university of utah general surgery residency handbook

University of Utah General Surgery

Residency Handbook Revised June 2020

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Table of Contents Introduction ............................................................................................................................ Page 3 Section 1: Policies ................................................................................................................... Page 4 Section 2: Clinical Responsibilities .......................................................................................... Page 5 Section 3: Educational Responsibilities .................................................................................. Page 8 Section 4: Administrative Responsibilities ............................................................................ Page 10 Section 5: Academic Actions ................................................................................................. Page 12 Section 6: Resident Assessments .......................................................................................... Page 13 Section 7: Leaves of Absence ................................................................................................ Page 15 Section 8: Professional Development ................................................................................... Page 20 Section 9: Travel .................................................................................................................... Page 22 Section 10: Pregnancy and Lactation .................................................................................... Page 24 Section 11: Moonlighting ...................................................................................................... Page 27

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Introduction Welcome to the University of Utah General Surgery Residency. Over the next 5-7 years, you will participate in various aspects of the training program. The purpose of this handbook is to provide you with information that will help you to navigate the program. This handbook is broken down into sections to make it easier for you to find the information you need. It would be impossible to address every aspect of being a resident, so if something is not included in the handbook it still can be considered an important part of the program. This handbook is also meant to be a “living” document, so please provide feedback on its contents to the Program Director’s office. If there are any questions regarding the handbook, please contact the Program Director’s office.

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Section 1: Policies As a resident at the University of Utah, you have two distinct roles. One is that of a learner, which is covered by most of this handbook. The second is that of an employee of the University of Utah. As an employee, you are bound by the policies of multiple entities, including:

University of Utah

University of Utah School of Medicine

School of Medicine Graduate Medical Education

University Hospital

Intermountain Healthcare

Intermountain Medical Center

Primary Children’s Hospital

Veterans Administration Medical Center Each of these entities has policies that describe what is expected of an employee, what is expected of a trainee, grievance processes, etc. All of these policies are available online or from the Human Resources office of the given entity. It is your responsibility to know and comply with the policies as outlined. Where areas of this handbook differ from policy, it is usually in the form of being more generous. If you have questions regarding policy, please contact the Program Director’s office, the Graduate Medical Education office, or Human Resources.

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Section 2: Clinical Responsibilities There may be some variability with regards to the guidelines listed below, based on the rotation expectations. If there is no listed expectation for the resident, then the guidelines below apply. It is the resident’s responsibility to know the clinical responsibilities of a rotation. These are typically located in the Goals and Objectives document in the Learning Management System (Canvas). For teams with multiple members, the most senior resident is the leader of the team. This person is responsible for orienting team members to the service, setting schedules for clinical work (rounds, clinic, operating rooms), and assuring that all patients are being cared for in the best way possible. Most services also have Advanced Practice Clinicians (APC) as part of the team. APCs may have different roles on a service. It is the responsibility of all residents to establish a good working relationship with the APCs and to seek guidance from the APC with regards to the structure of the service. It is highly recommended that the resident meet with the APC when they start a rotation to establish lines of communication, roles and responsibilities, and review how attending surgeons like to be notified about their patients. Admissions/consults:

Patients can be admitted to Acute Care Surgery, a designated surgical service, or to another service with consultation to general surgery

Patients must be seen in a timely fashion. This can be either a medical student, junior resident, or senior/chief resident

The senior/chief resident must be made aware of all admissions/consults within one hour of them being seen by a student/junior resident

Every admission must be staffed with an attending surgeon o Residents do not have admitting privileges and thus must staff patients with the

responsible faculty member o Either the junior or senior/chief resident can review the patient with the

attending surgeon

Documentation must be completed within 12 hours of admission/consultation o An exception is patients who need urgent/emergent operative intervention;

these patients need documentation completed prior to going to the OR Daily patient care:

Every patient will be seen by a resident and/or a faculty member each day

A progress note is required every day

Any resident on the team can staff a patient with the attending surgeon o If a resident operated on a patient, they are encouraged to staff the patient with

the attending surgeon

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o The senior/chief resident is still responsible for knowing and approving the plan for the patient

Tests and consults:

A senior/chief resident can initiate tests and consults at the discretion of the attending surgeon

A junior resident should get approval of the attending surgeon before ordering tests or consults

Change in patient status:

The attending surgeon must be notified in a timely fashion if there is a change in the patient status. This includes:

o Transfer to a higher level of care o Potential for development of a life-threatening condition o Need for urgent return to the operating room

In a truly life-threatening situation (e.g. exsanguinating patient or respiratory failure), a resident may initiate transfer to an intensive care unit or operating room while at the same time assuring notification of the attending surgeon.

Documentation:

Operative notes will be completed the day of surgery and will be signed by the resident within 24 hours

History and Physical exams and Consults will be completed within 6 hours of admission and signed by the resident within 24 hours of admission

o Exception being an urgent/emergent operation

Daily progress notes will be completed by 7 PM and signed by the resident the day they were completed

Discharge summaries will be completed within 24 hours of discharge and signed within 48 hours

Communication with patient family members:

Residents may be asked to update family members

This can be done with the approval of the attending surgeon

Please be aware of HIPPA rules and assure that those you are communicating with have the approval of the patient or have a HIPPA exemption

HIPPA:

There is policy to address all HIPPA questions and concerns

Some that need to be stressed: o Do not talk about patients in public places o Email communication with protected health information (PHI) should have PHI in

the subject line, with no identifiers in the subject line

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o Text messaging is not HIPPA compliant and identifiable PHI should not be sent via text

Smart Web is HIPPA compliant and can be used to send PHI o PHI will not be placed on social media o Photography that is sent to the cloud is a violation of HIPPA

An exception is photography that has no PHI and is being used for clinical decision making (e.g. a wound for a faculty member to review).

Electronic medical record (EMR)

There are multiple policies that apply to the EMR

Some that need to be stressed

Do not look at charts where you are not a responsible provider

Do not let others use your log in

If you walk away from a computer, log off What to do if you have to miss clinical duties (e.g. illness)

Everyone has the potential to get ill or have an emergency that requires them to miss a day or two of work

If this happens to you, you have the responsibility to notify

The residents on your team that you will not be at work

The faculty educational lead of your service that you will not be at work

If you will need to miss call, notify the administrative chief resident

If you are going to miss more than 2 days, o You will need to notify the program director’s office and the administrative chief

resident o If you are going to miss 7 or more days, you will need to check with the GME

office to set up FMLA (per U of U FMLA policy)

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Section 3: Educational Responsibilities The education program in general surgery is designed such that there is a rotation-based program, a residency-based program, and your own personal program. It is your responsibility to maintain and keep up to date in all three areas. As to specific parts of the program:

Rotation-based program o Each rotation has goals and objectives for which you are responsible o You will work with the rotation education lead to assure that you are meeting

these objectives o It is important that you know what the objectives are, as you will be assessed

based on the objectives o Each rotation has service educational activities in which you will participate

Residency-based program o The weekly curriculum is an important part of the residency o Each of the following are elements of the program:

Grand Rounds M&M Indications Wednesday didactics Simulation Non-clinical sessions

o Due to current circumstances with COVID 19, these sessions will be held using a virtual format.

o You are expected to attend all of these sessions, unless a special dispensation has been made based on a unique educational opportunity on a rotation

Your personal program o There is no way that an education system can provide all of the information you

need to succeed academically o You will need to have a personal education plan o This should be done in conjunction with your mentor and/or the Program

Director’s office o Recommend updating plan every six months o Things to consider when developing a plan

Resident readiness assessment ABSITE Performance on rotations Performance in conferences Your own perceived needs

Other education items o In-Training Exam (ABSITE)

Every resident is expected to take the ABSITE every year in training, including during the professional development year

o Simulation

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Simulation activities can be part of rotation or program-based education If a simulation is arranged, it is expected you will attend

o Fundamentals of Laparoscopy (FLS) PGY-1 residents will complete FLS by November of their PGY-1 year The residency will pay for the first attempt at FLS If the PGY-1 fails the first attempt, (s)he is responsible for expenses

related to retesting o Fundamentals of Endoscopy Curriculum (FEC)

All PGY-2 residents will complete the FEC This includes the knowledge test and the Fundamentals of Endoscopic

Surgery (FES) practical test The residency program will pay for the first attempt at FEC/FES Any expenses related to re-testing will be the responsibility of the

resident o Robotic Surgery

All residents will complete the basic program in robotic surgery

Online course

Basic simulation exercises

Docking and bedside assist Residents who are interested in pursuing robotic surgery are expected to

complete Phase 2 of the robotic curriculum Residents can receive an equivalency certificate from the residency, to

use for robotic privileges Once the Fundamentals of Robotic Surgery (FRS) is implemented, it will

be incorporated into the robotic surgery curriculum o Fundamental Use of Surgical Energy

Incoming PGY-1 residents are expected to complete the FUSE program either prior to starting residency or during the first three months of the PGY-1 year

There is no requirement to complete the FUSE exam, though residents are highly encouraged to do so

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Section 4: Administrative Responsibilities As a resident, you have certain administrative responsibilities as they relate to clinical care and rotations. Work hours:

The ACGME has outlined the policies as they apply to work hours and you are directed to their website for more information

You will submit your work hours into the residency management site, Medhub, on a weekly basis

Do not “pre-submit” your hours

Work hours must be kept up to date, defined as no more than seven days past due

Failure to log work hours, falsification of work hours, or repeated delay in reporting work hours puts you at risk for receiving an academic action, as outlined in a separate section of this handbook

Operative Case Logs:

The American Board of Surgery requires residents to keep a case log

It is both the program’s and your responsibility to assure that you are on target to meet required graduation case numbers

o Residents should be familiar with the case requirements, which can be viewed on the American Board of Surgery website

The residency program utilizes the ACGME case log system to generate case log reports

Residents will log all cases into the case log system

Expectations, based on the ABS requirements: o Residents will log a minimum of 250 cases by the end of their PGY-2 year o Residents will log 40 critical care cases in the seven categories, as defined by the

ABS, by the end of their second year o Residents will log all non-operative trauma cases in the case log system o Residents will log a minimum of 450 cases by the end of their PGY-3 year

Cases should be entered on the day they are performed

The expectation is that the case log will be no more than 14 days out of date

Failure to maintain and check your operative log puts you at risk for receiving an academic action, as outlined in a separate section of this handbook

Evaluations

Evaluations are critical to both programmatic improvement and personal growth

Residents are responsible for evaluations of rotations, faculty members, students, and other residents

Evaluations must be completed within seven days of completing a rotation or working with a student

We will be continuing an internal, anonymous evaluation every 6 months

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Failure to complete evaluations puts you at risk for receiving an academic action, as outlined in a separate section of this handbook

Surveys

There three required surveys each year, put out by the o ACGME o U of U GME Office o Division of General Surgery Program Evaluation Committee

Each of these surveys are important to the program maintaining accreditation

Failure to complete these surveys in a timely fashion puts you at risk for receiving an academic action, as outlined in a separate section of this handbook

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Section 5: Academic Actions The formal process for academic actions is provided in policy by the Graduate Medical Education office and can be found on Pulse. To summarize, there are various types of actions and one does not have to follow another. Academic actions are decided upon by a vote of the faculty members with the action and expectations authored by the Program Director’s office. Every academic action may have activities that need to be completed, suspension of other types of activities, limits on participation in extracurricular activities, or other items that are deemed important to address. These actions, in order of seriousness, are:

Informal email notification o This is meant to put the resident on notice that something needs to be done,

such as case logs or work hours. o This is not reportable to licensing agencies and medical boards

Formal email notification o This is more serious action and is used if the activity or behavior is recurrent or

more serious, such as professionalism issues, including not logging cases, work hours or completing evaluations or surveys in a timely fashion.

o This is not reportable to licensing agencies and medical boards

Letter of Concern o This is an action that is coordinated with the GME office o It is reviewed by the GME committee lawyer o There will be a case laid out as to why this action is necessary o Defined expectations that are measurable will be included o There will be a timeline associated with completing the action items o This is included in your permanent file and may become part of the letter sent to

licensing agencies o It is not a reportable action when applying for a medical license or hospital

privileges

Probation o Similar to a letter of concern o This is reportable for the rest of your career

Every job Every credentialing request Every medical license

Dismissal o This can be a contract non-renewal, or it can mean being dismissed from the

program o This is a reportable action, similar to probation

Due Process o If you decide to appeal an academic action, there is a process outlined in the

GME policy on academic actions

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Section 6: Resident Assessments Assessments are a way of receiving feedback on your performance. While assessments can be stressful, they are part of becoming the best surgeon you can be. Assessment Process:

The assessment process is a combination of clinical, professional, and administrative observations

o Clinical Based on rotation goals and objectives ABSITE Conference performance

o Professional Communication skills Leadership abilities Getting your work (clinical and administrative) done Showing a commitment to patients, where patient needs supersede

everything except for critical family needs o Administrative

Completing all of your tasks based on the timelines in Section 4. Being prepared to teach on rounds and in conferences Completing activities to which you have volunteered or have been

assigned

PGY-1 and PGY-2 residents will meet with a member of the Program Director’s office two times each year:

o November and May

PGY-1 and PGY-2 residents are expected to meet with their mentors at least twice each year

o August and February

PGY-3 and higher residents will meet with a member of the Program Director’s office twice yearly

o November and May

Formal Assessment o Residents will be assessed by the Clinical Competency Committee twice yearly

November and May o Residents will be assessed for contract renewal and advancement at the end of

February

Informal Assessment o Residents will be discussed and reviewed at the Graduate Education Committee

(GEC) PGY-1 and PGY-2 residents will be reviewed four times/year PGY-3 and higher residents will be reviewed twice/year

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Residents can also be reviewed more frequently based on their standing in the program

Academic actions can be given to a resident at any time, based on the resident performance in the program

o Please refer to Section 5 for academic actions and due process

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Section 7: Leave of Absence There are many different types of leave that you may require during your residency. There is University of Utah policy for nearly all of them, and some are covered under the GME contract you signed when you joined the residency. Some of the leaves described below are more generous than that provided by the University. If you have any questions about leave, FMLA, etc., please contact the Program Director’s office Time requirements for the ABS:

Per the ABS, there are specific requirements for time in training o During the first three years

48 weeks/year, or 144 weeks total You are provided two additional weeks for emergencies, health issues,

pregnancies, etc. Thus, you must complete 142 weeks of clinical duties

o During the last two years 48 weeks/year, or 96 weeks total You are provided additional weeks for emergencies, health issues,

pregnancies, etc. Thus, you must complete 94 weeks of clinical duties

If you have an issue where you will not meet weeks as required by the ABS, please contact the Program Director’s office. There are solutions and alternative pathways that can be used.

Vacation:

You are allotted 3 weeks of vacation/year

Vacations are assigned based on PGY-year

PGY-5 through PGY-2 residents get to pick the weeks of their vacation

PGY-1 residents are assigned their weeks

Vacation selection rules o For each resident on a rotation, that rotation must provide 3 weeks’ vacation

For example, Colorectal has a PGY-5 and a PGY-1 Colorectal must provide 3 weeks of PGY-5 vacation and 3 weeks of PGY-1

vacation o Exceptions are made for the PGY-4 and PGY-2 UTES night rotations, where no

vacation is given Rotations in the PGY-4 and PGY-2 year may have to provide up to 4

weeks of vacation/year o There can only be one resident on vacation at a time for a given “rotation pool”

For example, IMC general surgery has two services, with a PGY-5, PGY-4, PGY-2, and PGY-1

If a PGY-5 has a vacation week, then no other surgery resident rotating on general surgery at IMC can have vacation that same week

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o Vacation changes need to be communicated to the Program Director’s office You must get approval for any change from the education director of the

rotation and from the Program Director’s office If you do not have approval, the change will not be allowed

o Miscellaneous issues There will be times where a resident will request time to go to a meeting,

will request FMLA, or have an emergency. This time may conflict with a vacation

Residents can try to make arrangements such that clinical care is addressed

If arrangements are not possible, it is up to the faculty members on the rotation to design a solution, in conjunction with the residents, to assure that patient care is maintained

There will also be times where non-general surgery residents are on a rotation and have scheduled vacation

This is becoming a more complex issue and is taken into account during the vacation scheduling process

Where these vacations can be accommodated, rotations are encouraged to do so

Where they cannot be accommodated, once a general surgery resident schedules vacation, it must be honored

Fellowship Interview:

Fellowship interviews are a required part of the education process

Residents will make every effort to minimize the time away from clinical duties

Residents have two weeks of time that can be used for interviews o Any time beyond two weeks will need to be taken from vacation time o These two weeks are cumulative and count no matter how many rotations the

interviews impact

A resident who is planning to interview should have the fellowship interview schedule in hand when deciding on vacation weeks, with an assumption that one or more of the vacation weeks will be used for interviews

o It is the Program Director’s responsibility to adjudicate any conflicts regarding interviews and vacations.

Sick/Injury/Health Leave:

For the health of yourself and for the patients you care for, if you are seriously ill (beyond a cold), please take time off to get well

If you are going to be off 3 days or less, you do not need to use FMLA (see FMLA below)

3-7 days are middle ground regarding FMLA

Anything beyond 7 days requires FMLA (see FMLA below)

Please see section 2 about who to notify

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Funeral Leave:

Residents are entitled to three days of funeral leave in the event of a death of an immediate family member, which includes

o Spouse/Significant other o Child o Sibling and their spouse o Parent/Grandparent o Spouse/Significant other Parent/Grandparent

Time required beyond three days requires approval of the Program Director’s office and may require FMLA

Military Leave:

Residents involved in the National Guard or Reserves are entitled to a leave of absence to participate in military duties

o This leave is not to exceed 15 days/year o This is paid leave o This is leave in addition to vacation o This leave does count against the ABS weeks in training requirement

Parental Leave:

This section includes pregnancy/delivery in addition to adoption of a child

There is a section for the person who is pregnant and for the non-pregnant partner

Becoming pregnant o As soon as you or your partner become pregnant and you feel comfortable

sharing the news, you must let the Program Director’s office know Rotation schedules will be reviewed and adjusted as needed Service education leads will be notified

o You will be given time off to attend all pre-natal visits o FMLA will be discussed during this time o If there are any issues with regards to the pregnancy that will impact your ability

to participate in clinical care, please inform the Program Director’s office

Delivery o Hospital stay for delivery is based on your needs and the request of your

provider o FMLA will need to be activated

Post-partum o Per University policy, you will receive 6 weeks of FMLA

Paperwork is found on Pulse and is submitted electronically This can be extended to 12 weeks, but requires discussion with the

Program Director

This may impact your ability to graduate on time o As you reach six weeks, please set up a meeting with the Program Director to

discuss any special needs or accommodations you may require

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Plan to maintain breastfeeding Childcare issues Your physical and mental health Your child’s physical and mental health

Post-partum for the non-pregnant partner o You are provided one week off after delivery o This can be extended to two weeks

This will require the use of a vacation week o Time off needs to be discussed with the Program Director o If you require more time

You must use FMLA You must discuss this with the Program Director

Adoption o Planning for adoption

Let the Program Director know of your plans Your schedule will be reviewed, and any anticipated stressors will be

addressed FMLA will be reviewed at this time

o Adoption- Your “Delivery Date” The primary caregiver follows the same guidelines as the post-partum

resident above The partner of the primary caregiver follows the same guidelines as the

non-pregnant partner above

Unplanned events o During pregnancy

If you have to decrease your workload or take additional time off of work, you must notify the Program Director

ABS weeks in training requirements will be reviewed o Post-partum/Post-adoption

Notify the Program Director’s office if there are issues after delivery/adoption

Childcare issues (NICU, illness, etc)

Mental health issues o Loss of a pregnancy

You will be provided with time off from work There are resources available through the GME office to assist with

support FMLA:

FMLA is a program that guarantees your job in case you have a prolonged absence from work

There is a University of Utah policy on FMLA

FMLA covers

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o Birth of a child o Adoption of a child o Your own serious health condition o A family member’s serious health condition

You must be employed by the University of Utah for one year before you receive FMLA benefits

Please see the University of Utah website on FMLA for more information Communication of Absences:

Acute absences will be communicated to the PD office. The PD office will then work with the residents and attending surgeons to arrive at a solution that addresses the acute absence.

For absences that are more “planned”, the resident involved will discuss this with the other residents on their service, in addition to the Administrative Chief resident. Together, and working with resident groups that will be impacted, you will arrive at a plan to address the resident absence. That plan will be for night and weekend coverage and not day coverage. A resident can cover nights at a facility to which they are not assigned, with the understanding that they may have to miss the next day of their primary rotation. No one or two residents will shoulder the burden of the absence and no specific PGY-year will be asked to cover for the absence. Any plan that is arrived at will be reviewed with the PD or the APD. It will not be implemented unless the PD or the APD agrees.

If a resident has a planned absence, the following people need to be notified as soon as the absence is confirmed:

o The PD office o The faculty members of the service on which the absence will take place o The residents on the service that will be impacted o The Administrative and Education chief residents

It is then the responsibility of the residency, not any one specific individual, to arrive at a coverage plan and present it to the PD or APD for approval.

Failure to communicate and plan effectively may be considered a breach of professionalism and may be noted in your academic portfolio.

If you have a planned absence (including but not limited to ATLS, ACS meeting, presentation at a meeting, etc.) and you do not communicate this to the Administrative Chief resident AND to your service (faculty members and residents) in a timely fashion (such as you know about the absence but wait until the schedule is written to let the Chief resident know about it), you will not be allowed to attend the event. You will also be responsible for the cost as it pertains to the event (fee for ATLS, for example) which you will be required to pay from your own personal funds.

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Section 8: Professional Development Professional development is a key part to you becoming a surgeon. There are many things outside of clinical care that are important for you to master. Quality Improvement:

Every resident will participate in a quality improvement project

Every resident will participate in the quality improvement education program

The QI program includes: o Lectures on how to design and implement a QI project o Metrics that can be studied o How to report results o PGY-1 and PGY-2 residents are required to attend these lectures

The QI project entails o PGY-2 residents design a project and establish a team to work on the project o Provide updates on the project o Present the project at the annual Department of Surgery Quality Meeting

The quality program and projects are overseen by the Vice Chair of Education and the Program Director

Research/Career Development Year (RCDY):

Five of the six residents from each residency class will participate in the RCDY

The RCDY occurs after the PGY-3 year

For the six residents in each class o Two residents will participate for two years o Three residents will participate for one year o One resident will go straight through

There is a formal document that outlines timing and process for the RCDY. A brief outline is provided below.

o At the start of the PGY-2 year, residents will meet with the RCDY faculty supervisor, who will review the timeline for project development

o Proposals will be due in December of the PGY-2 year o Feedback will be provided, and the proposals will be revised, with final

submission in March of the PGY-2 year o Proposal decisions will be announced in April of the PGY-2 year o The PGY-3 year will be spent

Preparing IRBs Submitting grant applications Completing preparatory work for the RCDY

Work product o For the resident who is moving straight through, there is a one publication

requirement for successful completion of the RCDY o All other residents have a two publication requirement

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Funding o Salaries for the RCDY are to be paid according to the following:

If you are 100% in the Division of General Surgery, 100% of your salary will be paid by the Division of General Surgery

If you are 100% in the Department of Surgery (e.g. Cardiothoracic Surgery), 25% will be paid by the Division of General Surgery and 75% will be paid by the sponsoring Division

If you are participating in programs within the Department of Surgery (e.g. Global Surgery), 100% of your salary will come from the Department or the program in which you are participating

Research in any other program (IMC, another institution) will require salary support for you. Neither the Division of General Surgery nor the Department of Surgery will cover your salary

If there is a percentage of time in different areas, your salary will be distributed between those entities based on the percentages above and the percentage of time you spend in each area

o All residents will have $6000 deposited into their professional development account

o These funds are to be used for activities related to professional development, including:

Classes or courses Travel Data analysis Subscription to databases

o These are not clinical funds and cannot be used for things like: Books Computers Phones

o These funds will be relinquished back to the Division if not used when you complete the residency program

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Section 9: Travel One of the benefits of participating in scholarly activity is travel to meetings to present your work. In addition, the residency program feels that certain activities should be part of your professional development and should be included in your residency at no cost to you. Your professional development fund cannot be used for:

Interview travel

Personal travel An outline of how meeting travel is scheduled:

Generating an abstract o You must inform the RCDY faculty director that you are preparing an abstract o You must present your abstract idea to faculty members for review (e.g. U-

INQUIRE)

If your abstract is accepted o You must inform the administrative assistant who is in charge of travel, currently

Deborah Shaw, of the meeting, location, and date of presentation o If you abstract was accepted for an oral presentation, you must present your

planned presentation to faculty members for review (e.g. U-INQUIRE)

Reimbursement o The administrative assistant will review the planned expenses for travel o The expenses will be compared with the funds in your professional development

account o If there are enough funds, nothing further needs to occur and you can attend the

meeting o If there are not enough funds to cover travel expenses:

The faculty sponsor will be made aware If is up to the faculty sponsor to approve a funding source for expenses

not covered

Caveats o This funding mechanism is for research presentations where the University of

Utah will receive credit for the work done in the presentation o Work done outside of the University will need to have all travel covered by the

sponsoring entity o If you are traveling with other residents of the same gender, you are expected to

share a room with them to decrease costs If you decide not to share a room, only ½ of the room expenses will be

covered through your professional development funds Meetings paid for by the Division:

Association of Academic Surgeons Research Conference

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o PGY-3 residents will be covered to attend the ACS meeting and attend the AAS research conference

o Residents will participate in the meeting through the U of U reception on either Monday or Tuesday night

Other professional development travel:

Courses o Require approval by the Program Director o There needs to be a concrete objective for travel to the course o Course registration fee and travel expenses will be taken from your professional

development fund

National/Regional boards and committees o Participation on various boards and committees is a form of professional

development NRMP RRC Various ACS committees Specialty Society committees

o Expenses for travel to these meetings will be taken from your professional development fund

National Fellowships (e.g. Surgical Education Research Fellowship) o Fees for applying for the Fellowship will be taken from your professional

development fund o Travel expenses not paid for by the fellowship will be taken from your

professional development fund Things not covered in this section:

Any item not covered in this section requires review by the Program Director and the Chief of the Division of General Surgery before any action is taken on the item

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Section 10: Guidelines for Pregnant and Lactating Residents

1. Introduction a. These guidelines are designed to support pregnant and lactating surgical

residents in maintaining the health and safety of themselves and their babies and to meet their personal breastfeeding goals without compromising their surgical education and care provided to their patients.

b. It is important that all members of the University of Utah General Surgery Residency recognize that different residents will have different needs during their pregnancy as well as different breastfeeding goals when they return. It is also important to recognize that physical and emotional support during pregnancy and lactation support after returning to work is essential to help our residents be safe and healthy and meet their personal goals for breastfeeding.

2. Pregnant and lactating surgical residents needs from program educators and colleagues

i. Time to attend all pre- and post-natal care visits, including lactation consultants

ii. Appropriately frequent and sufficient time to express milk to avoid engorgement, pain, plugged ducts, mastitis, and/or decrease in supply.

iii. Awareness of potential emotional issues/stress during pregnancy and due to significant time spent away from young child

iv. Understanding that different pregnant and lactating residents will have different needs and that individual resident needs will change over time.

v. Flexibility and understanding when a resident is unable to schedule lactation breaks in advance given unpredictable nature of clinical practice

vi. Understanding that the pregnant or lactating resident is not disengaged or unwilling to work hard due to need to take time away for appointments or to pump

3. Responsibilities of the pregnant or lactating resident

a. Ongoing commitment to patient care and careful consideration for clinical continuity when determining appropriate times for appointments and to express milk

b. Advanced notice in writing/email to program director if the resident will require time to express milk upon return from maternity leave.

c. 1 week prior to a rotation change or returning from maternity leave, the pregnant or lactating resident should inform the residents, attendings and APCs on the upcoming service if she will require extra time for appointments and/or to express milk so that their needs can be anticipated and accommodated. This notice should be in writing/email so there is clear documentation of the request.

d. Clear communication with program director, attending surgeons, and colleagues (both co-residents and APCs) regarding specific needs for pre- and post-natal care and lactation (time interval, specific concerns)

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4. Responsibilities of the program

a. The education lead of each service will review these guidelines with members of the clinical teams including attendings, residents, APCs and coordinators and be responsible for monitoring adherence to them

b. The faculty and residents will provide a culture of support and flexibility for all pregnant and breastfeeding women in the program.

c. If issues or concerns arise regarding a pregnant or lactating resident, the Program Director’s office should be informed and involved in helping resolve any concerns.

d. Similar expectations and guidelines will apply to any medical student on a surgical rotation who is pregnant or lactating unless specific additional School of Medicine policies supersede these guidelines.

e. Resident on ward/ICU

i. The resident will provide clear communication with team members about pregnancy and pumping needs.

ii. For PGY4/5 residents on the UTES service, the resident will provide clear communication with the attending when the resident is pumping so that the attending knows when he or she needs to be present for all trauma 2s that would otherwise be run by the senior resident.

f. Resident in clinic i. Lactating resident will be allowed to leave clinic to pump at a reasonable

interval. ii. Lactating resident will not leave during a patient encounter.

iii. The resident will provide clear communication with attending about pumping plans prior to clinic.

g. Resident in operating room i. Lactating resident will notify attending surgeons on each service that they

will require lactation breaks during prolonged procedures. ii. Pregnant residents will notify attending surgeons on each service if they

will require breaks during prolonged procedures iii. Lactating resident will minimize interruption to operating team by

pumping before or after cases whenever possible and will not leave during critical portions of the operation.

iv. All attempts will be made to provide coverage in the OR and the lactating resident will minimize their time out of the operating room.

v. Pregnant or lactating residents in HIPEC case will assist during the initial portions of the case where no chemotherapy is present with the same expectation described above for any prolonged case. The resident will then scrub out and not be present for any portions of the case after the chemotherapy is administered. All attempts will be made to find another qualified resident or APC to come in to assist with this portion of the case.

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h. Resident in conference i. Lactating residents are allowed to leave mandatory teaching conference

for pumping if necessary.

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Section 11: Moonlighting Moonlighting:

Moonlighting is only allowed during the RCDY

Residents who moonlight during their clinical years will be dismissed from the program

university of utah general surgery residency handbook

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