1. science
2. medicine
3. surgery

INTRODUCTION
A. INTRODUCTION TO THE SURGICAL RESIDENCY TRAINING
The goal of the University of Arizona, College of Medicine’s General Surgery Residency
program is to provide you with the best possible education and training for a career in general
surgery, or in one of its disciplines. You will actively participate in every aspect of the program,
from the operating room to the classroom, in order to derive the maximum benefit from the
residency training. Self-instruction and motivation are the primary principles of adult education.
You have been selected for this residency program primarily because the faculty believes that
you can successfully fulfill the goals of the program.
B. GENERAL SURGERY RESIDENCY SELECTION POLICY (2013/2014)
The Department of Surgery General Surgery Residency program at the University of Arizona
fully adheres to the Resident Selection Policy as enumerated in the University of Arizona
College of Medicine Graduate Medical Education Policy and Procedures Manuel. The policy
for the recruitment and selection of residents into the General Surgery Residency program are
based on the following:
Resident Eligibility
Applicants that meet one of the following criteria will be considered:
• Graduates of medical schools in the United States and Canada accredited by the Liaison
Committee on Medical Education (LCME)
• Graduates of colleges of osteopathic medicine in the United States accredited by the
American Osteopathic Association (AOA)
• Graduates of medical schools outside the United States and Canada who meet one of
the following qualifications:
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Have received a currently valid certificate from the Educational Commission for
Foreign Medical Graduates
Hold a full and unrestricted license to practice in a United States licensing
jurisdiction
Resident Selection
The University of Arizona General Surgery Residency program is an equal opportunity employer
which considers applicants without regard to sex, race, religion, age, disability, national origin,
ethnicity, or veteran status.
The program director, associate program director, and assistant program directors along with
the faculty of the Department of Surgery rank each applicant based on the following:
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The eligibility requirements of the Accreditation Council for Graduate Medical Education
(“ACGME”)
The applicant’s grades and rank in medical school
The applicant’s performance on the USMLE Step I, II examinations
Letters of recommendation
A medical school dean’s letter with his or her assessment of the applicant’s aptitude and
preparedness
The applicant’s interviews with assessment of medical knowledge, interpersonal and
communication skills, motivation, integrity, and fit to the program.
Non-eligible graduates will not be considered for the residency program.
C. GOVERNANCE OF THE RESIDENCY PROGRAM
The Program Director has ultimate authority and responsibility for all aspects of the residency
program. The Program Director is able to perform all of these activities with considerable help
from all of the faculty and residents. In general, the Program Director is responsible for the
overall supervision of the academic responsibilities of the teaching faculty, maintenance of the
academic milieu of the residency program, overall performance evaluation of each individual
resident and each individual rotation, and the preparation of documents necessary to comply
with accreditation.
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The Residency Executive Committee (REC) meets monthly to manage short-term goals,
address problems, and develop any necessary plans of corrective action. The overall direction
of the residency, including promotion and retention decisions, allocation of clinical rotations,
curriculum development and faculty and resident selection is overseen by the Residency
Executive Committee. The Residency Executive Committee is comprised of the Program
Director, Associate Program Director, Assistant Program Directors, site directors, key faculty,
and the two resident Administrative Chiefs.
Additionally, there is a Resident Committee, comprised of representatives of each class
selected by their peers. This committee represents the residents at the Governance Committee
meetings and brings resident concerns to the attention of the faculty and residency leadership.
The Governance Committee meets four times a year and consists of the Residency Executive
Committee and the Resident Committee. This committee acts as an advisory committee to the
Program Director.
D. PROGRAM DIRECTOR RESPONSIBILITIES
The Program Director of the General Surgery Residency program is appointed by the Chair of
the Department of Surgery.
The Program Director is a full-time faculty member, practicing at the primary institution of the
residency program. The Program Director is certified by the American Board of Surgery and is
on the medical staff of the primary institution of the residency program.
The responsibilities of the Program Director include the following (adapted from the Residency
Review Committee “RRC” program requirements):
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Prepare written statements about the educational goals of the program with respect to
knowledge, skills, and other attributes of the residents at each level of training.
Prepare written statements about the expectations of the residents on each major rotation
and/or other program assignments.
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With the teaching faculty, select residents for appointment to the training program.
Develop a schedule of resident assignments to fulfill educational needs of each resident
throughout the duration of the training program.
Monitor the educational activities of all rotations with respect to maintaining a balance
between education and service obligations and assure that there is a prompt and reliable
system for communication and interaction between residents and teaching faculty.
Implement a fair but comprehensive evaluation system so that each resident understands
his/her progress through the training program. Identify deficiencies in resident performance
and outline a plan of correction for each deficiency.
Ensure an adequate environment for the residents’ overall needs on each rotation. This
includes the appropriate availability of relaxation time and time out of the hospital. For each
rotation, the Program Director must assure adequate resources for sleeping, relaxing, and
studying for each resident assigned to that rotation.
Provide complete and accurate program information and resident operative records to the
RRC so that appropriate assessments of the training program may be made.
Develop and direct the core curriculum of the weekly didactic program of clinical and basic
sciences, regularly scheduled conferences, such as Grand Rounds, and other organized
teaching activities.
Evaluate the results of the ABSITE in order to improve the curriculum and to counsel
individual residents regarding performance.
Work with all teaching faculty to improve the educational content of each rotation.
Evaluate educational versus service responsibilities on the various rotations, and develop
recommendations for improving the educational climate of those rotations.
Semi-annually, review each resident’s academic performance (including ABSITE results,
quizzes, mini-in service scores, etc.) and recommend the appropriate academic status for
each resident to the Residency Executive Committee.
Periodically assess the quality of each rotation, based on resident evaluation and other
criteria, and report those findings to the Residency Executive Committee and to the
responsible service directors.
EDUCATIONAL GOALS and RESIDENT RESPONSIBILITIES
The University of Arizona General Surgery Residency Program includes a preliminary track
(one or two years of training) and a categorical track (five or more years of clinical training.)
The program encompasses training in general surgery, its principles, and related surgical
specialties. The fundamental educational goal of the training program is to provide a complete
education in the basic and clinical science of general surgery. This will prepare the
postgraduate for the practice of clinical surgery, further specialty training or a career in
academic surgical investigation.
A. GLOBAL EDUCATIONAL GOALS
The ACGME has endorsed general competencies for all residents in the areas of: patient care,
medical knowledge, practice-based learning and improvement, interpersonal and
communication skills, and systems-based practice as follows:
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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 are
expected to:
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Communicate effectively and demonstrate caring and respectful behaviors when interacting
with patients and their families
Make informed decisions about diagnostic and therapeutic interventions based on patient
information and preferences, up-to-date scientific evidence, and clinical judgment
Develop and carry out patient management plans
Counsel and educate patients and their families
Use information technology to support patient care decisions and patient education
Perform competently all medical and invasive procedures considered essential for the area
of practice
Provide health care services aimed at preventing health problems or maintaining health
Work with health care professionals, including those from other disciplines, to provide
patient-focused care
Medical Knowledge
Residents must demonstrate knowledge about established and evolving biomedical, clinical,
and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this
knowledge to patient care. Residents are expected to:
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Demonstrate an investigatory and analytic thinking approach to clinical situations
Know and apply the basic and clinically supportive sciences which are appropriate to their
discipline
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Practice-based Learning and Improvement
Residents must be able to investigate and evaluate their patient care practices, appraise and
assimilate scientific evidence, and improve their patient care practices. Residents are expected
to:
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Analyze practice experience and perform practice-based improvement activities using a
systematic methodology
Locate, appraise, and assimilate evidence from scientific studies related to their patients’
health problems
Obtain and use information about their own population of patients and the larger population
from which their patients are drawn
Apply knowledge of study designs and statistical methods to the appraisal of clinical studies
and other information on diagnostic and therapeutic effectiveness
Use information technology to manage information, access on-line medical information, and
support their own education
Facilitate the learning of students and other health care professionals
Accurately enter case logs electronically in a timely manner in order to assess individual
areas of need
Interpersonal and Communication Skills
Residents must be able to demonstrate interpersonal and communication skills that result in
effective information exchange and teaming with patients, their patients families, professional
associates, and administrative staff. Residents are expected to:
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Create and sustain a therapeutic and ethically sound relationship with patients
Use effective listening skills and elicit and provide information using effective nonverbal,
explanatory, questioning, and writing skills
Work effectively with others as a member or leader of a health care team or other
professional group
Complete medical records (verbal orders/dictations, etc.) in a timely manner
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Professionalism
Residents must demonstrate a commitment to carrying out professional responsibilities,
adherence to ethical principles, and sensitivity to a diverse patient population. Residents are
expected to:
• Demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients
and society that supersedes self-interest; accountability to patients, society, and the
profession; and a commitment to excellence and on-going professional development
• Demonstrate a commitment to ethical principles pertaining to provision or withholding of
clinical care, confidentiality of patient information, informed consent, and business practices
• Demonstrate sensitivity and responsiveness to patients’ culture, age, gender, and
disabilities
• Report to conferences (M&M, Grand Rounds, Journal Club, etc.) and didactic sessions in a
timely manner and respectfully avoid use of electronic devices during this protected time
Systems-based Practice
Residents must demonstrate an awareness of and responsiveness to the larger context and
system of health care and the ability to effectively call on system resources to provide care that
is of optimal value. Residents are expected to:
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Understand how their patient care and other professional practices affect other health care
professionals, the health care organization, and the larger society and how these elements
of the system affect their own practice
Know how types of medical practice and delivery systems differ from one another, including
methods of controlling health care costs and allocating resources
Practice cost-effective health care and resource allocation that does not compromise quality
of care
Advocate for quality patient care and assist patients in dealing with system complexities
know how to partner with health care managers and health care providers to assess,
coordinate, and improve health care and know how these activities can affect system
performance
Timely and accurate recording weekly of duty hours
B. PROGRAM-SPECIFIC EDUCATIONAL GOALS
1. Gain a comprehensive knowledge base, clinical decision-making ability, and technical
skills in the principal components of general surgery, which include:
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the abdomen
the alimentary tract
the breast
critical care
the endocrine system
the head and neck
the skin and soft tissues
transplantation
trauma and acute surgery
the vascular system
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2. Acquire a broad experience in the additional components of general surgery, including
acquisition of the appropriate knowledge bases, the development of specific technical skills,
and an understanding of the principles of decision-making particular to the specialty.
The additional components include:
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anesthesiology
cardiothoracic surgery
endoscopy
neurologic surgery
orthopedic surgery
pediatric surgery
urologic surgery
3. To acquire the ability to quickly and effectively assess, stabilize, and manage the patient
with severe multiple injuries (operatively or non-operatively, as appropriate), regardless of
the organ systems involved.
4. To demonstrate the intellectual curiosity and commitment required to participate fully in the
didactic curriculum of the residency program and to develop personal, life-long habits of selfstudy and continuing education.
5. To develop professional habits consistent with sound, ethical medical practice, including:
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Effective interpersonal relationships with peers and other health professionals
A compassionate attitude toward patients, their families and friends
Clarity and timeliness of written communication in the medical record and elsewhere
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C. PGY-SPECIFIC EDUCATIONAL OBJECTIVES
As the surgical residency program is seen primarily as an educational endeavor, certain
educational objectives have been set for residents at each level of training. The RRC specifies
in considerable detail which clinical experiences must be included in a general surgery
residency program and the rotations in the five clinical years of our residency program conform
to that “blueprint.”
During the first two years of training, about half of the rotations are devoted to general surgery
and its principle components (e.g., trauma, vascular surgery, etc.) with experience in surgical
specialties and other specialties (e.g. anesthesia) constituting the other half. In the third, fourth
and fifth years, about two-thirds of the time is spent on general surgical services; the other
rotations include components of general surgery, such as transplant, pediatric, and vascular
surgery. Please see the specific PGY level rotational goals and objectives attached at the end
of this Program Policy Manual. It is expected that you will review these prior to the start of
each new rotation.
All Residents
1. Spend at least two half days/week in an ambulatory setting as appropriate for the
rotation.
2. This experience will focus on providing pre- and postoperative care to the patient.
3. Maintain a log of operative procedures. This will be done electronically via the ACGME
website http://www.acgme.org/. The individual case logs will be monitored on a
quarterly basis by the Program Director. The ACGME Case Log Quota states the
numbers of cases a resident should have logged at the end of a given training year as
the following:
a. PGY 1 - 100 cases
b. PGY 2 - 250 cases
c. PGY 3 - 400 cases
d. PGY 4 - 600 cases
e. PGY 5 - 750 cases (150 in Chief year)
4. If residents have not entered the expected number of cases (30 minimum/per quarter),
operative privileges will be withheld and other clinical duties will continue until case logs
are up to date. If the resident is up to date but has deficiencies compared with their
peers in categories or index cases, then their rotations may be modified to correct the
deficiencies.
5. It is expected that all residents (preliminary and categorical) will log all of their cases in a
timely and accurate manner.
6. Maintain a list of SICU/non-operative trauma experiences in a manner acceptable to the
RRC and the American Board of Surgery (ABS).
7. Maintain at least 80% attendance at all required conferences and didactic sessions. If
attendance goes below 80% a Notice of Deficiency will be issued.
8. Maintain his/her University of Arizona email account and check it daily for important
communications from the Program and the University.
9. Read his/her mail and empty his/her Housestaff mailbox on a weekly basis.
10. Log duty hours weekly.
• Failure to log duty hours in a timely manner will result in the resident being pulled off
service to log hours in the residency office, and/or suspension from the operating
room for 5 days.
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Junior Residents (PGY 1 and PGY 2)
1. Perform comprehensive history and physical assessment and share information with
senior resident and/or attending.
2. Use available information, in combination with the interpretation of basic laboratory and
radiographic data, to develop a plan for the preoperative preparation of the patient and
to discuss such plan with the senior resident and/or attending.
3. Understand the basic pathophysiologic disease process and its surgical implications.
4. Understand the decision-making process required of the surgeon and the principles on
which the decisions are based.
5. Understand the basics of the surgical procedures performed, including tubes placed,
drains placed, lines placed, etc.
6. With the aid of the senior resident and/or attending, develop a postoperative plan of care
and surveillance. Anticipate problems particular to the patient or disease entity.
7. Provide for the day-to-day care of patients on his/her service- write admission orders,
organize tasks, obtain data, etc.
8. Serve as instructor to medical students and supervise their assigned tasks along with
the senior resident.
9. Develop the interpersonal skills necessary for dealing with patients, nursing staff, fellow
residents and attending staff.
10. Master the principles of basic surgical biology as they influence care of the surgical
patient.
11. Accomplish the objectives stated for each rotation.
12. Learn basic surgical skills under supervision: sterile technique, OR conduct, dressing
changes, wound care, and basic surgical procedure.
13. Successfully complete ACLS and ATLS and maintain certification.
14. Adhere to the new ACGME supervision policies.
Senior Residents (PGY 3 and PGY 4)
Provide supervision of the junior resident in carrying out patient care responsibility to include:
1. Confirm and review pertinent history and physical findings with the junior resident.
2. Review subjective and objective evidence of patient progress or complications with the
junior resident.
3. Review pertinent laboratory and imaging data with the junior resident.
4. Modify (as needed) patient care plan developed by the junior resident.
5. Timely communicate details of patient progress or complications to attending surgeon.
6. Master the sophistication of the pathophysiology of the patient’s disease process.
7. Master the elements of preoperative preparation of the surgical patient, especially in
consideration of existing co-morbidity factors.
8. Understand the principles of the operative procedure including pertinent anatomy and
technical considerations as well as decision-making processes.
9. Develop, with attending surgeon, a postoperative plan of care considering co-morbidity
factors, basic disease process and conduct of operative procedure.
10. Supervise the junior resident in the day-to-day execution of the care plan.
11. Educate junior and senior medical students in basic surgical diseases, surgical biology
and the conduct of pre, intra and postoperative care of the surgical patient.
12. Refine interpersonal skills in dealing with patients, staff, fellow residents and
attendings.
13. Learn surgical techniques (under supervision of attending surgeon) specific to rotation.
14. Become conversant with the published surgical literature.
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Chief Residents (PGY 5)
1. Provide supervision of the junior resident in carrying out patient care responsibilities for
the patient chosen by the chief resident for care (patients with complex surgical
problems).
2. Communicate the details of patient progress or complications to attending.
3. Understand, at a sophisticated level, the pathophysiology of the patient’s disease
processes.
4. Perfect the elements of pre-operative preparation of the surgical patient, especially in
consideration of existing co-morbidity factors.
5. Understand, in depth, the principles of the operative procedure including pertinent
anatomy and technical consideration and the decision-making process.
6. Develop, with the attending physician, a postoperative plan of care considering comorbidity factors, basic disease process, and the conduct of the procedure.
7. Master the interpersonal skills in dealing with patients, staff, fellow residents, and
attendings.
8. Master the surgical technique (under supervision of attendings) specific to those patients
with complex surgical problems.
9. Function as consultant to junior and senior residents as needed.
10. Function as educator of surgical house staff and medical students.
11. Function as administrator of the junior and senior resident staff.
Administrative Chiefs (two PGY5s)
The Administrative Chiefs will be peer selected on an annual basis (typically in March) by all of
the categorical residents. The term of responsibility will be from April in their PGY 4 year
through April of their PGY 5 year.
1. Generate and maintain the monthly UAMC Multispecialty Surgery call schedule.
a. This is to be in a distribution ready form by the 15th of the preceding month for
approval and distribution by the 20th of the month prior to the rotation.
2. Maintain and distribute the General Surgery Resident Vacation Schedule
a. The schedule should comply with all policies as set forth in the Program Policy
Manual.
3. Maintain bi-monthly Animal Lab schedule, adjusting all other schedules when changes
occur.
4. Organize and distribute articles for the bi-monthly General Surgery Journal Club.
a. Select and distribute articles at least one week prior
5. Attend and moderate the Medical Student Surgical Orientation luncheon regarding
“Medical Student Expectations”
6. Attend the monthly General Surgery Residency Executive Committee Meeting
7. Attend General Surgery Residency Management Meetings once a month.
8. Participate in annual residency candidate interviews, including resident dinner, program
overview, 1:1 interviewing, and hospital tour
9. Distribute monthly reminder regarding didactic moderator, topic, and reading(s) for both
the Senior and Junior didactic sessions.
10. Attend and moderate the annual New Resident Orientation.
a. Welcome residents
b. Introduction of Administrative Chief(s)
c. Review basic policies and procedures of the Program
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d. Review general surgery conference schedules and attendance policy
e. Review and demonstrate computer entry for New Innovations for work hour
documentation and evaluation forms
f. Review and demonstrate ACGME case-log entry system
11. Role model professionalism and confidentiality to fellow residents.
ORIENTATION TO THE CLINICAL SERVICES
A. Duty Hours and Call Schedule Policies
The purpose of the duty-hour policy is to provide
residents with a carefully planned, sound academic
and clinical education that balances patient care,
safety and resident wellbeing. The Program ensures
that the learning objectives of the residency are not
compromised by excessive reliance on residents to
fulfill service obligations. Didactic and clinical
education must have priority in the allotment of
residents’ time and energy. Duty hour assignments
must recognize that faculty and residents
collectively have responsibility for the safety and
welfare of patients.
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Duty Hours
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Duty hours are defined as all clinical and academic activities related to the residency
program.
Duty hours are limited to 80 hours/week, averaged over a four-week period (inclusive of all
in-house call activities for the PGY 3, 4, and 5 levels).
Residents must be provided with 1 day (24-hour period) in 7 days free from all educational,
clinical and administrative responsibilities, averaged over a 4-week period, inclusive of call.
There must be a duty-free interval of at least 10 hours prior to returning to duty from inhouse call activities.
All time coming in from home call needs to be recorded as duty hours.
The PGY 1 level residents’ duty hour periods must not exceed 16 hours in duration.
Duty periods for PGY 2 & 3 level residents may be scheduled to a maximum of 24 hours of
continuous duty, with up to an additional 4 hours for transition of patient care. There must be
10 hours off between scheduled duty periods, and at 14 hours off after 24-hr in-house call.
PGY4 & 5 level residents may be scheduled to a maximum of 24 hours of continuous duty,
with up to an additional 4 hours for transition of patient care. There must be 8 hours off
between scheduled duty periods.
On-Call Activities
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In-house call must occur no more frequently than every third night, averaged over a 4-week
period.
Continuous on-site duty, including in-house call, must not exceed 24 consecutive hours.
Residents may remain on duty for up to 6 additional hours to participate in didactic activities
or transfer of patients for the PGY 3, 4, and 5 levels.
No new patients may be accepted after 24 continuous hours on duty.
Residents may participate in procedures on patients previously scheduled for outpatient or
A.M. admission surgery after 24 continuous hours on duty if doing so does not exceed 6
additional duty hours.
Services with home-call will be carefully monitored for excessive sleep interruption to ensure
adequate rest.
Residents on home-call must have one day (24 hours) per week free of all clinical and
educational duties.
Residents on home-call who return to the hospital must count all hours spent at the hospital
toward the total duty hours.
Strategic napping is recommended when feasible.
Oversight
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Continuous monitoring of duty hours will be required by each service.
Oversight will ensure an appropriate balance between education and service.
The Program Director will review all services on a monthly basis and report findings to the
Residency Executive Committee.
A service that is not in compliance with the duty hours policy will have the residents removed
from the service until corrective action has been taken.
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B. Resident Supervision
Operative Procedures
It is the policy of the Department of Surgery that an attending surgeon participates in all
operative procedures performed, as well as supervises other aspects of each patient’s care.
This participation is important, not only in the context of patient care and administrative
responsibility, but also in fulfilling the educational mission of the Department.
However, under appropriate circumstances, senior residents may benefit from the experience
of assuming responsibilities for independently executing surgical procedures. The following
conditions, however, MUST ALWAYS apply:
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Every patient undergoing an operative procedure must have an assigned attending
surgeon, identified by name in the medical record.
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Only the responsible attending surgeon may empower a senior resident to proceed with an
operative procedure in the attending’s absence. However, the attending surgeon must
remain available to respond in a timely fashion should assistance by the resident be
requested.
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Operating room personnel may, at any time, request verification of the attending’s
permission to proceed. Concerns regarding the appropriateness of that decision or the
subsequent execution of the procedure are to be discussed with the attending surgeon, the
Section Chief, or the Department Chair.
Invasive Procedures
The attending surgeon also has the responsibility for all invasive procedures performed upon
his or her patients outside of the operating room. These include, but are not limited to: central
line placement, pulmonary artery catheterization, arterial line placement, endotracheal
intubation, etc. Most procedures are performed either in the Intensive Care Unit or in the
Emergency Department although, on occasion, these procedures are performed in other
hospital units, (e.g., surgical wards). Junior residents who are not ‘privileged’ to perform a
given procedure must be supervised by a senior resident who is so privileged.
PGY 2 - 5 residents are privileged to perform invasive procedures after the satisfactory
completion of the PGY 2 CCM rotation or the supervised completion of a minimal number of
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cases (see below). For residents (PGY 2 - 5) who have not met the criterion stated above,
attending evaluation and documentation of the resident’s competence in the procedures is
required in order for the resident to be privileged.
PGY 1 residents may also be privileged by the documented satisfactory performance, under
supervision, of the following procedures in the numbers of cases indicated:
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Central line placement
Femoral
Internal jugular +/- US
Subclavian
Arterial line insertion
Radial
Femoral
Endotracheal intubation
Tube thoracostomy
Repair skin/soft tissue laceration
11 Cases CPT code 36656
3 cases
3 cases
5 cases
10 Cases CPT code 36620
5 cases
5 cases
10 Cases CPT code 31500
3 Cases CPT code 32551
5 Cases please log appropriate CPT
Depending on case
Residents will log these CPT codes via the ACGME website http://www.acgme.org/ as well as
through New Innovations. The resident is responsible for logging the procedures as well as
providing proof that s/he has indeed achieved the indirect supervision status. It is expected that
the PGY 1 categorical residents will have met these requirements on (or before) the six month
time frame. The Program Director will confirm completion of the procedures at the semi-annual
one on one resident evaluation.
C. Communication with the Attending Staff
On every service to which general surgery housestaff is assigned, one or more attending
surgeon(s) is/are always immediately available in-house or by telephone to provide
supervision, guidance and education. It is the responsibility of the resident physician to be
familiar with the call schedule and how to reach the attending surgeon on call. It is the
responsibility of the attending on call to ensure his or her availability at all times. By far the
most common cause of conflict between resident and attending is the failure to communicate in
a timely and effective manner. When in doubt, please call the attending. (See attached, When
Should a Surgical Resident Call an Attending Surgeon?)
In general the attending should be consulted for the following situations:
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The admission to the hospital of a patient for which the attending has primary responsibility
The completion of a consult on behalf of the attending
The completion of a clinic visit for a patient seen on behalf of the attending
A significant change of the medical condition of an attending’s patient
Placement of a patient into or out of the ICU.
D. Dress Code
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Residents are expected to adhere to the College of Medicine dress code. Business casual
clothing is appropriate when not in the operating room.
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Each surgery resident is issued a long, white lab coat. The lab coat should be worn during
patient contact at all teaching sites. This identifies you as a member of the residency
program and helps identify you to the patients and nursing staff.
Scrubs should not be worn home from the hospitals as they are the property of the
institutions. If scrubs are worn outside the operating room, then they must always be
covered with a white lab coat.
Residents are expected to dress professionally for educational events, including M&Ms and
Surgery Grand Rounds.
E. Resident Physician Responsibilities
Surgical residents of The University of Arizona College of Medicine are required to assume the
following responsibilities:
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Develop a personal program of self-study and professional growth with guidance from the
teaching staff.
Participate in effective and compassionate patient care, under supervision, commensurate
with his/her level of ability and responsibility.
Participate fully in the education and scholarly activities of their program including the
teaching and supervising of medical students and residents of a more junior level.
Participate in institutional programs and activities involving the medical staff and adhere to
established practices, procedures, and policies of the institution.
Participate in institutional committees and councils, especially those that relate to patient
care review activities.
Participate in evaluation of the quality of education provided by the program.
Develop an understanding of ethical, socioeconomic, and medical/legal issues that affect
graduate medical education and of how to apply cost containment measures in the provision
of patient care.
Additional responsibilities specific to the general surgery residency program include the
following:
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Accurately and timely completion of medical records and dictation of operative reports
Accurately and promptly log of operative cases.
Complete the rotation evaluation form and any other documents requested at the
conclusion of each rotation.
Maintain a minimum of 80% attendance at Surgical Grand Rounds, Morbidity and
Mortality Conferences, Didactics, Journal Club and additional educational conferences
provided on each rotation. Participate fully in teaching rounds and other educational
activities.
Establish and maintain a program of self-study appropriate to individual needs.
Protect one self and ones’ patients by consistently and conscientiously observing
universal precautions and other infection control measures, including immunization
against hepatitis B and up-to-date TB testing.
Universal precautions should always be practiced if exposure to blood or body fluids is
anticipated. If you do not wear glasses, it is good practice to keep a pair of goggles in
the lab coat pocket in case protective eyewear is needed.
Participate annually in the ABSITE (American Board of Surgery In-Training Examination)
if a categorical resident in the Program, with the expectation of a score above 40th
percentile.
PGY 3, 4, & 5 level residents will participate in biannual mock oral examinations.
Check mailbox and email account at least once a week to keep current with
communications from the Residency Program Office and Program Director.
Notice of Deficiencies will be issued to any residents not meeting minimum attendance
requirements.
JUNIOR RESIDENT (PGY1 and 2)
The major goal of the PGY 1 and 2 years is to provide the resident with the basics of patient
care. The major thrust of the two years is not operative experience on complex cases, although
substantial operating room experience is desirable. Service must be balanced with education.
Basic duties include:
• Taking first call for problems on the service to which he/she is assigned.
• Attending to the day-to-day needs of the patients in consultation with the senior resident or
chief resident and attending.
• Assisting in the operating room when patient care needs allow. Performing procedures in
the operating room at the appropriate level for his/her skills.
• Admission history and physical examination for patients admitted to the service.
• The collation and correlation of laboratory data for presentation to the senior resident and
attending.
• Participation in the pre-admission workup of patients as arranged by the senior resident
consistent with outlined guidelines.
• Adherence to the ACGME mandated duty hour and supervision policies.
SENIOR RESIDENT (PGY 3 or PGY 4 - depending on the rotation)
Generally, the senior resident will have the day-to-day responsibility of organizing and running
the service to which he/she is assigned. He/she is responsible for all aspects of care
(preoperative evaluation, participation in the operating room as surgeon or first assistant, and
the providing of postoperative care and a post discharge follow-up visit) for all patients
admitted to the assigned service.
17
During nights and weekend coverage times, the senior resident will provide:
•
•
•
Consultation with and oversight of junior residents covering wards, ICU and ER as needed.
Written surgical consultations on off-service patients when requested and followed by a
discussion of the patient with the appropriate surgical attending before making
recommendations for care.
Communication with the chief resident regarding complex patient care issues and complex
cases being admitted or requiring a consult.
CHIEF RESIDENT (PGY 4 or 5 - depending on the rotation)
Generally, the chief resident is to be involved in the care of the most critically ill, complex
surgical patients. This involvement should consist of preoperative evaluation, participation in
the operating room as surgeon, and the provision of ongoing postoperative care. The chief
must also arrange for a post-discharge follow-up with the patient. Any cases selected for care
by the chief become his/her case and he/she is responsible for maintaining attending
communication as well as delegation of responsibility to junior level residents.
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•
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•
Establishing a coverage schedule (including provision for vacations) or working with
residency office staff in the preparation of the schedule.
Presiding at all resident activities, conferences, etc., ensuring quality of resident
presentations.
Overseeing ICU and ED activities of surgery residents.
Reviewing the OR schedule prior to publication each day to make minor adjustments
consistent with educational needs.
Distributing the OR assignments for resident staff each day by 4pm for the following
day’s schedule.
Pagers
Each resident will be issued a pager. It is expected that each resident will have his/her pager in
their possession at all times while clinically active, even when carrying a service pager/phone.
Prompt response to pages is expected. If a pager is lost or permanently damaged, the resident
is responsible to notify the residency office immediately and pay for the replacement
(approximately $100).
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Loupes
Effective July 2011, categorical PGY 2 & 3 residents are eligible for up to $500 toward the
purchase of surgical loupes. Residents will submit itemized receipts for reimbursement within
10 days of purchase.
Lab Coats
2 Lab coats are issued to incoming residents in July. The program will assist continuing
residents with lab coats as needed.
Meals
Some hospitals provide meals for residents for periods of time they are required to be on the
premises after 5:00 pm on weekdays or anytime on weekends. A meal card will be provided to
residents accordingly.
Books
The Residency office has a library of clinical and educational books and CDs available for loan.
Textbooks will be provided to juniors and seniors in July. Additionally, supplemental books for
lab programs and examination preparation are available for loan.
Copy Technology Services
Each resident has a small monetary account with CTS, located on the 3rd floor of the College of
Medicine. These accounts do not accrue annually.
THE EDUCATIONAL PROGRAM OF THE RESIDENCY
A. Surgical Sciences Curriculum (Didactics)
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The schedule of classes for the residents has been developed for a 1-year cycle and is based
on the SCORE curriculum. Each class is taught by a coordinating attending and/or an invited
expert. All readings are selected and distributed in advance. Attendance is mandatory, and
didactics is considered protected time, therefore use of cell phones is prohibited. An excused
absence must be reported to the Program Director in advance of Didactics. Attendance below
80% is considered an academic deficiency and will be addressed by the Program Director.
Notice of Deficiencies will be issued to any residents not meeting minimum attendance
requirements.
B. Morbidity and Mortality Conference (M&M)
M&M is held on Wednesday mornings 7:00 am to 8:00 am. Attendance is mandatory, and M&M
is considered protected time, therefore use of cell phones is prohibited. Deadline for
submission of M&M forms will be the preceding Friday at 12:00 pm. The resident who had
the most involvement in the case will present. The presentation is to be in a format that is
concise and relevant. At the conclusion of the presentation, the presenting resident should be
prepared to discuss the relevant issues with reference to the global surgical experience,
including citing pertinent literature sources. The PowerPoint background slide template used for
presentation will be provided by the Department of Surgery. Attendance below 80% is
considered an academic deficiency and will be addressed by the Program Director. Notice of
Deficiencies will be issued to any residents not meeting minimum attendance requirements.
C. Surgery Grand Rounds
Grand Rounds are held weekly, immediately following M&M Conference, 8:00 am to 9:00 am.
Attendance is mandatory, and Grand Rounds is considered protected time, therefore use of cell
phones is prohibited. Relevant topics are presented by faculty, senior residents, visiting
faculty, and guest faculty. Grand Rounds attendance is mandatory and is considered protected
time. Attendance below 80% is considered an academic deficiency and will be addressed by the
Program Director. Notice of Deficiencies will be issued to any residents not meeting minimum
attendance requirements.
D. Journal Club
Journal club is held every other month. Attendance of all residents is mandatory. Three to
four articles pertinent to recent didactic topics are chosen by surgical specialists and assigned
to a resident to present. The articles will be distributed to residents and faculty at least two
weeks prior to the journal club meeting. Journal Club schedule and articles are posted on New
Innovations. Attendance below 80% is considered an academic deficiency and will be
addressed by the Program Director. Notice of Deficiencies will be issued to any residents not
meeting minimum attendance requirements.
E. Elective Requests
PGY3 level residents are assigned an elective rotation, which may be used outside the
program, provided the resident has prior approval from the host institution. The Outside Elective
Request Form must be completed and submitted to the residency office a minimum of 60 days
in advance of the rotation.
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F. Outside Rotations
PGY2 level residents are assigned a rural general surgery rotation in Tuba City, Arizona serving
the western part of the Navajo and Hopi Reservations.
PGY3 level residents are assigned a general surgery rotation in the mountains of Flagstaff,
Arizona.
THE IMPORTANT STUFF
A. Time Away From Program
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•
•
•
The American Board of Surgery defines one year of residency as 48 weeks of full-time
surgical experience.
Time away from a surgical residency, according to the American Board of Surgery, includes
vacations, sick time, interview days, travel for non-clinical activities, maternity/paternity
leave, documented medical problems, jury duty, etc. It is the responsibility of the resident to
monitor time away from the program so as to not exceed the allowable 28 days by the ABS.
Failure to adhere to regulatory requirements will result in going off cycle.
For documented medical problems or maternity/paternity leave, the ABS will accept 46
weeks of surgical training in one of the first 3 years, or one of the last 2 years, provided the
resident has received prior written approval from both the Program Director and the ABS
(see ABS website for details at www.absurgery.org ).
Residents will document all time away from the program along with their duty hours in New
Innovations.
B. Leave Policy
Each resident is allocated 28 days inclusively for time away from service. (Please refer to the
Education Leave Policy for leave pertaining to presentations and meeting attendance.)
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•
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•
The 28 days will be divided into four 7-day blocks.
Vacation requests for the entire academic year must be submitted to the Administrative
Chiefs no later than September 1, 2013
All vacation requests must be submitted electronically to the Administrative Chiefs to be
approved by the Program Director and Administrative Chiefs. Notification regarding approval
will be returned electronically within a short period of time.
One vacation week must be taken during each of the four quarters. No vacation time may be
carried over from one quarter to the next.
No more than one resident at a time may be on vacation from a given call service.
No more than one week of leave may be taken from the same call service.
Travel arrangements may not be made in advance of prior written approval.
No additional vacation days will be granted for holidays worked.
All patient care obligations, especially dictation and signing of documents, must be
completed before leaving for vacation.
Prior to leaving for scheduled time off, all duty hour logs must be current.
Residents leaving the program should plan to hold one week of vacation time for the end of
the year so that there is some flexibility when traveling to, and beginning, the next program.
No resident will be released early to start another program if they have not fulfilled their
21
•
•
•
mandatory 48 weeks of full-time surgical service.
Unused vacation or leave time cannot be carried forward to the next academic year.
Please note that the University of Arizona’s policy for leave may be more liberal than the
leave allowable by the American Board of Surgery. Choosing to leave the program for over
28 days will result in going off cycle.
The following black-out dates cannot be used for vacation scheduling: June 20 - 30, 2014
(reserved for Chiefs and Preliminaries traveling to new programs)
B. Sick/Injury Policy
Residents who become ill or injured are expected to do the following:
• Notify assigned service
• Notify assigned senior resident or attending
• Notify residency office
• Log sick time in New Innovations
Any on-the-job-injury must be reported immediately to the following:
• Senior resident or attending
• Residency office (to initiate worker’s compensation paperwork)
• Program Director
C. Extended Leave of Absence
In order to comply with the ACGME Common Program Requirements for Graduate Medical
Education, this policy is set for by the University of Arizona College of Medicine Graduate
Medical Education Committee (GMEC). All requests for unpaid leaves of absence must be
submitted to the program director with a letter indicating the reason for the leave and the
proposed leave schedule, which first must be approved by the program director before being
forwarded to the GME Office for handling in accordance with the University Handbook for
Appointed Personnel, Section 8.04.01.
In accordance with the Family and Medical Leave (FML) Act of 1993, eligible employees may
take FML as provided in University policy. (see online University Handbook for Appointed
Personnel).
Any protracted leave of absence may affect the completion date of the residency program. Any
effect on the completion of residency will be determined by the program director in consultation
with the requirements of the specialty's certifying board's criteria.
22
D. Educational / Academic Travel Policy
The General Surgery Residency Program has developed a policy concerning the support of
travel to meetings that tries to be fair to the residents while staying within the residency budget.
The policy for attending educational meetings is as follows:
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•
•
•
•
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•
All meeting attendance must first be approved by the Program Director. No travel
arrangements may be made prior to this approval.
The residency program has limited funds budgeted for up to $500 per year/per resident for
educational meetings for those residents who have been accepted to give oral
presentations (not a poster) at regional and national meetings.
The abstract/paper presentation must be submitted with the Travel Authorization prior to
travel. (The University of Arizona Travel Authorization form must be obtained from
the General Surgery Residency administrative staff immediately after Program
Director approval.)
For all residents accepted for poster or oral presentations, 48 hours will be given off to allow
for attendance, at the discretion of the Program Director. Any time greater than 48 hours,
even with the approval of the Program Director, must be logged in New Innovations as
Vacation/Leave. It is the presenting resident’s responsibility to make sure that the service
duties and call responsibilities are covered during this time away from service.
Residents must submit original, itemized receipts for reimbursement no later than ten
business days after travel has occurred. For air travel, proof of travel (i.e. boarding passes,
email confirmation, itinerary) is required; this applies to electronic tickets as well. Conference
brochures, certificates of attendance must be submitted to the Residency office for
completion of the Travel Expense Report.
Travel Authorization must be on file even if you seek no reimbursement.
No travel advances will be given.
UA Travel policy prohibits car rentals.
The policy of attending academic interviews is as follows:
•
•
•
Interviewing time away from the program must be logged in New Innovations as
Vacation/Leave.
Last minute requests must receive the approval from the Program Director before travel
arrangements are made.
All residents should arrange for service coverage and notify all involved parties, including
the residency office.
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D. Moonlighting Policy
The General Surgery Residency Program does not allow any moonlighting activities.
RESIDENT EVALUATION and PROMOTION
A. Clinical Evaluations
At the completion of each rotation, each resident will have the opportunity to anonymously
evaluate the rotation and the individual faculty. This process is through New Innovations. In
order to assure even further disassociation of the resident to the particular evaluation, the
program director will review all of the evaluations on an every six month basis. It is strongly
encouraged that each resident complete the rotation evaluation and individual faculty
evaluations for those with whom they have worked in order to provide feedback to the program
director.
In addition, the faculty members will be offered, at the completion of each rotation, the ability to
evaluate each resident individually. These evaluations will also be done via New Innovations
and will be released to the individual resident as they are completed. These evaluations are not
anonymous and the evaluating individual faculty or faculty group (i.e. pediatric surgery and
trauma surgery) will be displayed.
Each year the residents and the faculty of the department of surgery will be asked to
anonymously evaluate the residency program. The program director will evaluate and
summarize the results of these evaluations. The website is: www.new-innov.com
Please contact the Program Coordinator if you need any assistance with accessing the New
Innovations system.
B. Didactics (Surgical Sciences) Curriculum
Each resident’s attendance at didactics sessions is recorded and reviewed semi-annually with
the Program Director. Attendance data and results of the American Board of Surgery InTraining Exam (ABSITE), including clinical evaluations and number of cases entered in the log,
the Mock Oral Board passive results for the PGY 3, 4, and 5 levels, form the basis for judging
successful progress of the resident in the acquisition of cognitive skills and knowledge required
for a surgical career.
C. American Board of Surgery In-Training Exam (ABSITE)
Annually at the end of January, the American Board of Surgery (ABS) administers an intraining examination for all general surgery residents in accredited U.S. training programs. This
exam, the ABSITE, closely parallels the content and style of the ABS “Qualifying Exam” given
to graduates of general surgery residencies as part of their board certification process.
All categorical general surgery residents in our program are required to take the ABSITE.
General surgery preliminary residents may take the ABSITE to promote the chances of
matching.
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In addition to a raw score, the resident’s performance is compared with all residents at an
equivalent training level across the U.S. Key phrases of questions missed are also provided as
feedback.
All residents will be released from clinical duties at 6:00 p.m. night prior to the ABSITE. Clinical
duties will be resumed at 2:00 pm the day of the ABSITE.
Since the results of the ABSITE are a reasonable indication of the likelihood of successful
completion of Part I of the Board certification process, the Residency Governance Committee
uses the score as an indication of the satisfactory progression in gaining cognitive knowledge
of the surgical sciences. The ABSITE score constitutes one of a number of criteria for
advancement to the next training year.
A resident earning an ABSITE score of above the 85th percentile will receive an Academic
Honors Commendation.
A score below the 40th percentile on the ABSITE will result in a Notice of Academic Deficiency,
but alone will not be used for non-promotion of the categorical residents. In such instances, an
academic review will follow for a 1-year period and appropriate steps will be taken should no
improvement occur. In addition, a resident scoring at or below this level will be required to
participate in remediation sessions as detailed by the Program Director.
D. USMLE Step III Examination
As part of the promotion process, it is expected that all PGY 1 residents will have successfully
completed the USMLE Step III examination by the end of the PGY 2 year in order to advance to
the PGY 3 year.
E. Mock Oral Examination
Part II of the American Board of Surgery Certification process (the Certifying Exam) is an oral
examination, testing primarily the surgeon’s knowledge and reasoning in managing clinical
situations commonly encountered in surgical practice. The faculty of the General Surgery
Residency administers a “mock oral exam” each fall and spring to assist residents in preparing
for this experience. All PGY 3, 4, and 5 residents are required to participate.
25
The format of the exam closely approximates that of the actual ABS Part II Examination. In
addition to scores for each of the content areas, residents are provided feedback on their
general presentation during the exam and specific areas of difficulty in answering questions.
Additionally, chief residents are videotaped as a tool in preparation for the Oral Boards.
F. Large Animal Lab
The large animal lab is a week-long course managed under the direction of Dr. Carlos Galvani.
The assigned sessions are mandatory and participants may not take vacation during this
scheduled program. This is protected time and clinical duties end as of Sunday 6:00 pm prior to
the start of the lab. Clinical duties resume as of Friday, at the completion of the lab.
The Large Animal Lab is considered a privilege and the ability to participate may be rescinded
by the Program Director.
G. ASTEC Lab
The Arizona Simulation Technology and Education Center (ASTEC) Lab provides computerassisted surgical training. As part of the General Surgery Residency curricula, PGY1 & 2 level
categorical residents are mandated to attend the ASTEC Lab program directed by Dr. Carlos
Galvani.
This 1-hour weekly hands-on skills lab promotes the development of the dexterity and hand-eye
coordination required to perform laparoscopic and robotic surgery. Successful completion of the
training program is a prerequisite to taking the Fundamentals of Laparoscopic Surgery (FLS)
onsite examination.
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H. Fundamentals of Laparoscopic Surgery (FLS)
The FLS program is used to teach and assess both cognitive and technical skill aspects related
to laparoscopic surgery. The curriculum is proficiency-based, whereby trainees are oriented to
the materials and self-practice until expert-derived performance levels are reached.
The FLS onsite examination will be provided to senior level residents once, and is a prerequisite
for graduation. Failure of either part of the examination will result in a retest at the expense of
the resident.
I. Standards of Resident Performance and Advancement
The period of appointment is for one year, renewable annually for the length of the training
period. Acceptance into the residency program does not guarantee completion nor does it
establish a definite projected time period of completion. Advancement will be determined by
the resident’s performance. The standards of resident performance by which progression into
the next year are determined include the following:
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•
Excellent Performance
Satisfactory Performance
Notice of Deficiency
Probation
Non-Renewal of Contract
J. Criteria for Excellent Performance
Residents may achieve excellent performance in any of the following 3 areas:
1. Academic
• ABSITE score exceeding 85th percentile
• Mock Oral Exam high pass
• Receipt of Teaching Awards
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2.
Scholarship Excellence
• Publication in a national peer-reviewed journal
• Presentation at a national meeting
• Similar accomplishment
3.
Clinical Excellence
• Evaluations consistently excellent, with 50% or more of the rotations being
“Outstanding”
K. Satisfactory Performance
Residents whose performance satisfies the following criteria are achieving at a satisfactory
level and will be advanced to the next level of training.
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Attendance above 80% at mandatory education sessions
Satisfactory clinical progress as discussed at semi-annual evaluation sessions
with the Program Director.
ABSITE scores at or above the 40th percentile.
Mock Oral Passage (for PGY 3, 4 and 5)
L. Notices of Deficiency and Probation
A resident may receive a Notice of Deficiency for sub-standard performance in any of the
following 3 areas:
1. Academic
Any one (or more) of the following failures will result in a Notice of Academic Deficiency:
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ABSITE exam - a score below the 40th percentile for that year of training
Participation of less than 80% at mandatory education sessions
Unsatisfactory performance cumulatively in the Surgical Sciences Curriculum
with average quiz scores below 60%, or overall failure score on the mock oral
boards.
Conditions: The Notice of Deficiency is in effect for a minimum of six months; its
rescission requires documentation of substantial progress on the part of the resident
toward correcting the failure.
2. Clinical
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Clinical evaluation consistently indicating either substandard performance or failure
to progress satisfactorily
Poor performance on several rotations suggesting a lack of clinical dedication.
Specific areas needing substantial improvement are repeatedly identified (e.g.,
technical skills.)
Conditions: Term of up to 6 months
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Restrictions and Requirements:
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Prospective approval of any non-educational clinical activities
Bi-monthly meetings with Program Director after an initial meeting with the
Program Director/Governance Committee
Address specific areas of concern with remedial work
Subsequent notice of deficiency may result in probation
3. Administrative/Professional/Ethical
Any of the following are potential grounds for Notice of Deficiency or more severe sanctions, if
warranted.
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Failure to discharge resident responsibilities(e.g., medical records)
Failure to comply with governance policies
Interpersonal conflicts/psychosocial problems/substance abuse
Physical, verbal or sexual harassment
Unprofessional conduct, including but not limited to abrogating or failing to
respond to clinical responsibilities
Conditions: Term dependent on acknowledgment and resolution of the problems and
appropriate remedial action (e.g., counseling)
Restrictions: As appropriate
Failure to achieve substantial progress in correcting a Notice of Deficiency may result in
placement on probation. If satisfactory progress is again not made during a period of
probation, non-continuance for the coming academic year may be recommended by the
Program Director to the Governance Committee.
M. Probation and Dismissal
The probation period is typically three to six months. Vacation during probation is not allowed.
The University of Arizona College of Medicine resident physician suspension and dismissal
procedures (due process) can be found at: http://www.gme.medicine.arizona.edu/due_process.cfm
QUALITY ASSURANCE/IMPROVEMENT POLICY
UNIVERSITY OF ARIZONA COLLEGE OF MEDICINE
Graduate Medical Education Committee
Policies and Procedures
Purpose
The University of Arizona College of Medicine, through its Graduate Medical Education
Committee (GMEC), has the responsibility for assuring compliance with efforts to provide
the highest quality of safety of patient care by its resident physicians. Such efforts are
designed to protect the interests of patients, the University, through its compliance with the
Essentials of Accredited Residencies for Graduate Medical Education, and the University's
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affiliated institutions through their compliance with standards developed by the Joint
Commission on the Accreditation of Healthcare Organizations (JC).
Provisions
It is the responsibility of the Program Director to establish program specific guidelines
setting out resident participation in quality assurance activities (including reviews of
complications and deaths), to ensure collaborative efforts with affiliate institutions in those
activities and to provide a record keeping mechanism of those activities to ensure
substantial compliance with the Accreditation Council for Graduate Medical Education
(ACGME) Institutional Requirements as well as the relevant Residency Review Committee's
(RRC) Program Requirements.
In order to support the affiliate institutions in their attempts to ensure quality patient care and
to comply with Joint Commission requirements, GMEC shall enact a formal process for the
resolution of issues of resident-related patient safety and quality care. In furtherance of that
goal, the affiliated institutions will be requested to notify the Program Director and the GME
Office of resident-related patient safety and quality of care concerns raised in the course of
their institution's risk management or quality assurance activities. In that event, the Program
Director shall cooperate with and assist the risk management or quality assurance activity of
the affiliated institution. The COM recognizes that the affiliated institutions' quality assurance
activities are confidential peer review activities, and that its cooperation and assistance may
be necessary from time to time to assist such institutions in conducting their protected
quality assurance activities. The COM agrees to maintain confidentiality of all privileged
matters. Furthermore, the Program Director shall investigate any such concern and initiate
any remedial action as necessitated by the circumstance following established University
policies and procedures. Upon the completion of the investigation and, if needed,
remediation of the resident, the Program Director shall, in writing, communicate to the Chief
of Staff and the GME Office the assessment that the resident is deemed to be fit for return
to the clinical area.
The affiliated institutions Chief of Staff or designee will on a regular basis provide the GMEC
with reports assessing the general status of residents' performance in the areas of clinical
competency and patient safety.
ADVISING and MENTORING
Mentorship plays a fundamental role in shaping the future and success of any surgeon. The
General Surgery Residency Mentorship Program is structured to set residents on a path to
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success. Junior residents are assigned Advisors upon admission to the residency program.
Senior residents are asked to select a UAMC or VA surgery faculty member who will act as a
clinical and research mentor.
Mentors should be:
1. Someone who the resident is very comfortable with
2. Someone who will assist the resident and help determine career and fellowship direction
3. Someone who will advocate for the resident any time (especially if the resident is
experiencing issues)
4. Someone who the resident can discuss all types of concerns with, including
extracurricular ones
It is mandatory that you meet with your Advisor/Mentor on a quarterly basis (September,
December, February, and May). You are responsible to schedule these meetings. Your
Advisor/Mentor will be responsible for completing a meeting documentation form that is returned
to the Program Coordinator. If for any reason you would like a different faculty Advisor/Mentor,
please contact the Program Director and a new one will be assigned.
RESEARCH
Each categorical resident will be assigned a research preceptor. The research preceptor is
there to guide you as you progress through your yearly research requirements. Your research
preceptor can be, but does not have to be, the one with whom you do your research.
Each year includes a mandatory research requirement.
General Surgery Residency Research Protected Time Plan 2013/2014
In order to facilitate the ability of the general surgery residents to meet the annual research
requirements, it was deemed appropriate to give the residents protected time throughout the
year. This surfaced as a requirement needed following our recent GME internal review process
for our July 2011 RRC site visit. The following plan was developed after multiple meetings with
the residents and the Residency Executive Committee. For each week that a general surgery
resident is on the following services, one half- day taken per week will be given off in addition to
the one day per week off averaged over four weeks. This half- day off is to be used to work on
the required annual research project. The day of the week of the half-day off is to be set by
each service.
• PGY 1 VA Anesthesia
• PGY 2 VA Night Float
• PGY 3 UMC Elective/GI
• PGY 4 VA CT surgery
• PGY 5 TMC General/Vascular Surgery Dr. Schilling
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GENERAL SURGERY RESIDENTS
SCHOLARLY ACTIVITY AND RESEARCH HANDBOOK
Department of Surgery
College of Medicine
University of Arizona
Tucson, Arizona
Research Executive Committee
Ronald L. Heimark, PhD
Professor of Surgery
626-1913
[email protected]
Randall S. Friese, MD
Associate Professor of Surgery
626-0478
[email protected]
Amy Waer, MD
Associate Professor of Surgery
Residency Program Director
626-0071
[email protected]
Robert Krouse, MD
Professor of Surgery
792-1450 (x6631)
[email protected]
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Rainer Gruessner, MD
Professor of Surgery
Chairman, Department of Surgery
626-4409
[email protected]
Residency Research Office
Laura Ballesteros, Assistant to Dr. Friese
626-5056
[email protected]
RESEARCH AND SCHOLARLY REQUIREMENTS (CATEGORICAL RESIDENTS)
The following criteria must be met to ensure advancement and graduation from the
University of Arizona General Surgery Residency Program:
Overall goals for all categorical residents
•
•
Abstract submission to a regional or national conference by PGY 3
Manuscript submission to a peer reviewed journal in PGY 4 and PGY 5 (Two
manuscripts required)
Requirements for residents by postgraduate year:
PGY 1
o
o
o
o
Meet for the first time with assigned preceptor before August 1st
Meet with assigned preceptor at least twice per year (every 6 months)
 We anticipate that research preceptors will change as residents identify
particular areas of interest
 All preceptor changes must be requested from and approved by the
residency research office
 Preceptors are required to submit a brief summary of plans/progress for
each resident to the residency research office after each meeting (see
attached)
 Residents must notify Program Coordinator, of all dates and times for
research preceptor meetings
Projects may be completed with faculty other than research preceptor
Goals for PGY 1
 Complete on-line Human Subject Training (CITI)
http://www.irb.arizona.edu/training
• Once completed print training verification form and submit to
residency research office
 Identify area of research interest
• Surgical subspecialty
• Clinical or basic science
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


Notify residency research office of plans for non-clinical research year(s)
after PGY 3 by June 30th
Prepare a case report for submission to the residency research office
If approved by residency research office, submit case report to peer
reviewed journal
PGY 2
o
o
o
o
Meet with assigned preceptor for the first time this year before August 1st
Meet with assigned preceptor at least twice per year (every 6 months)
 We anticipate that research preceptors will change as residents identify
particular areas of interest
 All preceptor changes must be requested from approved by the residency
research office
 Preceptors are required to submit a brief summary of plans/progress for
each resident to the residency research office after each meeting (see
attached)
 Residents must notify Program Coordinator of all dates and times for
research preceptor meetings
Projects may be completed with faculty other than research preceptor
Goals for PGY 2
 Identify area of research interest
• Surgical subspecialty
• Clinical or basic science
 Notify residency research office of plans for non-clinical research year(s)
after PGY3 by June 30th
 Prepare a case report or case series for submission to the residency
research office.
 If approved by residency research office, submit case report to peer
reviewed journal
PGY 3
o
o
o
o
Meet with assigned preceptor for the first time this year before August 1st
Meet with assigned preceptor at least twice per year (every 6 months)
 Preceptor relationship should be well established (Preceptor changes
discouraged)
 Preceptors are required to submit a brief summary of plans/progress for
each resident to the residency research office after each meeting (see
attached)
 Residents must notify Program Coordinator of all dates and times for
research preceptor meetings
Projects may be completed with faculty other than research preceptor
Goals for PGY 3
 For those residents opting for laboratory experience (one to three nonclinical research years)
34
•

Obtain approval from Resident Executive Committee for all nonclinical research years
• Identify basic science mentor
• Pursue application for research funding (sponsorship of at least
one approved research funding mentor is required)
Funding sources included, but are not limited to the following:
o Society sponsored resident research fellowship awards
(see attached list of surgical societies with funding
available for surgical residents)
o American College of Surgeons Clinical Scholar Program
http://www.facs.org/ropc/clinicalscholars.html
o NIH Resident Teaching Award
http://grants.nih.gov/grants/guide/pa-files/PA-99-025.html
• Develop research plan with mentor
• Submit research plan to residency research office by May 1st for
final approval
• Submit IACUC or IRB application for planned project by June
For those residents not opting for non-clinical laboratory experience
• Pursue focused research interest within chosen subspecialty area
• Participate in ongoing faculty research (may be faculty other than
preceptor)
o Prospective/Retrospective cohort trials
o Randomized Controlled Trials
• Prepare and submit at least one abstract for regional or national
conference in area of interest with faculty mentor
o If accepted (oral) expenses funded by department
• Plan and initiate a retrospective or prospective cohort trial with
mentor supervision
PGY 4
o
o
o
o
Meet with assigned preceptor for the first time this year before August 1st
Meet with assigned preceptor at least twice per year (every 6 months)
 Preceptor relationship should be well established (Preceptor changes
discouraged)
 Preceptors are required to submit a brief summary of plans/progress for
each resident to the residency research office after each meeting (see
attached)
 Residents must notify Program Coordinator of all dates and times for
research preceptor meetings
Projects may be completed with faculty other than research preceptor
Goals for PGY 4
 Pursue focused research interest within chosen subspecialty area
 Participate in ongoing faculty research (may be faculty other than
preceptor)
35



• Prospective/Retrospective cohort trials
• Randomized Controlled Trials
Continue enrollment in retrospective or prospective cohort trial with
mentor supervision
Prepare and submit a manuscript to a peer reviewed journal
• Case report with review of literature
• Review article
• Surgical education research
• Practice guideline
Present research at yearly Surgical Resident Research Conference
PGY 5
o
o
o
o
Meet with assigned preceptor for the first time this year before August 1st
Meet with assigned preceptor at least twice per year (every 6 months)
 Preceptor relationship should be well established (Preceptor changes
discouraged)
 Preceptors are required to submit a brief summary of plans/progress for
each resident to the residency research office after each meeting (see
attached)
 Residents must notify Program Coordinator of all dates and times for
research preceptor meetings
Projects may be completed with faculty other than research preceptor
Goals for PGY 5
 Pursue focused research interest within chosen subspecialty area
 Participate in ongoing faculty research (may be faculty other than
preceptor)
• Prospective/Retrospective cohort trials
• Randomized Controlled Trials
 Complete retrospective or prospective cohort trial with mentor supervision
 Prepare and submit a manuscript to a peer reviewed journal
• Retrospective or prospective cohort trial
 Present research at yearly Surgical Resident Research Conference
 Present research at Graduation Research Symposium
36
Requirements for Non-Clinical Research Year(s)
o
o
o
o
o
o
o
o
o
o
Non-Clinical Research leave available after PGY3 year only
Meet with assigned basic science mentor weekly
Mentors are required to submit a brief summary of plan/progress for each
resident to the residency research office quarterly (see attached)
Abstract submission to at least one regional or national conference is required in
the first research year
Abstract submission to three regional or national conferences is required in the
second research year
All abstracts accepted for presentation at a regional or national conference (oral
or poster) will have an accompanying manuscript submission to a peer reviewed
journal
Participate in yearly Surgical Resident Research Conference
Presentation of Research at Graduation Research Symposium
NO Clinical responsibilities
NO moonlighting
Residents wishing to pursue two non-clinical research years will have the opportunity to obtain
an additional advanced degree through the Medical Sciences Graduate Program.
MEDICAL SCIENCES GRADUATE PROGRAM
The attainment of a Master of Science (MS) degree or a degree of Doctor of Philosophy (PhD)
with a major in Medical Sciences requires outstanding scholarship, demonstration of depth and
breadth of knowledge, and design and execution of original research leading to a dissertation
37
that contributes significantly to the general fund of knowledge in the discipline. The graduate
degree is never granted solely as certification of faithful performance of a prescribed program of
studies. All degree requirements must be fulfilled.
Residents admitted to the graduate program (MS or PhD) will be a highly select group. During
the pilot program in the Department of Surgery, the didactic portion of the program will consist of
advanced core courses in Surgery; a comprehensive course in biostatistics; and a course in
scientific writing, grant preparation and research ethics. In addition, the Ph.D. students will be
required to complete a Minor Program (typically three courses) in a relevant Basic Science
discipline. The thesis/dissertation may be clinically-based or may be a laboratory-based project
that addresses a clinical problem. The thesis/dissertation requirements and credits (see below)
will be in accordance with the regulations of the UA Graduate College.
The program Department of Surgery pilot program, open to resident physicians in the
department, will subsequently be expanded to include other departments that choose to
participate. After completing the first three years of traditional surgery resident training, program
enrollees will then complete 1 to 3 years of graduate research training (leading to a Master of
Science or Doctor of Philosophy degree). Following completion of graduate training, they will
complete the final two years of the clinical surgery residency.
Program of Study- Master of Science (MS)
Graded Courses
Surgery Grand Rounds (1 credit/semester x 2 semesters)
Principles of Surgery
Biostatistics (Epidemiology 576A)
Scientific Writing and Ethics (PHCL 595B)
Transferred Medical School Basic Science Course
2 Units
4 Units
3 Units
2 Units
5 Units
Ungraded Courses
Research (Surgery 900)
Thesis*
11 Units
3 Units
*Thesis: Submitted to Thesis Committee, reviewed and defended in an oral presentation to the
committee
Program of Study- Doctor of Philosophy (PhD)
Graded Courses in Major
Surgery Grand Rounds (1 credit/semester x 4 semesters)
Principles of Surgery
Biostatistics (Epidemiology 576A)
Scientific Writing and Ethics (PHCL 595B)
Electives*
4 Units
6 Units
3 Units
2 Units
5 Units
Ungraded Courses in Major
Research, Surgery 900 (9 units/semester x 2 semesters) 18 Units
Graded Courses in Minor
Courses (typically three) chosen in agreement
with ‘Minor’ Department
9 Units
Graduate Programs currently agreeing to offer a minor: Cancer Biology
IDP, Molecular and Cell Biology, Immunobiology, Physiological Sciences
IDP and Pharmacology.
38
Dissertation Proposal
To be prepared as a grant application and submitted for outside funding before entering
graduate program. To be presented and defended to the student’s Dissertation
Committee early in the first year of graduate education.
Comprehensive Examination
Must be taken following the first year of graduate training, (after coursework is
completed). This two-part exam consists of a written component and an oral component.
Dissertation
Submitted to Dissertation Committee and defended in open forum followed by a closed
session with committee. The Dissertation Committee will be multidisciplinary, including
faculty members within and outside the Department of Surgery.
RESEARCH FUNDING MENTORS
Ronald Heimark, PhD
David Armstrong, MD, PhD
Robert Krouse, MD
Randall Friese, MD
Peter Rhee, MD
Horacio Rilo, MD
Marlys Witte, MD
Rainer Gruessner, MD
BIOSTATISTICAL SUPPORT
Angelika Gruessner, PhD
Professor
Dept. of Public Health
626-3118
[email protected]
EDITORIAL SUPPORT
Email the final draft of your manuscripts and ask any writing-related questions
Mary E Knatterud, Ph.D.
Research Associate Professor
[email protected]
Tel. 651-645-3858
MEDICAL STUDENT EDUCATION
A. Duty Hours
The medical students rotating on any of our surgical services follow the ACGME duty hours as it
pertains to the 80 hours, 30 consecutive hours and one day off per week averaged over 4
weeks.
39
B. Clerkship Goals and Objectives
Educational Goals of the Clerkship
The goal of the surgery clerkship is to introduce the student to the principles of caring for the
surgical patient. This goal is accomplished by allowing the student to participate in the care of
patients in the various stages of evaluation and treatment by surgeons. These stages include,
but are not limited to, the preoperative office or clinic visit, inpatient admission, operative
procedure and inpatient/outpatient recovery. Through this exposure, the student will begin to
understand the general process of the application of surgical therapy to patients in a wide
variety of settings. Furthermore, by participating as a member of the surgical team, the student
will observe the role of the surgeon as a member of the multidisciplinary team that provides care
for the patient. The clerkship is structured upon the principle that learning is a process which
can be accomplished only by active participation by the student. The role of the faculty and
housestaff is to provide guidance, stimulation, support and example.
Educational Objectives of the Clerkship
The surgery clerkship is a six-week block experience divided into two three-week rotations
including inpatient and outpatient surgical exposure in both the academic and private practice
sectors. Listed below are the objectives for the six-week block:
Professionalism
The student must be committed to carrying out professional responsibilities, adhering to
ethical practices and demonstrating sensitivity to diverse patient populations.
The student is expected to demonstrate the following:
•
•
•
•
•
•
•
•
•
Honesty
Compassion for patients
Respect for patient’s privacy, dignity, and diversity of culture, ethnicity, religion and
sexual orientation
Integrity, reliability and dependability in all interactions with patients and their
families, professional colleagues and peers
The ability to maintain confidentiality
Altruistic behavior by prioritizing the patient’s well being above the student’s own self
interest
The knowledge of how to obtain informed consent
The skills to advocate for improvements in the access of healthcare for everyone
The understanding that medicine is a team effort involving the contributions of many
health care disciplines
40
Patient Care
The student must learn to obtain appropriate histories and perform skillful and accurate
patient examinations in regards to the surgical patient. They need to be exposed to
basic surgical procedures and begin to acquire the skills to perform them.
The student is expected to demonstrate the following:
•
•
•
The ability to obtain an accurate surgical history that covers all the essential aspects
Perform a complete and organ specific physical examination
Demonstrate the ability to perform simple suturing techniques
Medical Knowledge
The student will obtain a solid fund of knowledge relevant to surgical patients.
The student is expected to do a physical exam and work up at least one patient with the
following clinical conditions: (the accomplishment of this objective will be documented
based on patient encounter logs)
•
•
•
•
•
•
Hernia (incisional, inguinal, umbilical or ventral)
Bowel obstruction
Acute surgical abdomen
Breast disease (mass, abnormal mammogram, pain or infection)
Multisystem trauma
Biliary disease (cholelithiasis, cholecystitis, or choledocholithiasis)
The student will participate in an interactive lecture or case presentation for the following
topics or conditions:
•
•
•
•
•
•
Electrolyte abnormalities
Wound infections
Shock
Gastrointestinal hemorrhage
Vascular disease
Urological surgery
Practice-Based Learning
The student will read in-depth about the surgical patients and be prepared for the
operating room.
The student is expected to demonstrate the following:
•
•
The ability to access on-line resources for medically relevant information
The capability of critically evaluating the medical/surgical literature
41
•
•
The ability to understand the need of continuing medical education to remediate or
improve one’s own practice
The use of evidence based approach to decide or reject experimental findings and
approaches
Interpersonal and Communication Skills
The student will learn to communicate effectively with patients, family members,
coworkers, and supervisors.
The student is expected to demonstrate the following:
•
•
•
•
Clear, effective and empathetic communication with patients and their family
members
The use of effective listening skills
The ability to document and present data and clinical information in an organized,
accurate, legible and clear manner
The capability to encourage patients’ health and wellness through appropriate patient
education
Systems-Based Practice
The student will demonstrate comprehension of the complexity of the health care
system.
The student is expected to demonstrate the following:
•
•
•
•
Understand how their patient care and other professional practices affect other
health care professionals
Advocate for quality patient care and assist patients in dealing with system
complexities
Identify appropriate interactions between physicians, allied health professionals and
health care facilities
Learn how to partner with other members of the health care team to assess,
coordinate and improve health care
42