Required attendance and direct attending supervision in the outpatient clinics is provided at all sites. In the clinic, the resident will see and evaluate patients, and then present their findings and plan to the attending surgeon. In other instances, the patient is seen by the resident and attending together. The history, examination, assessment and plan for each patient are discussed, and the resident’s skills and knowledge are assessed. Pre-operative, post-operative, and non-operative management is included. As residents progress, the attending’s input can be reduced, but not eliminated, to allow progressive responsibility. Clinics are staffed by ancillary personnel as well as residents.
Ward rounds are made by all residents, on all inpatients, on a daily basis at all participating institutions. Formal attending rounds are held at the Shriners Hospital Monday through Friday and at the VA three days per week. At Lahey Clinic and BMC, attending staff round daily on their patients and review the patient’s progress and/or problems with the residents. At BMC, all admissions and consults are reviewed daily during morning conference. Nurse practitioners and physician’s assistants round with the team and participate in logistical management issues, orders, discharge planning, etc.
Residents participate in the operative procedures at all participating institutions. The specific amount of the casework that each resident performs is dependent on his/her experience, skills and preparation, and the complexity and technical demands of the procedure. Preoperative planning is an essential element of operative participation.
There is no emergency room at the Shriners Hospital and very few patients with acute injuries are seen at the Boston VA Medical Center. This section therefore applies primarily to BMC and the Lahey Clinic. At BMC all ER patients are seen by the resident on call (PGY-2, PGY-3, or PGY-5), depending on the nature of the problem and resident availability. In general, the PGY-2 resident is the first to be called for the ER, with direct supervision and guidance provided by the more senior residents. The PGY-5 resident evaluates all multi-trauma patients and the attending staff reviews all patients seen in the ER with the residents, at daily morning conferences. At the Lahey Clinic, ER consults during the day are usually seen by an attending (the residents are occupied in the OR and clinic). However, at night and on weekends, ER patients are managed by the resident staff with appropriate attending supervision.