UF Anesthesiology Housestaff Manual
Policies and Responsibilities for Residents and Fellows
The University of Florida Anesthesiology Residency Program abides by all ACGME and University of Florida College of
Medicine Institutional Policies and Procedures. For the purposes of this document, the terms “resident” and “housestaff”
also refer to fellows, except where specifically indicated. Unless otherwise noted, “Anesthesiology Residency Program” is
assumed to include the subspecialty fellowships of Adult Cardiovascular Anesthesiology, Critical Care Medicine, Pain
Medicine, and Regional Anesthesiology & Perioperative Pain Medicine.
Rev. 12 6/7/2012
Table of Contents
Section 1: Policies...................................................................................................................................................................... 4
1.1
Book Fund Policy ...................................................................................................................................................................... 4
1.2
Call Schedules – Faculty and Residents .................................................................................................................................... 4
1.3
Controlled Substance Policy ..................................................................................................................................................... 4
1.4
Counseling and Support Services ............................................................................................................................................. 4
1.5
Didactic Program ...................................................................................................................................................................... 5
1.5.1
Attendance Policies ......................................................................................................................................................... 6
1.5.2
Academic Requirement ................................................................................................................................................... 9
1.6
Duty Hours................................................................................................................................................................................ 9
1.7
Dress Code .............................................................................................................................................................................. 10
1.8
EPIC ......................................................................................................................................................................................... 11
1.8.1
EPIC Copy and Paste Guidelines .................................................................................................................................... 11
1.9
Fatigue – Faculty and Residents ............................................................................................................................................. 12
1.10
Grievance Procedures ............................................................................................................................................................ 12
1.10.1
Grievances ..................................................................................................................................................................... 13
1.10.2
Suspension ..................................................................................................................................................................... 13
1.10.3
Nonrenewal ................................................................................................................................................................... 14
1.10.4
Dismissal ........................................................................................................................................................................ 14
1.10.5
Appeal ............................................................................................................................................................................ 14
1.11
Impaired Physician/Substance Abuse .................................................................................................................................... 15
1.12
Leave Policy for Residents ...................................................................................................................................................... 16
1.12.1
American Board of Anesthesiology Policy: Absence from Training ............................................................................... 16
1.12.2
Leave Requests .............................................................................................................................................................. 17
1.13
Meal Tickets Policy ................................................................................................................................................................. 21
1.14
Moonlighting Policy ................................................................................................................................................................ 22
1.15
Prescription Writing ............................................................................................................................................................... 23
1.16
Other Learners........................................................................................................................................................................ 23
1.17
Quality Improvement and Education ..................................................................................................................................... 23
1.18
Resident, Faculty, and Program Evaluations .......................................................................................................................... 24
1.18.1
Resident Evaluation ....................................................................................................................................................... 24
1.18.2
Faculty and Rotation Evaluation .................................................................................................................................... 26
1.18.3
In-Training Exam ............................................................................................................................................................ 26
1.18.4
Mock Oral Boards .......................................................................................................................................................... 27
1.18.5
ACGME Competencies ................................................................................................................................................... 27
1.19
Resident of the Month ........................................................................................................................................................... 27
1.20
Resident Promotion and Dismissal ......................................................................................................................................... 28
1.20.1
Medical Knowledge Requirement ................................................................................................................................. 28
1.20.2
Academic Probation....................................................................................................................................................... 28
1.21
Resident Selection .................................................................................................................................................................. 29
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1.21.1
Application ..................................................................................................................................................................... 29
1.21.2
Eligibility......................................................................................................................................................................... 29
1.21.3
Selection ........................................................................................................................................................................ 30
1.22
Resident Supervision .............................................................................................................................................................. 30
1.22.1
General Supervision Policies .......................................................................................................................................... 30
1.22.2
Supervision of Clinical Base Year Residents ................................................................................................................... 31
1.22.3
Supervision of CA-1 Residents ....................................................................................................................................... 31
1.22.4
Supervision of CA-2 Residents ....................................................................................................................................... 31
1.22.5
Supervision of CA-3 Residents ....................................................................................................................................... 32
1.22.6
Supervision of Fellows ................................................................................................................................................... 33
1.23
Residents Transferring into Anesthesiology Training Programs ............................................................................................. 33
1.24
Sexual Discrimination/Harassment ........................................................................................................................................ 34
1.25
Social Networking ................................................................................................................................................................... 34
1.26
Technical Standards for Anesthesiology Residency Training ................................................................................................. 35
1.28
Turnover Checklist for Anesthesia Techs ............................................................................................................................... 36
1.29
USMLE Policy .......................................................................................................................................................................... 37
1.30
Work Environment ................................................................................................................................................................. 37
Section 2: Responsibilities .................................................................................................................................................. 38
2.1
Mole Team Responsibilities .................................................................................................................................................... 38
2.2
Moonlighting Responsibilities ................................................................................................................................................ 39
2.3
PACU Resident Responsibilities .............................................................................................................................................. 40
2.4
Preop Resident Responsibilities ............................................................................................................................................. 41
2.5
Saturday Call Team Responsibilities ....................................................................................................................................... 42
2.6
Simulator Sessions .................................................................................................................................................................. 42
2.7
Transplant Resident Responsibilities ...................................................................................................................................... 43
2.8
Trauma Resident Responsibilities........................................................................................................................................... 44
2.9
VA Resident On-Call Responsibilities ...................................................................................................................................... 45
2.10
ACGME Case Logs ................................................................................................................................................................... 46
2.11
Call the Anesthesiology Attending When… ............................................................................................................................ 48
2.12
ICU/OR Transport Guidelines ................................................................................................................................................. 49
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Section 1: Policies
1.1
Book Fund Policy
Residents may use book fund money to purchase educational materials including books and software, society
memberships, work-related equipment such as stethoscopes and goggles, and travel expenses to educational meetings,
including board review courses. The funds are intended to facilitate resident education during training and cannot be
used to pay for the USMLE, ABA exam or medical licensure. Purchase of PDAs may be supported up to $250, and iPadlike devices up to $500 (submit receipt and printout of device description to residency office). Residents who are
presenting at a meeting can often get funds from other sources, so use of the book fund for travel-associated costs
should be discussed with the faculty sponsor and/or the Program Director.
Residents who are selected as Resident of the Month receive an extra $75 for their book fund.
1.2
Call Schedules – Faculty and Residents
The Anesthesiology Residency Program provides schedules that inform all health care team members of attending
physicians and residents currently responsible for each patient’s care. At a minimum, these schedules are available on:
1. The departmental intranet;
2. Every inpatient unit where residents and faculty in a given training program care for patients;
3. Every clinic where residents and faculty in a given training program care for patients.
When schedule changes are made, program administrative staffs apply changes at each of these locations.
1.3
Controlled Substance Policy
Controlled substances are dispensed from the OmniCell Cabinets located in the Operating Room, PACU, Preop holding,
52 Psych and Block Room. The most up-to-date procedures for obtaining controlled substances are located here on the
intranet.
1.4
Counseling and Support Services
The University of Florida College of Medicine’s Resident Assistance Program (RAP) is designed to help residents and their
families with concerns or problems that may be troubling them. The program’s mission is to develop and maintain a
positive and productive work environment for residents, interns and fellows. Counselors provide short-term,
confidential, professional counseling and referral services to residents and their families, and teach residents how to
manage problems when their jobs are affected. Concerns that RAP addresses include:
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Stress
Adjustment to life changes
Marital or relationship difficulties
Parenting issues
Family illness
Job burnout
Anger
Depression
Anxiety
Gambling
Alcohol or chemical dependency
Benefits-eligible residents, interns, fellows, and their legal spouses and other eligible dependents all
qualify for RAP benefits. The UF College of Medicine pays for basic RAP services and regards the
program as a fringe benefit. Up to the first three visits to a provider are free. If more visits are needed,
the counselor will coordinate continued care with the residency benefits plan.
RAP Access
Self-referral: This is a completely confidential method of getting help. RAP’s 24-hour/7-day Shands Vista
number is 352-265-5493, or toll free 866-643-9375.
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Employer Referral: If a resident’s problems visibly affect job performance, the Program Director, Faculty
Advisor or GME Dean may recommend that he or she access RAP for an evaluation. Supervisors will not
have access to resident records, and participation in the RAP is not included in a resident’s personnel
file.
1.5
Didactic Program
*The section below pertains to residents only. Attendance and academic requirements for fellows are set
by each fellowship director.
Residents are responsible for attending departmental morning lectures and conferences, which are held
daily from 6:30 to 7:15 a.m. Lecture schedules are available online and remote viewing is available from
clinical sites. Logging attendance is mandatory. Generally, the morning lecture schedule is organized as
follows:
Mondays & Wednesdays
 Introductory Lecture Series: The Introductory Lectures are designed specifically for the new
residents to provide basic information pertaining to anesthesia. The Introductory Lectures
are held Monday and Wednesday mornings during July, August, September, and October.
The Introductory Lecture Series is repeated each summer for all residents and faculty, but
focuses on the needs of new residents.
 Advanced Practice Series: During the introductory series, a concurrent series of lectures for
the CA3 residents related to job search, contract negotiation, etc., will be scheduled.
 General departmental didactics focusing on topics of general interest, visiting professors,
CME-required conferences, and other formats of interest to the entire department.
 Simulation Sessions: To meet ACGME program requirements, each resident must complete
at least 3 simulator sessions per year. Offered scenarios include anesthesia machine,
difficult airway management (I and II), cardiac evaluation, and non-cardiac surgery in cardiac
patients. More information is contained in Section 2.5: Simulator Sessions.
Tuesdays & Thursdays
 CA-1: the general conference will focus on the needs of junior residents including discussion
of assigned reading and case-based conferences.
 CA-2/3 subspecialty residents: including neuroanesthesia, pediatric anesthesia,
cardiovascular anesthesia, airway, and outpatient anesthesia will have small group
discussions with their faculty. Acute pain management, chronic pain management, critical
care medicine and obstetric anesthesia have their subspecialty conferences at other times.
 CA-2/3 non-subspecialty: those upper-level residents not assigned to a subspecialty will
meet for Keyword Conference on Tuesdays.
 Breakfast Meetings: On the second and fourth Thursday of each month, breakfasts are held
to discuss new business, issues, and to answer any questions. The breakfast held on the
second Thursday, listed as “Resident’s Conference,” is conducted by our chief residents. The
breakfast held on the fourth Thursday, listed as “Chairman’s Conference,” is conducted by
the Chairman and Program Director. If there is a particular subject you wish to discuss at
these breakfasts, please contact a Chief Resident or the Chairman’s office.
Fridays
 Case Discussion Conference: Anesthesiology Case Conference enables the faculty, residents
and other clinical employees of the department to discuss and evaluate difficult or
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interesting cases. Discussion includes opinions, options, and quality and standard of care
issues. These are not lectures; questions and discussions are encouraged and necessary in
order for these conferences to be effective. Case Discussions will be moderated by various
faculty members, and residents will frequently be asked to participate either by presenting
cases or presenting a brief review of literature relevant to the presented case. In general,
CME credit is provided for those in attendance. Those viewing remotely (see “Remote
Viewing” below) must watch the lecture in real time to receive CME credit.
Anesthesiology Practice Improvement (APIC): Once per quarter, case discussions will be
directed toward quality assurance issues. This conference will be moderated by members of
the APIC group. Quality and resource management issues summarizing our quality
assessment activities, opportunities and strategies for improving care, risk management
activities, and the impact of economic constraints on the quality of care are discussed at this
conference.
Education Fridays: Every Friday, the ORs delay their start until 8:00AM to provide extra time
for resident education. From 7:15 until 8:00AM, residents meet to discuss quality projects or
engage in other appropriate educational activities.
1.5.1 Attendance Policies
The Anesthesiology Residency office maintains accurate attendance records for all conferences.
Residents are expected to show courtesy, respect and professionalism by arriving promptly. Each
resident is responsible for logging his or her attendance, and for ensuring attendance accuracy. The
Residency Office can provide residents with information on their attendance. For morning conferences,
residents should scan their ID badges or enter their UFID numbers into the attendance computer. Small
groups and afternoon journal clubs generally have a sign-in sheet that is turned in to the residency
office.
Remote Lecture Viewing/Attendance
Participating in person is always preferred; however, remote viewing is available for residents rotating
away from Shands. There is a designated sign-in computer at FSC, the VA, and the Children’s Surgical
Center (CSC/Ayers). Residents at the VA are expected to watch the lecture in person at Shands, but if a
resident’s responsibilities on a particular day make this impossible (i.e. managing the pagers), then that
resident may watch remotely from the VA. Because the VA Pain and UFPA rotations take place a
significant distance from campus, residents on those locations may log in from home. Other instances of
logging in from unapproved locations will be evaluated on a case-by case basis.
Remote viewing from approved locations. Before each lecture, all residents will receive an email with the
link to view the conference and a link for attendance login. You must log in to both systems.
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The attendance login looks like this:
You may use your fob number or your UFID number. Clicking “yes” takes you to the screen on the left,
while clicking “no” takes you to the screen on the right.
Once your fob or UFID is accepted into the system, you will be logged in and your attendance will be
recorded.
Remote viewing from home or other unapproved locations. If you are logging in from home or from a
computer that is not in one of the approved locations, when you attempt to log in, you will get this error
message:
Simply click where it says “click here” and you will be prompted to type a message on why you are
logging in from home (out sick, on vacation, on VA Pain rotation, etc.) Once you submit the message,
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you will be redirected to the login page and should be able to enter your UFID to log in. If you are going
to be watching from home for an approved reason and for more than just a day, then temporary access
will be provided during the needed time frame.
The morning lecture series is an integral part of resident education, and therefore attendance at
morning conference is mandatory. A satisfactory attendance rate is required to receive a completely
satisfactory clinical competence report to the American Board of Anesthesiology. Each resident must
sign a letter acknowledging an understanding of the following requirement:
A satisfactory attendance rate is 80% of required conferences during each six month period. The number
of conferences required is based on rotation. For residents on more difficult rotations, “required
conferences” are calculated as a percentage of all conferences offered. For instance, if a total of 20
conferences are offered during a resident’s Mole rotation, 50% of those (10) are considered to be
required, and the resident must attend 80% of required lectures (8) to be in compliance. Satisfactory
conference attendance is key to demonstrating clinical competency in Professionalism and Medical
Knowledge and reflects directly on progress toward promotion.
Residents in these rotations are required to attend 80% of the conference requirement indicated below:
 APM (Acute Pain Management) – no conference attendance required
 CV (Cardiovascular Anesthesia) – 50% of all conferences offered.
 CCM (Critical Care Medicine) – no lecture attendance required
 ENT (Otolaryngology) – 100% of conferences offered
 FSC (Florida Surgical Center) – 100% of conferences offered
 Mole – 50% of conferences offered.
 Nemours – no conference attendance required.
 Neuro (Neuroanesthesia) – 100% of conferences offered.
 OB (Obstetric Anesthesia) – 100% of conferences offered.
 OB mole – 50% of conferences offered.
 PACU (Post-Anesthesia Care Unit)– 100% of conferences offered.
 Peds (Pediatric Anesthesia) – 100% of conferences offered.
 Preop Clinic – 100% of conferences offered.
 Research – 100% of conferences offered.
 Shands OR – 100% of conferences offered.
 SJOB (Shands-Jacksonville OB) – no conference attendance required.
 SJPain (Shands-Jacksonville Pain) – no conference attendance required.
 Svasc (Shands Vascular Anesthesia) – 100% of conferences offered.
 TEE (Transesophageal Echocardography) – 100% of conferences offered.
 Transplant – 50% of conferences offered.
 TTP (Transition to Practice) – 100% of conferences offered.
 VA OR (Veterans Administration Medical Center OR) – 100% of conferences offered.
 VAC (VA Pain) – 100% of conferences offered.
 VACT (Veterans Administration Medical Center Cardiovascular Anesthesia) – 50% of
conferences offered.
 VA Neuro (Veterans Administration Medical Center Neuroanesthesia) – 100% of
conferences offered.
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Attendance records are necessary for accreditation and for frequent reports that must be submitted to
the ABA and various national and state agencies, and to meet the ACGME’s Medical Knowledge
requirement. Attendance and its honest reporting will be reflected in letters of recommendation for
fellowship and job applications. Residents are responsible for ensuring the accuracy of conference
attendance records.
1.5.2 Academic Requirement
Each resident must complete an academic assignment. This assignment usually occurs during the final
24 months of training, but it may, at the program director’s discretion, occur earlier. Academic projects
may include grand rounds presentations, preparation and publication of review articles, book chapters,
manuals for teaching or clinical practice, or similar academic activities. Alternatively, a resident may
elect to develop and perform or participate in one or more clinical or laboratory investigations. The
Review Committee expects that the outcomes of resident investigations will be suitable for presentation
at local, regional, or national scientific meetings and that many will result in peer-reviewed abstracts or
manuscripts. A faculty supervisor must be in charge of each project and investigation.
Residents at the University of Florida may choose from the following options during the CA-2 or CA-3
year:
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Present a formal lecture on a topic of choice. The Program Director must approve the topic, and
the resident must select a faculty mentor to review the presentation.
Present at a Friday morning Case Discussion Conference. The resident must conduct and
synthesize a literature review and present this review as well as the case.
Prepare for publication a case report. One option is submission through the Journal of Clinical
Anesthesia’s “Case Discussions at the University of Florida.” The faculty members presenting the
case with the resident will help to prepare the article.
Prepare a paper suitable for publication. This paper may be a case presentation, review article,
or results of research in which the resident participated.
Volunteer as an editor for the annual Departmental Keywords Book.
Prepare and present individual research, a case discussion, or topic review of the literature at
the Gulf Atlantic Residents’ Conference or another conference.
Completion of one of these activities is required for graduation.
1.6
Duty Hours
The Anesthesiology Residency Program adheres strictly to the ACGME Duty Hours Standards, which
require an 80-hour maximum work week. Rotation-specific details are discussed with residents prior to
beginning each rotation.
The Anesthesiology Core Program Policy is the following:
 Maximum work hours per week: 80 hours per week averaged over 4 weeks;
 Days off: at least one per week, averaged over four weeks;
 Maximum call time:
o SICU Rotation – 30 hours, no new patients or clinical procedures after 24 hours;
o OR Rotation – 24 hours + time to hand over a case;
o Mole Rotation – 24 Hours;
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Minimum hours between consecutive duty periods – 10; 14 hours after a 24-hour shift;
Moonlighting – hours are counted toward the 80 hour work week.
Exceptions for Fellows in an ACGME-accredited fellowship:
 Maximum Call Time: 24 hours. Hours past 24 are only for continuity activities, turnover of
patient care, and education;
 Fellows may not moonlight as attendings.
1.7
Dress Code
PURPOSE:
To establish the guidelines for appropriate dress for University of Florida College of Medicine
anesthesiology residents and fellows
POLICY:
The image of the University of Florida and Medicine in general is reflected in the appearance of its
residents and fellows. By maintaining a professional appearance, residents and fellows can influence the
opinion and confidence of patients and guests regarding our commitment to patient care. Therefore,
standards shall be established and maintained for dress requirements and personal appearance for
UFCOM residents and fellows while participating in patient care.
As health care professionals, UFCOM residents and fellows are expected to be clean, well groomed, and
appropriately dressed to reflect the professional standards of their department. General guidelines
regarding personal appearance apply to all departments.
Below are the specific dress requirements for the Department of Anesthesiology:
A) Scrub clothing
a. Scrubs should be clean and free of stains, spots or tears
b. Scrubs are hospital property and should not be taken for personal possession
B) Photo identification
a. Photo ID badges must be worn with the picture/name/title clearly visible and facing
forward
b. Loose or damaged badges should be replaced
c. No pins or decals
d. No unauthorized badges, stickers, advertisements or endorsements are permitted
C) Shoes
a. For your safety, please do not wear open-toe shoes in work area
b. Shoe cover, if worn, should be removed when leaving the operating room or procedure
area
D) Fingernails
a. Fingernails should be well manicured and less than a quarter-inch long
b. No artificial nails, jeweled or pierced nails, or extensions permitted
E) Jewelry
a. Jewelry must not interfere with job performance or patient safety
b. No visible body piercing permitted, except ears
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F) Hair/Head
a. Hair must be styled to limit contact with patients
b. Hair must be of naturally occurring colors only
c. Facial hair must be clean and trimmed
d. While in the operating room or other procedure areas, a scrub hat must be worn
e. Masks and disposable hats should be removed when leaving the operating room or
procedure area
G) Unprofessional attire for patient care
a. See through/immodest outfits
b. Casual t-shirts
c. Sweat shirts/pants
d. Jeans/denim/shorts
e. Flip-flops/sandals
GENERAL INFORMATION:
1. The policy described above pertains particularly to residents and fellows while they are engaged
in clinical patient care responsibilities. Appropriate casual or business casual attire (which may
include jeans without holes, patches, or stains) shall be worn when engaged in educational
activity only, e.g., conference, journal club, in-training exam—unless otherwise directed or
instructed by leaders of special events outside of the clinical setting.
2. Residents and fellows may be relieved from duty without pay for inappropriate dress, poor
hygiene, or noncompliance with the dress code policy. Repeated violations may result in
disciplinary action.
3. Where specialized clothing or exceptions to the policy are necessary for safety reasons or where
governmental regulations take priority, certain provisions of this policy may be suspended; such
decisions will be made jointly by the department head and the Senior Associate Dean for
Educational Affairs.
4. The policy does not apply to the resident or fellow who may be on campus as a patient or visitor
of a patient, or for personal study (outside of duty hours).
1.8
EPIC
This system is available at all times and is continuously being improved. EPIC guidelines and policies will
be added to this document as they are developed. The EPIC website is an excellent resource for training,
and also has a user forum to aid in database development.
1.8.1 EPIC Copy and Paste Guidelines
Although Copy and Paste can be a time-saver, it also carries risks, e.g. pasting information in the wrong
encounter/patient record; perpetuation of data errors; adding repetitive/irrelevant information to the
record; and adding information that does not reflect the patient’s current condition.
Users are responsible for the total content of their documentation including any content that is copied
and pasted from other sources. Copy and Paste may be used only for copying information that
supports current clinical decisions or has a direct impact on current patient care, subject to the following
rules:
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Do:
1. Limit copied/pasted material to that which is both currently accurate and medically necessary.
2. Attribute copied/pasted information to the originator of the information.
3. Review all information copied and pasted and revise as needed to reflect the patient’s current
condition.
4. Be sure you are copying and pasting information from and into the same patient’s record and
into the correct encounter.
5. Correct any errors subsequently found in information that you copied and pasted – do not delete
the entry.
Do not copy and paste any of the following:
1. A physical examination or medical decision-making, which should be unique to each
provider/visit.
2. Previously documented information, if known to contain errors.
3. Information for which the author is unknown.
4. Information more than 30 days old.
5. Information already available in other parts of the record for the current encounter. Refer to the
information by title, author, and/or date/time instead. This includes:
a. Entire reports, large blocks of text/data, or laboratory, radiology, or other reports/data
already recorded elsewhere.
b. Information that has already been copied and pasted from a previous entry.
8. Notes written by students (including medical students).
1.9
Fatigue – Faculty and Residents
Consistent with institutional policy, the Anesthesiology Residency Program provides education on
recognition and mitigation of fatigue/sleep deprivation. A broad-based education program on this
subject is available from the GME office. Residents and faculty must demonstrate training on the
subject. To meet training requirements, a lecture on this topic is scheduled annually. If a housestaff or
faculty member is unable to attend, he or she is required to view the online module, “Sleep Awareness
and Fatigue Education (SAFER),” through New Innovations.
Residents on duty in the hospital are provided with adequate and appropriate sleeping quarters. In the
event a resident is too tired to drive home after a shift, the Anesthesiology Residency Program provides
cab fare from hospital to home and back.
If a resident is fatigued to the point where he or she cannot perform effectively, the resident will alert
the attending and will be relieved as follows:
 The attending will take the call phone and the resident will be encouraged to rest in an oncall room.
 If the resident is unable to recover, the attending, a fellow, or a senior resident will take
over all responsibilities. If in the best judgment of the attending, the resident is unable to
return to duty, he or she will be sent home.
1.10 Grievance Procedures
Residents personify the dual aspect of a student who is in graduate training while also participating in
the delivery of patient care.
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The University of Florida Anesthesiology Residency Program is committed to maintaining a supportive
educational environment in which residents are given the opportunity to learn and grow. Inappropriate
behavior in any form in this professional setting is not permissible. A resident's continuation in the
training program is dependent upon satisfactory performance as a student, including the maintenance
of satisfactory professional standards in the care of patients and interactions with others on the health
care team. The resident's academic evaluation will include assessment of behavioral components,
including conduct related to professional standards, ethics, and collegiality. Disqualification of a resident
as a student or as a member of the health care team from patient care duties disqualifies the resident
from further continuation in the program.
1.10.1 Grievances
A grievance is defined as dissatisfaction when a resident believes that any decision, act or condition
affecting his or her program of study is arbitrary, illegal, unjust, or creates unnecessary hardship. Such
grievance may concern, but is not limited to, the following: academic progress, mistreatment by any
University employee or student, wrongful assessment of fees, records and registration errors, discipline
(other than nonrenewal or dismissal) and discrimination because of race, national origin, gender, marital
status, religion, age or disability, subject to the exception that complaints of sexual harassment will be
handled in accordance with the specific published policies of the University of Florida College of
Medicine.
Prior to invoking the grievance procedures described herein, the resident is strongly encouraged to
discuss his or her grievance with the person(s) alleged to have caused the grievance. The discussion
should be held as soon as the resident becomes aware of the act or condition that is the basis for the
grievance. In addition, or alternatively, the resident may wish to present his or her grievance in writing
to the person(s) alleged to have caused the grievance. In either situation, the person(s) alleged to have
caused the grievance may respond orally or in writing to the resident.
If a resident decides against discussing the grievance with the person(s) alleged to have caused such, or
if the resident is not satisfied with the response, he or she may present the grievance to the Chair. If,
after discussion, the grievances cannot be resolved, the resident may contact the Associate Dean of
Graduate Medical Education (ADGME). The ADGME will meet with the resident and will review the
grievance. The decision of the ADGME will be communicated in writing to the resident and constitutes
the final action of the University.
1.10.2 Suspension
The Chief of Staff of a participating and/or affiliated hospital where the resident is assigned, the Dean,
the President of the Hospital, the Chair, or Program Director may at any time suspend a resident from
patient care responsibilities. The resident will be informed of the reasons for the suspension and will be
given an opportunity to provide information in response. The resident suspended from patient care may
be assigned to other duties as determined and approved by the Chair. The resident will either be
reinstated (with or without the imposition of academic probation or other conditions) or dismissal
proceedings will commence by the University against the resident within thirty (30) days of the date of
suspension.
Any suspension and reassignment of the resident to other duties may continue until final conclusion of
the decision-making or appeal process. The resident will be afforded due process and may appeal to the
ADGME for resolution, as set forth below.
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1.10.3 Nonrenewal
In the event that the Program Director decides not to renew a resident's appointment, the resident will
be provided written notice which will include a statement specifying the reason(s) for nonrenewal. This
should be done at least 4 months prior to the end of the resident’s current agreement. If requested in
writing by the resident, the Chair will meet with the resident; this meeting should occur within 10
working days of the written request. The resident may present relevant information regarding the
proposed nonrenewal decision. The resident may be accompanied by an advisor during any meeting
held pursuant to these procedures, but the advisor may not speak on behalf of the resident. If the Chair
determines that nonrenewal is appropriate, he or she will use their best efforts to present the decision
in writing to the resident within 10 working days of the meeting. The resident will be informed of the
right to appeal to the ADGME as described below.
1.10.4 Dismissal
In the event the Program Director of a training program concludes a resident should be dismissed prior
to completion of the program, the Program Director will inform the Chair in writing of this decision and
the reason(s) for the decision. The resident will be notified and provided a copy of the letter of proposed
dismissal; and, upon request, will be provided previous evaluations, complaints, counseling, letters and
other documents that relate to the decision to dismiss the resident. If requested in writing by the
resident, the Chair will meet with the resident; this meeting should occur within 10 working days of the
written request. The resident may present relevant information regarding the proposed dismissal. The
resident may be accompanied by an advisor during any meeting held pursuant to these procedures, but
the advisor may not speak on behalf of the resident. If the Chair determines that dismissal is
appropriate, he or she will use their best efforts to present the decision in writing to the resident within
10 working days of the meeting. The resident will be informed of the right to appeal to the ADGME as
described below.
1.10.5 Appeal
If the resident appeals a decision for suspension, nonrenewal or dismissal, this appeal must be made in
writing to the ADGME within 10 working days from the resident's receipt of the decision of the person
suspending the resident or the Chair. Failure to file such an appeal within 10 working days will render
the decision of the person suspending the resident or the Chair the final agency action of the University.
The ADGME will conduct a review of the action and may review documents or any other information
relevant to the decision. The resident will be notified of the date of the meeting with the ADGME; it
should occur within 15 working days of the ADGME's receipt of the appeal. The ADGME may conduct an
investigation and uphold, modify or reverse the recommendation for suspension, nonrenewal or
dismissal. The ADGME will notify the resident in writing of the ADGME's decision. If the decision is to
uphold a suspension, the decision of the ADGME is the final agency action of the University. If the
decision is to uphold the nonrenewal or dismissal, the resident may file within 10 working days a written
appeal to the Dean of the College of Medicine. Failure to file such an appeal within 10 working days will
render the decision of the ADGME the final action of the University. The Dean will inform the ADGME of
the appeal. The ADGME will provide the Dean a copy of the decision and accompanying documents and
any other material submitted by the resident or considered in the appeal process. The Dean will use his
or her best efforts to render a decision within 15 working days, but failure to do so is not grounds for
reversal of the decision under appeal. The Dean will notify in writing the Chair, the ADGME, the Program
Director and resident of the decision. The decision of the Dean will be the final agency action of the
University. The resident will be informed of the steps necessary for the resident to further challenge the
action of the University.
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1.11 Impaired Physician/Substance Abuse
The UF Anesthesiology Residency Program fully participates in the provisions of the Florida Medical
Practice Act (F.S. 458), the rules of the Board of Medicine, and those of the Department of Professional
Regulation. Through the UF College of Medicine, the Department of Anesthesiology supports the Florida
Impaired Practitioners Program.
Faculty, staff, peers, family or other individuals who suspect that a resident is suffering from a
psychological or substance abuse problem are obligated to report such problems. Individuals suspecting
such impairment can either report directly to the Florida Professional’s Resource Network (PRN) or can
discuss their concerns with the Program Director, Department Chair, or Associate Dean of Graduate
Medical Education.
The UF Department of Anesthesiology strictly enforces all appropriate rules that govern the practice of
medicine:
 All referrals to the PRN are confidential and are evaluated by the professionals of the PRN.
Decisions about intervention, treatment and after care are determined by the PRN.
 As long as the practitioner satisfactorily participates in the PRN program no regulatory action
would normally be anticipated by the Board of Medicine.
 Resumption of clinical activity and residency program will be contingent upon the continued
successful participation in the PRN. Continuation of the resident in the program will be
determined in consultation between the program director and the professionals at the PRN.
 Shands Hospital has a rehabilitation program for impaired professionals that is available to
Department of Anesthesiology personnel. ShandsVista Behavioral Health – Impaired
Professional Treatment Program.
Impaired Practitioner’s Program of Florida
The Professional’s Resource Network (PRN)
P.O. Box 1020
Fernandina Beach, FL 32035-1020
1-800-888-8PRN (8776)
1-904-277-8004
Physicians (Allopathic or Osteopathic) with a past or current history of drug or alcohol addiction must
contact the PRN as soon as possible on or before arriving at your training program in Gainesville, FL. This
is a confidential and professional organization that will help you stay clean and sober while maintaining
your ability to practice medicine in our State.
The purpose of the PRN Program is to ensure the public health and safety by assisting the ill
practitioners who may suffer from one or more of the following:
 Chemical dependency
 Psychiatric illness
 Psychosexual illness, including boundary violations
 Neurological/cognitive impairment
 Physical illness
 HIV infections/AIDS
 Behavioral disorders
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By supporting ill practitioners in regaining their health, PRN attempts to maintain the integrity of the
healthcare team in its role in serving the public. You are treated with respect, confidentiality, and
without discrimination. Recommendations by the PRN for any type of follow-up, counseling, testing,
assessment, etc. is the privacy of you and the PRN in their Advocacy/Monitoring Contract.
For further confidential information, resources, intervention, referral or treatment, residents should
contact Sharron Wallace at 265-0787, or Dr. Scott Teitelbaum, Director of the Vista Professional’s
Recovery & Treatment Program at 265-5497.
1.12 Leave Policy for Residents
Members of the Anesthesiology housestaff shall be entitled to leave with pay for the purpose of annual
and sick leave depending upon the length of appointment during the training period July 1 through June
30, as described in this section. Leave will be granted and charged in one-day increments for each
workday of leave requested and approved. If specialty board regulations for annual and sick leave
accrual and usage differ from that outlined in this rule, written notification of the board policy shall be
completed by the program director and submitted to the Dean for approval. All absences must be
approved by the program director. If excessive time is taken, the resident may be required to extend
his/her training to fulfill Board requirements.
1.12.1 American Board of Anesthesiology Policy: Absence from Training
The ABA “Booklet of Information” contains the following guidelines for Anesthesiology residents:
The total of any and all absences may not exceed 60 working days (12 weeks) during the CA 1-3 years of
training. Attendance at scientific meetings, not to exceed five working days per year, shall be considered
a part of the training program. Duration of absence during the clinical base year may conform to the
policy of the institution and department in which that portion of the training is served. Absences in
excess of those specified will require lengthening of the total training time to the extent of the additional
absence. A lengthy interruption in training may have a deleterious effect upon the resident's knowledge
or clinical competence. Therefore, when there is an absence for a period in excess of six months, the
Credentials Committee of the ABA shall determine the number of months of training the resident will
have to complete subsequent to resumption of the residency program to satisfy the training required for
admission to the ABA examination system.
The ABA guidelines for absences during subspecialty fellowships are as follows:
The total of any and all absences during a subspecialty fellowship may not exceed the equivalent of 20
working days (four weeks) per year. Attendance at scientific meetings, not to exceed five working days
during the year of training, shall be considered part of the training program. Absences in excess of those
specified will require lengthening of the total training time to the extent of the additional absence.
Training in an anesthesiology subspecialty must not be interrupted by frequent or prolonged periods of
absence. When there is an absence for a period in excess of two months, the Credentials Committee of
the ABA shall determine the number of months of training subsequent to resumption of the program that
are necessary to satisfy the training requirement for admission to the ABA subspecialty examination
system.
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1.12.2 Leave Requests
All leave requests must be made in writing or by email. Leave requests for meetings must include the
name and dates of the meeting. Verbal requests for vacations or meetings will not be accepted. Leaves
of absence can only be authorized by the Program Director, the Department Chair, or the Associate
Dean for GME, with the following conditions:
 Residents will not be granted severance pay for unused annual or sick leave, as they are not
considered permanent State employees.
 Annual leave and sick leave may not be granted in advance of the current academic year.
 Annual leave and sick leave may be carried over to subsequent academic years if not used in a
given year; however:
o The Anesthesiology Residency Program has no obligation to allow leave beyond 15 days
of vacation and 5 days of meeting time each academic year.
o Residents are therefore encouraged to completely use their leave and meeting time
each academic year.
 Sick leave cannot be used for any purpose other than personal illness or family
illness/emergencies.
 A total of 60 working days is available for all leave during the three years of residency training;
generally that is 15 days of total sick leave.
Vacation Leave
Vacation leave shall be requested and approved by the Program Director prior to the date taken.
Vacation requests are granted through a vacation lottery at the end of each academic year. Changes and
additional vacation requests go through the Anesthesiology Residency Office on a space-available basis.
Vacation leave should not be fragmented into less than one-week periods except under unusual
circumstances and must be taken at the time approved by the Program Director. Vacation leave may be
advanced to housestaff proportionate to expected service. This advance leave cannot exceed the
amount of the leave accrual rate for a one-year period. The amount of advanced leave will not exceed
that which can be earned during the remainder of the housestaff leave year. Vacation leave which has
been granted but not earned by the housestaff member at the time of separation from the academic
department will require an appropriate reduction for the value thereof in the final stipend payment.
Vacation leave accruals are normally based on an annual rate of fifteen (15) work days for all housestaff.
Housestaff may be permitted to carry over unused leave to a new year, as consistent with
Anesthesiology Department policy; however, carryover must be approved by the Program Director, and
an excess of twenty-five (25) work days cannot be accumulated. All unused leave is considered nonpayable leave, and there is no entitlement for lump-sum payment for unused leave upon separation or
completion of training.
The following rotations do not allow vacation:
 Preop
 Mole
 Burn
 SICU (all rotations except for Fellows with prior approval from the Program Director)
 Recovery Room
 First month of OB (and first week of subsequent rotations)
 Nemours
 Shands-Jacksonville
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Exceptions to this policy may be granted only with the written approval of the Rotation Director and
Program Director. Leave may be granted on an individual basis from rotations at Shands-Jacksonville.
Residents may apply for vacation in any other rotation, although it is preferable to avoid vacation during
the first rotation of any subspecialty.
Please note: If a resident spends a significant period of training at the VA Medical Center or at ShandsJacksonville, that resident must take vacation from rotations at those locations in proportion to the
percentage of time during the year spent at those hospitals. For instance, if a resident spends > 20% of
time at either location, that resident will be expected to take at least 1 week of vacation from rotations
there.
Residents selected as Resident of the Month are given a day off.
Sick Leave
All Anesthesiology housestaff shall accrue sick leave at the rate of 10 working days per year of full
employment. However, in order to meet the ACGME requirement of no more than 20 days per year (60
days over three years) away from training, any sick leave beyond five days must come from vacation
leave. Housestaff shall be entitled to utilize sick leave for special cases of severe illness for themselves,
and those in their immediate family (spouse, parents, brothers, sisters, children, grandparents, and
grandchildren of both housestaff members and spouses). Sick leave may be advanced to housestaff
proportionate to expected service. This advance leave cannot exceed the amount of the leave accrual
rate for a one-year period. The amount of advanced leave will not exceed that which can be earned
during the remainder of the housestaff leave year. Sick leave which has been granted but not earned by
the housestaff member at the time of separation from the academic department will require an
appropriate reduction for the value thereof in the final stipend payment. Housestaff may be permitted
to carry over sick leave to a new year, as consistent with department policy; however, carryover must be
approved by the Program Director and an excess of 15 work days cannot be accumulated. All unused
leave is considered non-payable leave, and there is no entitlement for lump-sum payment for unused
leave upon separation or completion of training.
Residents on late stay or mole during the time they called in sick will be required to make up the time
and will be rescheduled by the chiefs. A resident who exceeds the number of days allowed by the ABA
will have to make up this time at the end of his or her residency. Alternatively, he or she can give up the
equivalent amount of vacation during the same academic year.
If a resident requires more than 5 sick days in an academic year, the Program Director may require him
or her to undergo a medical evaluation to document the extent of the problem.
To call in sick residents should, by 6:00AM, email [email protected], and call 265-0077 with basic
information on where they were scheduled. This must be repeated for each consecutive day that the
resident is sick.
Meetings
Residents in the Department of Anesthesiology may attend scientific meetings, not to exceed five
working days per year, in accordance with ASA policy. Meeting leave that is not used in an academic
year may be carried over to the following year, but must be used only for meetings, interviews, or test
taking.
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After the vacation lottery is complete there will be remaining weeks for meeting time.
These will be handled on a priority basis:
 Presenting at a meeting or serving on a committee (These are the only guaranteed meetings,
and then only if submitted sufficiently far in advance);
 CA-3s for major national meetings (ASA, major subspecialty);
 CA-3s for board review courses;
 CA-2s for major national meetings (ASA, major subspecialty);
 CA-3s for other educational meetings;
 CA-1s for major national meetings (ASA, major subspecialty);
 CA-2s for other educational meetings;
 CA-1s for other educational meetings.
All “educational meetings” must be approved by the Program Director. These requests must be
submitted at least a month prior to the meeting, and preferably well before that. Leave is approved
based on availability.
Once a meeting request is approved, residents must formally request the time off. If a resident has any
calls or late stays assigned during that period it is that resident’s responsibility to find coverage.
Parental Leave
Anesthesiology housestaff may take up to 6 weeks paid leave using accrued sick leave and vacation
leave to care for a new child by birth or adoption. Sick/Vacation leave may be advanced to housestaff
proportionate to expected service as detailed in the Vacation Leave and Sick Leave sections of this
document. The official parental leave period may begin two weeks before the expected date of the
child’s arrival and must occur with the 12-month period beginning with that date. Residents that plan to
utilize parental leave are expected to notify their Program Director as soon as they know they will need
to use parental leave to facilitate appropriate scheduling. Complicated pregnancy or delivery will be
handled through additional sick leave and disability policies. The Family and Medical Leave Act (FMLA)
mandates that up to 12 workweeks may be taken for the birth of a biological child or placement of child
pending adoption. If the housestaff member chooses to take more than the 6 weeks leave, he/she will
be placed on unpaid leave the remaining 12 weeks. While on unpaid leave, housestaff insurance
benefits will be covered by the Anesthesiology Department for up to two (2) months. After two (2)
months, the resident will be responsible for payment of insurance premiums. Such coverage may be
purchased for a time period consistent with COBRA regulations.
A housestaff member’s time lost must be made up in accordance with ABA policy. The resident will be
paid for makeup or extended time.
FMLA Entitlement
The Family and Medical Leave Act (FMLA) is federal legislation enacted to provide job protection for up
to 12 weeks per entitlement year to an employee, or for an employee to care for his or her parent,
spouse, or child who has a serious health condition determined to be FMLA-qualifying by the patient’s
physician, or when an employee must be absent due to becoming a parent. Employers must approve
leave for events that qualify under the FMLA.
FMLA is not paid leave. To qualify for FMLA entitlement, a resident must have used up all of his or her
sick leave and vacation leave.
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Residents who have been employed by the University of Florida at least 12 months (need not have been
consecutive), and have worked a minimum of 1,250 hours during the 12 months immediately preceding
the requested leave, are eligible for a total entitlement (not per event) of up to 12 workweeks of leave
without pay in a fiscal year for events determined to be FMLA-qualifying.
At the University of Florida, the leave benefits to which employees have access are frequently more
generous than those provided by the FMLA. As a result, when granting appropriate leave in keeping with
university policy, the Anesthesiology Department will likely meet the requirements of the FMLA as a
matter of course.
Domestic Violence Leave
Housestaff are eligible up to 3 days leave in a 12 month period if the resident or a family or household
member is a victim of domestic violence. The fiscal year of July 1 to June 30 will be considered the 12
month period. Except in the case of imminent danger to the health or safety of a housestaff member, or
the health or safety of a family or household member, a resident seeking leave from work under this
section must provide his or her Program Director advance notice of the leave. The housestaff member is
required to first use accrued sick or annual leave. In the event that the employee does not have
sufficient leave hours to cover the event, the leave that is not covered will be unpaid.
Bereavement Leave
Housestaff shall be granted, upon request to the Program Director, up to 5 days off for the funeral of an
immediate family member. Housestaff members are granted 2 days of bereavement pay, and may use
their sick or annual leave time for the remaining 3 days. Immediate family members shall include
spouse, cohabiters, registered same sex domestic partners, children, step children, parents, parents of a
spouse, and the stepparents, grandparents, grandchildren, brothers, and sisters.
Military Leave
Absences for temporary military duty (e.g. two-week annual training) will not be taken from sick or
annual leave but will be considered leave with pay for up to 17 days. If activated from reserve to active
duty status, the housestaff member will receive 30 days full pay before going on leave without pay.
Insurance policies will remain in effect for dependents during the period of active duty for one year.
Additional extensions require special approval from the Dean of the College of Medicine.
Jury Duty Leave
Housestaff who are summoned to jury duty will be granted paid leave for all hours required for such
duty. If jury duty does not require absence for the entire workday, the resident should return to work
immediately upon release by the court. The university will not reimburse the resident for meals, lodging,
and travel expense while as a juror. This type of leave must be approved by Program Director in
advance.
Educational Assignment
Housestaff shall be eligible for absence pertaining to educational and training provided it is allowed by
the ASA and agreed to, in writing, by the Program Director. This should not be charged as either annual
or sick leave.
Licensure Examination Leave
Housestaff shall be entitled to observe all official holidays designated by Shands/UF Administration for
state employees except when they are on call for clinical responsibilities. Housestaff on Veteran's
Administration Medical Center (VAMC) rotations shall be entitled to observe all official holidays
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designated by the federal government for VAMC employees except when they are on call for clinical
responsibilities. When on duty or call for clinical responsibilities on designated holidays, the assignment
will be considered as part of the residency and will not result in extra remuneration.
Holidays
Housestaff shall be entitled to observe all official holidays designated by Shands/UF Administration for
state employees except when they are on call for clinical responsibilities. Housestaff on Veteran's
Administration Medical Center (VAMC) rotations shall be entitled to observe all official holidays
designated by the federal government for VAMC employees except when they are on call for clinical
responsibilities. When on duty or call for clinical responsibilities on designated holidays, the assignment
will be considered as part of the residency and will not result in extra remuneration.
Doctor’s Appointments
In the case of an urgent/emergent problem, residents should follow the procedure for calling in sick
(email [email protected] and call the Residency Office at 265-0077).
For routine or elective appointments, residents should clear these through the Residency Office and try
to schedule appointments for as late in the day as possible. If the appointment must be first thing in the
morning, this must be cleared through the residency office. Assuming it is appropriate to do so, the
resident must return to work as soon as the appointment is completed. Residents who return in a timely
manner will not be charged a sick day.
Discretionary Rotation Leave
Occasionally during the academic year, days free from duty may be granted by an individual rotation
director. These free days occur most commonly around the winter holiday period. Annual leave is not
charged for this free time, provided that affected residents remain in town and are available to work in
an emergency. If a resident elects to leave town during these free days, he or she must request annual
leave and it will most likely be granted.
Extended Leaves of Absence
Extended leaves of absence with or without pay are allowed under certain circumstances. These are
detailed at the UF College of Medicine Housestaff Benefits website.
1.13 Meal Tickets Policy
1. Meal tickets are for U.F. College of Medicine and U.F. College of Dentistry OMFS Interns,
Residents and Fellows.
2. Meal tickets are for food purchased in the Shands @ U.F Cafeteria, Shands @ AGH Cafeteria,
Mini Mall (Wendy’s, Subway, Hovan, TCBY) Java Hut, Opus Coffee, and/or UF Sun Terrace
Restaurants.
3. Bulk food cannot be purchased with these meal tickets from any food service provider including
the loading dock, storefront, cafeteria, or any other food service provider.
4. Any problems involving the use or misuse of Housestaff Meal Tickets will be referred to the
Associate Dean of Graduate Medical Education
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1.14 Moonlighting Policy
The UF Anesthesiology Residency Program’s policy for Moonlighting (Extra Duty) meets RRC
requirements and University of Florida College of Medicine policy. The Program Director must approve
any resident’s participation in any type of moonlighting. To earn approval, residents must:
 Be in good standing with the clinical competency committee;
 Be at expected level of performance or better in all six core competencies;
 Have an on-track performance on the ASA/ABA In-Training exam that would predict passage of
the ABA written examination following completion of the residency training program; typically
>20th percentile for the year;
 Be approved by the individual area offering the moonlighting.
University and Anesthesiology Residency policy allows two types of moonlighting:
a) Programmatic: These activities are initiated by the Anesthesiology Residency Program to
provide additional clinical experiences in the resident’s specialty. Programmatic moonlighting is
available in various locations at Shands at UF. Residents who wish to participate in
programmatic moonlighting must be approved by the program director.
b) Non-programmatic: These activities are initiated by the resident and do not involve any
agreement between the College of Medicine and an outside employer. Work involved is not in
the same specialty and is not supervised by faculty in the resident’s current training program.
To qualify for non-programmatic moonlighting, the resident must:
a. Obtain a Florida License;
b. Obtain malpractice insurance for all moonlighting activities;
c. Provide evidence of both licensure and malpractice coverage to the Program Director
before beginning moonlighting;
i. Housestaff malpractice will not cover moonlighting activities, nor will sovereign
immunity.
d. Complete an Outside Employment Form. This form must be completed monthly and
specify dates and hours of outside employment;
e. Complete the day’s moonlighting in sufficient time to arrive for anesthesiology duty on
time (including conference) and with adequate rest to perform at expected level.
Important considerations:
 If a resident participates in non-programmatic moonlighting without completing the
appropriate paperwork and obtaining appropriate permissions, he or she is subject
to severe disciplinary action, up to and including dismissal from the program.
 For all moonlighting, a resident’s total work hours for the week must not exceed 80
hours. Moonlighting hours are counted toward residents’ 80 hour per week
maximum, maximum continuous duty period (24 hours) and requirements for 10
hours of time free from patient care responsibilities.
 All moonlighting hours must be documented as such in New Innovations.
 For home moonlighting, residents should only log hours worked in the hospital.
 The Program Director reviews and approves all moonlighting schedules each month.
 Housestaff employed under a J-1 or H1-b visa may participate in programmatic
moonlighting activities only. Non-programmatic moonlighting activities are strictly
prohibited by law. Prior to beginning any moonlighting activities, each individual
with a J-1 or H1-b visa must be certain that their individual visa permits this
additional work activity and receive clearance from the program director, the Office
of Graduate Medical Education, and the College of Medicine Dean’s office.
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
PGY-1 Residents may not moonlight. (CPR Vl.G.2.C)
1.15 Prescription Writing
Housestaff may only write prescriptions for patients with whom they have an established doctor-patient
relationship within the context of their residency or fellowship training program. Writing prescriptions
for themselves, family, friends or coworkers is strictly prohibited. Florida law specifically states that
“Prescribing, dispensing, administering, mixing, or otherwise preparing a legend drug, including any
controlled substance, other than in the course of the physician’s professional practice” is grounds for
discipline of the physician under Florida Law.
At the University of Florida College of Medicine, the “course of the physician’s professional practice”
means within the context of the residency or fellowship training program. Residents and fellows may
not write prescriptions for themselves, family members, friends, or coworkers.
The Pain Management Reference Guide for opioids can be found here:
http://gme.med.ufl.edu/files/2011/06/Pain-Card-5-3-11-from-Pain-Committee.pdf
1.16 Other Learners
The presence of other learners, including but not limited to residents from other specialty training
programs, subspecialty fellows, PhD students, physicians assistants, and nurse practitioners, may
potentially interfere with a residency program’s primary goal of providing the best possible education
for its trainees. The GMEC and the DIO must monitor the presence of other learners to be certain that
there is no interference with resident education. Medical students are not considered to be Other
Learners. The education of medical students is an integral part of our core mission, and teaching medical
students is part of every resident’s job description.
To ensure that resident education remains free from such interference, each Annual Meeting for
Program Improvement has a section devoted to other trainees. At this annual meeting, at a minimum,
the Anesthesiology Residency Program:
1. Documents the number and types of individuals training in anesthesiology who are not part
of the program, as well as the duration of training. (Example: During an academic year, the
Department of Anesthesiology trains 6 Anesthesia Assistant students for one month each in
the neuroanesthesia subspecialty).
2. Encourages resident input and faculty assessment of the impact of such trainees on the
resident education program. Sources of resident input include resident participation in the
annual meeting and the ACGME Resident Survey, among others. (Example: Given the
volume of neurosurgical cases, graduating residents in the past 3 years had 250% of
required case numbers in neurosurgery even with the presence of these trainees. Residents
did not report a problem in the survey. Assessment: No impact).
3. Provides a statement regarding whether such training in the following year will continue, be
increased, decreased, or eliminated. Any new programs planned are documented, along
with their anticipated impact and method of monitoring that impact on the program.
1.17 Quality Improvement and Education
Quality Assurance is accomplished through the identification and effective use of opportunities to
improve the overall quality and safety of care within the institution, as well as the correction of
problems identified. The Anesthesiology Residency Program accomplishes this purpose through:
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1. Hospital and medical staff department participation in the development and implementation of
quality assessment and improvement plans.
2. The responsibility for overall coordination of quality care is delegated to a Quality Assurance
Committee and a Departmental Physician Director of Quality (PDQ). The committee and/or the
PDQ will be responsible for assisting the program director to assure that each resident has an
opportunity to participate in Quality Improvement (QI) Activities. Some of these QI activities
must be interdepartmental.
3. Medical staff and hospital-wide monitoring functions include surgical case review, trauma
quality management, drug usage and evaluation, pain management, sedation, medical record
review, blood usage review, infection control, patient safety, risk management, patient
satisfaction and complaint management. Relevant results of these monitoring activities are
incorporated into each department’s monitoring and evaluation of the quality of patient care
and service.
a. In addition, monitoring results will be used to evaluate the clinical performance of all
individuals with clinical privileges as well as all others who provide patient care but are
not permitted by the hospital to practice independently. These results (reports) are
discussed with residents. Residents have the opportunity to serve on these committees
and to determine what data are monitored for quality improvement, particularly when
relevant to their daily practice.
4. The program ensures that quality improvement and patient safety are part of the daily
educational structure of the residency. Including patient safety and quality improvement in the
curriculum is accomplished through M & M conferences, morning reports, pre-operative
conferences, participation in root-cause analyses, and many other methods. Education
programs and resident involvement in patient safety and quality improvement are carefully
documented and are reviewed both during Internal Reviews and RRC site visits.
5. Program quality efforts are designed to give residents the knowledge, confidence and skills to:
a. Identify strengths, deficiencies, and limits in their own or in others’ knowledge and
expertise;
b. Set learning and improvement goals for their own self-identified deficiencies and find
and perform appropriate learning activities;
c. Systematically analyze their own practice and that of other healthcare providers using
quality improvement methods, and implement changes with the goal of practice
improvement;
d. Incorporate formative evaluation feedback from QI activities into daily practice;
e. Locate, appraise, and assimilate evidence from scientific studies related to patients’
health problems;
f. Use information technology to optimize learning.
1.18 Resident, Faculty, and Program Evaluations
1.18.1 Resident Evaluation
Formative Evaluation
Anesthesiology Residency Program faculty must evaluate resident performance in a timely manner
during each rotation or similar educational assignment. Evaluations are documented and are available
for review in New Innovations. In accordance with institutional guidelines, the program:
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1. Provides objective assessments of competence in patient care, medical knowledge, practicebased learning and improvement, interpersonal and communication skills, professionalism, and
systems-based practice;
2. Uses multiple evaluators (e.g., faculty, peers, patients, and other professional staff);
3. Documents progressive resident performance improvement appropriate to educational level;
and,
4. Provides each resident or fellow with documented semiannual evaluation of performance with
feedback. These evaluations must be face-to-face or telephone discussions with the program
director or designee (advisor).
The evaluations of resident performance are accessible for review by the resident at any time in New
Innovations.
So that Anesthesiology residents have a clear understanding of the criteria on which they will be
evaluated, they are presented with each rotation’s Goals and Objectives at the beginning of that
rotation. Goals and Objectives for each rotation are readily available on the departmental website.
Residents are responsible for reading and understanding this document, which details faculty
expectations of residents in terms of the ACGME’s six core competencies. These competencies are the
basis of resident evaluations.
Anesthesiology faculty members evaluate junior residents on a weekly basis using New Innovations. NI
prompts any faculty member at Shands and FSC who worked with a resident that week to evaluate that
resident. Several rotations provide the opportunity for additional members of the patient care team,
including CRNAs/AAs, nurses, perfusionists and others, to complete a “360 Evaluation” on residents with
whom they worked. Residents may view their evaluations at any time. Results are reported in the
following manner:
4 = Above Expected Level of Competence (reserved for outstanding at all levels);
3 = At Expected Level of Competence (most residents will receive this score);
2 = Below Expected Level of Competence (clearly below average for peer group, but some
aspects of performance are acceptable);
1 = Unacceptable Performance.
Any time a resident receives a 2 or 1, NI sends an alert to the Program Director. If a resident needs
clarification on an evaluation, he or she may contact the Program Director or advisor at any time to
discuss the score.
Faculty advisors are required to formally evaluate their resident advisees every six months using the
information compiled by the Clinical Competence Committee (please see the section below,
Performance Evaluation and Determination of Clinical Competence). This involves a face-to-face
discussion on the resident’s performance, and culminates in constructive feedback. An evaluation letter
is signed by the advisor, the Residency Program Director and the resident and is kept on file. Faculty
advisors may schedule quarterly meetings as well, and residents may ask for a review of their
performance at any time.
Summative Evaluation
The Anesthesiology Residency Program Director provides a summative evaluation for each resident
upon completion of the residency program. This evaluation is included in the resident’s permanent
record, which is maintained by the University of Florida. The letter is signed by the Program Director and
the resident, who also receives a copy. This allows the resident to have access to the summative
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evaluation in accordance with institutional policy. Each resident’s summative evaluation meets the
following institutional requirements:
1. documents the resident’s performance during the final period of education, and
2. verifies that the resident has demonstrated sufficient competence to enter practice without
direct supervision.
Performance Evaluation and Determination of Clinical Competence
The American Board of Anesthesiology (ABA) requires every training program to file an Evaluation of
Clinical Competence in January and July on behalf of each resident who has spent any portion of the
prior six months in clinical anesthesia training or under the sponsorship of the residency program or any
of its affiliates. This is essential to every resident’s board certification process. To meet this requirement,
the UF Anesthesiology Clinical Competence Committee (CCC), which is comprised of Anesthesiology
faculty members appointed by the Chair and Associate Chair for Education, as well as a resident
representative, analyzes resident evaluations every three months and reports these evaluations every
six months to the ABA. Residents should refer to the ABA’s Booklet of Information for a comprehensive
description of requirements and policies for certification.
1.18.2 Faculty and Rotation Evaluation
Resident Evaluation of Faculty
To improve teaching, Anesthesiology Residents are required to annually evaluate the Anesthesia faculty
members. Residents are encouraged to complete this evaluation on all faculty members with whom
they had significant contact. These evaluations meet the following criteria:
1. Each faculty member is evaluated on his or her clinical teaching abilities, commitment to the
educational program, clinical knowledge, professionalism, interpersonal and communication
skills and scholarly activities.
2. Evaluations are completely anonymous and are completed through New Innovations.
3. These evaluations are used by the Anesthesiology Department Chair in annual reviews of
faculty.
Resident Evaluation of Rotations
Residents and fellows are also required to complete anonymous evaluations of each rotation through
New Innovations. Residents will be automatically prompted to complete the evaluation at the end of
each rotation.
Additionally, faculty and residents who present at the departmental Morbidity and Mortality
conferences are evaluated on their lecture by attendees. These evaluations are used by the Department
Chair in the faculty evaluation process.
1.18.3 In-Training Exam
*This section does not apply to Fellows.
Anesthesiology residents are required to take the ABA In-Training Examination, which is a computerized
examination scheduled on a Saturday each spring. A portion of the questions comprise the actual Board
certification examination. More information, including a tutorial, is available at the ABA website.
Residents who need a testing accommodation should complete and submit this form from the ABA site.
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The Anesthesiology Department produced a pocket-size book, available in the residency office, which
contains the ABA Content Outline from 2006. This describes all topics that may be included on the
written examination. Some minor updates occurred in 2009 (2009 ABA Content Outline).
We have also implemented a Medical Knowledge requirement that links residents’ In-Training
Examination score with conference attendance. An ITE score < 20th percentile puts residents at risk for
academic sanctions.
1.18.4 Mock Oral Boards
*This section applies mainly to residents. Fellows may independently schedule mock orals with
Anesthesiology faculty members.
Twice per year each resident completes a mandatory mock oral board exam, reproducing the format
employed by the ABA. Two examiners meet with each resident and discuss a case for 25 minutes, and
then spend five minutes providing feedback. In their evaluation, examiners take into account a
resident’s level of training. Results are posted into the resident’s personnel file within New Innovations
so that improvement can be tracked. Residents on outside rotations during Mock Orals are responsible
for contacting the Program Director upon their return to schedule their exam.
More information, including sample stems, is available at the Housestaff Manual website.
1.18.5 ACGME Competencies
The Anesthesiology Residency Program requires its residents to develop proficiency in the ACGME’s six
core competencies:
1. Patient Care that is compassionate, appropriate, and effective for the treatment of health
problems and the promotion of health
2. Medical 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
3. Practice-Based Learning and Improvement that involves investigation and evaluation of their
own patient care, appraisal and assimilation of scientific evidence, and improvements in patient
care
4. Interpersonal and Communication Skills that result in effective information exchange and
teaming with patients, their families, and other health professionals
5. Professionalism, as manifested through a commitment to carrying out professional
responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population
6. Systems-Based Practice, as manifested by actions that demonstrate an awareness of and
responsiveness to the larger context and system of health care and the ability to effectively call
on system resources to provide care that is of optimal value
As mentioned in Section 1.15.1, the Goals and Objectives for each rotation reflect these competencies.
More information on ACGME Competencies is available in Section IV.A.5 of the ACGME Program
Requirements for Anesthesiology.
1.19 Resident of the Month
*This section applies only to residents.
The Resident of the Month is voted on by Anesthesiology residents, faculty members, and office staff.
Residents are nominated based on such criteria as work ethic, professionalism, exemplary performance,
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cooperativeness, congeniality, and dedication to the program. The winning resident receives an
additional $75 for his or her book fund plus a day off.
1.20 Resident Promotion and Dismissal
Residents are notified either of likely promotion to the following level or of non-renewal of contract for
the following academic year on March 1. Promotion in the Department of Anesthesiology Residency
Program is determined on the resident achieving the following:





Acquiring the knowledge base and clinical skills expected for level of training as outlined in the
goals and objectives for each rotation and training level;
Demonstrating the ability to acquire and access new knowledge, interpret new information, and
apply it to patient care as specified in the ACGME common program requirement for Medical
Knowledge;
High moral, ethical, and behavioral standards;
Satisfactory Clinical Competence Reports (see the section on Clinical Competence)
Acceptable performance on the annual ASA/ABA In-training examination. “Acceptable”
performance is determined on an individual basis by the Program Director based on baseline
performance, performance on other standardized tests, and the resident’s evident efforts to
improve.
1.20.1 Medical Knowledge Requirement
All Housestaff will take the In-Training Exam (ITE) in March. In the event of illness or family emergency,
the Program Director must be consulted as early as possible.
The policy by which the Clinical Competence Committee (CCC) will treat a resident who scores below the
20th percentile is as follows:
1. The resident will receive an Unsatisfactory mark for Medical Knowledge in the semi-annual
report to the ABA (June).
2. If the resident attended less than 70% of possible conferences over the preceding year (JulyMay), he or she will also be marked Overall Unsatisfactory at the June CCC meeting. This puts
the resident at risk for losing credit for the preceding 6-months of training (See #3 below).
3. If the resident does not attend 70% of possible conferences during the 6-months following the
June CCC meeting, he or she will be marked Overall Unsatisfactory again in December and will
lose credit for 6-months of training.
4. If a resident is below the 20th percentile in the subsequent year and fails to achieve an agreed
upon improvement goal at the next ITE (goal based on points required for passage by
graduation), he or she risks an Overall Unsatisfactory despite adequate conference attendance.
1.20.2 Academic Probation
Failure to satisfy the above criteria results in academic probation. Residents placed on probation will be
given a letter of probation containing specific documentation of deficiencies and explicit written goals
and objectives to correct noted deficiencies within a specified timeframe.


If subsequent evaluations indicate that the resident has corrected the deficiencies, he or she will
be returned to good standing and promoted accordingly.
If subsequent evaluations indicate that the resident has not improved within the allotted time
specified in the letter of probation, he or she will be dismissed from the program.
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Any major departure from acceptable resident performance may result in immediate termination
without a probationary period.
All residents have a right to due process, as detailed in the University of Florida Grievance Procedures
included in this manual.
1.21 Resident Selection
1.21.1 Application
Applicants to the core Anesthesiology Residency Program must be submitted through the Electronic
Residency Application System (ERAS). Applications to the subspecialty fellowship programs in Adult
Cardiovascular Anesthesia, Critical Care Medicine, Pain Medicine, and Regional Anesthesiology and
Perioperative Pain Medicine are available online at the UF Department of Anesthesiology Residency
website: http://anest.ufl.edu/education/residency/.
1.21.2 Eligibility
Applicants with one of the following qualifications are eligible for appointment to University of Florida
accredited residency programs:
1. Graduates of medical schools in the United States and Canada accredited by the Liaison
Committee on Medical Education (LCME);
2. Graduates of colleges of osteopathic medicine in the United States accredited by the American
Osteopathic Association (AOA);
3. Graduates of medical schools outside the United States and Canada who meet one of the
following qualifications:
a. Have received a currently valid certificate from the Educational Commission for Foreign
Medical Graduates prior to appointment, or
b. Have at least a training license to practice medicine in a U.S. licensing jurisdiction in
which they are training;
4. Graduates of medical schools outside the United States who have completed a Fifth Pathway
program provided by an LCME-accredited medical school.
5. For individuals who are not US citizens or permanent residents, J-1 is the accepted visa.
Consideration will be given to requests for sponsoring H1-b visas for exceptional individuals with
appropriate documentation.
a. Permanent resident aliens who have permanent work authorization are welcome to
apply.
b. All international applications must be filed through ERAS.
c. All international applicants should be aware that the Anesthesiology Residency Program
requires a score indicating near-native speaker skills on the Test of English for
International Communication (TOEIC) examination. Passing scores on the TOEFL, USMLE,
ECFMG, or CSA will not suffice, as the TOEIC is a verbal exam, while the others are
written.
i. If an international application to our residency program appears competitive,
we will issue an interview invitation and advise the applicant to take the TOEIC
exam. We do not advise taking the exam before an application is determined to
be competitive. Results must be available prior to February 1 in order to be
included on our rank order list for the NRMP.
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ii. This requirement may be waived by the Program Director if the applicant has
been raised or has otherwise spent considerable time in a country where English
is the primary language and who have received medical training in English.
1.21.3 Selection
Training programs in the Department of Anesthesiology select from among eligible applicants on the
basis of residency program-related criteria such as their preparedness, ability, aptitude, academic
credentials, communication skills, and personal qualities such as motivation and integrity. We do not
discriminate with regard to sex, race, age, religion, color, national origin, disability, or any other
applicable legally protected status.
The core Anesthesiology Residency Program selects qualified applicants from the National Resident
Matching Program (NRMP) at the level of PGY-1 or PGY-2 who have not completed any graduate
medical education beyond the PGY-1 level. Residents may also be chosen outside NRMP after
completing training in another specialty or after military service as a physician. Rules of the NRMP
govern the conduct of the applicants and of the Anesthesiology Residency Program.
Applications to the Fellowship Programs in Critical Care Medicine, Adult Cardiovascular Anesthesiology,
and Pain Medicine will be reviewed by the appropriate program director, who will select the fellow(s)
after personal interviews with top candidates.
Residents seeking to transfer from another program are governed by both this policy and the Resident
Transfer policy.
1.22 Resident Supervision
1.22.1 General Supervision Policies
When supervising residents in the operating room, attending faculty members will not direct anesthesia
care at more than two locations simultaneously. On complex cases requiring significant supervision or
when more than one individual is needed to care for a patient, a faculty member will be assigned to
work with a resident one-on-one.
Available to all residents are instructions for specific situations when the attending must be called.
These are posted on the departmental intranet and included in the “Call the Attending When…” section
of this document.
After 5:00PM on weekdays and during weekends, the attending may direct anesthesia care in the
operating room at up to 3 locations simultaneously, if appropriate clinically and appropriate for the
experience level of the assigned residents.
During the TTP rotation, in order to allow for increased independence, one faculty member will
supervise four locations simultaneously. A greater level of supervision must be immediately available if
the nature of the cases assigned to TTP requires greater supervision. Supervision of anesthesiology
trainees rotating on Critical Care Medicine is described in the CCM Rotation description on the
departmental intranet.
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1.22.2 Supervision of Clinical Base Year Residents
Supervision policies of CBY residents are set by the service where they are rotating each month. CBY
residents rotating in Anesthesiology will be supervised as CA-1 residents just beginning training. In
general, CBY residents will be carefully supervised by attending physicians and/or higher level
residents/fellows in all aspects of patient care, including initial evaluation, development of a cogent
differential diagnosis, development and implementation of patient care plans, all procedures performed
involving patients, and any follow-up care. Detailed information about the Clinical Base Year can be
accessed at the Education section of the Housestaff Manual by clicking on “Clinical Base Year”.
1.22.3 Supervision of CA-1 Residents
All CA-1 Residents will be supervised carefully by attending physicians in all phases of anesthetic
management, from preoperative evaluation all the way through the recovery phase. During the first
weeks of training, all CA-1 residents will be paired directly with a senior level (CA-2 or CA-3) resident, or
one-on-one with a faculty member. This pairing will continue until evaluations of daily performance
indicate readiness for unpairing for at least 5 consecutive working days. In general, the pairing period
will be at least one month to allow for sufficient experience and growth in self-confidence. No resident
will be unpaired unless faculty/pair evaluations indicate readiness and the resident’s self-evaluation
indicates readiness.
For the remainder of the CA-1 training year, supervision is guided by these policies:
1. Preoperative discussion of the planned surgical procedure, patient’s medical conditions, and
anesthetic plan must be discussed with an attending physician prior to taking the patient into
the operating room. The only exception to this policy is a life-and-death emergency case for
which there is no time for a preoperative evaluation. The resident will not make changes in the
anesthetic plan without discussion with the assigned attending physician.
2. The attending physician must be physically present for induction of anesthesia, any critical
portions of a particular case, such as induction of hypotension during total joint procedures, and
emergence from anesthesia. The attending physician will be immediately available at all other
times during a case for any consultation that the resident needs. The amount of time that the
attending physician spends directly at a patient’s OR bedside will be directed by the nature of
the case and the competence of the assigned resident. Any critically important decisions, such
as changing the anesthetic plan, administration of blood, ongoing need for a vasopressor agent,
or need to change FiO2, must be discussed with an attending physician.
Detailed information about the CA-1 Year can be accessed at the Education section of the Housestaff
Manual by clicking on “CA-1 Year”.
1.22.4 Supervision of CA-2 Residents
In the CA-2 year, residents will get exposure to subspecialty cases which will frequently introduce new
concepts and complexities to patient care skills. Accordingly, all CA-2 residents will be supervised
carefully by attending physicians in all phases of anesthetic management, from the preoperative
evaluation all the way through the recovery phase. When a CA-2 resident is assigned to a nonsubspecialty case that he or she performed frequently during the previous year, the resident will be
given more independence to develop and implement the patient’s anesthetic plans.
1. Preoperative discussion of the planned surgical procedure, the patient’s medical conditions, and
the anesthetic plan must be discussed with an attending physician prior to taking the patient
into the operating room. For routine cases seen frequently in the CA-1 year, the discussion may
be brief/superficial to allow the resident more latitude in developing and implementing
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anesthetic plans. The only exception to this policy is a life-and-death emergency for which there
is no time for a preoperative evaluation.
2. The attending physician must be physically present for induction of anesthesia, any critical
portions of a particular case, and emergence from anesthesia. The attending physician will be
available at all other times during a case for any consultation that the resident needs. Any
critically important decisions must be discussed with an attending physician; e.g., changing
anesthetic plan, administration of blood, ongoing need for a vasopressor agent, or evoked
potential change. Instructions for specific situations are included in the “Call Attendings
When…” section of this document, and are posted on the departmental intranet.
3. The CA-2 resident will be given more freedom to make management decisions during routine
anesthetics. With the concurrence of the attending physician prior to starting the case, the CA-2
resident may independently make clinically indicated adjustments in perioperative
management, including but not limited to anesthetic technique/drug, ventilator management,
and fluid management. In the subspecialty cases, particularly during the first month, the
resident should not expect to make any significant independent management decisions. In the
second month, however, with the concurrence of the attending physician, the resident will be
expected to do so.
Detailed information about the CA-2 Year can be accessed at the Education section of the Housestaff
Manual by clicking on “CA-2 Year”.
1.22.5 Supervision of CA-3 Residents
All CA-3 residents will be supervised carefully by attending physicians in all phases of anesthetic
management, from preoperative evaluation all the way through the recovery process. However, CA-3
residents will be given significantly more latitude in developing and implementing anesthetic plans for
individual patients in both general and subspecialty cases.
1. During the Transition to Practice (TTP) rotation, preoperative discussion of the patient with the
attending physician is optional. Residents who don’t have questions about management of an
individual patient assigned to the TTP group need not discuss the patient preoperatively with
the attending physician. When not on the TTP rotation, preoperative discussion of the planned
surgical procedure, the patient’s medical conditions, and anesthetic plan must be discussed with
an attending physician prior to taking the patient into the operating room. Most of these
conversations will likely be very brief for CA-3 residents, and will acknowledge the resident’s
ability to independently evaluate and prepare patients for surgery. The only exception to this
policy is a life-and-death emergency case for which there is no time for a preoperative
evaluation.
2. The attending physician must be physically present for induction of anesthesia, any critical
portions of a particular case, and emergence from anesthesia. During the TTP rotation, the
attending will only observe, not participate in, these critical periods. The attending physician will
be available at all other times during a case for any consultation that the resident needs.
3. The CA-3 resident will be given more freedom to make management decisions during routine
and subspecialty anesthetics. In most cases other than complex subspecialty cases not
commonly seen in practice, the CA-3 resident will be allowed substantial independence. The CA3 resident will develop his or her own anesthetic plan. With the concurrence of the attending
physician prior to starting the case, the CA-3 resident may make clinically indicated adjustments
in perioperative management, including but not limited to anesthetic technique/drugs,
32
ventilator management, and fluid management. In subspecialty cases, the CA-3 resident should
also be able to make significant independent management decisions. TTP residents are given
even more independence as noted above.
Detailed information about the CA-3 Year can be accessed at the Education section of the Housestaff
Manual by clicking on “CA-3 Year”.
1.22.6 Supervision of Fellows
Fellows in the operating suites are considered to be CA-4 residents, thus have successfully completed a
full Anesthesiology Residency program. The privilege of progressive authority and responsibility and a
supervisory role in patient care is delegated to each fellow by the Fellowship Program Director with
input from the faculty. The Fellowship Program Director evaluates each fellow’s abilities based on that
program’s criteria. Fellows are evaluated at least every 6 months by the faculty, and are apprised of the
limits of their scope, authority, and the circumstances under which they are permitted to act with
conditional independence. As Fellows progress toward independence, they may serve in a supervisory
role for residents. Even though the fellow earns increasing autonomy with good performance, each
patient has an identifiable, appropriately credentialed and privileged attending physician who is
ultimately responsible for that patient’s care, and who is available to advise the fellow at all times.
Without exception, the attending physician makes end-of-life decisions.
1.23 Residents Transferring into Anesthesiology Training Programs
If positions are available, and with careful consideration of all available documentation, the
Anesthesiology Residency Program allows transfers of highly qualified individuals who seek non-firstyear positions, additional training, or transfer for other reasons.
The Program Director and staff carefully review all documentation of training, with particular attention
to the credentials of International Medical Graduates (IMGs). We obtain and review original or certified
copies of documentation, as well as additional information from the appropriate state and federal
government agencies (i.e. Florida Board of Medicine, DEA, State Federation of Medical Specialties, AMA
Profile, National Practitioner Data Bank, etc.). Direct communication with any prior program directors is
a necessity.
Residents are considered as transfer residents under several conditions, including:
1. When residents move from one program to another within the same or a different sponsoring
institution;
2. When residents enter a PGY2 program requiring a preliminary year even if the resident was
simultaneously accepted into the preliminary PGY1 program and the PGY2 program as part of
the match (e.g., accepted to both programs right out of medical school). This situation
necessitates confirmation that there is no match violation.
Before accepting a transfer resident, the Anesthesiology Residency Program Director obtains written or
electronic verification of previous educational experiences and a summative competency-based
performance evaluation from the current program director. The term “transfer resident” and the
responsibility of the two program directors noted above do not apply to a resident who has successfully
completed a residency and then is accepted into a subsequent residency or fellowship program.
Transfer Procedure
1. The program obtains certified transcripts of medical school education.
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2. The program ascertains the validity of the medical school diploma by way of an original letter
from the source, usually a Dean’s Office at another institution. The program may also want to
verify the diploma with certified transcripts. (If the documents are not in English, notarized
translations must accompany the certified copies.)
3. For an IMG there must be:
a. A valid and current Educational Commission for Foreign Medical Graduates (ECGMG)
standard certificate, (verified certificate) and/or
b. Verification of licensure (and in good standing) if licensed in any state.
4. The program carefully verifies prior graduate medical education. General letters of
recommendation are not an acceptable substitute for primary source information. The Program
Director or staff makes contact (written and/or verbal) with the training director(s) from the
former training programs(s). This also includes verification (written and/or verbal) from the
appropriate institutional authorities of any clinical training obtained in the United States;
including the name of the medical school granting the educational credits, the disciplines in
which training was obtained, and an evaluation of the student’s performance.
5. Verification (written and/or verbal) of any practice affiliations, including partners, hospitals, etc.
Questions include: was M.D. in good standing? Any actions taken against him/her?, etc.
6. Timelines are verified with the source documentation, assuring that there are no empty periods
of time in the applicant’s history that are unaccounted for.
7. A formal letter of transfer is obtained from the previous program director which verifies
previous educational experiences and documents the resident’s skills in each of the six
competencies.
8. When requested, the Anesthesiology Residency Program Director provides information and
summative performance evaluations for residents who leave the program prior to completion.
1.24 Sexual Discrimination/Harassment
The Anesthesiology Residency Program adheres to the University of Florida’s Sexual Discrimination and
Harassment Regulations, which are posted online in the Housestaff Manual. In-service training is also
required every two years.
1.25 Social Networking
Housestaff who use Facebook, Twitter, YouTube, or other social media applications are expected to
recognize the critical importance of privatizing their information so that only trustworthy “friends” have
access. Housestaff must also understand that posting certain information is illegal. Violation of existing
statues and administrative regulations may expose the offender to criminal and civil liability, and the
punishment for violations may include fines and imprisonment. Offenders also may be subject to
adverse academic actions that range from a letter of reprimand to probation to dismissal from
resident/fellow training.
The following actions are strictly forbidden:

In your professional role as a care-giver, you may not present the personal health information of
other individuals. Removal of an individual’s name does not constitute proper de-identification
of protected health information. Inclusion of data such as age, gender, race, diagnosis, date of
evaluation, type of treatment, or the use of a highly specific medical photograph (such as a
before/after photograph of a patient having surgery or a photograph of a patient from one of
the medical outreach trips) may still allow the reader to recognize the identity of a specific
individual.
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You may not report private (protected) academic information of another trainee. Such
information might include, but is not limited to: course or clerkship grades, narrative
evaluations, examination scores, or adverse academic actions.
In posting information on social networking sites, you may not present yourself as an official
representative or spokesperson for the University of Florida College of Medicine.
You may not represent yourself as another person.
You may not use social media in a manner that interferes with your official work commitments.
Do not tie up a hospital or clinic computer with personal business. Do not delay completion of
assigned clinical responsibilities in order to engage in social networking.
In addition to the absolute prohibitions listed above, the actions listed below are strongly discouraged.
Violations of these suggested guidelines may be considered unprofessional behavior and may be the
basis for disciplinary action.
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Display of vulgar language
Display of language or photographs that imply disrespect for any individual or group because of
age, race, gender, ethnicity, or sexual orientation.
Presentation of personal photographs or photographs of others that may reasonably be
interpreted as condoning irresponsible use of alcohol, substance abuse, or sexual promiscuity.
Posting of potentially inflammatory or unflattering material on another individual’s website, e.g.
on the “wall” of that individual’s Facebook site.
When using social media, housestaff are strongly encouraged to use a personal e-mail address, rather
than their ufl.edu address. Individuals also should make every effort to present themselves online in a
mature, responsible, and professional manner. Discourse should always be civil and respectful.
Housestaff should be aware that no privatization measure is perfect and that undesignated persons may
still gain access to your social networking sites. A site such as YouTube, of course, is completely open to
the public. Future employers (residency or fellowship program directors, department chairs, or private
practice partners) often review these network sites when considering potential candidates for
employment.
Finally, although once-posted information can be removed from the original social networking site,
exported information cannot be recovered. Any digital exposure can exist beyond its removal from the
original website and continue to circulate in other venues. Therefore, think carefully before you post any
information on a website or application. Always be modest, respectful, and professional in your actions.
1.26 Technical Standards for Anesthesiology Residency Training
Based on Shands/UF Institutional guidelines, the Anesthesiology Residency Program has adopted the
following technical standards:
1. Observation: The candidate must be able to observe demonstrations and experiments in the
basic sciences, including but not limited to physiologic and pharmacologic demonstrations in
animals, microbiologic cultures, and microscopic studies of microorganisms and tissues in
normal and pathologic states. A candidate must be able to observe a patient accurately at a
distance and close at hand. Detailed observation necessitates the functional use of the sense of
vision and other sensory modalities. The candidate must be able to view monitors, and hear
audible alarms.
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2. Communication: A candidate must be able to speak, to hear, and to observe patients in order to
elicit information, describe changes in mood, activity, and posture, and perceive nonverbal
communications. A candidate must be able to communicate effectively and sensitively with
patients. Communication includes not only speech but reading and writing. The candidate must
be able to communicate rapidly, effectively and efficiently in oral and written forms with all
members of the healthcare team. The candidate must be able to communicate even when the
mouth of the speaker is obscured, as in masks worn in the operating room.
3. Motor: Candidates must have sufficient motor function to elicit information from patients by
palpation, auscultation, percussion, and other diagnostic maneuvers. A candidate must be able
to execute motor movements reasonably required to provide general care and emergency
treatment to patients. Examples of motor movements reasonably required of physicians are:
the administration of intravenous medication, the application of pressure to stop bleeding, and
the opening of obstructed airways. Such actions require coordination of both gross and fine
muscular movements, equilibrium, and functional use of the senses of touch and vision. The
anesthesiology resident must also have the strength and dexterity to manage airways both noninvasively and invasively. They must be able to obtain peripheral and central venous access and
be able to visualize in three-dimensions for placement of needles near nerve sheaths.
4. Intellectual-Conceptual, Integrative, and Quantitative Abilities: These abilities include
measurement, calculation, reasoning, analysis and synthesis of complex information. The
resident must be able to multi-task in the process, observing numerous inputs, both auditory
and visual, simultaneously.
5. Behavioral and Social Attributes: A candidate must possess the emotional health required for
full utilization of his or her intellectual abilities, the exercise of good judgment, the prompt
completion of all responsibilities attendant to the diagnosis and care of patients, and the
development of mature, sensitive, and effective relationships with patients. Candidates must be
able to tolerate physically taxing workloads and to function effectively under stress. They must
be able to adapt to changing environments, display flexibility, and learn to function in the face
of uncertainties inherent in the clinical problems of many patients. Compassion, integrity,
interpersonal skills, interest and motivation are all personal qualities that are assessed during
the admission and education processes. Teamwork and interpersonal communication skills with
all levels of the healthcare team are essential for the anesthesiologist.
1.28 Turnover Checklist for Anesthesia Techs
Anesthesia Cart Check
All expired medication will be discarded at the end of the case
All medications in the top two drawers shall be removed at the conclusion of the case.
All medications and syringes left on top of the anesthesia cart should be discarded at the end
of the case.
Any expired medications in the cart will be discarded
Medications prepared for the next patient may be left in the bottom drawer of the anesthesia
cart. As long as the medication is properly labeled and not expired, the medication will not be
discarded.
Empty, labeled syringes will be discarded at the end of the case.
36
IV Bags
All IV Flush bags will be discarded at the end of the case
Discard unlabeled IV bags at the end of the case
Discard all expired IV bags. IV bags are acceptable one hour from the time they are spiked.
All IV bags, spiked during a previous case must be discarded at the end of the case, even if
they are labeled "clean". IV bags or tubing may have become contaminated by a previous
patient.
Miscellaneous
Hotline tubing will be discarded at the end of the case, even if labeled clean.
1.29 USMLE Policy
As of April 10, 2010, the University of Florida College of Medicine passed a comprehensive
USMLE/COMLEX Policy. Effective with the Class of 2014:




Residents should pass Step 3 prior to their CA1 (PGY2) year.
If not yet passed, Step 3 must be scheduled for July/early August of the PGY2 year.
If not passed by December 31 of the CA1 year the resident will go on upaid leave of absence
until a passing score is provided.
A passing score on Step 3 must be provided to our office by March 1 of the PGY2 year or the
resident risks non-renewal of their residency training contract.
1.30 Work Environment
1. Anesthesiology residents on duty in the hospital are provided adequate and appropriate food
services and sleeping quarters. Call facilities are located in a part of the hospital that is
sufficiently quiet to allow both for nighttime sleeping and napping during the day as required.
These call facilities are available at all times to allow for residents too fatigued to safely drive
home to rest prior to returning home. Alternatively, the program also provides cab fare home.
2. Residents do not provide non-educational services that can be safely and appropriately provided
by other personnel. Accordingly:
a. Patient support services, including but not limited to, intravenous services, phlebotomy
services, laboratory services, dictation and transcription services, as well as messenger
and transporter services are provided in a manner appropriate to, and consistent with,
educational objectives and excellent patient care.
b. An effective laboratory and radiologic information retrieval system is in place to provide
for appropriate conduct of the educational programs and quality and timely patient
care.
c. A medical records system (EPIC) documents the course of each patient’s illness and care
and is available at all times. It is adequate to support the education of residents, qualityassurance activities, and provide a resource for scholarly activity.
3. Appropriate security and personal safety measures are provided to residents in all locations
including, but not limited to, parking facilities, on-call quarters, hospital and institutional
grounds, and related clinical facilities.
4. Educational materials to support patient care in the working environment (computer with
internet access, library materials, etc.) are available at all times.
37
Section 2: Responsibilities
2.1
Mole Team Responsibilities
There are 5 people on the mole team. They are all required to be in the hospital and expecting to take
over rooms by 5:30 (this means they must arrive before that time, get meds, and assignments, and then
be in the OR by 5:30). You must eat dinner prior to coming to the hospital, so you can start your work
shift at 5:30. Each number has a responsibility:
1 – Go directly to the north tower and take over a room – stays in house all night. Gives face-to-face
sign-off to the daytime preop resident no later than 7:15.
2 – Go directly to the north tower and take over a room – stays in house all night. Gives face-to-face
sign-off to the daytime trauma person no later than 7:15.
3 – Go directly to the south tower and take over a room as needed (on Sunday’s does not show up until
9:30am unless there are 4 8am starts)
4 – Go directly to the south tower and take over a room as needed
5 – Go directly to the north tower, get sign-out from the preop resident and take the phone. Then go to
the south tower and sign-out with the trauma resident and get the trauma phone. Coordinate the
completion of the pre-ops and consents using available CRNA’s and Residents as they are relieved. No
one should go home without signing out to you and making sure there are no pre-ops or consents for
the next day that need to be done.
Other specific responsibilities
 There is always an upper level resident who is hearts eligible. This person may want to trade
with #5 in order to be available for a possible large heart case. Your team can decide this.
 Once all the rooms are down, and #1 and #2 are left, each of them will carry a phone and keep
in contact with the Charge Nurse in their respective towers through-out the night for any addons.
 The daytime residents must seek out the mole residents at 0715 as the moles may be occupied
with their tasks.
 There may be times when numbers 1 and 2 (and 3, etc.) are in a case at the end of the shift.
However, there is always someone with the phones outside of a room. That person must know
about the preop list and the things that need attending to so that the day time resident receives
a proper handoff.
Rules




All late stays (including late-stay CRNA’s) must be relieved or gone home prior to mole members
going home.
Moles must sign out with #1 and #2 and confirm with the AOD prior to leaving
Moles must be out of the hospital by 0730. If they stay past 0730 then they must come in at the
appropriate time conforming to the 10 hour rule (or 14 hours if the shift lasted 24 hours). If no
one has appeared to relieve you by 0720, call the person scheduled for the room or the AOD. If
you are relieved late please write on the board the time that you will be returning to work later
that night.
Consents that were not obtained by the daytime team (i.e. preop done by preop nurse, CRNA,
etc.) will not be the responsibility of the mole team unless: 1. They are a difficult to obtain
consent (i.e. language barrier, needs family for consent, etc.), 2. They are an ICU patient.
38

On Sunday’s no one is to work longer than a 22 hour shift. Other moles must be called in to
relieve anyone approaching 22 hours. If it happens that a mole works 24 hours, then they are
not to return until 14 hours later. To help with this, we have allowed Sunday moonlighting in
order for the #3 mole to not need to arrive until 9:30 am (as this person is likely to have the
longest shift).
Questions/changes/clarifications – contact the Chiefs
2.2
Moonlighting Responsibilities
Moonlighting is considered a privilege above the basic duties you are required to fulfill for your
residency. So, to be able to moonlight residents must be at least a CA-1 with 6 months of experience,
must have passed USMLE Step 3, must be in good academic standing (including ITE performance >20th
percentile, adequate conference attendance, and no issues with the clinical competence committee),
and must not have broken the 80-hour rule due to moonlighting in the past.
Rule on missed shifts: First missed shift results in loss of moonlighting privileges for 2 months. Second
missed shift results in permanent loss of moonlighting privileges until reinstated by your Faculty advisor
and the Program Director.
Scheduling:
There are currently 3 opportunities for moonlighting for a total of 28 monthly shifts. Requests for these
shifts must be done at the time Chief residents send out the rotation requests. You may only accept
these shifts if you will not break the 80-hour work rule. You cannot pick the kind of shift, only request
the weekend you would like to work, as these will be assigned in order to fill them all. These are listed
below, with the rules you must follow for each.
1. OB moonlighting: Friday and Saturday nights from 8pm to 8am. Must have completed an OB
rotation and meet all the above requirements.
2. Sunday Pre-op moonlighting: Sunday from 10am to 4pm. Must meet all the above
requirements.
a. Duties
i. the pre-op resident is responsible for doing only pre-ops and is not to be used as
a backup for any OR related activities.
ii. they are not to carry a phone as they are not responsible to cover the pre-op
add-ons for the Sunday OR cases.
iii. they are exclusively responsible for working on pre-ops on Monday’s OR
schedule.
iv. they must average 3 pre-ops per hour, or around 12-18 pre-ops per shift. This
will of course fluctuate, but some will be difficult and others will be simple
updates so we will start with this expectation.
v. They must report regularly with the mole team and update the pre-op posting
list in the clinical office so they can enlist help if needed.
vi. They must complete all CRNA/AA pre-ops first, then proceed to work on
resident pre-ops.
39
vii. Only when having completed the other pre-ops should they consider doing a
pre-op for those on cardiovascular rotations (not just assigned to the heart
rooms).
viii. They must record and email the name and MRN number of the patients that
were pre-op’ed by them, so the quality can be audited and the rotation
improved. Please email this list to [email protected]
3. ICU moonlighting: Saturday and Sunday daytime, and Friday and Saturday nighttime shifts
from 6:30-6:30.
Please address any questions about these rules to the Chiefs
2.3
PACU Resident Responsibilities
The PACU resident is responsible for the pre-op and post-op areas in the North Tower. In the South
Tower, the trauma resident or other available person will cover these areas for now.
Timeline of responsibilities:
6:00am – PACU resident goes to the pre-op area and ensures all needed preop orders are in. Talks to
the charge nurse in that area and informs that person to let the PACU resident know if any new pre-op
orders are needed, that they should page you. PACU resident is to facilitate 8am starts in this manner.
6:30am – Attend lecture
7:15am – Obtain sign-out for any patient in the PACU overnight. Post the list of post-ops notes for the
previous day. Start doing post-op notes for any patients in the ICU that were done within the past 24
hours (this means that you should leave any post-ops for the person who did the case for the first 24
hours, but those that need to be done after 24 hours and before 48 hours are your responsibility to
complete or ensure they are completed. CRNA’s and AA’s do not work every day, so you need to get
help to finish those post-ops. Check the OR schedule or the players list that day to see who is there (ie.
When residents or CRNA’s are not on the schedule). You must find free CRNA’s or AA’s to help you do
this. Send one to the south tower and you work on the one’s in the North Tower. At the end of the day,
it is your responsibility to ensure all post-ops have been seen. Call and page any resident/CRNA/AA on
the list during the daytime to make sure they have done their job, or remind them as they role into the
PACU.
Daytime – admit patients to the PACU from the OR. Get sign-out from residents/CRNA’s/AA’s when the
patients arrive. Place orders and Aldrete for the AA’s. Sign the patients out when they leave the PACU,
do another Aldrete score, fill out a post-anesthesia evaluation note, do med reconciliation d/c’ing all
PACU orders, and place a discharge order to the floor or home.
Sign-out – At the end of the day, usually around 5:30, the mole team will be taking over. Coordinate
with the AOD and #5 mole to sign-out your PACU patients. You will be relieved when the AOD and mole
team feel they have sufficient coverage. Finish any post-ops prior to leaving. Do not leave them for
the mole team to finish.
40
Questions/additions/clarifications? Contact the chiefs.
2.4
Preop Resident Responsibilities
The preop resident is responsible for coordinating the efforts of the preop nurse and intern to fulfill all
the inpatient preop assignments. These assignments are as follows:
07:15 – receive face to face sign-out from a mole #1 and #2 getting a list of any preops or consents that
need to be done for 8am starts, or other. Note: non-emergent add-ons after 6am are the responsibility
of the pre-op resident to work on.
07:30 - contact the charge nurse and check for any add-ons after 6am.
08:00 – post the preop list for the following day in the North Tower and contact the Trauma resident to
ensure it gets posted in the South Tower clinical offices.
 Pre-Op List General Instructions
 Open your Outlook Email
 In the top row, on the right hand side next to the Log-Off link it shows your
name – click on this.
 In “Select Mailbox” type: ANES-ResidentReports
 A new mailbox appears, click on the most recent email from Anthony George,
then open the attachment and then open the .pdf file.
 This .pdf file is a list of all inpatient pre-ops that have been posted.
Through-out the day – Primary responsibility is to complete add-on pre-ops and consents for that day
and discuss any issues or concerns with the attending or resident doing the case. If they are not
available then discuss these issues with the AOD. Note: If an add-on case is posted or you are asked to
do a pre-op for a patient who had surgery within the past 48 hours, you must place a post-op
anesthesia assessment note prior to the patient going for surgery, in addition to updating the preop.
Second responsibility is performing pre-ops for inpatients scheduled for surgery the following day
(except cardiac surgery patients). Along with this, the pre-op list should be kept up to date. A new list is
generated at 8:00am, 11:00am, 1:00pm, 3:00pm, 5:00pm and 6:00pm. There should be effective
communication between the pre-op nurse, the trauma resident/CRNA/AA, and the pre-op residents.
When residents and CRNA/AAs are available they should help with pre-ops. Residents who are finished
with their cases or relieved from their rooms prior to 5:00pm should do at least 1-2 pre-ops. After
5:00pm, residents that are not late-stay should not be expected to do pre-ops other than their own.
When a pre-op is done by someone other than a physician they cannot get anesthesia consent. So you
will be responsible for ensuring this gets done by a resident.
17:30 – When the mole team arrives there should be a face-to-face sign-out of all pre-op issues with the
mole team. After this sign-out the pre-op resident is then relieved.
Note: Pre-op resident does do late-stay calls, but is not considered post-late the day after as there is no
other person assigned to this service to fill the void.
Questions/changes/clarifications – contact the Chiefs
41
2.5
Saturday Call Team Responsibilities
There are 5 people on the Saturday call team, usually. They are all required to be in the hospital and
expecting to start 8:00 cases (this means they must arrive before 7:30 to get organized, know their
patients, prepare drugs, and get the patient into the room). Residents are numbered 1-5 by the senior
on the team who determines the numbers prior to the shift. The number order changes at 7:30pm. #1,
and #5 need to be “heart eligible” residents, and one of the heart eligible residents needs to be in-house
at all times. All residents are to come in on Saturday morning to help with the post-op notes. It is up to
the senior to relieve anyone as long as the work, including the notes, is done. Therefore it is the
daytime senior’s responsibility if the post-op notes are not completed by the end of the day shift.
Each number has a responsibility:
1 – Go directly to the north tower. Get sign-out from the mole team, including any pre-ops to do. #1
who is the senior is responsible for ensuring the post-ops from Friday’s cases are completed by the call
team. No one is to be relieved until that work is done.
2 – Go directly to the north tower and start a room.
3 – Go directly to the south tower and start a room.
4 – Go directly to the south tower and start a room.
5 – Go where needed.
There needs to be 1 extra person carrying the phone at all times. So if there are 4 rooms running, then
there needs to be a 5th person in-house carrying the phone and doing the post-op and pre-op notes. So,
if your team has sent residents home and then your call is very busy and it looks like the post-op notes
are not going to get done, residents must come back in to finish the notes.
Other specific responsibilities
 There is always an upper level resident who is hearts eligible. This person may need to remain
free for the possibility of a large heart case. Your senior can decide this.
 Once all the rooms are down, and #1 and #2 are left, each of them will carry a phone and keep
in contact with the Charge Nurse in their respective towers through-out the day or night for any
add-ons. Do not wait for the charge nurse to call you all the time. Check in every few hours to
ensure you don’t get a rude wakeup with many add-ons in the morning.
Questions/changes/clarifications – contact the Chiefs
2.6
Simulator Sessions
Residents are required by the ACGME to participate in simulation sessions. The following are a list of
scenarios that Dr Kulkarni has prepared. Session will take place on Wednesdays weekly and will include
up to 4 residents at a time. Each resident must complete 3 simulator sessions in a year (you can do
more if you want). When you arrive at the simulator for your session the group of residents can choose
which scenario you prefer to learn about that day. You must report your simulator requirement
completion to Ricky McHugh after each session you attend to obtain credit.
The following are the scenarios that you can choose from:
42
1. Anesthesia machine: pipeline cross connection, delivery of hypoxic mixture, missing expiratory
and inspiratory valves, exhausted oxygen reserve, pipeline oxygen failure, various machinerelated causes for inability to ventilate (e.g., sodasorb placed in the canister with plastic wrap
intact), significance of inspiratory oxygen analyzer, sudden loss of end-tidal C02 waveform.
2. Difficult airway management I: how to handle a difficult to ventilate and intubate situation, the
difficult airway algorithm, airway rescue techniques, advanced airway techniques and
emergency cricothyroidotomy.
3. Difficult airway management II: how to manage a patient with pulmonary aspiration and a
difficult airway, reactive airway disease and anesthetic implications.
4. Cardiac evaluation: preoperative evaluation of cardiac patient for non-cardiac surgery evidence
based approach, perioperative myocardial ischemia\infarction and treatment strategies, cardiac
evaluation for peripheral vascular surgery, and pharmacology of cardiovascular drugs.
5. Noncardiac surgery in cardiac patients: emergency bowel surgery in a patient with mitral
stenosis and pulmonary hypertension, anesthetic considerations in a patient with severe systolic
and diastolic dysfunction for general surgery.
6. Vascular Surgery: anesthetic management steps and massive hemorrhage as a complication of
TEVAR and EVAR, general vascular surgery principles, managing a spinal drain (zeroing
techniques, MAP and CSF pressure).
7. Trauma injuries: chest wall injuries, cardiac tamponade and pneumothorax, intraabdominal trauma and massive blood transfusion.
8. Laparoscopic procedures: anesthetic implications, paralysis and the twitch monitor (TOF, PTC),
morbid obesity and anesthetic challenges.
9. The green button: cardiac rhythm disturbances and treatment options, situations leading to
cardiopulmonary resuscitation (CPR), unexpected pulseless electrical activity, (diff diagnosis and
immediate interventions), advanced and basic life support (ACLS).
10. Outback challenges: SVC stent graft for SVC syndrome in IR (anesthetic challenges, acute
circulatory failure, treatment options), general IR anesthesia principles, MRI principles.
11. Thyroid storm versus malignant hyperthermia: Thyroid surgery for hyperactive nodules,
prevention and management of thyroid storm, preparation for a patient with known MH,
differentiating a thyroid storm from MH intraoperatively.
2.7
Transplant Resident Responsibilities
There are 2 possibilities this year for transplant rotation given what residents signed up for:
A) 2 residents on during the same month
B) 1 resident on during the month
43
A) Scheduling for the 2 resident months:
Resident A – Mon, Wed, Fri, Sat, Sun
Resident B – Tues, Thurs
The residents will alternate weeks as above. OR daytime assignments (preferably large liver
resections/pancreatectomies, etc) will be given but will be trumped by any incoming transplant. IN
those instances the transplant resident will be relieved from the regular OR case to start the transplant
case. 24 hours shifts require 14 hours off between shifts before the resident can return to start another
transplant. In those instances, a mole or other resident will start the transplant until the transplant
resident can return according to work-hour rules. The 10 hour rule between shifts (<24 hours) does not
apply in this rotation. You need to log transplants as “pager call-called in” in New Innovations.
B) Scheduling for the 1 resident months:
The resident will be on-call for the entire month, including 2 weekends (must inform the chiefs and Ricky
which weekends you choose) but will not be scheduled in the OR. 24 hours shifts require 12 hours off
between shifts before the resident can return to start another transplant. In those instances, a mole or
other resident will start the transplant until the transplant resident can return according to work-hour
rules. The 10 hour rule between shifts (<24 hours) does not apply in this rotation. You need to log
transplants as “pager call-called in” in New Innovations.
Any changes to this format must be communicated to the AODs and the Chief Residents.
2.8
Trauma Resident Responsibilities
07:15 - Obtain the phone and sign-out about any patients, preops, or consents from the overnight
team immediately following lecture.
07:30 - Make sure all consents are done for 8am starts in the pre-op holding area
- Make sure the trauma room is set up
-hotline with fluids dated
-clean airway set up
-non-expired trauma pack (DO NOT OPEN IT unless you are doing a case
-echo machine, central line supplies, FMS in room (DO NOT SPIKE IT)
-arterial lines/CVP set up
08:00 Post-ops
Post the list of postops from the previous day and dispatch the free CRNA, AA, or
resident that is also in the south tower to start completing them. Note: If a patient is
added on to return to the OR prior to 48 hours, you must place a post-op note
explaining that the patient is returning to the OR.
Preops
Post the list of preops for the next day as well so the free person can start working on
them once the post-ops are done. Complete consents for these as needed.
Add-ons
44
Complete add-on preops for the South Tower during the day. This may include patients
who are having surgery in the North Tower---the preop resident from the NT may call
you for these, but you should coordinate these preops to ensure the list is completed.
PACU
Let the PACU nurses know you are covering PACU and that they should call your phone
for all sign-outs.
17:30 - Sign out to the overnight team at the end of the day with any remaining preops to be done,
and patients in the PACU.
Responsibilities in order of priority:
1. cover trauma cases that come in (room setup and do the case)
2. cover PACU sign-out
3. pre-op and consent all add-ons
4. ensure 8am starts by confirming all morning consents
5. coordinate the free CRNA/AA/residents to do post-ops, next day pre-ops
6. breaks are to be given by free CRNA/AA/residents/attendings (if you are called by AOD to give
breaks/lunches, then person on lunch must carry phone and do PACU sign-outs, add-on preops)
…the chiefs
2.9
VA Resident On-Call Responsibilities
In order to be in compliance with ACGME 24 hour shift rules, the following rules for VA call must be
followed.
1. The hours for the on-call resident are from 7am to 7am (24 hours) maximum. They are not to go
over these hours. Therefore all sign-outs must be done within the confines of these hours.
2. On weekdays, the on-call resident will sign out at 6:00 to the late-stay resident. The late-stay
resident will be responsible for carrying the code pager and remaining at the VA during the
hours of morning lecture so must watch it remotely.
3. On weekends, call will be from 7am to 7am. Please sign out Saturday and Sunday mornings at
7am sharp.
4. The on-call person may arrive at 6am setup their room, but the next morning must sign-out by
6am even if that person stays until 7:15 to attend lecture. The time from 6:00 to 7:15 must be
logged as transitional hours. Any time past 24 hours must not be used for patient care.
Violations of these work hour rules must be immediately reported to the chiefs at the time of violation
so we can ensure you are relieved from your shift at the appropriate time.
Please address any questions about these rules to the Chiefs
45
2.10 ACGME Case Logs
Required Case Numbers
OB
Peds
Cardiac
Noncardiac
Vascular
Neuro
Regional/Pain
Trauma
Preop
Special techniques
PACU
CCM
Outside OR
Documentation
vaginal delivery involvement
C-sections
<12 yo
Of the 100, <3 yo
Of the 100. <3 mo
majority must be CPB
intrathoracic
major open or endovascular
intracerebral / endovascular
patients with epidurals
patients with spinals
peripheral nerve blocks
acute/chronic/cancer consult
acute post-op pain
management
crashes, falls, burns
40
20
100
20
5
20
20
20
20
40
40
40
20
documented involvement
20
4 weeks
significant experience
difficult airway, DL ETTs,
bronchial blockers, CVL,
PACs, TEE, EPs, EEG
0.5 mo
4 mo
instruction and clinical
experience
documented evidence
didactic and therapeutic
procedures
preops and postops
5 critical things to remember to get those difficult numbers:
1. Intrathoracic noncardiac cases can include:
 TEVAR
 Aortic arch procedures
 Klodell sympathectomies
 Carotid-axillary bypass
 Substernal thyroids
 Esophagus cases
 TEF repair
 Ductus closures,
coarctation, CDH







Thoracic aortic aneurysm
repair
Thoracoscopy
Lung
resections/transplants
Mediastinal explorations
Neuro spine (eg, thoracic
corpectomies)
Pediatric pectus cases
Nuss procedures
2. Taking care of a patient in the OR who had a nerve block, epidural or spinal counts as a PNB
case. It’s not the placement of the block only, but the management of a case under a block.
Managing a patient in the block room for anticipated acute pain counts as an acute pain consult.
All new encounters in the pain clinic count as chronic pain consults. Also, remember that if you
46
put in 6 needles, log it as 6 cases (ie. 6 median branch block levels, or 6 paravertebral single shot
injections). Don’t forget to log all blocks under Anesthesia/Analgesia type, or it won’t count!
3. Also log your procedures and techniques (u/s for CVL) as some credentialing agencies ask for
those numbers long after you graduate.
4. See how many you have and need by going to Reports, then clicking Resident Minimums Report
and click OK button.
5. Go back and edit the cases you didn’t complete by going to Case Entry, then click
Search/Update Case Entries, then search by other case descriptors (the most useful I have
found is Type Description. I went to DL ETTs and made sure I entered all the intrathoracic
noncardiac cases, for instance)
47
2.11 Call the Anesthesiology Attending When…
This list is not inclusive. Its purpose is to facilitate communication between the provider and the
attending staff, increase awareness and decrease intraoperative complications. Please call your
attending at any point when you feel it is appropriate. Discussion with attending overrides any issue
below.
1) Changes or disparity in surgical and/or anesthetic plan
2) Prior to initiation of anesthetic induction
3) Critical events during the surgery
a) positioning (prone, ¾ prone, lithotomy, etc)
b) repositioning or unexpected patient movement, prolonged period with limb unsupported
c) microscope in/out of the field, head pinioning, tracheostomy placement, aortic cross clamp
on/off, single lung ventilation, aneurysm clipping or any other critical portion of the surgery
4) Important laboratory parameters or any “critical” value:
a) Lactate > 2.5 mmol/L
b) Hct < 24, Hb < 8.0
5) Hemodynamic instability that would require:
a) Need for frequent vasopressors for blood pressure support
i)
e.g. > 200 mcg phenylephrine or 25 mg ephedrine or 2 U vasopressin over 15 min period
ii) when a total of 10 mg phenylephrine or 2 U vasopressin has been exceeded
b) Initiation of a vasoactive infusion
c) Cardioversion or defibrillation
d) Crystalloid administration of > 20 ml/kg/hr
6) Vital sign abnormalities
a) Core temperature: < 35ºC or > 38ºC
b) Unanticipated SpO2: < 90%
c) EKG changes (ST segment change from baseline, sustained tachy/bradycardia or arrhythmias)
d) FiO2: Unexpected increase in requirement
e) EtCO2: Unexpected changes in values or waveform
f)
SBP: < 30% baseline for > 10min
g) HR: > 100 or < 50 bpm in adults
h) Urine output: < 0.5 ml/kg/hr or > 5 ml/kg/hr (absence of mannitol)
i)
BIS consistently > 60 (paralyzed patient)
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7) PIP > 30 cm H2O unless insufflation of the abdomen is present, then PIP > 40 cm H2O
8) EBL greater than 10ml/kg or a preset number determined specifically for the patient, decision or
consideration of blood transfusion not previously discussed with the attending, coagulation issues
9) Airway
a) unexpected change in peak airway pressure
b) dislodgement, wheezing
10) Suspected adverse medication or transfusion reaction (rash, hypotension, fever, red urine)
11) Machine fault
12) Billed procedures (e.g. a-line, CVL, TEE, etc)
13) 10-15 min anticipation of end of surgery: (attending surgeon breaking scrub)
14) Any knowledge of a medical error (e.g. unintended laceration, abrasion)
15) A concerning environment
2.12 ICU/OR Transport Guidelines
ICU patient to the OR:
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One hour notice from the OR to prepare the patient for transfer.
Anesthesia calls the ICU nurse for report at approximately 0715 for first case, one hour prior to
all other cases. Any concerns regarding transport of the patient and patient instability should be
addressed at this point.
Handoff communication for the Anesthesia call prior to patient being transported to the OR
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Any changes in patient condition, any resuscitation efforts in the last 12-24 hours
Ventilator settings
Current infusions, verify continuation of drips for travel to the OR
Lines
Precautions
Hemodynamics
ICU patient to the OR:

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
ICU will notify the Respiratory Care therapist on the unit, after receiving the preoperative
notification.
OR checklist must be completed prior to transfer.
All consents must be signed and placed in the consent section of the chart. (The consents must
be easily accessible to the OR nurses.)
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
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If consent is not complete, please notify the surgeon or anesthesia immediately. The patient is
not transported to the OR unless there is a consent.
ICU nurse will pack the patient for transport, utilizing a transport monitor, O2, etc
OR nurse to call the ICU RN for report 45 minutes prior to the case, (first case at 7:10 or 7:20).
Notify the OR nurse of the surgery listed on the consent. (Please see Figures 1 and 2 for handoff
communication)
ICU support tech will call the OR front desk clerk or charge nurse when the patient is leaving the
ICU.
Sterile blue gown and cap for the ICU RN, Respiratory Therapist and transport team.
Once the transport team arrives in the OR, they tell the clerk the patient’s names, put on the
gown and cap, then proceed to the door of the designated OR room. The clerk will overhead
page the arrival of the patient (Room 12 your patient is on the way back).
Patient is turned over to the OR nurse and anesthesia provider at the door of the OR room, ICU
RN returns to their unit.
Equipment will stay with the patient and returns with the patient
Return of patient to the ICU
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Anesthesia provider will call report to the receiving nurse 60 minutes prior to admission
OR nurse notifies ICU RN of admission as the patient is ready to leave the room (We are rolling
call).
OR nurse will call and give report to the primary nurse or the charge nurse if the primary nurse is
busy, prior to transport
ICU nurse informs CCM of imminent arrival of patient
Anesthesia provider gives ICU report at the bedside to nurse and CCM
Anesthesia attending to CCM attending report is necessitated if the patient is unstable
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Figure 1. New Communication handoff tool in EPIC that will be available for all staff to view during
report that creates a current picture of the patient.
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Figure 2. OR Nurse Handoff Tool. The goal of the handoff communication is to increase patient safety,
enhance communication between departments and contribute to the continuity of patient care.
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