At all sites in the UCSF General Surgery Residency Training Program, patient care is provided by credentialed attending surgeons, either directly or through active supervision of residents enrolled in the Program. As such the attending surgeon delegates authority to the residents, but always has the ultimate responsibility for the patient. The chain of responsibility begins with the intern (PGY-1) and ascends through all resident levels to the attending. Each level of resident is responsible to and reports to the level of resident above him/her. However, the chain of command does not require that the discharge of responsibility and communication of information always proceed in a step-wise manner through the patient care hierarchy.
Specific Site Guidelines
Call Schedules and Contacts
Each service or clinical specialty will maintain a published call schedule that will clearly identify the attending and residents with the primary patient care responsibility for a given time interval. The schedule will be publicly available and made known to the residents. It will specify the contact mechanism (pager number, phone number) and must be current and accurate at all times. It is expected that the junior level resident will contact the mid-level resident, who will contact the senior resident, who will contact the chief resident and the chief resident will contact the attending.
Contact is required to report any new clinical circumstances, either involving an established patient or a new patient. At any time the resident who needs to communicate clinical information can and should move to the next level in the patient care hierarchy if the immediately superior resident is unavailable or if a higher level of clinical expertise is needed for safe and optimal patient care. If all else fails the service or section chief (attending), the Program Director or the Department Chair should be called.
Competencies and Supervision
Surgery residents are expected to master many technical procedures during their training. All procedures are performed under supervision as well, with the nature of the supervision dictated by the clinical situation and the experience and expertise of the surgery resident. Adequate training requires the graduated assumption of increasing responsibility for patient care, including the assumption of a more primary role in the performance of operative procedures. Nonetheless, it is expected that there will be immediate attending supervision at the appropriate level for all procedures performed in the operating room. In addition all procedures performed in non-operating room settings require supervision.
Table of Procedure Competencies
Important
The Table of Procedure Competencies comprises the list of non-operating room procedures, indicating the level of supervision required according to the procedure and the level of resident in the training program. This list is included in the UCSF Bylaws regarding resident supervision. Other sites in the Program may have procedural supervision guidelines specific to that site. In the absence of any formal guidelines at other sites, follow these guidelines.
It is important to realize that these guidelines are not meant to prevent the provision of emergency care during a life-threatening event. In those circumstances clinical judgment and common sense should dictate the actions of the resident, not concern about a list.