Residency Training in General Surgery

RESIDENT SUPERVISION POLICY

The Department of Surgery and University Hospital maintain a strict policy on resident supervision. It is the responsibility of each resident to understand this policy, as follows:

Every patient is admitted by a faculty attending who is ultimately responsible for that patient’s care. At University Hospital and at Winthrop–University Hospital, each patient has his/her own attending; and at the VA Medical Center, the service attendings are responsible. The faculty, therefore, is directly responsible for the supervision of residents caring for patients at each of the three participating hospitals. It is departmental policy to have a faculty attending scrubbed on all surgery performed by a resident. New York State law requires direct supervision and/or credentialing for a variety of common bedside procedures that are performed by residents. The Department of Surgery ensures this, and maintains written documentation of these activities.

During the first 2 years (PGY-1 and PGY-2), the residents are closely supervised during all patient-related activities in and out of the operating room. The junior resident is directly supervised by the senior and chief residents on all services and directly by the attendings in the ICU and cardiothoracic surgery services where there are no senior residents. Attendings are to make rounds on a daily basis at all three hospitals. All patients seen by a junior resident in the emergency room are discussed with a senior/chief resident as well as the attending before a final disposition is made.

During the PGY-3 year there is more latitude for independent decision-making on the part of the resident. Third- and fourth-year residents answer in-house consultation and direct the patient care efforts of the more junior residents. During this transition period, the resident is frequently required to make critical decisions regarding patient management in crisis situations on the floors as well as in the emergency room. At all times, there is faculty backup if needed. The resident must communicate his/her assessment and plan of care directly to the attending, and must be able to justify his/her actions to the attending in charge, in real time and at the weekly morbidity and mortality conference. While still under the direct supervision of faculty, mid-level residents are allowed more flexibility in the operating room as more advanced and complex operations become available to them.

Fourth- and fifth-year residents are expected to be actively involved in patient care decisions and function more independently, while being supervised by attendings. The senior resident will initiate and direct the evaluation and workup of all patients admitted through the emergency room. The senior/chief residents assume more responsibility as teachers for both medical students and junior residents. As residents progress, they are given increased responsibilities in the preoperative, operative and postoperative care commensurate with their individual level of experience and expertise.