Resident Supervision

Each rotation has a chain of command, which ethically and legally begins with the attending surgeon. However, the chief resident of each service is responsible for the entire conduct of the decisions made on the service as well as actions of his/her junior residents. Therefore, the Chief Resident is responsible for guiding patient management by his/her junior residents. Although a chief resident assigns cases and directs management, a team concept is emphasized so communication at all levels is maintained on a given service. The Chief Resident (or a junior resident appointed by the Chief Resident) is responsible for emergency room and in-house consultations, the deliberations about such patients are discussed early with the attending physician before treatment is begun or as it is being instituted. At the responsible resident’s discretion, the responsible faculty member is contacted during an unexpected clinical event at which time the resident presents his/her evaluation and treatment plan, be it non operative or operative.

Supervision in Operative Cases

When treatment plans call for an operation, the residents involved must present a plan to the responsible faculty member prior to the operation. This allows for discussion of options, resident reasoning and an opportunity to further direct resident reading and scientific research. The responsible faculty member is always present during operations, but the degree of participation varies according to the resident(s) involved and the type of cases. This ranges from being first, second or third assistant or to being present, but not scrubbed.

Supervision of Technical Procedures outside the Operating Room

Technical procedures outside the operating room (e.g., insertion of Swan Ganz catheter, chest tube, etc) are performed independently by junior residents after they have performed the procedure enough times under the supervision of a senior resident or faculty member.

Resident Supervision Inpatient/ Outpatient Services

a. Inpatient Services

The resident team assigned to each service is responsible for total management of all patients on that service. All residents on a given service make rounds on their service as a team. The resident

team is also responsible for following patients they have seen in consultation for another service. Each junior resident is assigned patients by the chief resident and the assigned resident is responsible for those patients.

b. Outpatient Services

All of the residents on a given service and the entire full time faculty associated with that service attend clinic during specified hours on their non operative day. The majority of patients are initially seen by the residents and then presented to the responsible faculty member for discussion.

Resident Supervision in Emergency Room

All residents have mandatory PGY II rotations in the Detroit Receiving Hospital Emergency Room. The residents are responsible for initial evaluation and treatment as well as formulating treatment plans under the supervision of the chief surgical residents, full time surgical faculty and the full time faculty of the Department of Emergency Medicine, who are always present.

Resident Supervision in Intensive Care Unit

All residents, particularly at the PGY-III, IV and V levels are responsible for the care of all patients on the Surgical Service in the Intensive Care Unit. The daily evaluation of the patients along with the diagnosis and therapeutic plan is initiated by the resident. Additionally, the General Surgery Service assumes the ICU care for many surgical specialties including Urology, Otolaryngology, and Orthopaedics and is actively involved in the Spinal Cord and Neurosurgery ICUs. The residents are responsible for the management of the invasive monitors, ventilators, vasoactive drugs, supplemental nutrition, and infectious disease. Formal rounds are made in the ICU at least once a day in the participating institutions with the attending responsible for the patient, many of whom have Board Certification in Surgical Critical Care. In addition, Unit wide ICU rounds are made with the Director of the SICU at the Veterans Medical Center daily.