DUTIES OF RESIDENTS
The resident works closely with each member of the attending staff as the availability of clinical material dictates. Time spent in the clinic, endoscopy unit, and operating room is typically divided equally between all three staff surgeons. The resident is responsible for the admission notes, the history and physical examinations, preoperative orders, postoperative orders, progress notes, operative dictations and discharge summaries of all Northwest Colon and Rectal Clinic patients. During operative procedures one of the attending staff is always present for the purpose of education and supervision. The resident will participate in operations according to his or her level of expertise and experience.
Our goal is to provide the best possible educational experience in colon and rectal surgery. We therefore encourage you to be alert for complex or unusual cases which are scheduled, as these should take priority for your education. Examples might include sphincter repairs, IPAA procedures, APR's, and operations for rectovaginal fistulae, rectal prolapse, and complex fistulae.
We maintain a liaison with the Department of GI Surgery at the University of Washington, for whom our contact person is Dr. Mika Sinanan. It is anticipated that our Fellow may spend time with Dr. Sinanan as circumstances and complex cases allow. Examples would be complicated surgeries for malignancy and inflammatory bowel disease, as well as experience with the management of metastatic tumors to the liver. The Fellow will be expected to become familiar with current management techniques for metastatic liver disease, though the performance of these techniques is usually outside the scope of practice of most colon and rectal surgeons. Experience with anorectal physiology studies will be obtained by working with Dr. John Hinds and Dr. Daniel Froese in the anorectal physiology lab at Swedish Hospital. Training in transrectal ultrasound techniques will be provided at Swedish Hospital, as well as the US Army’s Madigan Hospital and/or at off site courses throughout the training year.
It is expected that the resident will spend at least 3 half-days per week in the clinic, approximately equally with each of the attendings. It is anticipated that he/she will spend Monday mornings at the Downtown office with Dr. Billingham, Monday afternoons at the Downtown office with Dr. Kratz, and Wednesday afternoon at the Downtown office with Dr. Billingham. Tuesday, Wednesday mornings, Thursday mornings and Friday are OR days. The specifics and times are subject to change, based on patient volume, vacations, or other circumstances. In the clinic, rigid sigmoidoscopy, flexible sigmoidoscopy, ligation of internal hemorrhoids as well as other office procedures will be performed by the resident and the attending, and as they are procedures, must be entered in the resident’s operative procedure log. New patients will be interviewed by the resident and all patients (especially post –op) will be followed and examined during the time the resident is in the Clinic. This clinic exposure has proven to be extremely valuable in the training experience of the resident, as office management of anorectal disease represents an important facet of the practice of colon and rectal surgery.
An office is available for the residents' use at each office. It is equipped with a large desk, telephone, computer, audio-visual equipment and library.
INTERACTION WITH OFFICE STAFF
The resident should check with the staff in the downtown office at least twice a day. When operative cases are being done, particularly simultaneously, the staff is often unsure where the resident is, and how to contact him or her to minimize disruption while in the middle of a case. Pre-emptive contact on the part of the resident greatly facilitates transfer of information about more urgent issues, as well as paperwork issues for upcoming cases.
The resident should plan to make rounds no earlier than 6am, and have rounds completed by 8am each day. When working with Swedish Hospital general surgery residents, careful re-evaluation of the patient, formulating your own assessment and plan, and comparing this with that suggested by the general surgery resident should be done. Beware of excessive reliance on the general surgery residents, whose availability, interest and familiarity with colorectal surgery may vary significantly from resident to resident and from day to day, depending on scheduling considerations. It is your responsibility to ensure that our patients are managed appropriately.
STYLES OF PRACTICE
Even within the same clinic, each of the attendings may have their own style and manner of managing patients and their clinical problems. Nevertheless, we expect that you will evaluate patients, derive differential diagnoses, and formulate clinical management plans based on evidence-based medicine and an understanding of the literature as much as possible. We are all trying to use the same best available evidence and guidelines when caring for patients, and it behooves the resident to become familiar with these throughout their training year and, indeed, throughout the rest of their clinical practice years.
PATIENT PHONE CALLS
The resident will return patients’ phone calls for patients with whom he/she has been involved. If the resident cannot solve the problem, it should be discussed with the attending. Any patient who insists on speaking with the attending should obviously be allowed to do so, if the attending is available. The Medical Assistant may also contact the resident to seek advice after speaking with a patient. If the resident is unsure how to advise the patient, he/she should seek out an attending for advice, rather than asking the Medical Assistant to call the attending instead.
Most hospital consultations are performed by the resident and then reviewed by the attendings. Consultations must be handled promptly i.e., on the day requested, and at a time appropriate to the urgency of the situation. A consultation note should be dictated so that the patient's history will reach the office chart. A copy of the patient's demographic information should be picked up from the hospital chart and brought to the office, and the appropriate charge slip filled out and attached to the demographic sheet. These items (as well as the office chart, for established patients) should be given to the appropriate covering attending for coding review prior to being submitted for billing.
All calls may be taken from home. During the week, on Tuesday and Thursday nights, the resident is responsible for calls from all patients, and for those from the Emergency Departments of Swedish Hospital (First Hill campus) and Northwest Hospital. The resident is on call every other weekend. The weekend call extends from 5:00 PM Friday to 7:00 AM Monday. During Holiday weekends the resident covers the full Friday or Monday as well. The resident is always backed up by one of the attendings on second call. All calls from hospitals, physicians, and office patients are initially handled by the resident. Patients with urgent problems will be seen and taken care of in the emergency room by the resident, with phone consultation and/or assistance from the attending staff. It is expected that, except in unusual circumstances, all patients in the ER will be seen by the colorectal surgery resident, regardless of having also been seen by the Emergency Medicine physician and/or a general surgical resident. Appropriate evaluation and treatment is rendered, but prior to hospital admission or discharge from the Emergency Room, the resident should usually discuss the case with the responsible attending. A copy of the patient's “face sheet” with demographic and billing information should be collected on all patients seen in the ER, and taken to the downtown office. Please note that we do NOT see patients at Swedish Cherry Hill campus or Swedish Ballard campus. If these hospitals have a patient they think needs to be seen urgently by a colorectal surgeon, they are to transfer the patient to the ER at Swedish First Hill (unless admission is obviously necessary, in which case they’re admitted to Swedish First Hill). This is the case for all of the colon and rectal surgeons at Swedish.
All calls from patients should be documented in the patient’s chart. When the chart is not available, the calls should be recorded on the provided small tear-out forms for this purpose, which will subsequently be put in the patient’s chart. (This does not apply to calls from nursing personnel, etc. regarding hospitalized patients, as these issues should be documented in the inpatient chart) After a weekend on call, on Sunday evenings around 8-9pm, the resident should call, text or email each of the attending staff working the next day, to inform them of progress or problems with their patients which were encountered during the weekend. On off-call weekends for the resident, a Sunday evening communication from the on-call staff member will update them on patient issues.
The resident will receive two weeks vacation per year, as well as time off to attend the Northwest Society of Colon and Rectal Surgeons meeting in August, the Colorectal Disease Symposium at the Cleveland Clinic Florida in February, and the American Society of Colon and Rectal Surgeons annual meeting in May or June. Under NO circumstances are vacations permitted during the last two weeks of June. Vacation and other time-off requests must be submitted in writing to the Program Director and approved with sufficient lead time to permit scheduling of important cases from which the resident would derive substantial learning benefit. Two weekdays of non-vacation time will be allowed for the individual General Surgery board exams. Extra days taken around that time will be subtracted from vacation days.