UCLA Surgical Education
 
UCLA Surgical Education





Policies and Procedures

Policies and Procedures

Scope | Mission Statement | Goals of the Program| Definitions | Trainee Eligibility and Selection | Morbidity and Mortality Conference | Solicitation and Receipt of Gifts | Dress Requirement| Resident Travel for Professional Activities| Duty Hours

Medical Record Keeping | Medical Licensure | Drug Enforcement Agency (DEA) | Supervision | Moonlighting | Education-Related Benefits for Trainees | Participation in the Education Program | ABSITE | Leave | Minimum Operative Case Volume | Transitions of Care

Scope
These policies and procedures apply to all resident physicians participating in the Core Surgical Training Program and the General Surgery Residency Program which exist under the authority of the UCLA School of Medicine. These same policies and procedures apply to all full-time and clinical faculty of the Departments of Surgery, Urology, Neurosurgery, and Orthopedic Surgery who participate in, and contribute to, the education and training of the resident physicians in the Core Surgical Training and General Surgery Residency Programs.

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Mission Statement

Residency is an essential dimension of the transformation of the medical student to the independent practitioner along the continuum of medical education.

The Mission of the Core Surgical Training Program is to provide a superior education in the fundamental principles and skills which are common and requisite to all fields of surgery during the PGY-1 and PGY-2 years.

The Mission of the General Surgery Training Program is to provide our graduates with the education and training necessary to become excellent clinical surgeons, accomplished scientific investigators, and effective teachers. It is our, the faculty’s, belief that accomplishing this goal will afford our graduates the skills and versatility necessary to become the future leaders of academic surgery.

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Goals of the Program
1. Maintain a scholarly environment which is committed to the education and training of resident physicians in general surgery, or the surgical subspecialties.
2. Maintain the accredited status of the programs throughout the education period of the trainees.
3. Provide a safe and clean working environment for trainees.

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Definitions
For the purposes of these Policies and Procedures, the following definitions will apply:

  • “Resident physician” refers to an individual who has received the degree of Doctor of Medicine, Dentistry, or Osteopathy and is enrolled in either the Core Surgical Training or General Surgery Residency Program, for the purpose of obtaining an advanced postgraduate education in surgery. This individual may also be referred to as “resident” or “trainee”.
  • “Faculty” refers to an individual who has completed an approved training program in surgery or a surgical subspecialty, and by virtue of their staff or academic appointments directly participate in the education and training of resident physicians. These members have been granted the assignment to teach resident physicians.  
  • “Attending physician” is an individual who has completed an approved training program in surgery or a surgical subspecialty, is appropriately credentialed, and has been granted institutional privileges to conduct, without supervision, all pertinent aspects of patient care including admission, consultation, relevant operations or invasive procedures or other defined activities. An attending physician accepts full responsibility for a specific patient’s medical/surgical care.
  • “Supervising physician” is one either faculty member or more senior resident designated by the program director who is enrolled in the training program, and has, by virtue of demonstrated competence, been granted privileges to conduct, without supervision, hospital admission and discharge, and specified invasive or operative procedures.
  •  “Intermediate resident” refers to resident physicians who are enrolled in their PGY-2 or PGY-3 year.
  • “Chief resident” refers to resident physicians who are completing their final year of clinical training (PGY-5).
“Research resident” refers to resident physicians who are engaged in education and training to obtain and develop skills in scientific investigation. These individuals are not, in general, assigned primary clinical responsibilities or duties.

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Trainee Eligibility and Selection

UPDATED: June 2011

SUBJECT: TRAINEE ELIGIBILITY AND SELECTION

PURPOSE: To define eligibility criteria for the selection of trainees for enrollment in the Core Surgical Training and General Surgery Residency Programs.
POLICY:

Eligibility

To be eligible to enroll in the Core Surgical Training or General Surgery Residency Programs, applicants must fulfill the following criteria:

  • A diplomat of a medical school in the United States or Canada which has been accredited by the Liaison Committee on Medical Education (LCME) or;
  • A graduate of a college of osteopathic medicine in the United States accredited by the American Osteopathic Association (AOA).
  • Graduates of medical schools located outside of the United States or Canada must obtain certification from the Education Council for Foreign Medical Graduates (ECFMG) and a letter of evaluation from the Medical Board of California indicating that they are eligible to participate in postgraduate training.
  • Near eligible to obtain medical licensure in the State of California by virtue of successful completion of the United States Medical Licensing Examination, Parts I and II, by the first day that postgraduate training is to begin.

Selection

  • The selection of trainees for first-year training positions will be made via participation in the National Resident Matching Program (NRMP).
  • Applicants will submit, via written or electronic communication, the following information, which will form the basis for selection:
  • Curriculum vitae
  • Medical school transcript
  • Letter of recommendation from the Dean, or his designee, of the applicant’s medical school
  • Letters of recommendation from a maximum of four (4) faculty members of the applicant’s medical school. Two (2) letters must be from faculty members with clinical responsibilities and appointment to a department of surgery or a surgical subspecialty.
  • Examination scores from the USMLE, Part I, and, if available, Part II at the time of application.
  • Personal statement demonstrating appropriate written communication skills.
  • A preliminary selection committee, comprised of the Directors of the Core Surgical and General Surgery Training Programs, the Chief of the Division of General Surgery, and the Director of the Office of Surgical Education will select applicants who will be offered an opportunity for a personal interview.
  • Applicants granted a personal interview will select from a number of scheduled dates allotted for conducting applicant interviews. In general, no interviews will be conducted outside of the scheduled dates unless unusual circumstances prevail.
  • Each applicant will be separately interviewed by three (3) General Surgery faculty members. Each interview will be allotted twenty (20) minutes apiece.
  • In the setting of the interview, faculty members will refrain from discussing an applicant’s age, race, sex, religion, sexual orientation or marital status.
  • Group discussion and rank ordering of applicants will be performed following the final date of interviews.
The discussion group will consist of the General Surgery faculty members of the Program and the current PGY-5 residents.

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Morbidity and Mortality Conference

  UPDATED: June 2011

SUBJECT:   MORBIDITY AND MORTALITY CONFERENCE

PURPOSE:   To provide an educational forum for the open discussion of the perioperative and intraoperative aspects of patient care.   Such discussion will provide resident physicians the opportunity to critically review various aspects of patient care, to be exposed to contemporary principles guiding surgical decision-making, and insight into the processes of improving the quality of care.   This conference is an essential component of the educational process necessary for the training of residents and a requirement for accreditation by the Residency Review Committee for Surgery of the Accreditation Council for Graduate Medical Education (ACGME)

POLICY: Attendance to this conference is considered a compulsory component of participation in the educational program for both faculty and residents alike.   Confidentiality regarding the discussion conducted during this conference is expected.

  • The following criteria for case reporting to the conference will be used:
  • It is the administrative responsibility of the service chief or senior resident to report the required data on a weekly basis to the Division of General Surgery Office by 10 AM on the Monday of the conference.   The data required is the average daily census of the service, the number of hospital admissions and discharges to and from the service, the total number of inpatient and outpatient operative cases performed the number of reportable events occurring, and the number of deaths occurring.
  • The data accrual period is the seven (7) calendar days preceding the date of the conference.   In the event that a conference is postponed, or cancelled, the data must still be reported.   Any cases previously reported since the last conference was conducted, but not presented, may still be selected for presentation at the discretion of the conference moderator.
  • All events will be reported for the week in which they occurred, regardless of severity, responsible attending availability, or current status of the patient.   The selection for presentation of the case will be at the discretion of the conference moderator.
  • Reportable events are defined as the following:
  1. Unplanned need for secondary operation, whatever the nature.
  2. Unanticipated admissions to any acute care facility within 30 days of discharge.
  3. Unanticipated significant escalation of care required.
  4. Death
  • Event Codes: see attachment regarding classification of cases presented at conference.
  • The chief or senior resident involved in the critical aspects of the perioperative care, primarily the decision for operation and the operation itself will make the presentation of the case.   This includes clinical training years III to V only.   In the event, that the involved resident is no longer on service, that individual will still be responsible for the presentation of the case. The appropriate clinical data and imaging studies will be available for presentation, and that the presenting resident is expected to have reviewed the case, and considered the possible causes of the complication and potential approaches in which the complication could be avoided in the future.

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Solicitation and Receipt of Gifts

UPDATED: June 2011

SUBJECT: Solicitation and Receipt of Gifts or Funds from Commercial Sources (“Drug and Medical Instrument Companies”)

POLICY: Residents in the General Surgery and Core Training Programs are prohibited from the active solicitation of monetary donations or grants from commercial or industrial sources.

Any unilateral offers of monetary donations, grants, or other gifts originating from a commercial source, will be referred to the Program Director or Chief of the Division of General Surgery. Each offer will be considered, and a decision made based on the UCLA SOM Guidelines on Industry Activities (http://www.uclahealth.org/workfiles/industry-guidelines/UCLA-industry-guidelines.pdf).

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Dress Requirement

UPDATED: June 2011

SUBJECT: DRESS REQUIREMENTS

PURPOSE: To ensure that resident physicians in the Core Surgical and General Surgery Training programs will be attired with consideration for professional appearance and safety at all times while discharging their duties.

SCOPE: The following policy is applicable to all rotation sites including the UCLA Medical Center, UCLA Medical Plaza, UCLA School of Medicine campus, West Los Angeles VA Medical Center, Olive View-UCLA Medical Center, Sepulveda VA Medical Center, Harbor UCLA Hospital, and the Los Angeles County-USC Medical Center

POLICY:

  • Professional dress: Clothing appropriate for professional activities will be worn while engaged in the execution of both service and educational responsibilities. Clean white coats with proper photo identification displayed will be worn while on-duty. No collar-less shirts are permitted while on-duty. Male residents are expected to wear collared shirts with ties, and appropriate slacks. Female residents are expected to dress in a manner consistent with a working environment.
  • Scrub uniforms: Are allowed in the Operating Rooms and Surgery Center, or while between operative cases. At the UCLA Medical Center, only the Trauma Surgery team on-call, and resident physicians assigned to ICU rotations are allowed to remain in scrubs throughout the day. On-call residents for other services may change into scrubs after 6 PM. All hospitals prohibit the wearing of scrubs outside of the respective facilities. This ruling, in turn, prohibits the wearing of scrubs issued by another facility (e.g. no UCLA scrubs at Olive View, etc.).
  • Footwear: Appropriate professional footwear is expected. No open-toed shoes or sandals are allowed. Clogs are acceptable in the Operating Rooms or Surgery Center. Alternate footwear may be acceptable if deemed medically justified on a case-by-case basis.
Eye protection: Protective eyewear is both recommended and required in situations where the risk of exposure to patient body fluids is high, especially in the operating room and during bedside procedures. Prescription eyewear should be supplemented by additional splash protection.

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Resident Travel for Professional Activities

UPDATED: January 2011

SUBJECT: RESIDENT TRAVEL FOR PROFESSIONAL ACTIVITIES

POLICY: The involvement of residents in travel related to professional (educational) activities is necessary and encouraged. Because such travel can result in absences from clinical duties and also results in numerous expenses, a number of conditions must be met before such travel will be allowed.

Criteria for Approved Travel:

  • The reason for traveling is to present the results of original investigative work conducted while at UCLA; or for participation in educational activities approved by the residency program director.
  • The traveler will be personally making the presentation of the investigative work.
  • Time away from clinical duties is minimized. Travel to the away location on the date prior to the day of presentation, and return immediately following completion of the presentation.

Authorization for Travel: Absences from clinical Duties must be approved in writing by the:

  • Chief of the Service involved
  • Chief Resident
  • Program Director
  • Sponsoring faculty member

This action is necessary so that adequate coverage can be arranged for the resident’s absence from clinical duties. A travel request form must be completed and signed by the three (3) above-named individuals, as well as the faculty member who will be the financial sponsor of the resident’s travel. The completed travel request form will indicate that coverage has been arranged in anticipation of the resident’s absence.

Travel Form

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Resident Duty Hours

UPDATED: June 20, 2011

SUBJECT: Duty Hours

The Department of Surgery requires that the residency training programs foster both quality resident education and facilitate quality patient care. Overall, resident duty hours in all programs must be consistent with the Institutional and specific program Residency Review Committee (RRC) accreditation requirements established by the Accreditation Council for Graduate Medical Education (ACGME). The structuring of duty hours and on-call schedules focus on the needs of the patient, continuity of care and the educational needs of the residents.

  • Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities. Duty hours do not include reading and preparation time spent away from the hospital.
  • Residents must be provided with one day in seven free from all educational and clinical responsibilities, averaged over a four-week period. One day is defined as one continuous 24-h our period free from all clinical, educational, and administrative activities.
  • Duty periods of PGY-1 residents must not exceed 16 hours in duration.
  • Duty periods of PGY-2 residents and above may be scheduled to a maximum of 24 hours of continuous duty in the hospital.
  • After 24 hours, PGY-2 residents and above may remain on-site for an additional 4 hours in order to accomplish transitions of care or to attend an educational conference. Residents may not be assigned new patients, participate in outpatient clinics, or perform elective scheduled operations.
  • Strategic napping, especially after 16 hours of continuous duty and between the hours of 10:00 p.m. and 8:00 a.m., is strongly suggested.
  • Residents should have 10 hours, and must have eight hours, free of duty between scheduled duty periods.
  • Residents must not be scheduled for more than six consecutive nights of night float.
  • 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).
  • 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 every-third-night limitation, but must satisfy the requirement for one-day-in-seven free of duty, when averaged over four weeks.

Residents are required to report and log all duty hours on Verinform. Resident must log in at least once every week. The Program Directors and coordinators will run reports on a weekly basis to review each resident’s reported duty hours to ensure compliance and address potential violations.

Duty Hour Noncompliance

In the circumstance where a resident recognizes that he or she will be noncompliant with duty hours, he or she must notify the chief resident, service faculty member, and program director. Accommodation will be arranged immediately to bring the hours back into compliance.

Duty hours are reviewed weekly by the program coordinator and program director. Residents who have not entered duty hour logs will be asked to complete these. Completing duty hour logs is a matter of professionalism and the resident will be judge on this. If a duty hour issue is identified by the program director, the program director will contact the resident in order to understand the circumstances that led to the violation. Corrective action will be arranged with the service in order to bring the resident back into compliance.

Fatigue

All residents need to have enough time without clinical responsibilities to stay well-rested and avoid fatigue while on duty. Residents receive instruction annually on issue of fatigue, sleep, and napping.

Residents that have fatigue symptoms at any point could jeopardize patient care.  These symptoms include falling asleep, irritability, apathy, and careless medical errors. Residents are required to consult immediately with other members of the team including service faculty, and inform the program director so that the resident may be immediately be relieved of duty. Patient care should then be delivered by other members of the team or by a faculty member.  Call rooms at each site are available 24 hours a day for strategic napping. It is the responsibility of the fatigued resident to take advantage of time away for rest.

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Medical Record Keeping

UPDATED: June 2011

SUBJECT: MEDICAL RECORD-KEEPING

PURPOSE: To inculcate in trainees the importance and process of appropriate and timely medical record documentation and completion.

SCOPE: All trainees in Core Surgical and General Surgery Training Programs, and all institutions.

POLICY:

All trainees are expected to ensure that the following criteria is followed for appropriate documentation of patient care activities:

  • All notes and orders are dated and timed.
  • All notes and signatures are legible.
  • All notes and orders written by medical students are co-signed by a resident physician or attending physician.
  • All patients admitted to an in-patient service will have a history and physical performed and recorded by a resident physician within twenty-four (24) hours of admission.
  • A preoperative note will be written by the resident physician who intends to participate in the operation noting the patient’s condition or problem, the pertinent preoperative evaluation and the planned operative procedure.
  • A brief handwritten operative report will be completed in the medical record indicating the following:
  • preoperative diagnosis
  • postoperative diagnosis
  • operation performed
  • attending surgeon
  • resident surgeon(s)
  • anesthetic used
  • estimated blood loss
  • parenteral fluids administered
  • urine output
  • drains placed
  • specimens obtained
  • apparent complication
  • The resident physician participating in the operation will personally document postoperative visits for inpatients during the immediate postoperative period.
  • Each patient will have a daily progress note, completed in SOAP format, recorded in the medical record noting the patient’s current status requiring hospitalization, pertinent physical findings, and any active intervention being provided.
  • All procedures will be documented by a procedure note containing the following information:
  • indication for procedure
  • obtaining of informed consent
  • procedure preformed
  • procedurist
  • supervising resident or attending physician
  • anesthetic used
  • apparent complications

Any significant event occurring in the course of a patient’s care will be documented.   This includes the following situations:

  • confusion or delirium resulting in the need for physical restraint or chemical sedation
  • deterioration in a patient’s clinical condition
  • the need to escalate the level of intervention or care for a patient
  • any belligerent, threatening, or hostile actions, either physical or verbal, on the part of the patient, or any of the patient’s family members.

A discharge summary will be completed for all inpatients at the time of discharge from the hospital.

Completion of the Medical Record:

All trainees are expected to complete medical records in an accurate and timely manner.

  • UCLA Medical Center: policy regarding delinquent medical records is established by the Medical Staff ByLaws. “All individuals with clinical privileges (Medical Staff and House Staff) are required to complete discharge summaries in a timely manner.   Clinical privileges of Medical Staff members and House Officers who have 3 discharge summaries delinquent more than 14 days, (when the chart is available) or 1 discharge summary delinquent more than 30 days shall be immediately suspended and clinical privileges (admitting, consulting, and surgical) rescinded; this shall include charts without signatures.   The suspension will be in force until such time as the delinquent medical records are completed.”
  • West Los Angeles VA Medical Center: medical records delinquent for greater than fourteen (14) days when the chart is available, will be reported to the Program Director for action.
  • Olive View-UCLA Medical Center: medical records delinquent for greater than thirty (30) days when the chart is available, will be reported to the Program Director for action.

Failure to complete medical records will result in the following actions, in sequence:

    • Verbal notification and opportunity to complete the records within 72 hours.
    • Formal letter of reprimand for failure to complete medical records to be placed in the trainee’s file.
    • Suspension of clinical privileges, including admitting, consulting, and surgical privileges.   Such suspension will result in removal from the clinical rotation, and assignment of leave without pay status until such time as the Program Director is notified that the delinquency has been removed.   No credit for residency training will be given for the period of suspension.   In the event that your clinical privileges are suspended by the date named in your written notification, the following actions are mandated by UCLA Medical Staff ByLaws, and California State Law.   Notification of your specialty Certification Board for failure to comply with Medical Center and Medical Staff Rules and Regulations and notification of the Medical Board of California, which may jeopardize the ability to obtain or maintain medical licensure in the State of California.
    • Three (3) episodes of suspension of clinical privileges may result in dismissal from the program.

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Medical Licensure

UPDATED: June 2011

SUBJECT:   MEDICAL LICENSURE

 POLICY:   The State of California Business and Professions code Sections 2065 and 2066, states the following:

All graduates of foreign or domestic medical schools are allowed to train in an ACGME accredited training program for a maximum of two years without medical licensure.   Graduates of foreign medical schools who have trained in a ACGME accredited program in another state; the period of time of that training reduces the amount of time allowed for unlicensed training in California.

Residents who continue to train after the two-year licensing exemption has expired may be fined by the Medical Board in amounts ranging from $100 to $2500 depending upon the severity of the violation.

The policy of the program will be as follows:

  • All resident physicians must obtain California medical licensure before the end of the second year of clinical training. Accomplishing this requires that USMLE Parts I, II, and III are successfully completed by May of the first year of training.
  • In the event that licensure is not obtained by the end of the second year of training, the trainee will be immediately suspended from the program. No credit for residency training will be given for the time under suspension.
  • Reinstatement to the program will require adequate documentation of licensure.
  • The forms may be obtained from the Medical Board website: http://www.mbc.ca.gov/.

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Drug Enforcement Agency (DEA)

UPDATED: June 2011

SUBJECT: DRUG ENFORCEMENT AGENCY (DEA) CERTIFICATION

PURPOSE: To comply with Federal statutes governing the use of DEA certification.

SCOPE: Resident physicians in Core Surgery and General Surgery Training Programs, all institutions.

POLICY:

  • Trainees are expected to obtain DEA certification as soon as possible, after they have obtained medical licensure in the State of California.
  • First-year trainees without medical licensure may write and sign outpatient prescriptions only if such prescriptions will be filled within the facility to which they are assigned.
  • Trainees without DEA certification are forbidden from using the DEA and medical license numbers of other resident physicians to write outpatient prescriptions.
  • Outpatient prescriptions to be filled outside of the institution should be written by a physician, either attending physician or resident physician who possesses valid DEA and medical license numbers.

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SUPERVISION OF RESIDENT ACTIVITIES

UPDATED: June 2011

SUBJECT: GUIDELINES FOR SUPERVISION OF RESIDENT ACTIVITIES

PURPOSE: These guidelines are established to ensure patient safety, enhance the quality of patient care, and improve the training experience of residents. Consistent with the philosophy of progressively increasing individual responsibility, these guidelines are intended to provide the trainee the opportunity for graded levels of responsibility.

SCOPE: These guidelines apply to all residents enrolled in the Core Surgery and General Surgery Training Programs, and attending surgeons of all integrated and affiliated institutions who are involved with the UCLA General Surgery and Core Surgery Training Programs.

General Guidelines

  1. The supervision and communication between the attending surgeon and any resident should exceed that required to ensure that the clinical care delivered meets the established community standard of care.
  2. The resident can identify and contact a responsible attending surgeon for a given patient at all times.
  3. In the event that an attending surgeon is not available to provide supervision, he or she must designate an alternate or covering attending and identify that person to the resident.
  4. For ambulatory or non-urgent care, an attending surgeon is required to be available on-site at the facility during daytime hours of operation.
  5. For inpatient admissions, an attending surgeon or supervising resident will be notified of the admission and such notification will be documented in the admitting resident’s admission note. An attending surgeon will personally see and evaluate each assigned inpatient admission within twenty-four (24) hours of admission, and co-sign the resident’s admitting note or create their own written or printed documentation.
  6. For inpatients, residents should maintain ongoing communication at least one (1) time per day with the designated attending surgeon. The attending surgeon should document such communication by co-signing the resident’s progress note, or the resident will include in his progress note that the case has been discussed with the attending surgeon.
  7. It is assumed that there is a mutual responsibility on the part of both the resident and attending surgeon to recognize the need for increased frequency and quality of communication, and attending surgeon participation in the following circumstances
    a .limited experience of the resident
    b. increased acuity of the patient’s condition (e.g. transfer to intensive care unit, need for higher level of clinical care, etc.
    c. higher risk of complication or mortality associated with the clinical intervention being considered
    d. end of life decisions or initiation of “no CPR” order per hospital protocol

Lines of Supervision and Communication

Consistent with the philosophy of graded levels of responsibility, it is expected that the resident will directly communicate with, and be, in turn, supervised by the most senior supervising resident on their assigned surgical team. In turn, it is expected that the most senior supervising resident will directly communicate with the designated attending surgeon. In urgent, or emergent situations, immediate communication with the attending surgeon by any resident on the team is expected.

  • Supervision of PGY-1 Residents
    Indirect supervision (the supervising physician (a senior resident or attending) is immediately available to provide direct supervision) is allowed for:
    a. Patient Management Competencies:
    - evaluation and management of a patient admitted to hospital, including initial history and physical examination, formulation of a plan of therapy, and necessary orders for therapy and tests.
    - pre-operative evaluation and management, including history and physical examination, informed consent, formulation of a plan of therapy, and specification of necessary tests
    - evaluation and management of post-operative patients, including the conduct of monitoring, and orders for medications, testing, and other treatments
    - transfer of patients between hospital units or hospitals
    - discharge of patients from the hospital
    - interpretation of laboratory results

    b. Procedural Competencies
    - performance of basic venous access procedures, including establishing peripheral intravenous access
    - placement and removal of nasogastric tubes and Foley catheters
    - arterial puncture for blood gases
  • Direct supervision (the supervising physician is physically present with the resident and patient) is required until competency is demonstrated for:
    a. Patient Management Competencies
    - initial evaluation and management of patients in the urgent or emergent situation, including urgent consultations, trauma, and emergency department consultations (ATLS required)
    - evaluation and management of post-operative complications, including hypotension, hypertension, oliguria, anuria, cardiac arrythmias, hypoxemia, change in respiratory rate, change in neurologic status, and compartment syndromes
    - evaluation and management of critically-ill patients, either immediately post-operatively or in the intensive care unit, including the conduct of monitoring, and orders for medications, testing, and other treatments
    - management of patients in cardiac or respiratory arrest (ACLS required)
    b. Procedural Competencies
    - carry-out of advanced vascular access procedures, including central venous catheterization, temporary dialysis access, and arterial cannulation
    - repair of surgical incisions of the skin and soft tissues
    - repair of skin and soft tissue lacerations
    - excision of lesions of the skin and subcutaneous tissues
    - tube thoracostomy
    - paracentesis
    - endotracheal intubation
    - bedside wound debridement

Lines of Supervision by Service

Service

U

C

L

A

Anesthesia

Urology

Vascular

H&N

Attending

Attending

Attending

Attending

Attending

Attending

Attending

Attending

Ü

Ü

Ü

Ü

Ü

Ü

Ü

Ü

R5

R5

R5

R4

R1

R1

R4

R1

Ü

Ü

Ü

Ü

Ü

R4

R3

R3

R3

R2

Ü

Ü

Ü

Ü

Ü

R1

R1

R1

R1

R1

Service

Liver

Transplant

Liver ICU

MIS

Neurosurgery

Orthopedics

Outpatient

Surgery

Pediatric

Surgery

Plastic Surgery

Attending

Attending

Attending

Attending

Attending

Attending

Attending

Attending

Ü

Ü

Ü

Ü

Ü

Ü

Ü

Ü

Transplant Fellow

R2/R1

R1

Chief Resident

Chief Resident

R1

R5

Plastic Fellow

Ü

Ü

Ü

Ü

Ü

R1

R1

R1

R2

R1

Ü

R1

Service

Ortho VA

Plastic VA

GS SMH

GS OV

Plas OV

CT VA

GS VA

Neuro VA

Attending

Attending

Attending

Attending

Attending

Attending

Attending

Attending

Ü

Ü

Ü

Ü

Ü

Ü

Ü

Ü

R1

R1

R5

R5

Plastic Fellow

CT Fellow

R5

Chief Resident

Ü

Ü

Ü

Ü

Ü

Ü

R3/R2

R3

R1

R1

R3

R1

Ü

Ü

Ü

R1

R2

R1

Service

USC Burns

CT CHS

Urol VA

Burns

Harbor Trauma

CT CHS

Attending

Attending

Attending

Attending

Attending

Attending

Ü

Ü

Ü

Ü

Ü

Ü

Chief Resident

CT Fellow

Chief Resident

Chief Resident

R4

CT Fellow

Ü

Ü

Ü

Ü

Ü

Ü

R1

R1

R1

R2

R2

R2

Invasive Procedures and Operations

  1. An attending surgeon or supervising resident will be physically present with the patient for all invasive procedures.
  2. An attending surgeon or supervising resident will be physically present with the patient for all operations. In the event that an attending surgeon is not physically present for an operation, the supervising resident will ensure that appropriate preoperative documentation of the attending surgeon’s notification and approval of the operation was obtained prior to proceeding with the operation.
  3. An attending surgeon or supervising resident will see and evaluate each patient prior to the operation and ensure that appropriate documentation of a preoperative note has been performed.
  4. An attending surgeon or supervising resident will ensure that an appropriate and adequate informed consent has been obtained and documented in the medical record.
  5. An attending surgeon or supervising resident will ensure that appropriate documentation of the procedure has been included in the medical record at the time of the conclusion of the procedure or operation.

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Moonlighting

UPDATED: June 2011

SUBJECT: PROFESSIONAL ACTIVITIES OUTSIDE THE SCOPE OF TRAINING (“MOONLIGHTING”)

PURPOSE: To comply with the tenets of the American Board of Surgery, and the Residency Review Committee in Surgery of the ACGME.

POLICY: Professional activities outside the scope and intent of residency training detract from the education experience and may adversely affect patient care. It is the policy of the Department of Surgery that absolutely no such activities or any type of outside employment may occur during assignment to clinical rotations.

Participation in outside employment may be allowed during assignment to the research hiatus. Formal approval for such activities must be obtained from the Program Director and the research mentor or principal investigator. Any residents not in good academic standing with the program will not be allowed to participate in moonlighting activities until being reinstated to good standing.

Violation of this policy may result in immediate dismissal from the training program.

 

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Education-Related Benefits for Trainees

UPDATED: June 2013

SUBJECT: EDUCATION-RELATED BENEFITS FOR TRAINEES

POLICY: To support and foster the education of trainees, the Division of General Surgery will provide the following items:

  • Two (2) sets of the American College of Surgeons SESAP program for use by all residents.
  • Two (2) sets of Selected Readings in Surgery for use by all residents.
  • mini iPads for General Surgery categorical residents and General Surgery preliminary residents
  • $500 for each resident in general surgery training available for use in either their fourth or chief year of training. The total amount of support cannot exceed $500 for any individual resident. These funds are intended for the purchase of books, journals, or review materials.

Please note that the following expenses incurred by trainees, will not be reimbursed by either the Division of General Surgery or the Department of Surgery (this list is not intended to be all inclusive):

  • laboratory coats (these are supplied by the hospital
  • embroidery for laboratory coats
  • business cards
  • personal computers
  • stethoscopes, or other medical equipment
  • cellular phones
  • cellular airtime
  • eye protection
  • surgical loupes
  • USMLE examination fees
  • Medical Board license application fees
  • DEA certificate application fees

 

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Participation in the Education Program

UPDATED:June 2011

SUBJECT: PARTICIPATION IN THE EDUCATIONAL PROGRAM

PURPOSE: To establish and communicate expectations for both faculty and trainees regarding participation in the educational program.

POLICY: Ongoing participation in the educational program is the mutual responsibility of the faculty and the trainees. The following expectations are outlined to enhance the educational process.

Attendance of Teaching Conferences:

Wednesday conferences are an integral component of the educational program. These conferences are compulsory for all residents. Attendance will be documented by personnel signature recorded on the sign-in sheet. The absence of a signature will be regarded as an unexcused absence. Failure to comply with the minimal attendance standards set forth below or the failure to demonstrate an effort to attend conferences may result in probationary action for trainees.

Excused absences will be allowed in the following circumstances:

  • Notification of the Surgery Education Office (310 825-6557) prior to or within 48 hours of the conference date.
  • Scheduled vacation time.
  • Approved absence from the program such as meeting travel, interviews, and leaves.
  • Post call residents.

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ABSITE

UPDATED: June 2011

SUBJECT: AMERICAN BOARD OF SURGERY IN-TRAINING EXAMINATION

POLICY: All residents in the Core Surgical and General Surgery Training Programs are required to complete the ABSITE in January of each year.

If the resident is scheduled for vacation at that time, he/she must plan upon returning to UCLA for the examination, or register at a testing site near their vacation area.

Exemptions for sitting for the examination are the following:

Head and neck surgery residents.

Urology residents.

Orthopedics residents.

Oral surgery residents.

Prior written excuse from the Core Surgical or General Surgery Training Program Director.

 

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Leave

UPDATED: June 2011

SUBJECT: Leave

PURPOSE: To comply with institutional policy regarding housestaff leave.

POLICY: The following program policy regarding leave from clinical duties during training is in effect.

Vacation: Twenty-eight (28) days of vacation are allowed for each trainee per academic year.

Residents in the Core Surgical Training Program are assigned (1) four-week block of vacation. Preferences for dates of vacation will be considered but not assured. Residents in General Surgery training from the third clinical year and up will be allowed to schedule vacation in one-week blocks. Vacations may be scheduled by mutual agreement of the residents if the following conditions are met:

Only one resident will be absent from a service at any time.

Each hospital must have a chief resident available for coverage. It is not acceptable to have a chief resident assigned to CHS to cover the West Los Angeles VA, etc.

Changes in posted vacation schedules must be submitted to the Program Director in writing not less than four (4) weeks prior to the desired change. Such changes are subject to approval and are contingent upon the needs for the delivery of appropriate clinical care.

Vacations must be taken within the academic year of appointment. No carry over to subsequent years will be made.

Non-approved days of leave in excess of the allowed (28) days, will be considered absences without approval and no credit for training will be given for this time.

Sick Leave: sick leave is accrued at the rate of eight (8) hours per month of appointment. In the event of illness, the resident must notify the chief resident of his/her service, and the Surgery Education Office immediately.

Family Illness or Death Leave: up to five days of sick leave may be used if the resident is required to be in attendance or provide care because of an illness in the family or attendance is required due to the death of a relative.

Paid Maternity Leave: two (2) weeks per academic year. Leave in excess of this time, with the exception of sick or vacation time will be leave without pay and may not be credited for training requirements.

Paid Paternity Leave: one (1) week if the following conditions are met:

Written notice given to the Program Director of the intention to take paternity leave at least 30- days prior the expected birth or adoption.

The paternity leave cannot be taken later than thirty (30) days after the actual birth or adoption date, nor commenced prior to 30 days before the projected birth or adoption date.

Medical Leave: may be requested if a medical condition affects a trainee’s ability to continue in the training program or to safely or adequately fulfill their patient care responsibilities. Please refer to UCLA Housestaff manual for the necessary procedure to follow.

Leave for Interviews or Meeting Travel: a maximum of ten (10) working days are allowed per academic year for each resident for interviewing or meeting attendance. (See Travel For Resident Professional Activities). Written approval from the Program Director and the Chief of Service is required prior to departure. Post facto approvals will not be given and in such instances, the time taken will be considered leave without pay. The traveling resident must provide their own coverage for their absence. This leave time, if unused, will not accrue annually and cannot be applied toward vacation time.

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Minimum Operative Case Volume

DATED: June 2011

SUBJECT: Minimum Operative Case Volume

PURPOSE: To ensure adequate operative experience and documentation of cases.

POLICY: All residents in the Core and General Surgery Residency Programs are required to enter cases in the ACGME Case Log system in a timely fashion. Core surgery residents will not be given a favorable review unless cases logs are up to date at the completion of the Core program. This means that the Program Director will inform the subsequent Program of the issue and will not sign off on any documentation required by the residency, future employment, or hospital privileging forms. Residents must complete a minimum number of cases to advance to the next year or have a favorable review. A deviation of 20% fewer cases than the minimum may lead to disciplinary action or dismissal.

Minimum number of cases per year:

PGY1 60

PGY2 125

PGY3 250

PGY4 200

PGY5 150

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Transitions of Care

UPDATED: July 2011

SUBJECT: Transitions of Care

PURPOSE: To minimize number of transitions in patient care and to comply with the Institutional and specific program Residency Review Committee (RRC) accreditation requirements established by the Accreditation Council for Graduate Medical Education (ACGME).

POLICY:

  • All patient hand offs should take place in a designated workplace, office, or conference room to ensure patient confidentiality and lack of distraction. Hand offs in public areas such as hallways, cafeterias, and elevators are prohibited.
  • It is acceptable to conduct hand-offs over the phone, as long as both parties are in an appropriate room, without other distractions, and have access to the electronic surgery sign-out checklist.
  • Hand-offs should only occur with direct one-to-one communication between the resident responsible for the patients being released and the resident that will be taking over their care. No third party communication is allowed.
  • Handoffs during the first month of residency should be conducted in the presence of a senior resident of attending physician to ensure that residents are competent in communicating with team members in the hand-over process.
  • Always use the electronic checklist during hand-off to ensure transmission of pertinent information and allow senior residents and faculty to monitor effective, structured hand-over processes to facilitate both continuity of care and patient safety. The list is available in a password protected website: http://signout.mednet.ucla.edu/surgery/
  • The sign out checklist should be updated at least twice a day and as often as necessary during the work day or night. Do not delete any relevant information from the list until the patient is discharged.
  • Senior residents are responsible for reviewing the sign-out checklist at least daily to ensure that the information is accurate.  Attending physicians are ultimately responsible for all patient care and must supervise residents at all times.
  • Elements of the checklist cannot be modified without approval from the administrative chief residents and program directors.
  • Required elements on the checklist should include, but are not limited to:
    • Patient name, age, medical record number, and location
    • Attending physician and upper level residents responsible
    • Admission date and admitting diagnosis
    • Important elements of history and physical examination
    • Relevant social information including contacts
    • Code status, advance directives
    • Dates and titles of operative procedures, if any
    • Current medication list
    • Key information on current condition and care plan (diet, activity, planned operations, pending discharge, significant events during the previous shift, changes in medications etc.)
    • Specific tasks that need to be accomplished by the resident that is taking over such as following up on laboratory and imaging studies, wound care, clinical monitoring, pending communication with consultants etc.
    • DO NOT sign-out complex tasks that require synthesizing information from separate sources and tasks that involve multiple steps.
  • Allow ample time for the resident receiving sign-out to ask questions
  • Exchange contact information in the event there are any additional questions
  • Scrutinize and question data if “something does not make sense” or you think it is wrong
  • Use the virtual pager for the service you are covering when on duty. Sign on when you start duty and sign out the pager to the appropriate person at the end of your shift. Use the virtual pager number for all communications with caregivers and written records.
  • Current call schedules for all services that inform all members of the health care team of attending physicians and residents currently responsible for each patient’s care are posted on the surgery education website: http://www.surgery.medsch.ucla.edu/resident/call_schedules.html The schedules are also available through the hospital operators.
 
 

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