Case Volume & Transitions
Minimum Operative Case Volume
The purpose of Minimum Operative Case Volume is to ensure adequate operative experience and documentation of cases.
It is the policy of the Department of Surgery that all residents in the Core and General Surgery Residency Programs are required to enter cases in the ACGME Case Log system in a timely fashion. Core surgery residents will not be given a favorable review unless cases logs are up to date at the completion of the Core program. This means that the Program Director will inform the subsequent Program of the issue and will not sign off on any documentation required by the residency, future employment, or hospital privileging forms. Residents must complete a minimum number of cases to advance to the next year or have a favorable review. A deviation of 20% fewer cases than the minimum may lead to disciplinary action or dismissal.
Minimum number of cases per year:
- PGY1 60
- PGY2 125 (As required by the American Board of Surgery, Categorical General Surgery Residents must have 250 cases by the end of their PGY2 Year)
- PGY3 250
- PGY4 200
Transitions of Care
The purpose of Transitions of Care is to minimize number of transitions in patient care and to comply with the Institutional and specific program Residency Review Committee (RRC) accreditation requirements established by the Accreditation Council for Graduate Medical Education (ACGME).
- All patient hand offs should take place in a designated workplace, office, or conference room to ensure patient confidentiality and lack of distraction. Hand offs in public areas such as hallways, cafeterias, and elevators are prohibited.
- All hand-offs should occur in a face-to-face (in-person) meeting between the resident responsible for the patients being released and the resident who will be taking over their care. This applies to residents at all levels of training (e.g. even if a senior resident is signing out to a covering intern). No electronic, telephone, or third party communication is allowed.
- Handoffs during the first month of residency should be conducted in the presence of a senior resident or attending physician to ensure that residents are competent in communicating with team members in the hand-over process.
- Always use the electronic checklist during hand-off to ensure transmission of pertinent information and allow senior residents and faculty to monitor effective, structured hand-over processes to facilitate both continuity of care and patient safety. The list is available in a password protected website.
- The sign out checklist should be updated at least twice a day and as often as necessary during the work day or night. Do not delete any relevant information from the list until the patient is discharged.
- Senior residents are responsible for reviewing the sign-out checklist at least daily to ensure that the information is accurate. Attending physicians are ultimately responsible for all patient care and must supervise residents at all times.
- Elements of the checklist cannot be modified without approval from the administrative chief residents and program directors.
- Required elements on the checklist should include, but are not limited to:
Patient name, age, medical record number, and location
Attending physician and upper level residents responsible
Admission date and admitting diagnosis
Important elements of history and physical examination
Relevant social information including contacts
Code status, advance directives
Dates and titles of operative procedures, if any
Current medication list
Key information on current condition and care plan (diet, activity, planned operations, pending discharge, significant events during the previous shift, changes in medications etc.)
Specific tasks that need to be accomplished by the resident that is taking over such as following up on laboratory and imaging studies, wound care, clinical monitoring, pending communication with consultants etc.
DO NOT sign-out complex tasks that require synthesizing information from separate sources and tasks that involve multiple steps.
- Allow ample time for the resident receiving sign-out to ask questions
- Exchange contact information in the event there are any additional questions
- Scrutinize and question data if "something does not make sense" or you think it is wrong
- Use the virtual pager for the service you are covering when on duty. Sign on when you start duty and sign out the pager to the appropriate person at the end of your shift. Use the virtual pager number for all communications with caregivers and written records.
- Current call schedules for all services that inform all members of the health care team of attending physicians and residents currently responsible for each patient's care are posted on the surgery education website.