St. Barnabas Department of Surgery

Intern, Student, and Resident Manual

Rounds

• Start promptly at 6:30 a.m. on 7 North (6:00 a.m. on Fridays)

• Interns/Medical & P.A. students must have the following prepared for rounds:

  • All vitals

  • Drain outputs: Eg. Jackson-Pratt, Chest tubes, Nasogastric tubes, Foley

  • Dressing kits

• Have all charts ready on each respective floor to review. 

• Communicate with intern on-call regarding previous overnight events

• Sign-out rounds will be announced overhead by team chief.  All members of the respective teams, ON-CALL intern and ON-Call residents should be present. DO NOT page residents for sign-out. In addition, do not go to surgical on-call rooms to find residents.

1. Interns

• Co-sign student note

• Interns are responsible for reviewing the charts TWICE (~11:00 a.m. and ~3:00p.m.) for any updates. 

• Check all labs, radiology reports by noon. Page junior resident with results. If resident in OR, page senior resident, if both are unavailable, then go to OR and ONLY report the significant labs. 

• Designate only one intern to report all significant labs and chart update if both junior and senior residents are in the operating room. 

• Check the OR schedule by 1100 everyday for any preops (Posted on 5^th Floor in OR Holding Area).  Divide up any preops that need to be done for your respective team. Preops should generally not be signed out to the on-call intern(s). 

2. Medical/ P.A. Student Assignments

• Medical students will fail rotation if absent from rotation for  two or more days without a written excuse (as per nycom guidelines).

• Will be assigned one or more patients on surgical service and present case on rounds each day.

• Rotations:

  4 weeks RED team

  4 weeks BLUE team

  1 week Anesthesia Rotation

  2 week TRAUMA/SICU Team

  1 week pre-admission testing/ambulatory surgery

• Students and interns will present each assigned patient on rounds. Students will write their respective daily progress notes co-signed by the intern.

(other students who come for less time will spend the appropriate amount of time on each team)

3. PGY-II SURGICAL RESIDENTS

• You are responsible for the interns. 

• You MUST know all the labs and chart updates. 

• Report all labs and chart updates to the senior resident STAT.

• A copy of the team lists are to be made by 06:30 a.m. everyday. 

• A copy of the OR schedule is also to be made.

• You will be assigned cases and are responsible for knowing when they go to the OR. 

• Any concerns, problems, or questions that you have will be addressed to your respective senior resident. 

• Make sure all the preops are checked when on-call. 

• All orders should be written in chart immediately while rounding in AM.

• On-Call PGY II  MUST be present at all sign outs.  There is no excuse for missing sign out rounds except if you are in the operating room.

4. ON-CALL

• There will be one intern on-call Monday through Friday overnight.   Patients should be seen by the weekend on-call PGY II by 7 am so that everyone is updated on the patients as well as facilitating sign out rounds. 

• PGYII surgical residents are to check all pre-ops when on call. 

• All questions regarding patient care are to be addressed to the junior surgical resident.  If the junior surgical resident is unable to answer your question, only then should the senior resident or in-house surgical attending be called.

• Students have the choice during the week to either finish call at 10 pm and return for rounds at 6 – 6:30 am the next day or take 24-hour call and take the post-call day off.  On weekends, student call ends at 10 pm

• ALWAYS check the OR schedule for any add-ons. 

• On-call intern is to do check-in rounds with the junior resident at 9pm Monday through Friday. On Saturday & Sunday at 1pm and 9pm.  Communication is of the utmost importance. 

5. Physician Assistants

• Coordinate interns in regards to notes and responsibilities. Sub-specialty clinic coverage (See attached.).

6. Intern/Student Lectures

• Wednesdays with Dr. Vernenkar at 7 am a topic will be discussed.  This will be held on the 2^nd floor conference room of the Mills Building. 

7.     Resident Lectures

• The surgical residents will also provide a lecture, which will be held on Tuesdays at 0700 in the second floor conference room of the Mills Building.  Mandatory attendance by all students.

8. Director’s Rounds

• This is held every Friday morning at 0700 in the auditorium.  Mandatory attendance by ALL surgical housestaff (Surgical residents, Podiatry, Interns, and Students).

• Either a junior surgical resident/intern/student will be assigned a case to present.  It is that individual’s responsibility to have the case presentation written by Wednesday, allowing time for it to be reviewed by your senior resident.  All radiologic studies pertaining to the case need to be presented as well.  It would be in the best of the presenter’s interest to go over the studies with an attending radiologist. 

9. Clinics

Red clinic:

General surgery clinic:

Wednesdays, Tuesdays & Fridays 1pm -5pm

Hand/Plastic Surgery clinic: 

Wednesdays & Fridays 9am – 12pm

Urology:

Thursdays 9 am – 12 pm

Mondays 1 – 5 pm

Trauma:

Tuesdays 1pm – 5pm

Blue clinic:

General surgery:

Mondays 1pm -5pm

Breast clinic:

Fridays 9am -12pm

Vascular:

Wednesdays 1 – 5 pm

Orthopedic:

Mon, Tues, Weds & Fridays 9 am – 12 pm

Thursdays 9 – 12 pm (Peds Only)

Podiatry:

Tuesdays 9 am – 12 pm

Mondays & Wednesdays 1 – 5 pm

Thursdays 9 – 5 pm

Pediatric Surgery clinic:

Every other Wednesday 3 -5 pm

• General surgery and vascular clinic is on the 5^th floor clinic building.

• Breast clinic is on the 3rd floor clinic building.

• Orthopedic & Podiatry Clinics – New Clinic Bldg. 1st floor

• Mandatory attendance by all respective team members.  Only individuals assigned to PAT’s are allowed to leave clinic to attend to the needs in ambulatory. 

10. TEAM RESPONSIBILITIES

TRAUMA/SICU

• The Trauma/SICU team will cover all trauma alerts and consults from 6:30 am to 5 pm.  The beepers will then be handed off to the on-call team.  Only members assigned to trauma team shall respond to alerts.

• Trauma Team, Surgical Critical Care, Trauma Neurosurgery

RED TEAM

• General Surgery, Thoracic Surgery, Hand & Plastic Surgery & Urology.

BLUE TEAM

• General Surgery, Vascular Sx, GYN Surgery, & Pediatric Surgery.

*The Red team will cover all trauma alerts and consults from 6:30am to 5 pm. The beepers will then be handed off to the on-call team. Only members assigned to Red team shall respond to alerts.

SILVER TEAM

• Podiatric Surgery, Orthopedic Surgery

11. CONSENTS / DISCHARGES

• Consents for procedures for in-house patients should be witnessed and placed in the front of the chart. Consent for BLOOD TRANSFUSIONS should accompany the general consent.  Pre-op notes should be placed in the chart with the consent forms and EKG if present

• Discharge paperwork consists of 3 forms. They include 1. Discharge summary 2. medications and follow-up sheet, and 3. 24 hour discharge notice (to be signed by the patient.)

12. SCHEDULE CHANGES

• Any changes in the call schedule will be arranged amongst the interns. This must be submitted in writing in advance and placed in the mailbox of each Chief Surgical Resident on the 2^nd floor.  This must then be relayed to the operator.