OTHER RELATED DISCIPLINES
Radiology, Nuclear Medicine and Ultrasound
Training in Radiology will be provided at required conferences and by members of the Radiology Departments at Swedish Hospital and at Northwest Hospital, and will cover upper GI and small bowel examinations, enteroclysis, air contrast and single column barium enemas, pouchograms, and videodefecograms. Other important studies include technetium-labeled red blood cell scans, visceral angiography, CAT scans, MRI scans, conventional abdominal and pelvic ultrasound exams as well as trans-rectal ultrasound. The resident will be expected to observe the performance of at least one of each of these procedures on patients they know or have previously seen in the office, to enhance clinical correlation with these examinations. A record should be kept of these observations, and presented to the Program Director at the quarterly meeting of the Graduate Medical Education Committee.
Training in Pathology will be provided at required conferences and also in didactic sessions given by Dr. Paul Edmondson, a GI pathologist at Northwest Hospital, and Dr. Joe Rank, a GI pathologist at Swedish Hospital. These sessions will be scheduled at least twice yearly and will be based on review of 35 mm slides provided by the American Society of Colon and Rectal Surgeons, with supplementation by material provided by the individual pathologist. In addition, a pathologist is present at the weekly Tumor Board and monthly Gastroenterology conferences at that institution, as well as at the weekly Tumor Board and bimonthly GI Pathology-Radiology conferences at Northwest Hospital. The resident is expected to review (with a pathologist) the histologic material from all patients with neoplasms whom he encounters during his fellowship year.
Training in anesthesiology will be provided by discussion with the anesthesiologist before, during and after surgical cases in which the Fellow is involved, and will include considerations of general anesthesia, epidural and caudal anesthesia, local anesthesia, and spinal anesthesia. In addition, familiarity will be gained with the use of monitored anesthesia care, such as supplemental to the use of local anesthesia, and considerations of postoperative pain control using epidural opioid and local anesthesia techniques. Techniques of conscious sedation will be taught and reviewed in the endoscopy suite throughout the year.
The Director of the Department of Enterostomal Therapy at Swedish Hospital Medical Center, Laura Vadman, R.N.,E.T. will provide the resident with two or more half-day sessions on the care and management of intestinal stomas, as well as offering the resident the opportunity on two pre-determined days to spend an afternoon in the Enterostomal Therapy clinic. In addition, the resident is encouraged to attend any visits to the enterostomal therapist by patients with whom he or she has come in contact during the course of the clinical experience provided by the residency.
As with conference attended, the resident is expected to keep a log of all relevant procedures observed, conferences held, and rounds attended, for presentation at the time of the quarterly meeting of the ColoRectal Programs’ Graduate Medical Education Committee.
Please keep a record of your hours worked, so we can show it to the ACGME should they want verification
Records to be kept by Resident:
1. Hours worked
2. Conferences attended
3. Radiologic procedures observed
4. Ultrasound procedures observed and/or done
5. Anorectal manometry sessions observed or done
6. Sessions completed with enterostomal therapist
7. Pathology review sessions completed
The above should be turned in quarterly to the Program Director at the time of the Program Advisory Committee meetings (which are generally held on the last Wednesday of each quarter). An additional copy of hours worked and conferences attended should be turned in to the Program Coordinator at the end of each month. You may use the On Call schedule to track both.
During the first two weeks of the residency, the resident will develop a reading plan, such that two up to date complete colorectal surgery textbooks will be read in their entirety during the first 6 months of the year. Monitoring of reading/study progress will be discussed at the quarterly meetings of the Graduate Medical Education Committee.
The resident is responsible for familiarizing him/herself with the contents of this binder, kept in the Library at the Downtown Office, and for arranging his/her reading schedule to encompass the topics felt necessary for complete education in colon and rectal surgery, as outlined in the Core Curriculum. This is also available in electronic form, and will be forwarded to the resident on request.
The residents must work closely with patients, office and hospital personnel, as well as other residents, attendings, referring physicians and others. The resident is the representative of the Clinic and must conduct him or herself accordingly. Interpersonal and Communication skills, as well as Professionalism are now defined as core competencies by the ACGME and accordingly, evaluation and progress in these areas is done by members of the Attending Staff, and will be reviewed and documented by the Program Advisory Committee.
OPERATIVE CASE RECORD
The American Board of Colon and Rectal Surgery requires a log of cases in which the resident participates as surgeon or first assistant. This should be entered via the ACGME website, ideally at the end of every day; cases be entered no less often than once a week. This also includes procedures and evaluations done in the clinic such as rigid and flexible sigmoidoscopy, rubber band ligation, excision of hemorrhoids and drainage of abscess. In addition to completing this form at the end of the year, you are requested to provide the case information to the Program Director at the end of each 3 month period, with the list of “minimum acceptable case numbers” from the ABCRS, so we can see whether there are any areas for which we need additional concentration.
At the conclusion of each 3 months of training, each resident is evaluated in writing by the attendings as to his/her performance, and these evaluations are discussed with the resident at the quarterly meetings of the Graduate Medical Education Committee, of which the resident is a member. A record of the evaluation is kept on file, as well as minutes of the GMEC meetings. The Residency Review Committee requires that each resident provide a confidential written evaluation of the program, and we ask that this be done halfway through the residency year, as well as at the end of the year. These evaluations will be presented to the GMEC. The residency certificate of completion of training and ABCRS recommendations are contingent on completion of these forms.
The resident is responsible for completing the history and physical, operative dictation and discharge summary on each patient with whom he/she is involved. It is imperative that a copy of the discharge summary be sent to the referring physician. This is vital to the continued flow of patients to our practices and is also an excellent habit for you to develop, and necessary for progress in areas of professionalism and communication.
For patients seen in the office, with or without a member of the Attending Staff, a record should be dictated for each patient, using the SOAP format. Dictations should be sent via email at the end of every day to the transcriptionist! Without fail!
Operative reports must be dictated on the day of surgery. Experience has shown that, if an operative report is dictated more than 24 hours after the surgery, it is not considered an accurate reflection of the events of the surgery. As a consequence, it is often inadmissible in any legal proceedings. It is a good idea to use the playback function at the end of the dictation to be sure that the dictation was properly recorded. The purpose of the operative report is to allow us to be able to quickly look back in the clinic chart and see actually what was done and what was found at the time of surgery. For this reason it is important that a section which describes the operative findings be a separate section before the description of operation. Further, it is suggested that the operative report begin, on major cases, with a section entitled: “Indications for Surgery”, followed by one entitled, “Findings”, followed by “Description of Operation”. There is an art to dictating an operative report to describe what was done in clear terms without using too many words. Ask your attendings for their critiques or suggestions.
Also, a Brief Operative Note should be recorded in the patient’s clinic chart, as well as their hospital chart. This should include the procedure done, and for outpatients, any medication prescribed (with # and sig), and when the patient was instructed to return to the clinic for follow-up.
The essential elements of the discharge summary include the admission date, the discharge date, the final diagnosis, and operative procedures performed during the hospital stay. If the final diagnosis and operative procedures are included in the dictated summary, most hospitals don't require that these also be handwritten on the face sheet. The summary should briefly describe the reason for the admission, the pertinent history and physical findings (not a complete rehash of the history and physical), a brief summary of the course in the hospital and the disposition of the patient. “Disposition” should include instructions to the patient, diet and physical restrictions, medications, any plans for future radiation/chemotherapeutic consultation, and when they are to be seen in the clinic. Pertinent laboratory data for cancer patients should also be included especially CEA results and final pathology results, with tumor staging in the TNM classification.
CLINICAL RESEARCH STUDIES
The resident is required to become involved, early in the Fellowship, in one or more clinical research projects. The goal is to advance clinical knowledge in the area chosen, as well as to impart that knowledge to colleagues in the form of oral presentations and/or submission of the results of such research for publication. The Fellow will use the patient base and databases available in our office.