undergo operative or major invasive procedures without the chief’s hands on assessment. Cases will include: Anorectal examination under anesthesia Appendectomy – Laparoscopic Appendectomy – Open Axillary node dissection Breast Biopsy Cholecystectomy – Laparoscopic Colonoscopy Dialysis catheter placement Esophagogastroduodenoscopy Herniorrhaphy – Inguinal (open) Herniorrpaphy – Umbilical (open) Incision and drainage of pilonidal and perirectal abscess Line placement Lumpectomy Modified radical mastectomy PEG placement Porta-cath placement Sentinel node biopsy Skin grafts Wound debridement or excision of hydradenitis Open gastrostomy Exploratory laparotomy, lysis of adhesions Hickman catheter Inform attending of all admissions and consults promptly. If attending is not present prior to induction of anesthesia, call the attending to let them know the patient is going to sleep. Describe the case briefly and your operative plan. Notify the attending after the case is completed. If the attending is not present at the case, have a very low threshold for calling them to the OR immediately should you encounter any significant challenge or difficulty.

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SUPERVISORY LINES OF RESPONSIBILITY FOR THE CARE OF ALL PATIENTS The attending surgeon has the ethical and legal responsibility for the overall care of the individual patient and the supervision of the resident involved in the care of the patient. If the surgeon is checked out, the surgeon who is providing coverage becomes responsible. On specific rotations, there may be one or two (junior and senior) residents responsible for patient care. If there is one resident on the rotation, he is supervised by the attending surgeon (s). If there are two residents, the junior resident is also supervised by the more senior resident. Proper supervision should not conflict with progressively more independent decision making on the part of the resident. A chain of command that emphasizes graded authority and increasing responsibility as experience is gained must be established. Judgment on this delegation of responsibility must be made by the attending surgeon based on his direct observation and knowledge of each resident’s skills and ability. Surgery residents are not allowed to start an operative procedure in the OR suite without the attending surgeon being present within the institution, other than in an absolute emergency. See the WCGME policies manual, page E10, for additional information on resident supervision.

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GENERAL COMPETENCIES Residents are expected to obtain competencies in the 6 areas below to the level expected of a new practitioner 1. Patient Care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health 2. Medical Knowledge regarding established and evolving biomedical and clinical sciences and the application of this knowledge to patient care 3. Practice-Based Learning and Improvement that involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care 4. Interpersonal and Communication Skills that result in effective information exchange and teaming with patients, their families, and other health professionals 5. Professionalism, as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population 6. Systems-Based Practice, as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value

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RESIDENT WORK HOURS Work hour assignments must recognize that faculty and residents collectively have responsibility for the safety and welfare of patients.

Work Hours

a. Work hours are defined as all clinical and academic activities related to the residency program, i.e., patient care (both inpatient and outpatient), administrative duties related to patient care, the provision for transfer of patient care, time spent in-house during call activities, and scheduled academic activities such as conferences. b. Work hours must be limited to 80 hours per week, averaged out over a 4 week period, inclusive of all in-house activities. This is monitored and tracked monthly by the residency office. c. Residents are provided with 1 day in 7 free from all educational and clinical responsibilities, averaged over a 4 week period, inclusive of call. Days off need to be reflected on your timecard. (Vacation days DO NOT count as days off.) d. Adequate time for rest and personal activities are provided. This consists of a minimum of 10 hour time period between all daily duty periods and after in-house call, with a few exceptions. e. Interns must limit daily duty periods to 16 hours with a minimum 10 hour time period between duty periods. f. Residents must have 14 hours free of duty after a 24 hour shift.

On-Call Activities

The objective of on-call activities is to provide residents with continuity of patient care experiences throughout a 24 hour period. In house call is defined as those work hours beyond the normal work day when residents are required to be immediately available in the assigned hospital. a. In-house call occurs on Friday, Saturday and Sundays. The Night Float residents cover evenings during the week. b. Continuous on-site duty, including in-house call, must not exceed 24 consecutive hours. Residents may remain on duty for up to 4 additional hours to participate in didactic activities, transfer care of patients, conduct outpatient clinics, and maintain continuity of medical and surgical care. c. No new patients may be accepted after 24 hours of continuous duty. d. At-home call (pager call) is defined as call taken from outside the assigned institution. 1. The frequency of at-home call is not subject to the every third night limitation. However, at-home call must not be so frequent as to preclude rest and reasonable personal time for each resident. Residents taking at-home call are provided with 1 day in 7 completely free from all educational and clinical responsibilities, averaged over a 4 week period. 2. When residents are called into the hospital from home, the hours residents spend in the hospital are counted toward the 80 hour limit. 3. The program director and the faculty will monitor the demands of at-home call and make scheduling adjustments as necessary to mitigate excessive service demands and/or fatigue.

See the WCGME policy manual, section E2 for additional information on Duty Hours / Work Environment.

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LEAVE POLICY A Resident Leave Request Form MUST be completed anytime a resident is going to be absent from their assigned rotation. This form is to be completed for vacation leave, education leave, sick leave and leave without pay. Time off needs to be requested accurately, and in a timely manner. This form must be turned into the Surgery Education office BEFORE time is taken (except for sick leave). When there are two residents assigned to a service, only one resident may be gone at a time. No vacation time is allowed on the night float rotation, the trauma rotation or the unassigned rotation. Vacations during the period from June 15th – July 15th will be granted by the program director only under special situations. No more than one week may be taken per rotation. This includes time taken for vacation, education leave, interviews, or presentation of an accepted paper at a conference. Obtain the signature of the other resident on the service (if applicable); obtain the signature of the index surgeon for the service prior to approval by the Program Director. Signed request must be turned into surgery education office and approved by the Program Director PRIOR to your leave. You will be notified by the surgery education office if your request is denied.

Sick leave (cumulative – 30 days maximum)

Call the attending surgeon on your teaching panel as well as the surgery education office. After 2 consecutive days of sick leave, you are required to be seen by a physician. (Not another resident)

Vacation

15 weekdays (Non-cumulative) No vacation is allowed while the chief residents are attending ACS conference in October. Vacation is allowed from June 15 to July 1 for PGY 5 residents if all vacation days have not been used. Chief residents can take up to 2 weeks off at the end of residency. This can include vacation and up to one week unpaid leave.

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LEAVE POLICY (CON’T) Interviews 3 days (Non-cumulative) The program supports our residents who are pursuing fellowships or finding a practice. Residents are given 3 days off for interviews. Other days will be allowed by the program, however residents must use vacation time to cover the additional days off. Scheduling interviews while on trauma or unassigned service is discouraged and requires the prior approval of the program director.

See the WCGME policy manual, sections A1 & A2 for additional information on Time off.

Although WCGME policy allows for more time off, the department of surgery limits time off to a maximum of 4 weeks a year. This is due to the fact that in order to be accepted into the certification process, the American Board of Surgery REQUIRES that applicants obtain “no

fewer than 48 weeks of full-time surgical experience in each residency year.”

MOONLIGHTING GUIDELINES Moonlighting is only allowed if a resident takes vacation to moonlight. Eligible PGY 3-5 may moonlight with signed permission from the Program Director and adherence to the moonlighting guidelines. Eligibility requirements for moonlighting: Satisfactory academic and clinical performance ABSITE score >50th percentile Research in good standing: PGY3 – data collection completely collected or in act of enrolling patients in prospective study. PGY4 – 1st draft of manuscript submitted to our surgery department PGY5 – research requirement of final, complete manuscript completed and submitted for publication. See the WCGME policy manual, section E for additional information on Moonlighting/Locum Tenens.

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RESIDENT TRAVEL The following guidelines are provided as a quick reference to the Policy on Travel Authorization and Reimbursement. •

Travel must be approved in advance of travel by the Program Director, NO reimbursement will be made for travel which is NOT approved in advance.

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When possible residents will be expected to share rooms.

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You MUST submit your expense report and all travel receipts to Surgery Education within 14 days after completion of travel to obtain reimbursement.

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Reimbursement will be made on the basis of single accommodations (spouse expenses are NOT INCLUDED IN ALLOWABLE EXPENSES).

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Original, itemized receipts must be submitted along with a department expense report to obtain reimbursement.

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To secure the hotel room in advance, you must use your credit card.

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There will be NO reimbursement for car rental unless approved in advance.

Approved Expenses: Registration fees Airline tickets Lodging costs based on single occupancy (hotel recreational services or in room movies are not covered) Hotel internet access charges (if applicable) Meals (based on actual cost plus gratuity up to a maximum of $40.00 per day – alcoholic beverages excluded). Tips (reasonable meal tips not to exceed 15% are included in the $40/day per diem). Taxis (to an from airport, between hotel and meeting site)

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EDUCATIONAL GOALS OF THE PROGRAM The goal of the University of Kansas School of Medicine – Wichita General Surgery Residency Program is to prepare the resident to become a highly competent surgeon who is board certified. This goal is attained by means of a progressively graded curriculum of study and clinical experience under the guidance and supervision of the faculty. Progression continues through succeeding stages of responsibility for patient care, culminating in complete management of patient care at the senior / chief level. 1. Use sound judgment to guide surgical decision making based upon a firm ethical base. 2. Manage surgical disorders based on a thorough knowledge of basic and clinical science. 3. Attain and perfect surgical skills necessary to be a competent surgeon. 4. Communicate effectively with patients and their families regarding life altering decisions. 5. Respect the cultural and religious needs of patients as it pertains to their surgical care. 6. Collaborate effectively with colleagues, residents, medical students and other health care providers. 7. Teach patients and their families about the patient’s health needs. 8. Provide cost-effective care to surgical patients and families within the community. 9. Value life-long learning as a necessary prerequisite to maintaining surgical knowledge and skill.

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RESEARCH REQUIREMENTS All residents entering into the General Surgery Residency program of the University of Kansas School of Medicine – Wichita, Department of Surgery are required to complete at least 1 publishable paper. The requirement is met when the manuscript is polished to the level of publication quality. The manuscript must be submitted to the Research Scientist or Chairperson of the Department of Surgery Research Committee no later than January 1st of the residents 5th year or there may be a delay in the resident’s receiving their program certificate. Scope of the Research ProjectsThe research projects initiated must be approved by the Surgery Research Committee, and should be processed through the Surgery Research Scientist, Stephen D. Helmer, Ph.D. The research projects shall be either prospective or retrospective studies in order to fulfill the research requirement. All research projects must be approved by the UKSM-W Human Subject’s Committee (HSC2) and specific hospital IRB’s where implemented. Projects that have not received HSC2 and IRB approval will not be approved toward fulfilling the research requirement. Fulfillment of the Research RequirementA research project will only fulfill part of the resident’s research requirement under the following conditions: 1. The project must be completed to the satisfaction of the Surgery Research Committee Chairman. 2. The data must be analyzed and a manuscript written. 3. The manuscript that results from the research project must be submitted to an approved journal of the Surgery Research Committee. 4. The Research Committee recognizes that we cannot guarantee the acceptance of a manuscript by a journal. We require that the manuscript be submitted to an acceptable journal, not that it be accepted in order to fulfill the research requirement, although we do hope for all manuscripts to be accepted.

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Deadlines – 1. Residents are required to have completed ½ of the surgery research requirements by the end of their third year, with the other ½ of their research initiated to the level of at least a formal written IRB proposal. 2. If this requirement is not met, the resident may be placed on probation for six months, and/or be required to take mandatory research leave that will be made up in July after completion of their 5 years of residency. 3. Dr. Osland will not sign the American Board of Surgery application for any chief that does not have their research completed. The ABS application deadline is May 1st and late application deadline with an additional $200 fee is the end of May. Determining Credit for a research projectGenerally, only one resident will obtain credit for their research requirement from any given research project. Therefore, if more than one resident participates in a given research project, the involved residents must determine at the outset who will obtain credit for that project. Typically, this is the resident who is primarily responsible for writing the project proposal and then the manuscript that arises as a result of the research project. Exception: the exception to this rule is where it is anticipated at the outset that the project in question will generate sufficient data that it will result in more than one publication. If this is the case, then each resident who writes a manuscript from the data generated by said project can obtain credit toward fulfillment of the research requirement. However, the Surgery Research Committee must concur at the outset of the project that it will generate sufficient data to justify completion of 2 manuscripts or otherwise justify giving credit to 2 residents for the study.

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CALL SYSTEM TRAUMA:

St. Francis

2 teams 1. Chief (4th) and Junior (2nd) cover trauma on alternating 24 hour shifts Sunday through Friday. 2. Intern shift runs 7am to 5pm Monday – Friday. 3. Duties: team does new trauma admits and trauma clinic, trauma consults are done by chief. 4. Trauma team on call Friday round on Saturday morning and takes pages on all existing in-house trauma patients all day Saturday. Saturday Coverage: Call team 1. Chief : 4th Duties: New traumas, trauma consults, help juniors if necessary with lines/consults/uncovered surgeries 2. Midlevel : 2nd (3rd if necessary) Duties: New traumas, floor consults, outpatient burns/admissions, supervise intern, uncovered OR cases. 3. Intern Weekend Call: 1st Shift runs Saturday from 6am to 8pm and then Sunday 7am to 5pm. Duties: New traumas, help out with any uncovered cases, admissions, consults as necessary. 4. Intern Night Float : 1st Shift runs from 5 pm to 6 am Monday through Saturday nights. Exception is Wednesdays which start at 7 pm – if skills lab is scheduled, the intern will come in at 6pm Tuesday and not start Wednesday until 9pm. Duties: ER/Unassigned admissions, uncovered OR cases, help midlevel with consults. Call team takes pages on all new trauma admits throughout the day on Saturday until the trauma team comes in on Sunday morning.

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NIGHT FLOAT:

Midlevel : 2nd year – Sunday through Thursday 5 p.m. to 7 a.m. Wednesdays 7 p.m. to 7 a.m. Duties: new floor consults, supervise intern with lines, etc, outpatient burns/admissions, late OR cases. Intern : 1st year – Monday through Saturday 5p.m. to 6 a.m. Wednesdays 7 p.m. to 7 a.m. Duties: ER/Unassigned admissions, late OR cases, help with trauma if available.

BURN:

1. It is recommended but not required that the burn resident come in for all new admissions (major burns) Monday through Friday and Weekends unless off for the weekend. 2. Night Float can see outpatient burns after 5:00 p.m. and on weekends. 3. Midlevel on call does burn admissions when burn resident is off for weekend. They must be supervised by the chief.

UNASSIGNED:

5th year unassigned (chief) resident: 1. In House Duties: See all new admissions, round on patients, schedule/operate on all unassigned patients. **Surgeries are NOT to be scheduled if chief will be out (vacation, etc) and are only to be scheduled for the chief that saw the patient.** 2.

Clinic Duties: Wesley - Wednesdays 3 p.m. to 5 p.m. new patients, follow up St. Francis – Monday and Thursday 1 p.m. to 3 p.m. New patients, follow up In special circumstances, will help out with Trauma Clinic

1st year anesthesia or general surgery intern: Help chief at St. Francis and have same in house and clinic duties Coverage: After 5 p.m. and weekends: In house on call residents see new patients / consults, chief then sees at appropriate interval. 19

Weekends off/Vacation: No elective vacation on the unassigned service All absences must be cleared in advance by Dr. Osland, including meetings and presentations. Coverage of this service must be performed by a 5th year resident. The only exception will be for the American College of Surgeons meeting and the last 2 weeks of June.

Wesley Medical Center FLOAT COVERAGE (call):

Friday 5 p.m. to 7 a.m. and Sunday 7 a.m. to 5 p.m. (same person) Saturday 7 a.m. to 7 a.m. 3rd year – in house alone all year long, no home backup 2nd year – in house alone all year long, must have home backup by the unassigned surgery chief on call for the weekend. Intern to work 7am-9pm Saturday, after 10 hours off, work Sunday 7am to 5pm. 1st year – must be backed up by an in house upper level all year long.

NIGHT FLOAT:

Midlevel : 3rd year – Sunday through Thursday 5 p.m. to 7 a.m. Wednesdays 7 p.m. to 7 a.m. Duties: ER admissions/unassigned, consults, late OR cases. ________________________________________________

CALL REQUESTS

Scheduled and approved vacation will take priority Excessive requests cannot be honored REMEMBER: you are allowed (owed) 2 weekends off – if it is a 5 weekend month, you should be working 3, not taking 3 off. Thus, if you get scheduled for 3 weekends of call in a five weekend month, this DOES NOT represent excessive call scheduling. 20

CLINIC Via Christi Panel A 5th year – Ammar clinic Wed AM/PM 3rd year – Ammar clinic Wed AM/PM Dr. Ammar requests that you switch off each week (each resident working one whole clinic day every other week) Panel B 4th year – Osborne clinic Wed PM 1st year – JL Smith clinic Mon PM Panel C 5th year – Beamer clinic Thurs AM 1st year – Beamer clinic Thurs PM Panel D 5th year – Sanchez clinic Wed AM 2nd year – Sanchez clinic Wed PM Panel E / Breast Resident works 4 half day clinics per week Osland clinic Tuesday AM/PM Cusick clinic Monday & Wednesday AM/PM

Wesley

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