MCV Campus Department of Surgery Resident Handbook and Policies

2011 -2013 VIRGINIA COMMONWEALTH UNIVERSITY HEALTH SYSTEM Department of Surgery We are pleased that you have chosen the Virginia Commonwealth University Health System for your graduate general surgical education and look forward to providing you a rewarding educational experience. The staff in the Surgical Education Office looks forward to working with you and is available to assist you.

James P. Neifeld, MD Stuart McGuire Professor and Chairman, Department of Surgery th West Hospital, 16 Floor, West Wing 827-1033

Brian J. Kaplan, MD Residency Program Director th West Hospital 7 Floor, West Wing Surgical Oncology 828-3250

Jeannie Savas, MD Associate Residency Program Director VA Medical Center, Surgical Services 112 General Surgery Services 675-5112

Susan Haynes, MSW Educational Administrator th West 16 Floor, West Wing 828-1141

Cindi Phares, C-TAGME Residency Coordinator West Hospital 16th Floor, East Wing 828-2755

Doris Farquhar, MBA Graduate Medical Education Consultant th West Hospital 16 Floor, West Wing 827-1030

Christina Lozada Administrative Assistant th West Hospital 16 Floor, North Wing 628-2435

Diane Hundley Clerkship Coordinator th West 16 Floor, East Wing 827-1032

Rahul Anand, MD Clerkship Director West 16th Floor, East Wing 827-1032

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Table of Contents Section

Page

Departmental Welcome Chairman’s Message Program Directors Message Affirmative Action/Equal Employment Policy Mission Statement Resident Acknowledgement of Receipt of Handbook and Policies Department of Surgery Contract Numbers Department of Surgery Goals and Principles Scope of General Surgery Training Educational Oversight Surgical Education Committee (SEC) Academic Review Committee (ARC) Resident Council Resident Assessment of Performance Cause for Dismissal and/or Disciplinary Action Probationary Status Remediation Suspension - Clinical and/or Program Dismissal Dismissal During or at the Conclusion of Probation Summary Dismissal GME Appeals and Grievance Policy GME Appeals Process Departmental Appeal Appeal to the Associate Dean for Graduate Medical Education Appeal to the Dean Grievance Policy and Procedure Informal Resolution – Step I Informal Resolution – Step II

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Formal Resolution Department of Surgery Policies and Expectations Selection Process Eligibility Requirements Expectations of Residents Operating Surgeon, Education and Trust Evaluations Minimum Operative Case Volume Duty Hours Fatigue Duty Hours Scope & Responsibility Monitoring Duty Hour Requirement for All Residents Duty Hour Attestation Oversight Taxi Vouchers Moonlighting Fitness for Duty Sexual Harassment Professional Attire Meal Tickets Operative Log Resident as Teachers of Junior Residents and Medical Students ABSITE Mentor Program On-Call Activities Call Rooms Pagers Virtual Pagers Resident Pagers Faculty Pagers

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Clinical Education and Supervision of Residents General Principles Site Specific Supervision Inpatient Teaching Service Clinics and Consult Services Operating Rooms Skills Lab Lines of Supervision Cumulative by Year and Procedures Appropriate by Level Supervisory Lines of Responsibility Supervision of Residents PGY-1 PGY-2 PGY-3 PGY-4 PGY-5 Activities and/or Procedures Appropriate by PGY-Level PGY-1 PGY-2 PGY-3 PGY-4 PGY-5 Conferences Attendance Resident Conferences Departmental Conferences Divisional Conferences Conference Presentation Protocol D&C Conference D&C Ground Rules D&C Weekly Schedule Basic Science Conference

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Intern Noon Case Conference Evaluations Patient Care Medical Knowledge Practice Based Learning and Improvement Interpersonal and Communication Skills Professionalism Systems-based Practice Evaluations of Residents Evaluations of Faculty Evaluations from Patients Resident Self Evaluation Annual Program Evaluation by Resident Leave Policies Leave Forms Absence from Clinical Duties Unexcused Absence Travel Academic Leave Travel for Interviewing Authorization Sick Leave Vacation Family Medical Leave (FML) FML – Maternity Leave Policy Paternity Leave Bereavement, Extended Illness/Injury/Jury/Witness Duty/Military and/or Personal Leave American Board of Surgery Requirements for Time in Training General Information

Autopsies

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Advanced Directives Families Occupational Exposures McGuire VA Medical Center

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CHAIRMAN’S MESSAGE Welcome to the Department of Surgery at the Virginia Commonwealth University Health System and Medical College of Virginia Hospitals. Your life as a general surgery resident will offer you many opportunities for growth educationally, socially, and in maturity. The Department of Surgery has prepared this handbook to provide useful information in a compact, readily accessible format; we hope that this information will save you time and aid you in your work. As Chairman of the Department of Surgery, I look forward to working with you and helping you to learn, teach, and attain your potential. Sincerely, James P. Neifeld, MD Stuart McGuire Professor and Chairman, Department of Surgery

PROGRAM DIRECTOR’S MESSAGE Welcome to the Virginia Commonwealth University Health System, Medical College of Virginia Hospitals General Surgery Residency Program. Because the Department of Surgery will be your home for the next several years, we’ve developed this manual to help make your lives a little easier. This manual contains our expectations of residents in the program and also provides a quick reference for the multitude of services that you will need to make use of during your residency years. In our program you will have the opportunity to work with clinicians who are at the forefront of their professions and to participate in operations that are performed at few other medical centers in the country. While the acquisition of clinical knowledge and technical skills are vital in patient care, compassion and genuine concern also have a profound impact upon patients and their families. Brian J. Kaplan, MD Professor of Surgery and Program Director in General Surgery

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AFFIRMATIVE ACTION/EQUAL EMPLOYMENT POLICY In agreement with the policies of the Virginia Commonwealth University Health System (VCUHS) and the Medical College of Virginia Hospital (MCVH), the Department of Surgery is committed to basing judgment concerning the admission, education, and employment of individuals upon their qualifications and abilities and affirmatively seeks to attract to its faculty, staff and study body qualified individuals of diverse backgrounds. In accordance with this policy and as delineated by federal and Virginia law, VCUHS and MCVH does not discriminate in admissions, educational programs, or employment against any individual on account of that individual’s sex, race, color, religion, age, handicap national or ethnic origin, or sexual orientation. Our policy is committed to affirmative action under the law in employment of women, minority group members, handicapped individuals, special disabled veterans, and veterans of the Vietnam era. For information write to Brian J. Kaplan, MD Program Director Department of Surgery 1200 East Broad Street P.O. Box 980135 Richmond, VA 23298-0135

MISSION STATEMENT The Department of Surgery at VCUHS will serve the people of Virginia through national leadership in surgical science, patient care and education. The Department is committed to exemplary clinical care and clinical investigation. The Department will be steward of our traditions of compassionate and competent care. The Department will equip a talented cadre of young physicians with the skills of inquiry, analysis and communication to achieve roles of leadership as lifelong scholars and clinicians. The Department will accomplish its mission in an atmosphere of collegial mutual respect and support for all elements of the University, its faculty and staff. The Department will manage its affairs in conscientious recognition of our mission and its relation to a changing world and continuously seek ways to improve the quality of work, our processes and our people.

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Resident Acknowledgement of Receipt of Handbook and Policies. As a resident in the General Surgery Program I acknowledge receipt of the Handbook which includes departmental protocol, policies, and procedures that must be followed as part of my training program. By my signature below, I acknowledge receipt of such policies and will review the Resident Handbook and will abide by the Departmental, Hospitals and University requirements throughout my training at VCUHS.

Department of General Surgery Residency Handbook and Policies available on the VCUHS Surgery web-site http://www.surgery.vcu.edu Virginia Commonwealth University Health System policies available on the VCUHS GME website http://www.medschool.vcu.edu/gme/policies/index.html

Resident Acknowledgement of Receipt of Handbook and Policies By my signature, I acknowledge receipt of the general surgery resident handbook and policies. I will abide by the Departmental, Hospitals and University policies and procedures as outlined in the Departmental Handbook and VCUHS GME Handbook. I will review the handbook by August 15, 2012.

________________________________

______________

Signature

Date

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Department of Surgery Contract Numbers Administration James P. Neifeld, MD, Chairman Brian J. Kaplan, M.D., Vice Chairman for Education Donna Hensel, Assistant to Chair Sherry Elliott, Interim Financial Administrator Debbie Nicholas, Faculty Support Coordinator

827-1033 828-3250 827-1033 827-1035 828-8290

Educational Programs Susan Haynes, Educational Administrator Doris Farquhar, Educational Consultant Cindi Phares, Residency Coordinator Christina Lozada, Administrative Assistant Diane Hundley, Clerkship Coordinator

828-1141 827-1030 828-2755 628-2435 827-1032

Divisional Chiefs Dr. Dr. Dr. Dr. Dr. Dr. Dr. Dr. Dr. Dr. Dr. Dr. Dr.

James P. Neifeld Vig Kasirajan James Maher Harry Bear Omar Abubaker Charles Bagwell Andrea Pozez Marc Posner Rao Ivatury Lance Hampton Mark Levy Jeannie Savas Rahul Anand

Dr. Brian J. Kaplan

Chairman Cardiothoracic General Surgery Oncology Oral Surgery Pediatric Plastic Transplant Trauma Urology Vascular VA Hospital Third Year Clerkship Director Associate Program Director Residency Program Director

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827-1033 828-2774 828-9516 828-9325 828-0602 828-3500 828-3033 828-9298 828-7748 828-5318 828-7749 675-5112 675-5112 . 828-3250 Cell – 344-3951

DEPARTMENT OF SURGERY GOALS AND PRINCIPLES This Handbook reinforces training requirements to which every surgical resident is subject. In addition, it attempts to clarify and detail any training requirements that are specific to the Virginia Commonwealth University Health System (VCUHS) General Surgical Residency Program. Residents are provided with a copy of this book at the beginning of every academic/post-graduate year. This Handbook is posted on the Department of Surgery website http://www.surgery.vcu.edu. Residents are asked to sign letters of acknowledgement that they are aware of the need to abide by these policies, and other specific acknowledgements including but not limited to the 80-hours (ACGME) Duty Hours Policy at the beginning of the post-graduate year. If any resident is aware of significant deviations to national or local surgical residency training guidelines they should immediately report these concerns to the Program Director or his/her designee. The Department of Surgery subscribes to the Virginia Commonwealth University Health System (VCUHS), Graduate Medical Education Institutional Policies and Procedures. Full details of the policies can be viewed at http://www.medschool.vcu.edu/gme/policies/index.html

SCOPE OF GENERAL SURGERY TRAINING The curriculum in surgery is comprehensive to include didactic, research, and clinical training and is highly interactive among residents, faculty and administration. The resources of the department include not only our faculty and extensive clinical environments but also teaching laboratories, research facilities and advanced computer facilities. In April 2009 our Minimally Invasive Surgery Center was designated an official Test Center for FLS Certification. The clinical training program is a "hands-on" experience. Residents participate in preoperative evaluation of patients, peri-operative experience, beginning in their internship year, and post-operative care and follow-up in outpatient clinics. All operative cases, outpatient and inpatient care are supervised by attending staff. Residents will gain experience in the Intensive Care Unit beginning in the first year. Our educational program exposes residents to a broad spectrum of acceptable alternatives and allows you to begin to evolve your own way of doing things allowing you to develop your own styles, which will continue throughout your surgical life. Taking care of a patient is a privilege, not a right. Residents are required to adhere to surgical discipline in an ethical fashion. Commitment to a patient's care does not merely imply an operative procedure. Preoperative evaluation and postoperative management are equally important. Residents are expected to communicate constantly with the appropriate faculty members. Senior residents participate in the education of junior residents. Weekly divisional conferences are led by senior residents who discuss interesting cases and share recent literature on the topic. Additionally, there is a weekly teaching conference for all residents to cover basic science and clinical surgical topics. All residents are expected to teach medical students.

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The curriculum has been designed to lead to the acquisition of an appropriate fund of knowledge and technical skills. Through graduated levels of responsibility you will develop the ability to integrate and acquire knowledge in clinical situations, and develop sound surgical judgment. Your clinical experiences, didactic sessions, education in procedural skills and operative techniques, and participation in scholarly activities will prepare you to function as a qualified practitioner and prepare you for a career of life long learning.

EDUCATIONAL OVERSIGHT The Surgery Education Committee (SEC) Charge: The Surgery Education Committee (“SEC”) will advise the Department on the planning, implementation and performance of its education programs. The Committee should be familiar with the institutional and regulatory policies of the general surgery, urology, plastic surgery, vascular surgery, critical care surgery and cardiothoracic surgery training programs. It is also the goal of the Department of Surgery that the process for educating M3 students would reflect the most modern, effective and efficient techniques with the best use of clinical resources. The Clerkship Subcommittee should also assure acceptable performance by our students on national examinations and should assure the students of adequate preparation for the ethical, scientific and clinical practice of medicine. The M3 Clerkship Subcommittee will have oversight of the clerkship curriculum and will review the curriculum annually using National Board Scores from the General Surgery exam and other sources as benchmarks. The M3 Clerkship Subcommittee will report to the SEC committee on curricular changes and any issues of concern. The SEC will also review the general surgery didactic curriculum and clinical rotations annually and make recommendations for improvement in the overall general surgery training program. Faculty members and/or the Program Director may refer concerns regarding resident performance on rotations to the SEC for discussion. The SEC will discuss current written documentation of a resident’s performance and may refer the matter for further review to the Academic Review Sub-Committee. The SEC should meet at least monthly and document minutes for the Departmental Executive Committee that meets monthly. The SEC shall include the directors or their designees from surgical subspecialty programs who have residents in the preliminary years of general surgery for their core experience and the M3 Clerkship Director. In addition, 2 resident representations are appointed to this committee. The SEC is co-chaired by the Department of Surgery Chairman and the Surgery Program Director. Ms. Fonda Neal, Residency Coordinator, will staff the meetings. The Academic Review Committee (ARC) Charge: The ARC, a sub-committee of the Surgery Education Committee, shall review resident performance concerns forwarded from the SEC and/or complaints. The ARC will review the academic record of any resident who has been recommended for review by the Surgery Education Committee. Upon review of resident performance, the ARC will vote on an action to be taken and the Program Director, a non-voting member, will notify the resident of the action that has been decided upon by the ARC. A resident may request to meet with the ARC to rebut unsatisfactory evaluations or letters in their file. The following are possible actions the ARC may recommend: 1. A warning (letter of concern) 2. Probation 3. Remediation

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4. Suspension from clinical duties and/or program activities 5. Dismissal The ARC will provide written documentation to the Program Director of their recommendations or decision. The Program Director will notify the resident in writing of the decision of the ARC. The resident may requests a meeting with the committee to rebut any statements. Documentation requesting such meeting will be provided to the Program Director. The ARC is comprised of 6 faculty representatives, chosen by the Chairman of the Department of Surgery, the Program Director and one resident representative. The Administrative Chief Resident shall be the resident representative. Dr. Kaplan, the Program Director, will chair the ARC as a non-voting member. The meeting shall be staffed by Susan Haynes, Educational Administrator. M3 Clerkship Subcommittee: The Clerkship subcommittee is made up of representatives from the various services in which medical students rotate through. Students spend four weeks on a general surgery service at MCVH or VAMC. Students may elect two subspecialty rotations where they spend two weeks on each subspecialty. Students are required to take the National Board of Medical Examiners Shelf Exam, which is part of their overall grade along with evaluations from the three services, and completion of required procedures outlined as part of the clerkship. The subcommittee meets each eight-week block to finalize student grades prior to filing them with the Dean’s Office. Residents are expected to participate in the teaching of medical students on services and serve as role models professionally. Resident Council: The Resident Council is comprised of one peer selected representatives from each level of training in the General Surgery Residency Program. The council meets periodically to discuss issues related to the education program or to make recommendations for improvement to the training program. A representative of the Resident Council will meet with Dr. Kaplan to discuss recommendations from the Resident Council.

RESIDENT ASSESSMENT OF PERFORMANCE The Department of Surgery follows the GME policies on resident assessment and performance. For full details on the VCUHS policy on Resident Assessment and Performance please refer to the GME web-site. http://www.medschool.vcu.edu/gme/policies/index.html In addition, all residents must read and adhere to the Department of Surgery Policy regarding assessment and performance which follows. Residency Program Assessment Policies and Procedures: The Program Director is responsible for monitoring the clinical and technical competence and professionalism of residents in the program. The Program Director will work in conjunction with the Surgery Education Committee (SEC) and the Academic Review Sub-Committee (ARC) to provide educational oversight for general surgery residents and medical students. The SEC membership is comprised of surgical education leaders for both the medical students and the surgical sub-specialties, the Department Chairman and two resident representatives. Membership for the ARC is comprised of other surgical education leaders in the department and one resident representative. The Program Director for general surgery is a member of both committees but serves as a non-voting member on the ARC. The primary responsibility of the SEC is to advise on the planning, implementation and performance of educational programs for medical students and general surgery residents. The SEC will

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support the Program Director in addressing concerns with regard to residents’ performance. The primary function of the ARC is to review issues of resident performance which the SEC has referred to the committee and make recommendations for action to the Program Director. Evaluations of general surgery residents will be completed by the teaching faculty addressing each of the six core competencies. Any evaluation that indicates below average or questionable behavior will be brought to the attention of the Program Director for close monitoring and/or discussion at the next SEC meeting. The Program Director has the responsibility for recommending promotion and certification based on faculty, nursing, peer, student, and patient evaluations. The Program Director is responsible for initial counseling of residents regarding any remedial or adverse action which may be needed. Residents will be evaluated on individual specialty requirements, program requirements, and compliance with policies at VCUHS, MCVH, VAMC, and other sites where residents may rotate. The SEC has the responsibility of oversight to ensure that these requirements are met. It is the responsibility of this committee to review, with the Program Director, any resident’s clinical, technical or professional performance which has been rated unsatisfactory. Should the committee feel that action is warranted, they may refer the matter to the ARC for their review. It is the primary responsibility of the ARC to review the performance of any resident who has been referred by the SEC and to make recommendations to the Program Director with regard to what specific action/s they deem appropriate. Where circumstances necessitate, the membership of the SEC and/or the ARC may be altered to avoid a potential conflict of interest, or to protect the privacy of the resident. Any of the following will be considered cause for dismissal and/or disciplinary action. • • • • • • • • • • • • • •

Failure to be present during duty hours or when on call. Intoxication or imbibing of alcohol or illicit drugs while on duty or on call. Conviction of a felony or violation of federal, state, or local narcotics law. Falsification of medical records. Repeated violation of Department rules after counseling. Patient neglect resulting in injury or harm to the patient. Performance of invasive procedures without appropriate authorization, except in definite life-threatening situations. Failure to maintain academic standards and educational requirements of the Department. Falsification of data on your application. Performing operating room procedures without proper attending supervision. Failure to give emergency help to all patients at all times throughout the hospital, regardless or whether or not that patient is on the service. Recommendation by faculty evaluation process. Repeated failure to answer pages during assigned duty hours. Repeated delinquent administrative responsibilities. (OP-Log, Medical Records, Duty Hours, etc.)

The following actions may be recommended. 1. Warning: A resident may be issued a letter of concern (warning), in writing, which should include the specific behaviors, performance issues, and /or incidents which warrant the warning and measures that can be taken to improve performance. The letter should also include notice that failure to establish improved performance may result in probation. Additionally, the letter will

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establish a timeframe in which the resident will be re-evaluated, usually 3 months. 2. Probation: A resident may be placed on probation and receive notification in writing and verbally in a meeting with the Program Director, the Department Chairman, or both. The written documentation of probation must contain the following. a) A statement of the grounds for the probation, including identified deficiencies, issues or problem behaviors; b) The duration of probation and a time-frame in which the resident will be reevaluated by means of written documentation which is ordinarily 3 months; c) A plan for remediation and criteria by which successful remediation will be judged; d) Notice that failure to meet the conditions of probation could result in extended probation, additional training time, and/or suspension or dismissal from the program during or at the conclusion of the probationary period; and e) Written acknowledgement by the resident in the form of a signature to verify receipt of the probation document. Probationary Status - If, at the end of the initial period of probation, the resident’s performance remains unsatisfactory, probation may be extended or the resident may be suspended or dismissed from the program. Probationary actions must be reported to the Graduate Medical Education Office and probation documents must be forwarded to the GME Office for review prior to being issued. 3. Re-mediation: A resident may be required to re-mediate a year or re-mediate specific rotations. The number of months required to right the deficiencies will be outlined by the ARC subcommittee in their report to the Program Director. 4. Suspension: A resident may be suspended from all clinical activities and/or suspended from all program activities. Clinical Suspension: A resident may be suspended from clinical activities by his or her Program Director, Department Chair, or by the faculty director of the clinical area to which the resident is assigned. Additionally, performance issues in the clinical area may be identified by the Chief of the Medical Staff and/or the Director of Graduate Medical Education. Action may be taken in any situation in which continuation of clinical activities by the resident is deemed potentially detrimental or threatening to patient safety or the quality of patient care. Unless otherwise directed, a resident suspended from clinical activities may participate in other program activities. A decision involving suspension of clinical activities of a resident must be reviewed within three working days by the department chair (or his or her designee) to determine if the resident may return to clinical activities, and/or whether further actions is warranted (including, but not limited to, counseling, probation, fitness for duty evaluation, or summary dismissal). Program Suspension: A resident may be suspended from all program activities and duties by his or her Program Director, Department Chair, the Associate Dean for Clinical Activities or Graduate Medical Education, or the Dean of the School of Medicine or Dentistry. Program suspension may be imposed for conduct that is deemed to be grossly unprofessional, incompetent, erratic, potentially criminal,

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or threatening to the well-being of patients, staff, or the resident. A decision involving program suspension of a resident must be reviewed within three working days by the department chair (or his or her designee) to determine if the resident may return to some or all program activities and duties and/or whether further action is warranted (including, but not limited to, counseling, probation, fitness for duty evaluation, or summary dismissal). 5. Dismissal: A resident may be dismissed from the program due to incompetence, impairment, or unprofessional behavior. Permanent dismissal will be preceded by suspension of a resident from all program activities for a minimum of three days, at the end of which time the resident will receive notification, in writing, of dismissal from the program. Such dismissal will be based upon written evaluations and/or letters notifying the resident of probation. Non renewal will be based on lack of improvement as outlined by program director in previous letters and probation letter as well as current evaluations. Dismissal During or at the Conclusion of Probation - Probationary status in a residency program constitutes notification to the resident that dismissal from the program can occur at anytime (i.e., during or at the conclusion of probation). Dismissal prior to the conclusion of a probationary period may occur if conduct, which gave rise to probation, is repeated or if grounds for Program Suspension or Summary Dismissal exist. Dismissal at the end of a probationary period may occur if the resident’s performance remains unsatisfactory or for any of the foregoing reasons. The GME office must be notified prior to the dismissal of any resident during or at the conclusion of a probationary period. The resident will be given a copy of the VCUHS GME Policy on Assessment of Performance where the Appeals Process is completely outlined. The Department of Surgery follows the VCUHS GME Appeals Policy on Assessment of Performance for dismissal, non-promotion, or any adverse action. Summary Dismissal - For serious acts of incompetence, impairment, or unprofessional behavior, a Department Chair may immediately suspend a resident from all program activities and duties for a minimum of three days and, concurrently, issue a notice of dismissal effective at the end of the suspension period. The resident does not need to be on probation, nor at the end of a probationary period, for this action to be taken. The resident must be notified in writing of the reason for suspension and dismissal, have an opportunity to respond to the action before the dismissal is effective and be given a copy of the GME Appeals Process. The GME office must be notified of the dismissal plan. Residents have the right to request to meet with the ARC to rebut unsatisfactory evaluations and/or appeal an adverse action which they have recommended pursuant to the Appeals and Grievance Policy for the General Surgery Program.

GME APPEALS AND GRIEVANCE POLICY GME Appeals Process - In the event a resident is not promoted, is dismissed from a program, or is the subject of any adverse action that is reported to the State Board of Medicine or a relevant specialty board, the resident may appeal such non-promotion,

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dismissal, or adverse action. Complete details of the GME appeals process can be viewed in full on the VCUHS GME web-site under Policies, Assessment of Performance. http://www.medschool.vcu.edu/gme/policies/index.html. The Department of Surgery subscribes to the following steps in the appeals process: Departmental Appeal - A resident may initiate a departmental appeal by submitting a written notice of appeal to the program director (with a copy to the GME office) within ten (10) working days of the date of the appealable action (hereinafter ‘adverse action’). The ARC will hear the department appeal, which ordinarily will be the same committee, which initiated the adverse action. If a faculty committee did not initiate the adverse action, the chair will appoint a departmental review committee. A departmental review hearing will be held within thirty (30) days following receipt of the notice of appeal. The protocol for the hearing is as follows: • The resident may select a faculty advocate to appear and participate on the resident’s behalf at the hearing. It is the responsibility of the resident to secure the participation of the faculty advisor. • Prior to the hearing, the resident must notify the program director of the number of witnesses (if any) the resident expects to call and whether the resident will be accompanied by a faculty advocate and/or legal counsel. • At the departmental review hearing, the program director (or his or her designee) will present a statement in support of the adverse action and may present any relevant records, witnesses, or other evidence. • The resident will have the right to present evidence, call and question witnesses, and make statements in defense of his or her own position. • Legal counsel may be present on behalf of the resident and the department but counsel will not be permitted to participate in the proceeding. • A record of the hearing will be kept by a court stenographer. • After presentation of evidence and arguments by both sides, the departmental committee hearing the appeal will meet in closed session to consider the adverse action. • The committee may uphold or reject the adverse action or may impose alternative action that may be more or less severe than the initial action. • The committee’s decision must be submitted to the resident within ten (10) working days of the close of the hearing. Appeal to the Associate Dean for Graduate Medical Education - If the adverse action is upheld by the departmental committee that heard the appeal or if the committee recommends alternative action that still is not acceptable to the resident, the resident may appeal the departmental committee’s decision by submitting a notice of appeal to the Associate Dean for Graduate Medical Education within ten (10) working days of the departmental committee’s decision. For procedural details please refer to the VCUHS GME policy on their web-site. Appeal to the Dean - Either the resident or the department chair may, within ten (10) working days of the decision by the Associate Dean, may appeal the decision of the Associate Dean to the Dean of the Medical School (or their respective designee) by written notice to the GME Office. The GME Office will notify the appropriate Dean (or designee) who will appoint an Appeals Committee composed of faculty members from other departments. The Appeals Committee will submit a written recommendation regarding the matter to the Dean within fifteen (15) working days of the closure of the Committee’s review. The Dean will review the recommendation of the Appeals Committee and accept or reject it

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within ten (10) working days. The Dean’s decision is final within Virginia Commonwealth University Health System. Grievance Policy & Procedure - The grievance policy and procedure is to provide a mechanism for resolving disputes and/or complaints which may arise between residents and their program director or other faculty members. Residents or fellows may appeal disagreements, disputes, or conflicts with their program using the GME Grievance Policy and Procedure. This grievance procedure does not cover controversies or complaints arising out of (1) termination of a resident/fellow during an annual contract period; (2) alleged discrimination; (3) sexual harassment; (4) salary or benefit issues. Complete details on the Grievance Process are available on the VCHUS GME web-site http://www.medschool.vcu.edu/gme/policies/index.html The Department of Surgery subscribes to the following steps in the grievance process: Informal Resolution - Step I - A good faith effort will be made by an aggrieved resident/fellow and the Program Director to resolve a grievance at an informal level. This begins with the aggrieved resident/fellow notifying the Program Director, in writing, of the grievance. This notification must occur within 15 calendar days of the event precipitating the grievance and should include all pertinent information and evidence that supports the grievance. Within seven (7) calendar days after notice of the grievance is given to the Program Director, the resident/fellow and the Program Director will set a mutually convenient time to discuss the complaint and attempt to reach a solution. Step I of the informal process of the grievance procedure will be deemed complete when the Program Director informs the aggrieved resident/fellow in writing of the final decision. A copy of the Program Director’s final decision will be sent to the Department Chair and to the Director of Graduate Medical Education. Informal Resolution - Step II - If the Program Director’s final written decision is not acceptable to the aggrieved resident/fellow, the resident/fellow may choose to proceed to a second informal resolution step which will begin with the aggrieved resident/fellow notifying the Department Chairman of the grievance in writing. Such notification must occur within 10 work-days of receipt of the Program Director’s final decision. This notification should include all pertinent information, including a copy of the Program Director’s final written decision, and evidence that supports the grievance. Within seven (7) calendar days of receipt of the grievance, the resident/fellow and the Department Chairman will set a mutually convenient time to discuss the complaint and attempt to reach a solution. Step two of the informal process of this grievance procedure will be deemed complete when the Department Chairman informs the aggrieved resident/fellow in writing of the final decision. Copies of this decision will be kept on file in the Chairman’s office and sent to the Director of Graduate Medical Education. Formal Resolution - If the resident/fellow disagrees with the Department Chairman’s final decision, he or she may pursue formal resolution of the grievance. The aggrieved resident/fellow must initiate the formal resolution process by presenting their grievance, in writing, along with copies of the final written decisions from the Program Director and Department Chairman and any other pertinent information, to the office of the Associate Dean of Graduate Medical Education within fifteen days of receipt of Department Chairman’s final written decision. Failure to submit the grievance in the fifteen-day time frame will result in the resident/fellow waiving his or her right to proceed further with this procedure. In this situation, the decision of the Department Chairman will be final.

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Upon timely receipt of the written grievance, the Associate Dean of Graduate Medical Education will appoint a Grievance Committee and will contact the aggrieved resident/fellow to set a mutually convenient time to meet. The Grievance Committee will review and carefully consider all material presented by the affected parties at the scheduled meeting. The Grievance Committee will provide the resident/fellow with a written decision within five days of the meeting and a copy will be placed on file in the Graduate Medical Education Office. The decision of the Grievance Committee will be final.

PROMOTION

The VCU Department of Surgery adheres to the policies as outlined by the VCUHS GME Office with regard to the promotion of residents from one level to the next. (http://www.medschool.vcu.edu/gme/ed_resources/policies/index.html) Residents commencing their post graduate medical education in 2009 and beyond, must pass Step 3 of the USMLE or NBOME in order to be promoted to the PGY 3 level. DEPARTMENT OF SURGERY POLICIES AND PROCEDURES VCU DEPARTMENT OF SURGERY Eligibility and Selection Policy The Department of Surgery subscribes to the Virginia Commonwealth University Health System, Graduate Medical Education Institutional Policies and Procedures. Full details of the policies can be viewed at http://www.medschool.vcu.edu/gme/policies/index.html

Selection Process:

All applications and other supporting material for the residency program must be submitted using the ERAS system. The VCUHS Department of Surgery deadline for receipt of applications is determined annually based on the NRMP deadlines. The following information is required: • • • • • • •

Completed Application Three (3) letters of recommendation from U.S. or Canadian physicians, including the Chair of Surgery or designee. Dean's letter (or equivalent), IMG's must have letters of recommendation which clearly document U.S. or Canadian clinical experience of at least 3 months direct patient care Medical school transcript Personal statement Results of standardized tests: Part 1, Part 2, CK, CS USMLE, NBME, FLEX, FMGEMS or equivalent; all in-service exams prior to beginning residency training Valid ECFMG certificate (IMG applicants)

After each interview session the faculty meet to rank candidates interviewed. After the three weekend interview sessions, faculty will compile the final rank list for submission to the match. Eligibility Requirements Applicants are expected to display a commitment to a career in surgery, strong analytical ability, good judgment, proven academic skill and be of sound moral character: In addition:

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• •

• •

All applicants must be within four years of graduation from medical school or direct patient care activity (either independent or ACGME, AOA, or ADA accredited residency) Non-clinical graduate work in the US or Canada does not meet this requirement. All applicants must have a minimum of three months of U.S. or Canadian direct patient care activity. For U.S. and Canadian Medical students, their clinical rotations during medical school will meet this requirement. For IMG's, externships of direct patient care will meet this requirement, observerships do not qualify. All applicants for residency at the PGY 1 level must have passed Step 1 and taken Step 2, CK, and CS of USMLE or NBOME/COMLEX prior to beginning residency. Prior to their first day of employment as a PGY1, all residents must have passed Steps 1 and 2 CK and CS of the USMLE or NBOME. All applicants for a residency program at the PGY2 level must have passed Steps 1 and 2 CK and CS of the USMLE or NBOME. All applicants for a residency program at the PGY3 level or higher must have passed Steps 1, 2 CK and CS, and 3 of the USMLE or NBOME. There is no minimum board score requirement. Any ECFMG certified applicant who has not been enrolled in a United States or Canadian residency program within eighteen months of being issued his/her ECFMG certificate must take the Test of English as a Foreign Language Exam (TOEFL) and obtain a score of at least 600 before beginning their residency. The Test of Spoken English (TSE) and Test of Written English (TWE) are also required. ECFMG certification is required before you will be accepted into the program; however, an interview can be granted without a certificate. All applicants must have sufficient written and spoken English language skills. Licensed to practice medicine in Virginia (or eligible). For additional information please go to the VCUHS GME policies webpage.

Under certain circumstances, with prior approval, VCU may accept a J-1 visa for an applicant who is not a US citizen.. EXPECTATIONS OF RESIDENTS It is expected that all residents: • Answer pages promptly • Respond courteously and appropriately to hospital physicians/house staff • Complete consults to the ER within one hour • Arrive to the clinics on time • Attend all mandatory conferences ( see conference section) • Complete administrative responsibilities in timely fashion

staff

and

consulting

Operating Surgeon, Education and Trust One of the main tenets of adult education is that the adult learner must take responsibility for, and be actively involved in, their own education. Every day, it is your responsibility to ensure that you are prepared to optimize your learning for that day. Patients must be seen and evaluated by the operating resident (and intern if possible) before the case begins. The operating resident should document this by placing a pre-op note on Cerner. Patients must also be evaluated by the operating resident postoperatively/prior to discharge for all

21

inpatient and outpatient surgery. This is critical to maintaining continuity of care and a sound educational process. It is expected that all residents participating in a procedure: • • •

Read about the case ahead of time and understand the indications Have a basic knowledge of technical anatomy and possible complications for all elective cases. Discuss with the responsible faculty any questions they may have.

Residents should make their best attempt to meet this same standard for urgent and emergency cases for the good of their patients as well as their own education. It is also expected that residents read about the co-morbid conditions of those on their inpatient service. Operative reports must be dictated immediately after the case is completed. Discharge summaries should be dictated at the time of or prior to patient discharge from the hospital. Dictations should be concise and accurate, including all relevant information only. Evaluations: Residents will be asked to anonymously evaluate each attending, chief resident and the service in general at the end of each rotation. Residents will be evaluated at the end of each rotation by faculty and nurses and periodically by patients. All residents will be asked to anonymously evaluate the program annually. Each year residents will evaluate the services they rotated on for a cumulative service evaluation to evaluate the educational value of each service. Chief residents are additionally asked to evaluate the program in writing anonymously prior to their departure. Minimum Operative Case Volume: Residents must complete a minimum number of cases to advance to the next year or have a favorable review. Minimum number of cases per year: PGY-1 50 PGY-2 170 PGY-3 300 PGY-4 250 PGY-5 200

Duty Hours

Duty hours and call schedules will be monitored by the program director and other program faculty. Duty 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. Duty hours do not include reading and preparation time spent away from the duty site.

22

Adjustments will be made, as necessary, to address excessive service demands and/or resident fatigue. Services must ensure that residents are provided appropriate backup support when patient care responsibilities are especially difficult or prolonged. There is a hotline, 827-LIFE, that is available to residents to report problems with duty hour compliance. Fatigue Awareness and Training: All faculty and residents must complete the SAFER (Sleep Alertness and Fatigue Training Education in Residency) training provided by VCUHS. Monitoring: 1.

Residents are required to swipe in and out with their VCUHS ID cards using the card readers associated with the Kronos System. Kronos card readers are located throughout the hospital. It is the resident’s responsibility to report duty hours in real time. When residents are rotating at sites other than VCUHS, they are to clock in and out following the directions below. Below are your instructions for calling into the Kronos System. • •

• •

Call "MCV-TIME" 628-8463 (area code 804). When prompted for Employee ID, use 6-digit Employee # plus last 4 digits of SSN (Your Employee # is found under "Personnel Data" in NI. Log in, go to "Main", click on drop down box, then "Personnel Data". Please remember to include your last 4 digits of your SSN or your will not be able to get into the system. Enter clock code "1" for beginning of work hours. Enter clock code "9" when leaving the hospital.

You do NOT need to enter the time of entry or departure as Kronos will automatically do this for you. 2. Prior to each 4-week block of rotation time, each resident is required to notify the Program Director if they are not scheduled for a minimum of 4 days off in a 4-week period. 3.

4.

It is important to remember that compliance with the ACGME Duty Hours Policy is everyone’s responsibility. If residents are aware that they or others will be in violation of the Duty Hours Policy due to scheduling, they must notify the Program Director immediately. Clinical-year advancement is dependant on honesty and integrity. All members of the Department of Surgery Residency Program will sign the Duty Hour contract specific to our department.

Specific Duty Hours Rules Maximum hours of Work Per Week Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities.

23

Mandatory Time Free of Duty Residents must be scheduled for a minimum of one day free of duty every week (when averaged over four weeks). At-home call cannot be assigned to these free days. Maximum Duty Period Length PGY 1 Residents Duty periods for PGY 1 must NOT exceed 16 hours in duration. PGY 2 and Above Residents Duty periods of PGY-2 residents and above may be scheduled to a maximum of 24 hours of continuous duty in the hospital. Strategic napping, especially after 16 hours of continuous duty and between the hours of 10:00 pm and 8:00 am is strongly suggested. It is essential for patient safety and resident education that effective transitions in care occur. Residents may be allowed to remain on-site in order to accomplish these tasks; however, this period of time must be no longer than an additional four hours. Resident must not be assigned additional clinical responsibilities after 24 hours of continuous in-house duty. In unusual circumstances residents, on their own initiative, may remain beyond their scheduled period of duty to continue to provide care to a single patient. Justifications for such extensions of duty are limited to reasons of required continuity for a severely ill or unstable patient, academic importance of the events transpiring, or humanistic attention to the needs of a patient or family. Under those circumstances, the resident must appropriately hand over the care of all other patients to the team responsible for their continuing care; and document the reasons for remaining to care for the patient in question and submit that documentation in every circumstance to the program director via e-mail. The program director must review each submission of additional service, and track both individual resident and program-wide episodes of additional duty. Minimum Time Off Between Schedule Duty Periods PGY 1 Residents PGY-l residents should have 10 hours, and must have eight hours, free of duty between scheduled duty periods. PGY 2 and above

24

Intermediate-level residents should have 10 hours free of duty and must have eight hours between scheduled duty periods. They must have at least 14 hours free of duty after 24 hours of in-house duty. PGY 4 and 5 Residents Residents in the final years of education must be prepared to enter the unsupervised practice of medicine and care for patients over irregular or extended periods. This preparation must occur within the context of the 80 hour, maximum duty period length, and one-day-off-in-seven standards. While it is desirable that residents in their final years of education have eight hours free of duty between scheduled duty periods, there may be circumstances when these residents must stay on duty to care for their patients or return to the hospital with fewer than eight hours free of duty. Circumstances of return-to-hospital activities with fewer than eight hours away from the hospital by residents in their final years of education must be monitored by the program director. It is the responsibility of the resident to e-mail the program director for each of these occurrences. The Review Committee defines such circumstances as: required continuity of care for a severely ill or unstable patient, or a complex patient with whom the resident has been involved; events of exceptional educational value; or, humanistic attention to the needs of a patient or family. Maximum Frequency of In-House Night Float Residents must not be scheduled for more than six consecutive nights of night float. Night float rotations must not exceed two months in succession, or three months in succession for rotations with night shifts alternating with day shifts. There can be no more than three months of night float per year. The total amount of night float for any resident over a five-year residency must be no more than 15 months. Maximum In-House On-Call Frequency PGY-2 residents and above must be scheduled for in-house call no more frequently than every-third-night (when averaged over a four-week period).

25

At-Home Call Time spent in the hospital by residents on at-home call must count towards the 80-hour maximum weekly hour limit. The frequency of at-home call is not subject to the everythird night limitation, but must satisfy the requirement for one-day-in-seven free of duty, when averaged over four weeks. At-home call must not be so frequent or taxing as to preclude rest or reasonable personal time for each resident. Residents are permitted to return to the hospital while on at-home call to care for new or established patients. Each episode of this type of care, while it must be included in the 80-hour weekly maximum, will not initiate a new “off-duty period”. Duty Hours Integrity The VCU General Surgery Residency Program takes the monitoring and compliance of duty hours very seriously. It is expected that at all times residents will practice integrity in representing the hours they are in the hospital on duty.

Surgical Resident Duty Hour Attestation As the issue of work hours gains importance, we need a system to more easily ensure all residents stay within the ACGME work hours restrictions. As such, we will begin the following standardization for surgical residents (and off service residents on our services): Intern call will cover 3 twelve hour shifts over the weekend, i.e. Saturday am, Saturday pm and Sunday day. For PGY 2 and above residents coverage will involve 24 hour call on Saturday and a 12 hour call on Sunday. Residents working 24 hour calls may not remain on duty longer than 28 hours (24 + 4). Night Float begins at 6:00 pm and ends 6:00 am except Thursday mornings for departmental conferences when it end at 9:00 am and resumes on Thursday night at 7:00 pm. Days when conferences are not held, clinical duties start at 6:00 pm. PGY 3 and 4 residents on NF must attend the Basic Science Conferences at 5:00 pm. Clinical duties resume after conference. These rules will help ensure adherence to the duty hour requirements revised July 2011. These regulations are not guidelines but are to be rigidly enforced requirements. The sole exception is for a senior resident (PG3-5) staying late to finish a case in the OR. That resident may stay up to an additional 3 hours (until 10pm) provided the Program Director is informed by email or telephone that evening and the resident delays her/his arrival the next morning by the same number of additional hours spent in the hospital the night before. (For example, a resident staying in the OR until 8:30pm to finish a case and leaving MCVH or VAMC at 9pm may not arrive the next morning before 8am.) This system of shifts will have some important consequences. As sign-out will gain importance, we must protect 2 important times each day. At 6am and 5pm, all residents

26

performing sign-out for their service should have a predetermined area to pass on important information to the services coming on. I anticipate this will take at least 30 minutes each day. Thus residents arriving on weekdays will not be able to begin rounding until 6:30am. If those same residents need to be in the OR at 7:15am or in clinic at 8am, they may not have time to thoroughly see every patient in the morning. Each service will need to adjust its workday around these new restrictions. I have read and will abide by the above rules. _________________________________signed

____________________date

Print Name: ________________________________________

27

Oversight - Each program must have written policies and procedures consistent with the Institutional and Program Requirements for resident duty hours and the working environment. These policies must be distributed to the residents and the faculty. Monitoring of duty hours is required with frequency sufficient to ensure an appropriate balance between education and service. Back-up support systems must be provided when patient care responsibilities are unusually difficult or prolonged, or if unexpected circumstances create resident fatigue sufficient to jeopardize patient care. Taxi Vouchers – Taxi vouchers are available for post call residents who feel they are not able to drive home. They may be found on the New Innovations website. These vouchers may be used to obtain taxi service from the hospital to the resident’s home and back to the hospital the next day. Any resident who is hesitant to drive home due to fatigue and/or lack of sleep is strongly encouraged to utilize this resource. MOONLIGHTING Because residency education is a full-time endeavor, the program director does not allow moonlighting so as not to interfere with the ability of the resident to achieve the goals and objectives of the educational program. Residents who have chosen one or two years in a research laboratory may moonlight, while they are in the laboratory, with the written authority of the program director. FITNESS FOR DUTY It is the responsibility of each resident to manage their behavior and conduct outside of duty hours in such a way as to avoid excessive fatigue or mental impairment while on duty. If a resident is identified by a faculty member as not fit for duty due to impairment or fatigue, the Program Director is authorized to suspend the resident from all clinical duties until further notice. Any action on the part of the resident to disregard the instruction of the Program Director may result in personal liability to the resident, extended suspension and/or possible termination from the program. SEXUAL HARASSMENT “Virginia Commonwealth University Health System (VCUHS) shall not tolerate any verbal or physical conduct by any member of the University community, which constitutes sexual harassment of any other University community member as outlined in the Federal Civil Rights Act of 1964.” A discussion of the above stated University policy, explanations of harassing behaviors, and an exposition of resolution procedures are outlined in the booklet “Policy on Sexual Harassment” published by the Department of Human Resources, VCU, and is available from the EEO/AA Services at 828-1347. The provisions of the VCUHS policy are applicable to house staff-faculty and all other interpersonal combinations regardless of the gender of the individual involved. For a copy of the booklet and for direction to the appropriate division of the University regarding formal and informal complaint procedures, call 828-1347. The policy is also distributed to each house officer at orientation. PROFESSIONAL ATTIRE House staff members, as practicing physicians and dentists in graduate medical education, shall observe the professional dress standards of the School of Medicine and Dentistry. Violations of these standards will be viewed by the administration as evidence that a house officer is not professional in his/her relationship to patients. VCU cards should be worn at all times. “Scrub attire” is allowed only in surgical areas, the emergency rooms, intensive care

28

units, labor-delivery-nursery areas, the burn unit, the cardiac “cathlab,” and other aseptic radiological areas. “Scrub attire” is not allowed outside the hospital, on general medicalsurgical floors, or on the first floor (including the dining area) unless covered by a professional coat or jacket. Caps, masks, and “booties” are never appropriate outside the defined areas. MEAL TICKETS Each resident will receive a monthly stipend for meals. This stipend will be credited to their University ID card via the Graduate Medical Education Office. OPERATIVE LOG It is the responsibility of each resident to keep an up-to-date log of all cases in which you were the operating surgeon, teaching assistant or first assistant. This log should include the patient’s name, MR#, age, diagnosis, date of procedure, procedure performed, CPT code and complications. ALL categorical, designated and undesignated preliminary residents in General Surgery are to enter their cases in the ACGME’s Resident Case Log System (www.ACGME.org). Each resident will be given a log-in name and password. For instructions on entering cases please view the tutorial available on the ACGME website under “Case Log Information”. Do not rely on the operating room or medical record for this data as it is your responsibility to keep accurate data on cases you participate in. Residents are expected to enter their cases on a weekly basis. The Program Director will review case entry information weekly. Any resident not up to date with entering cases may be removed from service and the OR until cases are entered. This log is required in order for you to successfully complete the program and be allowed to take your board examination.

RESIDENTS AS TEACHERS OF JUNIOR LEVEL RESIDENTS AND MEDICAL STUDENTS While much of any resident’s energy and effort is necessarily focused upon his/her own growth and education in his/her chosen field, residents are inevitably role models, especially for professionalism, in general surgery for all of the medical students and junior level residents with whom they come in contact. The relationship between on-call students and house officers is a uniquely close one; it provides unparalleled opportunities for one-on-one teaching. Small group education, whether it be didactic or demonstrational, such as with procedures both inside and outside the operating room, are good examples of such opportunity. An important part of the educational process is optimizing personal communication skills with both students, residents and patients, teaching them how best to communicate with one another. Practice-based learning is one of the 6 critical components of contemporary graduate education, and it needs to be exemplified in the undergraduate years. When a house officer demonstrates exactly how he/she does something and why he/she does it, this often becomes a wonderful educational experience for any student or junior resident and epitomizes practice-based learning. System-based practice involves a realization that the practice of medicine occurs in a vastly complex social and medical system in the United States, which is a system not

29

duplicated around the world. Understanding the greater context in which patients develop illnesses and/or in which patients seek corrective care or alleviation constitutes a very good example of system-based practice. Correcting a surgical abnormality only to return a patient to an unattainable or intolerable social situation could represent little help at all under this perspective. All surgery residents are expected to provide objective evaluations of the students’ performances rotating through the various services. Composite evaluations are completed by each service at the end of the student rotation and residents should meet with the service evaluating the students for objective input. Residents may have insight into acquisition of certain technical skills that should be evaluated. It is also important that residents realize that, as the whole medical educational process merges with an 80-hour duty week, student education becomes innately very demanding. Residents must realize that often third-year student surgery rotations are the first time that students have really been asked to perform in a serious and sustained way at the bedside. Helping them through that and realizing how much a positive impact could have been made on one’s own education will help residents become better role models. There is obviously a major expectation on the part of all the Program Directors and the Department Chairs that all of our residents play vital and important roles in medical education, and your performance in that area contributes significantly to the decision regarding your own levels of higher seniority within your residency program. Formal teaching awards are only the tip of the iceberg of first-class teaching—and learning. ABSITE All Categorical General Surgery Residents are expected to take the American Board of Surgery In-Service Exam (ABSITE). This exam is scheduled for the last Saturday each January. The expectation is that residents will receive a test score of 50% or higher. Any resident with a score of 35% or lower will be discussed at the Surgery Education Committee meeting and possibly placed in a structured tutoring program with a faculty member. MENTOR PROGRAM Each resident will be asked to select a mentor for the duration of their training. Interns are to notify the education office by October 1st whom they have selected to be their mentor. Residents are required to meet with their mentor at least twice annually or as often as needed to review their progress and discuss strengths and weaknesses. The mentor will complete an evaluation after review of your file and discussions with the resident. These evaluations will suffice as a semiannual review to assess your progress in the program. Residents must notify the program coordinator of meetings they have scheduled with their mentors so the coordinator can make the file and evaluations available at the time of the meeting. Should remediation be necessary the mentor plays a key role in developing a plan for the resident whereby improvement can be assessed and measured. Mentors also help residents prepare for presentations for local, regional and/or national meetings. It is the residents’ responsibility to set up meetings with their mentor throughout the year. 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 duty hours beyond the normal work day when residents are required to be immediately available in the assigned institution.

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a. In-house call must occur no more frequently than every third night, averaged over a four-week period. b. Continuous on-site duty, including in-house call, must not exceed 24 consecutive hours. Residents may remain on duty for up to six additional hours to participate in didactic activities, transfer care of patients, conduct outpatient clinics, and maintain continuity of medical and surgical care as defined in Specialty and Subspecialty Program Requirements. c. No new patients, as defined in Specialty and Subspecialty Program Requirements, 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 must be 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-house are counted toward the 80-hour limit. 3. The program director and the faculty must monitor the demands of at-home call in their programs and make scheduling adjustments as necessary to mitigate excessive service demands and/or fatigue. e. All call schedules are generated by the administrative chief resident f. All changes in the call schedule at any hospital must be authorized by the administrative chief resident and the service attendings and the Department of Surgery Program/Assistant Program Director. g. Senior Residents must be readily available at all times for consultation and patient care at night and throughout the year. Call Rooms Room

Dept Occupancy

Lock

CCH 2-405

Surgery

Workroom

CCH 7:D7-403

Acute Care Surg

Call

345

CCH 7:D7-405

Acute Care Surg

Call

CCH 8:D8-401

SURG: Burn

Call/Team

345 2405-both doors 513 call rm door

CCH 9:D9-141

Surg

Call

345

CCH 9:D9-407 CCH10:D10141 CCH10:D10407

Surg

Call

345

CSICU

Call

345

CSICU

call

345

M 4-601

GENERAL USE

Work-Kitchen-Lockers

None

M 4-602

GENERAL USE

Call

513

M 4-604

GENERAL USE

Call

513

M 4-606

GENERAL USE

Call

513

M 4-608

GENERAL USE

Call

513

M 4-610

GENERAL USE

Call

513

M 4-612

GENERAL USE

Call

513

M 4-614

GENERAL USE

Call

513

31

M 4-615

GENERAL USE

Male Handicap Shower

M 4-616

GENERAL USE

Call

M 4-617

GENERAL USE

Women’s Shower

513

M 4-618

GENERAL USE

Call

M 4-619

GENERAL USE

Male Shower

M 4-620

GENERAL USE

Call

M 4-621

GENERAL USE

M 4-623

GENERAL USE

Women’s Shower Women’s Handicap Shower

M 8-406

SURG: Women’s MedSurg

Team Room

521

M 9-129

SURG: Surgery

Library

PROX Swipe

M 9-247

SURG: Transplant

cc

24/3

M 9-249

SURG: Transplant

24/3

M9-300

Surgery

PROX - Swipe

513 513

Virtual Pagers

Pager

Position

Description

9990

Transplant Surgery

Floor and Consults

9991

STICU

ICU patients and ICU consults

9992

Trauma Surgery PGY2

Trauma alerts, Trauma surgery consults

9993

Surgery Consults PGY1

Consults for CT, General, SO, Vascular, Pediatrics

9994

Surgery PGY1

Covers floor patients for CT, General, SO, Vascular, Pediatrics

9995

Trauma PGY1

Covers Trauma floor patients, Trauma alerts

Surgery Chief

Covers surgical consults, surgical services

Trauma Chief

Covers Trauma alerts, Trauma service

32

PGY-1

RESIDENT PAGER NUMBERS 2010/2011 PGY - 2

Sasa-Grae Espino

8608

Ashley Limkemann Eden Payabyab Krista Terracina Katarzyna TrebskaMcGowen Justin Brown Yulia Dzhashiashvili Joshua Kunellis Jonathan Schaaf Christopher Bednarek Mary Ellen Dolat Nathan Miller Collier Pace Xi Bei Tian Shaoqing Zhou

1631 1728 1729 8877 1289 1371 8370 1753 1260 8850 8026 8913 1778 1808

PGY-4

Pikulkaew Dachsangvorn Michelle Hamel Matthew Kaspar Dan Parrish Rajesh Ramanathan

5114

Irene Caillouet

1062

5137 5149 5184 5195

Joseph Hartwich Omar Rashid Adewuni Ojo Amanda Tubbs

5253 1240 1393 1428

Shuhao Zhang (P)

5252 PGY-5 Richard Carter Sundeep Guliani Frank Margaron Sihong Suy David Williams Richard Carter

8487 5689 1308 5680 5703 8487

PGY-3 Kevin Long Keri Quinn Brock Lanier Abel Gebre-Giorgis Andrew Young

8209 1629 1026 5614 1438

LAB Barbara Adams Brian Le Hadley Herbert Christine Zoon Shannon Rosati Poornima Vanguri

8022 8204 away 1700 away 1678

33

Faculty Pager Numbers Name Aboutanos, Michel Akbari, Homayoon Albuquerque, Francisco Anand, Rahul Bagwell, Charles Bear, Harry Brinster, Derek Campbell, Christopher Cassano, Anthony Chen, Stephen Cotterell, Adrian Chikunguwo, Silas Duane, Therese Feldman, Michael Ferrada, Paula Fisher, Robert Goldberg, Stephanie Grob, Mayer Grover, Aimee Guruli, George Hampton, Lance Haynes, Jeffrey Ivatury, Rao Kaplan, Brian Cell – 334-3951 Kasirajan, Vigneshwar Katlaps, Gundars Kellum, John Klausner, Adam Koo, Harry Lanning, David Lange, Patricia Lawrence, Walter * Levy, Mark Maher, James Malhotra, Ajai Merrell, Ronald* Miller, Thomas Neifeld, James Nicolato, Patricia Orton, Vernon Oiticica, Claudio Pfeifer, John Posner, Marc Pozez, Andrea Rhodes, Jennifer Savas, Jeannie

Pager #

Office#

Division

3030 3072 3211 3238 3965 3016 3186 3370 3553 8424 3075 3338 4233 3328 3467 3855 8133 3042 3510 3269 3188 3242 3110 3241

8-7748 7-0049 8-9849 8-7748 8-3500 8-9325 8-4663 8-3033 84628 8-3033 8-9298 7-0045 8-7748 8-3033 8-7748 8-2461 7-2409 8-5318 8-9322 8-5318 8-5318 8-3500 8-7748 8-3250

Trauma Critical Care General Surgery Vascular Trauma/Critical Care Pediatric Oncology Cardiothoracic Plastic Cardiothoracic Plastic Transplant General Surgery Trauma/Critical Care Plastic Trauma/Critical Care Transplant Trauma Urology Oncology Urology Urology Pediatric Trauma/Critical Care Oncology

3058 3145 3179 3106 3217 3099 3562 3202 3286 3164 3369

8-2774 675-5403 8-9514 8-5320 8-5320 8-3500 6-0196 8-9323 8-9849 8-0569 8-7748 7-1031 675-5986 7-1033 8-4641 8-5320 8-3500 675-5986 8-9298 8-3031 8-3033 675-5986

Cardiothoracic Cardiothoracic General Urology Urology Pediatric Pediatric Oncology Vascular General Trauma/Critical Care General General (VA) Oncology Cardiothoracic Urology Pediatric Vascular Transplant Plastic Plastic General (VA)

3089 3257 7405 3269 3142 3281 3452 3132 1748

34

Sharma, Amit 5786 Szentpetery, Szabolcs 3219 Takabe, Kazuaki 1292 Tang, Daniel 3382 Vu, Huan 3459 Whelan, James 5796 * Professor Emeritus

8-9298 675-5403 8-9234 8-9168 8-3250 7-1207

Transplant Cardiothoracic (VA) Surgical Oncology Cardiothoracic Oncology Trauma

CLINICAL EDUCATION AND SUPERVISION OF SURGICAL RESIDENTS GENERAL PRINCIPLES Attending surgeons are responsible for the care provided to each patient, and they must be familiar with each patient for whom they are responsible. It is recognized that other attendings may, at times, be delegated responsibility for the care of a patient and provide supervision instead of, or in addition to, the assigned attending surgeon. Within the scope of the training program, all residents, without exception, will function under the supervision of attending surgeons. A responsible attending will be immediately available to the resident in person or by telephone and be able to be present within a reasonable period of time, if needed. Each surgical service will publish, and make available, “call schedules” indicating the responsible attendings if needed. The surgery residency program will be structured to encourage and permit residents to assume increasing levels of responsibility commensurate with their individual progress in experience, skill, knowledge, and judgment throughout the course of their training. Each facility must adhere to current accreditation requirements as set forth by the VCUHS for all matters pertaining to the training program including the level of supervision provided. The requirements of the American Board of Surgery, the American Board of Medical Specialties, the Residency Review Committee for Surgery, the VA Resident Supervision Policy, and the ACGME will be incorporated into training programs to ensure that each successful program graduate will be eligible to sit for a certifying examination. The provisions of this document are applicable to all patient care services, including both inpatient and outpatient care settings, and the performance and interpretation of all diagnostic and therapeutic procedures. The attending surgeons are responsible to assure continuity of care provided to patients. 1. Notify the appropriate chief resident and attending physician of any critical changes in a patient’s status; 2. Notify the appropriate chief resident and attending physician of any and all patients going to the operating room; 3. All spheres of house staff activity will be supervised by attending faculty members who will share responsibility with house officers for patient care rendered and who will have ultimate authority for final decision making. The nature and extent of attending physician involvement will vary according to site as outlined below. SITE-SPECIFIC SUPERVISION The structure of resident-attending interactions and the form that faculty supervision of resident takes will vary according to site and type of patient care setting and are summarized below. In general, these rules are uniform for the VCUHS/MCVH, the VAMC and other affiliated institutions unless otherwise noted.

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Inpatient Teaching Services 1. All patients admitted to the service will be cared for by a patient care team which may include medical students, interns, residents and fellows under the direction of faculty attending physicians. 2. Although decisions regarding diagnostic tests and therapeutics may be initiated by the resident, these decisions will be reviewed with the attending surgeons. 3. All patients will be seen by the attending and discussed daily with residents. 4. The attending will review the medical record and document his/her involvement in the care of the patient. 5. All transfers to another service and discharges will be approved by the attending in advance. 6. Residents are required to notify the patient’s attending, in a timely fashion, independent of the time of day, of any substantial controversy regarding the patient care, any serious change in the patient’s course including unexpected death, need for surgery or transfer to an intensive care unit or to another service for treatment of an acute problem, or for any other significant change in condition. 7. Attendings or their designee are expected to be available and responsive, either by phone or pager, for resident consultation, 24 hours a day for their term on service, their on-call day, for their specific patients. Clinics and Consult Services 1. A faculty member will be present in at all clinics. His/her responsibility will be the supervision of residents working in the clinic. 2. All inpatient consultations written by a resident will be presented to an attending, countersigned by that attending, and amended or supplemented by the attending as necessary, in accordance with the MCVH Consultation Policy. Operating Rooms 1. The faculty is responsible for direct supervision of all operative cases. 2. A PGY-4 or PGY-5 may act as a “teaching assistant” on appropriate cases and supervise operative procedures performed by a junior resident, although the attending surgeon retains ultimate responsibility and will be present for the critical portion of the surgical procedure.

Skills Lab The MIS Center is a fully functional surgical simulation center serving students, residents, and established surgeons learning new laparoscopic surgery skills. Through advanced telecommunications, the videoconference center is fully interactive with operating rooms at VCU Medical Center hospitals and the skills labs consist of a Mock OR with three MIST-VR devices, a LapSim VR and a METI unit. There are two FLS set-ups and a station for learning the endo-stitch.

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LINES OF SUPERVISION CUMULATIVE, BY YEAR And PROCEDURES APPROPRIATE BY LEVEL SUPERVISORY LINES OF RESPONSIBILITY This document outlines policy and procedural requirements pertaining to the supervision of postgraduate residents. Attending surgeon refers to either full or part time faculty of the Department of Surgery at the VCUHS, who is providing supervision to residents in the postgraduate training program in general surgery. All attendings should be board certified (or eligible to be examined) in general surgery or a surgical specialty, and have a specific interest in teaching residents in the general surgery residency program at the VCUHS. SUPERVISION OF RESIDENTS 1. All patient care must be supervised by qualified faculty. The program director must ensure, direct, and document adequate supervision of residents at all times. Residents must be provided with rapid, reliable systems for communicating with supervising faculty. 2. Faculty schedules must be structured to provide residents with continuous supervision and consultation. 3. Faculty and residents must be educated to recognize the signs of fatigue and adopt and apply policies to prevent and counteract the potential negative effects. PGY 1 During the PGY-1 each resident begins his/her clinical experience in the General Surgery Residency at the Virginia Commonwealth University Health System on a variety of clinical rotations at The Medical College of Virginia Hospital and The Veterans Administration Medical Center. Your training will include education and experience in inpatient care and outpatient care for the surgical patient. In addition to daily patient care you will attend didactic sessions on each specific rotation, as well as, required departmental conferences. You will learn: ¾ Basic history/physical techniques. ¾ Care of the surgical patient including preoperative evaluation, perioperative, and postoperative care. ¾ Writing pre and postoperative orders. ¾ Basic pathophysiology of surgical disease. ¾ ACLS and ATLS certification. ¾ Surgical Skills: basic techniques, sterile technique, surgeon in simple procedures, excisions subcutaneous lesions, breast biopsies, hernia repair, and first assist on more complex procedures. ¾ Communications skills: communicate as a professional with patients, patient families, hospital staff, students, colleagues, and attending staff. All residents are expected to utilize web-based resources, journals, surgical texts, and other material in preparing for regular weekly conferences and daily patient care. All PGY-1 residents will present interesting cases at the Tuesday Noon Case Conference with the Chairman of the Department. PGY 2 During the PGY-2 year surgical residents are involved in rotations through clinical services at MCVH and VAMC. On a daily basis the resident provides care for surgical patients in an outpatient and inpatient clinical setting, as well as caring for critically ill patients in the

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STICU (Surgery Trauma Intensive Care Unit). The educational experience involves direct patient care, procedural training and interaction with patients and families, attending physicians and other health care providers. Residents will spend time in the outpatient clinics which, involves interviewing patients, reviewing medical data including images, and formulating treatment plans that are presented and discussed with the chief resident and/or attending surgeon. In addition to daily patient care you will attend didactic sessions on each specific rotation, as well as, required departmental conferences. The PGY-2 resident will: ¾ Care for more complex or severely ill patients including critical care, trauma, and burns. ¾ Evaluate and determine disposition for all consults. ¾ Under supervision perform invasive procedures on STICU patients. ¾ Expand basic surgical knowledge and learn to apply it during evaluation and care of patients with more complex surgical problems. ¾ Gain an understanding of surgical specialties while caring for patients with multiple injuries. ¾ Perform surgery: be able to perform more advanced procedures under supervision and first assist on more complex surgical procedures. ¾ Communicate more effectively with patient care team; begin to assume leadership position within the team, demonstrate foresight and planning in regards to patient care, and concise and effective presentations. ¾ Coordinate with PGY-1 supervision of medical students assigned to the service. The Consult/Skills Lab rotation allows the PGY-2 resident ample time to log hours on the simulation equipment in the skills lab. All residents are required to become proficient in using laparoscopic equipment through training in simulation. All residents are expected to utilize web-based resources, journals, surgical texts, and other material in preparing for regular weekly conferences and daily patient care during each rotation and for regularly scheduled departmental conferences. PGY 3 During the PGY-3 surgical residents will learn the essential content areas of general surgery: alimentary tract, abdomen and its contents, surgical oncology, transplant surgery, vascular surgery, and endoscopy. The PGY-3 resident will directly supervise the PGY-1 and/or PGY-2 resident and medical students in the delivery of care to all patients on the service. At this level of training the resident is expected to make daily rounds and have full knowledge of medical and/or surgical problems of all patients on the service. Your role on the outpatient service is to know the conditions of patients who may undergo surgical procedures and insure accurate assessment and plans are reported to the chief and/or attending, and that appropriate information about each case is communicated to the OR. The PGY-3 on the inpatient service is responsible for making daily rounds on every patient on the service and to insure appropriate information is communicated to the chief resident and/or attending. You will also arrange proper follow-up of patients discharged from the service. The PGY-3 resident must prepare for cases assigned in the OR and take a prominent role in the case to develop leadership and supervisory skills under the direct supervision of the attending. In addition to daily patient care you will attend didactic sessions on each specific rotation, as well as, required departmental conferences. The following are resident expectations: ¾ “Leader/supervisor” on a smaller surgical team with close attending supervision.

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¾

¾ ¾

¾ ¾

¾

“Mid-level/sub leader” on larger surgical teams with supervision and input from more senior residents and attendings. Coordinate patient care to include appropriate evaluation and treatment by other health care professionals and consultants. Mastery of basic surgical pathophysiology and patient care (ward and ICU), basic understanding of surgical alternatives. Surgery: teach and supervise junior residents in the performance of basic surgeries including excision of subcutaneous masses, breast biopsies, and hernia repairs. Perform as surgeon on more complex surgical procedures. Focused exposure to general, trauma surgery, and transplant. Develop teaching and supervision skills. Improve communication with patient care team and function more effectively as team leader. Communicate effectively with other health care professionals. Begin to address issues of problem solving and dispute resolution. Demonstrate an understanding of the role of different specialists and other health care professionals in overall patient management. Improve mastery of adult learning skills.

All residents are expected to utilize web-based resources, journals, surgical texts, and other material in preparing for regular weekly conferences and daily patient care during each rotation and for regularly scheduled departmental conferences. PGY 4 During the PGY-4 surgical residents will learn the essential content areas of complex general surgery: alimentary tract, abdomen and its contents, surgical oncology, pediatric surgery, thoracic surgery and trauma. The PGY-4 resident will directly supervise the PGY-1 and/or PGY-2 resident and medical students in the delivery of care to all patients on the service. The PGY-4 year involves direct patient care on a daily basis, experience in the outpatient clinic, inpatient clinical setting as well as taking a leadership and supervisory role on the trauma service. As chief resident on some of the services, you are responsible for reviewing treatment plans with junior level residents and insure accurate documentation is entered in the EMR. Additionally you must be familiar with all patients and assume direct responsibility for their care. It is your responsibility to keep the attending appraised of the progress of patients on the service. In the OR the PGY-4 resident will teach junior level residents and medical students. In addition to daily patient care you will attend didactic sessions on each specific rotation, as well as, required departmental conferences. All residents are expected to utilize web-based resources, journals, surgical texts, and other material in preparing for regular weekly conferences and daily patient care during each rotation and for regularly scheduled departmental conferences. The PGY-4 resident is expected to: ¾ Function in the role of senior resident with its associated increase in responsibility in an affiliated hospital. ¾ Assume leadership of larger surgical teams and supervise care of surgical patients at various levels of acuity with input from surgical attendings, consultants and other health care professionals. ¾ Achieve mastery in common surgical procedures. ¾ Surgery: teach and supervise some more advanced surgeries. ¾ Mastery of general surgical knowledge. ¾ Possess advanced understanding of subspecialties including surgical oncology, vascular surgery, and head and neck surgery.

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¾ Further develop skills in problem solving and dispute resolution. ¾ Continue to improve the mastery of adult learning skills. PGY-5 During the PGY-5 surgical residents will teach junior level residents the essential content areas of general surgery: alimentary tract, abdomen and its contents, surgical oncology, thoracic surgery and trauma. In concert with the attending the PGY-5 resident will directly supervise the junior level residents and medical students in the delivery of care to all patients on the service. The PGY-5 year is involved with direct patient care on a daily basis, is responsible for the leadership and supervision of the outpatient clinic, inpatient clinical setting, the OR. As chief resident you are responsible for reviewing treatment plans with junior level residents and insure accurate documentation is entered in the EMR. Additionally you must be familiar with all patients and assume direct responsibility for their care. In the OR the PGY-5 resident will teach junior level residents and medical students. All residents are expected to utilize web-based resources, journals, surgical texts, and other material in preparing for regular weekly conferences and daily patient care during each rotation and for regularly scheduled departmental conferences. The PGY-5 resident is expected to: ¾ Provide clinical and administrative leadership of residents and students assigned to the surgical services of the affiliated hospitals. ¾ Begin to function as a responsible surgeon under appropriate supervision. ¾ Master surgical skills. ¾ Provide oversight of all aspects of pre, peri and postoperative care. Coordinate evaluation, input, and care from consultants and other health care professionals. ¾ Achieve the full competence (knowledge, skills and attitudes) of a board eligible general surgeon. ¾ ACTIVITIES AND/OR PROCEDURES APPROPRIATE BY PGY-LEVEL

SCOPE OF PRACTICE PGY 1

Independently

Needs Supervision

Target # neede under supervisio

Drainage of Seromas Feeding Tube Replacement/Removal Foley Catheter Placement Incision and Drainage of Abscesses Nasogastric Tube Placement/manipulation Opening Infected Wound Peripheral IV Catheter Insertion Pneumothorax Decompression w/needle Sedation Thoracentesis Arterial Catheter Placement/Manipulation Biopsy of Soft Tissue Mass Bronchoscopy Central Venous Catheter

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5 5 15 5

Chest Tube Placement/Manipulation Debridement of Soft Tissue Diagnostic Peritoneal Lavage Diagnostic Upper endoscopy Flexible Anoscopy Flexible Sigmoidoscopy FNA of Soft Tissue Mass Measurement of Compartment Pressures Paracentesis Suturing of Lacerations Swanz-Ganz Catheter Placement/Manip. Thyroid Nodule Aspiration/Biopsy Venous cannulation for hemiodialysis

PGY 2

Independently

Needs Supervision

5 5 5 5 5 5 5 5 5 5 5 5 5

Target # neede under supervisio

Cardioversion Drainage of Seromas Feeding Tube Replacement/Removal Foley Catheter Placement Incision and Drainage of Abscessees Nasogastric Tube Placement/manipluation Opening Infected Wound Peripheral IV Catheter Insertion Pneumothorax Decompression w/needle Sedation Thoracentesis Arterial Catheter Placement/Manipulation Biopsy of Soft Tissue Mass Bronchoscopy Central Venous Catheter Chest Tube Placement/Manipulation Debridement of Soft Tissue Diagnostic Peritoneal Lavage Diagnostic Upper endoscopy Flexible Anoscopy Flexible Sigmoidoscopy FNA of Soft Tissue Mass Measurement of Compartment Pressures Paracentesis Suturing of Lacerations Swanz-Ganz Catheter Placement/Manip. Thyroid Nodule Aspiration/Biopsy Venous cannulation for hemiodialysis

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5 5 15 5 5 5 5 5 5 5 5 5 5 5 5 5 5

PGY 3

Independently

Needs Supervision

Target # needed under supervision

Arterial Catheter Placement/Manipulation Biopsy of Soft Tissue Mass Cardioversion Central Venous Catheter Chest Tube Placement/Manipulation Debridement of Soft Tissue Diagnostic Peritoneal Lavage Diagnostic Upper endoscopy Drainage of Seromas Feeding Tube Replacement/Removal Flexible Sigmoidoscopy FNA of Soft Tissue Mass Foley Catheter Placement Incision and Drainage of Abscessees Measurement of Compartment Pressures Nasogastric Tube Placement/manipluation Opening Infected Wound Paracentesis Peripheral IV Catheter Insertion Pneumothorax Decompression w/needle Sedation Subcutaneous Foreign Body Removal Suturing of Lacerations Swanz-Ganz Catheter Placement/Manip. Thoracentesis Thyroid Nodule Aspiration/Biopsy Venous cannulation for hemiodialysis Bronchoscopy Cricothyrotomy * Flexible Anoscopy Thoracotomy, Emergency *

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15 5

PGY 4

Independently

Needs Supervision

Target # needed under supervision

Arterial Catheter Placement/Manipulation Biopsy of Soft Tissue Mass Bronchoscopy Cardioversion Central Venous Catheter Chest Tube Placement/Manipulation Debridement of Soft Tissue Diagnostic Peritoneal Lavage Diagnostic Upper endoscopy Drainage of Seromas Feeding Tube Replacement/Removal Flexible Sigmoidoscopy FNA of Soft Tissue Mass Foley Catheter Placement Incision and Drainage of Abscessees Measurement of Compartment Pressures Nasogastric Tube Placement/manipluation Opening Infected Wound Paracentesis Peripheral IV Catheter Insertion Pneumothorax Decompression w/needle Sedation Subcutaneous Foreign Body Removal Suturing of Lacerations Swanz-Ganz Catheter Placement/Manip. Thoracentesis Thyroid Nodule Aspiration/Biopsy Venous cannulation for hemiodialysis Cricothyrotomy * Flexible Anoscopy Thoracotomy, Emergency *

PGY 5

Independently

Needs Supervision

Arterial Catheter Placement/Manipulation Biopsy of Soft Tissue Mass Bronchoscopy Cardioversion Central Venous Catheter Chest Tube Placement/Manipulation Debridement of Soft Tissue Diagnostic Peritoneal Lavage

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5

Target # needed under supervision

Diagnostic Upper endoscopy Drainage of Seromas Feeding Tube Replacement/Removal Flexible Sigmoidoscopy FNA of Soft Tissue Mass Foley Catheter Placement Incision and Drainage of Abscessees Measurement of Compartment Pressures Nasogastric Tube Placement/manipluation Opening Infected Wound Paracentesis Peripheral IV Catheter Insertion Pneumothorax Decompression w/needle Sedation Subcutaneous Foreign Body Removal Suturing of Lacerations Swanz-Ganz Catheter Placement/Manip. Thoracentesis Thyroid Nodule Aspiration/Biopsy Venous cannulation for hemiodialysis Cricothyrotomy * Flexible Anoscopy Thoracotomy, Emergency * * PGY 3's-5's can start, but an attending must be present to supervise in order for the procedure to be marked completed

Residents are allowed to perform level appropriate procedures independently as outlined below. For procedures requiring supervision, target numbers are outlined for the minimal number of procedures that must be performed under supervision before a resident is credentialed to do a specific procedure independent of supervision. It is the resident’s responsibility to log their procedures in the ACGME Case Log under the rotation “Scope of Practice Procedures”. When target numbers have been reached and faculty supervisors have verified competency, residents will be credentialed to perform procedures independent of faculty supervision.

CONFERENCES On time attendance is required at the following conferences. Attendance is taken the first 10 minutes of the conference. If you are more than 10 minutes late to conference you are not counted as in attendance. Attendance is monitored and reported to the Program Director and Chairman. Repeated absence from conferences may lead to disciplinary actions. The Departmental Grand

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5

Rounds and Resident Basic Science Conference is Teleconferenced to the VA weekly. There are sign-in sheets for you to sign at the VA. Please remember to sign in so your attendance can be counted. Resident Conferences - Residents are required to maintain conference attendance of 75% or greater for all conferences in the basic clinical sciences fundamental to General Surgery, Attendance is taken and monitored at the principal conferences for general surgery residents, which are: Death and Complications (D&C) teaching conference. Surgical Didactic Conferences includes Surgical Grand Rounds and Basic Science/Skills Lab. Department of Surgery faculty or distinguished visiting faculty give lectures on topics that address the clinical and basic science components of surgery. Departmental Conferences The Department of Surgery has weekly teaching conferences on Thursday mornings beginning at 7:00 am. These include Grand Rounds from 7:00 -8:00 am and Death and Complications (D&C) 8:00 -9:00 am. Basic Science conference for the PGY 1, 2 residents (juniors) will be held each Monday from 6:00 – 7:300 pm on Main 9-300. The PGY 3’s and 4’s and lab residents will meet on Mondays from 5:00 – 6:30 pm in Sanger B1-020. The chief residents will meet each Thursday morning from 9:00 – 10:30 am in the Urology Conference Room on West 7, East Wing for basic science conference. The 1st Thursday of each month is generally reserved for Journal Club Debates. The 2nd, 3rd and 4th Thursdays Grand Rounds will feature clinical presentations from faculty, residents or invited guests. Divisional Conferences When residents are assigned to the specific services they are expected to attend and participate in the divisional weekly conferences as well as the weekly departmental conferences. Cardiothoracic Surgery Thoracic Surgery Weekly – Wednesday 4:30-5:30 pm, Main 3 Radiology Conference Rm. Cardiac Cath Weekly – Thursday 8-9 am, Main 1 Cafeteria Conference Rm. * Cardiac Surg/Anes Weekly – Friday 1 – 2 pm, Main 5 OR Conference Rm. M & M Conference Monthly – 3rd Wednesday 3 pm, Main 5 OR Conference Rm. * General Surgery GI Conference General Surgery

Weekly – Monday 4:30-6:00 pm, Main 3 Radiology Conference Rm. Weekly – Tuesday 7:30-9:00 am., MIS Center Conference Rm.

Surgical Oncology Surgical Oncology Breast Breast Health Cen GI Tumor Center Journal Club

Weekly – Tuesday 7:30 – 8:30 am, MCC Demonstration Rm. Weekly – Tuesday 9:00 am, MCC Demonstration Rm. Weekly – Tuesday 12:30 – 2:00 pm, Weekly – Thursday 1:30 pm, MCC Demonstration Rm. Monthly – 2nd Tuesday 6:00 – 7:00 pm

Pediatric Surgery Pediatric Surgery Weekly – Wednesday 4:30 -5:30 pm, Sanger 8 Conference Rm.

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Transplant Surgery Transplant Weekly - Thursday 12:30 – 2:00 pm, MSB 104/105 Trauma & Critical Care Surgery Trauma Weekly – Wednesday 7:30 – 9:00 am, Main 1 Learning Center Trauma D & C Weekly – Tuesday 12:30 – 2:00 pm, Main 9-300 Vascular Surgery (MCV & VA) Vascular Weekly – Tuesday 7:15 – 8:30 am, Main 3-201 Journal Club Monthly – last Tuesday 7:15 – 8:30 am, VA Medical Center Room 2K113 VA Conferences

(When assigned to the VA service)

Cardiothoracic

CT Conference

Tuesday 8:30 -9:30 am

General Surgery

GI Conference Tumor Conference M&M

Wednesday 8:00 9:30 am 2K113 Conf. Rm. Wednesday 3:30-4:30 pm, 2K Conf. Rm. Friday 7:30 – 9:30 am 2L153 Conf. Rm.

* conference is optional on that service

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Cardiology Conf. Rm.

CONFERENCE PRESENTATION PROTOCOL D&C 1. 2. 3.

Ground Rules Every service must submit all cases and complications by Monday at 7 am Cases should include any case from Friday to Thursday You will be notified by Tuesday morning by mass email that you have been selected for presentation 4. Use the PowerPoint Template (see VCU D and C file on thumbdrive) 5. All residents are required to attend the D & C Conference. Words of Wisdom 1. Slides and presentations should be reviewed by the attending of record. 2. The verbal portion should help in focusing the audience’s attention on the most important points and provide clarification of particular details. 4. The presentation is essentially a creation of a story and a logical argument, so it should flow and make sense. 5. Although the complication is the central focus of the oral presentation and slides, the presenting residents are expected to be familiar with the entirety of the case. This includes having a thorough understanding of the management options and outcomes for those options (whether surgical or medical) of the underlying disease process(es) and the complication. This will generally require reading in addition to a discussion with the attending. Variations from standard management and the reasons for them should be discussed with the attendings prior to presentation so that decision making for the case is clearly understood by the presenter.

Resident Basic Science Conference This schedule is prepared for the year. It is the resident’s responsibility to prepare the presentation with the faculty facilitator and present to the residents. The following week faculty will review, with the residents, the previous week presentation. Residents are expected to have read ahead of time and be prepared to answer questions. There are several General Surgery Textbooks available in the department where you can find information on the topic being discussed. The junior and senior basic science schedules will follow outlines provided through SCORE (Surgical Curriculum on Residency Education) and resources materials are provided on the website, as well. Textbooks are located in the Program Director’s Office on West 7, the Resident Library on Main 9, and some are in the OR Faculty Lounge on Main 5. In addition, there are online resources as indicated on the Surgery Website. This conference is required and attendance is taken and monitored. The conference is teleconferenced to the senior resident rotating at Winchester. With the exception of the presenter, all residents are required to complete the study questions provided in SCORE relevant to the topic and turn them in to the faculty facilitator assigned to that particular conference. (It is anticipated that changes will be implemented into the 2012-2013 Basic Science Conferences – details will be forthcoming.) Intern Noon Case Conference Each Tuesday interns meet with the Department Chair and present an interesting case integrating current literature and best practices. It is the resident’s responsibility to prepare the presentation and present to the Chair and residents. This conference is required for all PGY-1 residents assigned to MCVH. Attendance is taken and monitored.

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EVALUATIONS All evaluations are designed around the six core competencies as outlined by the Accreditation Council of Graduate Medical Education (ACGME) below: Patient Care: Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Residents: (1) will demonstrate manual dexterity appropriate for their level; (2) will develop and execute patient care plans appropriate for the resident’s level, including management of pain; (3) will participate in a program that must document a clinical curriculum that is sequential, comprehensive, and organized from basic to complex. The clinical assignments should be carefully structured to ensure that graded levels of responsibility, continuity in patient care, a balance between education and service, and progressive clinical experiences are achieved for each resident. Medical Knowledge: Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social behavioral sciences, as well as the application of this knowledge to patient care. Residents: (1) will critically evaluate and demonstrate knowledge of pertinent scientific information and, (2) will participate in an educational program that should include the fundamentals of basic science as applied to clinical surgery, including: applied surgical anatomy and surgical pathology; the elements of wound healing; homeostasis, shock and circulatory physiology; hematologic disorders; immunobiology and transplantation; oncology; surgical endocrinology; surgical nutrition, fluid and electrolyte balance; and the metabolic response to injury, including burns. Practice-based Learning and Improvement: Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning. Residents are expected to develop skills and habits to be able to meet the following goals: (1) identify strengths, deficiencies, and limits in one’s knowledge and expertise; (2) set learning and improvement goals; (3) identify and perform appropriate learning activities; (4) systematically analyze practice using quality improvement methods, and implement changes with the goal of practice improvement; (5) incorporate formative evaluation feedback into daily practice; (6) locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems; (7) use information technology to optimize learning; and, (8) participate in the education of patients, families, students, residents and other health professionals. (9) participate in mortality and morbidity conferences that evaluate and analyze patient care outcomes, and (10) utilize an evidence-based approach to patient care Interpersonal and Communication Skills: Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals. Residents are expected to:

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(1) communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds; (2) communicate effectively with physicians, other health professionals, and health related agencies; (3) work effectively as a member or leader of a health care team or other professional group; (4) act in a consultative role to other physicians and health professionals; and, (5) maintain comprehensive, timely, and legible medical records, if applicable. (6) counsel and educate patients and families; and (7) effectively document practice activities. Professionalism: Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to demonstrate: (1) compassion, integrity, and respect for others; (2) responsiveness to patient needs that supersedes self-interest; (3) respect for patient privacy and autonomy; (4) accountability to patients, society and the profession; and, (5) sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation. (6) high standards of ethical behavior, and (7) a commitment to continuity of patient care Systems-based Practice: Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Residents are expected to: (1) work effectively in various health care delivery settings and systems relevant to their clinical specialty; (2) coordinate patient care within the health care system relevant to their clinical specialty; (3) incorporate considerations of cost awareness and risk-benefit analysis in patient and/or population based care as appropriate; (4) advocate for quality patient care and optimal patient care systems; (5) work in interprofessional teams to enhance patient safety and improve patient care quality; and, (6) participate in identifying system errors and implementing potential systems solutions. (7) practice high quality, cost effective patient care; (8) demonstrate knowledge of risk-benefit analysis; and, (9) demonstrate an understanding of the role of different specialists and other health care professionals in overall patient management. Evaluations of resident Written evaluations are solicited from faculty members, nurses, OR nurses, and peers, at the conclusion of each resident rotation. Should an evaluation of a resident indicate that the resident’s performance be discussed by the Surgery Education Committee (SEC), a copy of that evaluation is forwarded to the Program Director. Upon review of the evaluation, the Program Director may request additional documentation or provide this documentation at the next SEC meeting and the resident’s performance will be discussed. The SEC may recommend the following:

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1) The resident be carefully monitored in the upcoming months due to recent evaluations. This discussion will be document in the minutes of the SEC meeting. 2) Review of the resident by the Academic Review Sub-Committee (ARC). Evaluations of Faculty All residents will be expected to evaluate the faculty on their service and the rotation itself. Evaluations are conducted at the end of each rotation all evaluations should be completed in a timely fashion. It is important that residents evaluate the rotations in order to maintain quality in the educational program. Evaluations from Patients Throughout the year random patient evaluations of residents are completed. Resident Self Evaluation Residents will complete a self-evaluation annually which will be discussed with your mentor. At the meeting to discuss the self-evaluation a performance plan will be implemented. Each year your mentor will discuss your improvements, strengths and weaknesses. Annual Program Evaluation by Resident Each year all residents will complete an anonymous evaluation of the program identifying strengths and weaknesses. This evaluation will be used to improve the educational components of the residency program. All evaluations of residents and faculty are managed through an electronic software program New Innovations. Residents are given a user ID and password to sign in to record their evaluations of faculty and to review their evaluations. The web-site is www.newinnov.com.

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VCU GENERAL SURGERY RESIDENCY LEAVE POLICIES The resident is responsible for notifying the program of any type of leave. In some instances the VCUHS GME office requires that a Leave Request Form be completed. The American Board of Surgery (ABS) require programs to report all types of leave, sick, interview time, academic meetings, vacations. In order to ensure you meet the ABS 48 week rule we must have complete and accurate information which is the responsibility of the resident. Residents must complete a leave form and submit it to the Program Director prior to any type of leave taken. The form can be obtained from the surgery website. Residents must notify both the Program Director and the Residency Coordinator, Cindi Phares ([email protected] or 804-828-2755), of any leave that has been or will be taken. Any leave taken without prior approval by the program director will be counted as unexcused absence and is subject to disciplinary action. You will be expected to make up the time at the end of that training year.

FORMS to Request Leave are on the Surgery Website

Absence from Clinical Duties: All activities that will require absence from clinical duties including vacations, meeting/course presentations and attendance, taking USMLE or other standardized tests, require that residents get approval from the Program Director prior to scheduling activity. Other resident absences such as vacations may take priority. Not

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getting prior approval for absence from clinical duties may result in your not being able to participate in the activity and loss of fees. Unexcused Absence: If a resident does not show up for assigned hours, including night call, without notifying the Chief Resident or Program Director, the absence will be considered unexcused. Unexcused time will be taken as leave from the resident’s leave entitlement. If the unexcused absence is repeated, disciplinary action may be taken by the Program Director depending upon the severity and frequency of the infraction. Arrangements for “payback” to other residents who may be assigned to cover night call or assigned hours will be made at the discretion of the Program Director. Travel : All resident travel must be approved in advance. A “Request for Travel Authorization Form” must be completed and approved by the chairman prior to travel. (The Travel Authorization Form is available on the Surgery Website.) Boarding passes and itemized hotel invoices reflecting a $0.00 balance are required documentation for all travelers seeking reimbursement from the department. In addition, the following documents are REQUIRED for reimbursement. FOR ALL INTERNET TRAVEL PURCHASES: Due to continued occurrences of fraud, Procurement & Payment will be asking for additional documentation to all internet travel purchases for reimbursement. When procuring services via the Internet, the following supplementary documentation will now be required with the Travel Expense Reimbursement Voucher (TERV) in order to receive reimbursement: • Hardcopy final pages from Internet site showing total cost and confirmed service (proof of payment). • Airline confirmation (itinerary, ticket stub, or boarding pass) of the class of ticket purchased (e.g. coach, business). • Credit Card statement verifying the purchase. Lacking any one of these pieces of documentation may result in delay or the inability to reimburse airline tickets. This policy has been changed and is effective immediately. http://www.vcu.edu/procurement/travel/pdf_docs/Chap_7a.pdf Academic Leave: Resident academic travel is available only to residents presenting research and/or publications at national, regional and/or local meetings. Poster presentations are not funded by the department. •

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Residents must complete two forms prior to academic travel. 1. Departmental Resident Request for Leave. 2. University Request for Travel Authorization for insurance purposes and reimbursement upon completion of travel. University Policy outlining Travel Reimbursement Allowable Expenses will be followed for In-State and Out-of-State travel. Original receipts (including receipts for airline tickets purchased online, and boarding passes) must be submitted for reimbursement (except for meals). Please note the Out-of-State standard lodging reimbursement excluding taxes and surcharges is $77 per day. Meals and Incidental Expenses, including tips, taxi, personal phone calls, and other transportation is $46 per day.

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• •

The maximum reimbursement for any trip is $1200 and residents agree to be personally responsible for all expenses in excess of $1200. Travel is limited to 3 trips per year per resident. Residents will not be reimbursed for travel taken without prior approval by the chairman.

Papers presented as a result of your research with a faculty should be paid for by the grant which funded your research work. If the faculty you are presenting for does not have travel funds you may request approval in advance from the department chair. Travel for Interviewing: We recognize that travel related to interviews for Fellowships or post-residency employment is necessary. Because such travel will result in absences from clinical duties which impact the entire residency, conditions must be met before such travel will be approved. • Time away from clinical duties will be minimized. Travel the night before your interview and return the day of the interview to limit your time away to 1 or 2 days. • Residents are responsible for all costs involved in travel for interviews. In addition, travel must be approved by the program director prior to your travel. This policy is necessary so that adequate coverage can be arranged for the resident’s absence from clinical duties. Time up to one week total, spent at interviews, will not be considered vacation time. If an individual is away for a total of greater than seven days, then the days in excess of seven are subtracted from vacation days either in the current academic year or in the subsequent year. If you are interviewing in your chief year and you are away for more than seven days and have no vacation time left, days will be added to your training, delaying completion of the program. In summary, up to seven days of combined absence for meetings and interviews per year will be considered educational leave; the days in excess of this will be subtracted from vacation days as noted above, or time may be added to the resident year to make up days away. Sick Leave Policy It is the resident’s responsibility to notify the department if you are going to be out sick. The following is required. ƒ Call the administrative chief resident so coverage can be arranged. ƒ Call Cindi Phares at 828-2755 and leave a message or send an email ([email protected]). ƒ Sick days must be reflected in GME-one when you enter your weekly duty hours. In the event of illness, the affected resident/fellow is personally responsible for notifying the faculty member of the affected clinic(s)/service(s) and the Surgical Education Office as soon as the resident knows that the illness will cause an absence from clinical responsibilities. Sick leave will be approved only for legitimate illness. A physician’s note may be requested to support the resident request for sick leave. If the above policy is not followed, the absence will be counted as vacation time. It is the responsibility of the resident and the program director to ensure that Board eligibility requirements are met within the original residency period or alternative arrangements are made. Resident’s are granted up to 30 calendar days per year in sick leave. It cannot be carried over. Extra compensation is not allowed in lieu of sick leave. Any documented leave

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and/or vacation that results in more than six weeks off must be made up before you can be advanced to the next level of training. (See ABS policy below)

Vacation Leave

Interns are given one month of vacation. All other residents will receive three weeks vacation which will be scheduled according to seniority. Once vacation times have been approved by the Program Director and the Administrative Chief Resident notification of approved leave must be sent in writing (email is sufficient) to Cindi Phares and Susan Haynes. Notifying either Ms. Phares ([email protected]) or Ms. Haynes([email protected]) is the resident’s responsibility.

Vacation Leave requests for the Academic Year may be submitted in advance. Vacation blocks will be spread evenly throughout the year and evenly across all rotations. Requests submitted by the due date will be granted according to seniority. Remaining vacation blocks will be granted on a first come, first serve basis with consideration to service coverage and by rotation call schedule. At a minimum, vacation requests must be submitted by August 1. We encourage Residents to plan ahead and spread vacations throughout the year so as not to lose allowed days. For compliance of the Duty Hour Restrictions as outlined by the ACGME, our program will maintain a minimum of one-in-four call for all residents. These criteria may result in leave request denials. Any exception to this policy will be reviewed on an individual basis. Family Medical Leave Please refer to the VCUHS GME Policy on Family and Medical Leave Guidelines for complete information on the application and time frames for these policies. Any resident taking FML leave must complete a House staff Leave Request Form which is available on the VCUHS GME website. http://www.medschool.vcu.edu/gme/policies/index.html The Family Medical Leave Act (FMLA) may allow you to be away from work for Up to 12 weeks of job-protected leave during a 12-consecutive month period to care for certain qualifying family and/or medical situations. FML Eligibility You are eligible for FML if you have completed 12 months of employment with VCUHS and have worked at least 1,250 hours in the 12-month period before your FML is scheduled to begin. Qualifying FML situations ¾ For incapacity due to pregnancy, prenatal medical care or child birth; ¾ To care for your child after birth, or placement for adoption or foster care; ¾ To care for your spouse, son or daughter, or parent, who has a serious health condition; ¾ For a serious health condition that makes you unable to perform your job; ¾ For a qualifying exigency arising out of the fact that your spouse, son, daughter, or parent is on active duty or call to active duty status in the National Guard or Reserves in support of a contingency operation; or

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¾ To care for your spouse, son, daughter, parent, or next of kin (nearest blood relative) who is a covered service member (member of the Armed Forces, including a member of the National Guard or Reserves), and who has a serious injury or illness incurred in the line of duty on active duty that may render the service member medically unfit to perform his or her duties for which the service member is undergoing medical treatment, recuperation, or therapy, or is in outpatient status; or is on the temporary disability retired list. Estimated periods for Family Leave must be submitted to the Surgical Education Office at the time the circumstances necessitating leave arise. Notification of Use of Family and Medical Leave House officers should notify the Program Director in writing, at the earliest possible time, but at least 30 days in advance, before family and medical leave is to begin, if the need for leave is foreseeable, such as an expected birth, adoption, or planned medical treatment. If emergencies or unforeseen events preclude such advance notice, the house officer should give notice as soon as practicable under the circumstances. The Program Director must be notified as soon as possible of the expected leave in order to arrange coverage and ensure compliance with the ABS requirements. FML - Maternity Leave Policy It is the resident’s responsibility to notify the program director (in confidence) of her pregnant status as soon as it is known so that coverage issues can be mapped out well in advance. In most instances the resident should schedule her vacation around the time of delivery. The affected parties (i.e., the pregnant resident, or the resident taking leave, and the residents who will be affected by an absence) will work out a solution for coverage (with the administrative chief resident) for the allowed six weeks of FML. A contingency plan will be implemented only in an emergency which may require the pregnant resident to go out early due to complications. All affected residents will be aware of the plan for coverage while the resident is out and the resident and the Program Director will generate a plan to make up time off service, should that be necessary. Paternity Leave Fathers desiring to take time Family Medical Leave when their wives deliver should notify the program director as soon as possible so that arrangements can be made to schedule vacation close to the due date. Residents may take up to 12 weeks of paid or unpaid family and medical leave. If prolonged leave is taken, timely promotion to the next level may be affected and is governed by specialty requirements. Please refer to the VCUHS GME website for specific details on Family Medical Leave. Bereavement, Extended Illness/Injury, Jury/Witness Duty, Military, and Personal Leave: Guidelines for leave are outlined in the VCUHS GME Institution Policy at http://www.medschool.vcu.edu/gme/policies/index.html

AMERICAN BOARD OF SURGERY REQUIREMENTS FOR TIME IN TRAINING Based on the requirements set forth by the American Board of Surgery (ABS) for Board Eligibility, the number of weeks of full-time surgical experience needed to complete residency training is as follows:

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“For documented medical problems or maternity leave, the American Board of Surgery will accept 46 weeks of surgical training in one of the first three years, for a total of 142 weeks during the first three years, and 46 weeks of training in one of the last two years, for a total of 94 weeks during the last two years.” Any resident taking leave that results in less than 46 weeks of clinical training, as stated previously, will be required to make up the time before being advanced to the next level of training. 1.

First three clinical years; 144 weeks completed of 156 calendar weeks. Vacation permitted: 3 weeks/year (21 days). This allows an additional 7 days/year available for academic leave (meetings, interviews, etc.) The ABS endorses one additional 2-week period within the first three clinical years for documented medical or family leave. The American Board of Surgery (ABS) will accept 46 weeks of surgical training in one of the first three years, for a total of 142 weeks during the first three years.

2.

Fourth and Fifth clinical years; 96 weeks completed of 104 calendar weeks. Vacation permitted: 3 weeks/year. This allows an additional 7 days/year available for academic leave (meetings, interviews, etc.) The ABS will accept a total of 46 weeks of training in one of the last two years for a total of 94 weeks during the last two years for documented medical or family leave. Any additional time taken will require additional training time in order to meet the ABS requirements for certification.

To comply with the American Board of Surgery rules for eligibility, all residents must complete at least 48 clinical weeks of full-time surgical experience each year of training. However, the board does make allowances for documented medical leave and maternity leave as outlined above. The Program Director will work out details with you to ensure you have met the required weeks for training. Understand additional time may be required to satisfy the ABS requirement of clinical weeks based on the information above. Funding for additional time will be provided only according to the VCUHS GME Leave Policy. (See below)

Make-up training that occurs in a fiscal period other than when leave is taken requires that funding for housestaff salary and benefits is carried forward into this next fiscal period. This funding will not be provided by VCUHS unless approved following a request in writing by the Program Director to the Associate Dean for Graduate Medical Education. Funding past the initially scheduled completion date for the post-graduate year will be for a maximum of six (6) weeks. In exceptional cases, funding for housestaff salary and/or benefits for make-up time that extends beyond six weeks may be granted by the Executive Committee of the Graduate Medical Education Committee. The Executive Committee will consider these requests on a case by case basis. It is the responsibility of the Program Director to request this additional paid make-up time at the time of the leave request. Requests for

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paid make-up time that extends beyond six weeks made after the initial leave request will not be considered.

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GENERAL INFORMATION AUTOPSIES Request for autopsies is legally mandated in the Commonwealth of Virginia. If the request for an autopsy is decoupled from the death telling, the chances of consent escalate dramatically. When approaching a family about an autopsy, if you approach it from the perspective of what the family has to learn to protect themselves or others that they love and care about versus what we might be able to learn about their loved one’s disease, you will have a much more successful request rate. Again, the objective in situations of death is to care about/for the family. ADVANCE DIRECTIVES Advance Directives are defined as wishes that someone expresses about their care prior to an event occurring. The Federal Law related to Advance Directives is The Patient SelfDetermination Act (PSDA). This Act was passed by the U.S. Congress in 1990 and became effective December 1, 1991. The PSDA is a law that promotes education and communication between individuals about the kind of end-of-life treatment one would desire. Under the PSDA, patients are asked during an admission if they have either a living will or a medical durable power of attorney. At MCVH, this responsibility falls to each of us to ascertain patients’ wishes and to make certain that it gets documented in the chart and entered into the Permanent Patient Record. The two Advance Directives most often talked about in the law are a Living Will and a Medical Durable Power of Attorney. The Health Care Decisions Act of 1992 is the law in the Commonwealth of Virginia that addresses surrogate decision making. If you need assistance with either completing an Advance Directive, education of patient or family about Advance Directives, or help in answering questions related to Advance Directives, please contact the Chaplain’s office at 8-0928, the department of social work at 8-0212, or the Patient Representatives at 8-0958. FAMILIES Please remember that most families that are present in the environment of MCVH are grieving the losses of many things; i.e., independence, role, status, and relationships. Because of this, their stress levels and coping abilities are probably dramatically diminished. Be patient with families and use other resources within the environment to assist them in their coping and to assist you in your communication with them; i.e., Chaplains, Patient Representatives, and Social Workers. One of the benefits in being at MCVH is that there are many individual services with a multitude of available resources. You do have the opportunity to ask for assistance for you and your patients and families! OCCUPATIONAL EXPOSURES In order to provide timely assessment of occupational exposures to blood or body fluids, MCVH has a unique post-exposure program. During a regular working day (8:00 a.m. to 4:00 p.m.), the exposure must be reported to the Employee Health department (8-0584 or 8-0585). Determination for the need for prophylaxis will be made at that time. After hours, on weekends or holidays, a phone consult service team (PEP Team) is available (page number 4508). If it is determined that prophylaxis is deemed necessary, the medications will be called into the Inpatient pharmacy in the basement of the Main Hospital. Prophylaxis should be started within two hours after exposure, as directed by the CDC guidelines. In order to perform post-exposure antibody testing on the source patient, the orders must be

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entered through the HIS Occupational Exposure screen. The source patient must be notified the testing will take place because of an occupational exposure. Consent is necessary due to the “Deemed consent” in the state of Virginia.

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RICHMOND VA MEDICAL CENTER The facility is one of VA’s leading medical centers and serves as tertiary care referral center. This 1.2 million square foot facility is home to the latest and most sophisticated medical equipment and facilities for health care delivery for our Nation’s Heroes. Contained within the main building are a Polytrauma Center of Excellence, a radiation therapy facility, an MRI suite, a large spinal cord injury and disorders unit, a hospice unit, nursing home care unit, and extensive ambulatory care facilities. As part of the General Surgery training residents are assigned to the Veterans Administration Medical Center (VAMC) to the general surgery, oncology and vascular service. The PGY-1 residents may rotate through the cardiothoracic service. The policies and procedures outlined in this handbook are applicable during rotations through the VAMC. For information on VAMC Policies please refer to their specific policies. COMPUTERIZED PATIENT RECORD SYSTEM (CPRS) TRAINING The VA Medical Center in Richmond, Virginia, now requires all incoming housestaff to go through computer training PRIOR to receiving their computer access codes. This policy applies to all housestaff who have rotations through the VA Medical Center (everyone except Emergency Medicine, Pediatric residents and fellows, and Obstetrics/Gynecology). We will have many scheduled training sessions and will work to accommodate your schedule. The training takes approximately 4 hours to complete. If you plan to be in Richmond during April, May, or June 2010 prior to Orientation, please call or email our computer trainer to schedule your appointment. Please identify yourself as an incoming house-officer. Name: Lorrie Swartley (804) 675-5248 Email: [email protected] Those previously trained at this medical center as a medical student are required to attend housestaff training. We will assign you to scheduled training classes at Orientation. For any questions about this policy or any other VA issues, please call the Associate Chief of Staff for Education at 804-675-5249.

VAMC Staff: Chief of Surgical Services Assistants:

Jeannie Savas, MD Belinda Pfeiffer

General Surgical Faculty

Michael Amendola, MD

Vascular Surgery Faculty

John Pfeiffer, Vascular Ron Davis, MD

Oncology Faculty

Huan Vu, MD Walter Lawrence, MD

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675-5986 675-5986