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Administrative Guidelines
You must maintain ACLS certification throughout your residency. In addition, you must be recertified for neonatal resuscitation every two years. It is your responsibility to keep track of your certifications. The program will assist you in obtaining re-certification.
Administrative Chief Resident:
The administrative chief resident for academic year 2005/2006 is Vivien Lee. The assistant administrative chief resident is Susan Mikaelian. Vivien is responsible for creating the call schedules, coverage for conferences and vacations, interviews, departmental examinations. She is responsible for knowing who is where and when. Any deviation from the schedule MUST be approved by Vivien prior to the change. The administrative chief resident also acts as mediator for any resident conflicts. She will refer to the Program Director as needed. In Vivien's absence you should refer any administrative questions to Susan Mikaelian.
American Board of Obstetrics and Gynecology
You must register to take the written boards at the end of your fourth year. You must sign up yourself, the program does not automatically do this for you. Send the registration by registered return mail to document that you sent it in on time.
American College of Obstetrics and Gynecology
You should apply to become a Junior member in the College. This will entitle you to your own copy of the Green Journal and many important updates.
Billing
Billing is a very important part of your job and also for your education. Once you graduate, you will be expected to bill accurately and to understand billing nuances. You will be asked to fill out the billing form in the Women's Center. You should review the billing form with the attending prior to leaving your continuity clinic. Specifics:
- The billing form must accurately reflect the correct diagnosis, coding of the service, and any procedures. There is a billing guideline in the resident room, on team A to assist you in choosing the correct level of service.
- The attending physician MUST see all patients for whom you plan to bill a level IV or V.
- The attending must be physically present for all procedures, not only to supervise and teach, but also to bill.
- Resident ambulatory statistics are recorded on the back side of the billing slip in the women's center, in the FCC and on Labor and Delivery. You must fill out the appropriate category(ies) for every patient encounter.
All complications are tracked for monthly Quality Assurance meetings and to improve our practice patterns. Complications include unintended major surgery, unplanned readmission, blood transfusion, death, hemorrhages, unintended bowel or bladder injury, maternal morbidity and neonatal admission to the NICU. You are not "getting anyone into trouble" by reporting a complication. In many cases, preemptive interventions can assist the patient and also avert a malpractice suit. If you are involved in any complications, talk to the Program Director immediately.
Counseling
Counseling and advise on career or personal matters is available to all residents. The department has a mentoring program, where all residents are encouraged to select a mentor with whom to meet. Dr. Lee-Parritz, Dr. Hendessi and Dr. Heffner are available to meet as needed.
Dress Code
Always wear a clean white coat over scrubs when not in the OR or on Labor and Delivery. The hospital will provide you with 2 clean white coats each year. You are responsible for washing them and should do so frequently. You should remove masks immediately after leaving the operating room. Hospital ID MUST be worn at all times.
Drug Company Reps
The relationship between the pharmaceutical companies and physicians has been the topic of much ethical discussion over the last several years. The PhRMA Code on Interactions with Healthcare Professionals was produced by the pharmaceutical industry to regulate their relationship with healthcare providers. The distilled PhRMA code states that gifts from pharmaceutical companies can only be educational in nature, and can only be modest in scope. Appropriate "gifts" are those that are items of minimal value, educational books, and support for educational conferences. "Drug lunches" are appropriate, however, a faculty member MUST be present for all drug lunches to supervise the appropriateness of the presentations. No gifts, in the form of items or compensation for travel and food, may be offered to the spouses of physcians.
Educational Conferences
Chief residents are afforded an additional week per year to attend an educational conference. The department will pay $1500 to defer the costs of this conference. All conference time must be planned well in advance, and must be approved by the administrative chief resident. More junior residents may attend conferences as well, however must use vacation time to do so, unless they are presenting a paper, in which case they may take up to one additional week per year. The department will contribute $1000 to defray the costs of attending a national or regional conference at which the resident is presenting original research. Presenting at a review course does not qualify as a national or regional meeting.
Email
We encourage the use of email for communication. However, be aware that email is easily forwarded to many other people without your knowledge or permission and is easily printed as a permanent record. If writing an email while angry, please consider first sending it to an impartial reader. Never use profanity, never threaten, never forward inappropriate material, and take care to avoid accidentally offending or insulting. The privacy officer at Boston Medical Center has asserted that you may transmit patient information via email IF you know that the person with whom you are communicating has encryption technology and is the ONLY person who has access to the email account. It is prudent, therefore, to strictly limit the email communication you have with patients.
Examinations
The Council on Resident Education (CREOG) in-service examination is given in January. You are all expected to take this examination, and should take it very seriously. It not only reflects on your personal performance, but also on the performance of the program in general. If you are considering a fellowship, some fellowships ask for your third year CREOG scores. The department awards $500 at the end of the year to the resident with the highest scaled score for their year of training.
The department also gives an OSCE (objective standardized clinical examination), which is usually scheduled in November.
HIPPA
The Healthcare Information Portability and Accountability Act (HIPAA) was passed in 1996. The Administrative Simplification provisions required the Department of Health and Human Services to establish national standards for electronic health care transactions and national identifiers for providers, health plans, and employers. It also addresses the security and privacy of health data.
All employees are required to take the HIPPA training. You will do this in your orientation. The salient points of the training are that patient confidentiality MUST be maintained at all times. You must not leave patient lists where they can be seen by others. You should not leave messages on someone's answering machine without their express permission. When rounding on one patient in a two-person room, you must be careful to speak in a quiet voice and pull the curtain. You must not give out information about patients to anyone but the patient, without the express permission of the patient. It is desirable to avoid communicating with patients via email, unless you explicitly know that they are using encryption technology and are the only person with access to that email account.
Jehovah's Witness
We are expected to honor the rights of autonomy and refrain from transfusing members of this faith against their wishes. If you are uncertain about what to do, always consult with your attending and notify anaesthesia immediately. The legal office is well versed in the management of these patients and should be consulted liberally as needed.
Job Interviews
Job interviews are an essential part of the chief year for securing employment or fellowship. However, the American Board of Obstetrics and Gynecology will only permit a chief resident to miss up to six weeks during their chief year in total, including vacation, conferences and interview days. This is an immutable policy. If you miss more than six weeks for illness etc, you must petition the Board for an extension of your residency program.
Medline Access
Medline is accessible from all computer terminals. You may get a password through the BU library. You are encouraged to use Medline liberally.
Mentors
The department has a Faculty for Mentor program. The residents are required to select a mentor after six months of internship. The role of the faculty member is to stay in touch with you, be your advocate, and be available for counseling as needed. You may change your mentor at any time during your residency.
Objectives
The Educational Objectives for the residency program are undated and distributed to all residents at the beginning of each academic year. These objectives are specific to year and rotation, and should be used to guide your learning of topics and procedures acquired. These objectives are very useful for structuring your independent reading.
Practice Guidelines
These guidelines are developed by ACOG to establish good standards of care. The ACOG technical bulletins and Committee Reports are available in the resident library and on-line on the ACOG web-site. You should be very familiar with these guidelines.
Professionalism
Developing a professional demeanor is critical to your success as a resident and a practicing physician. Professionalism is defined not only in your interactions with patients, but also in your ability to work as a team, to interact with nurses and other non-physician personnel and medical students. You will be formally evaluated on your professionalism, but more importantly, you should establish your own professional reputation.
Professional patient physician relations are marked by a respectful demeanor with sensitivity to the patient's cultural background, race, age and personal beliefs. Interactions with nurses should always be respectful. It is never appropriate to yell, raise your voice or speak disrespectfully to anyone. The days of the cowboy surgeons are gone, and for good reason. It is beneficial to view every one in the hospital as part of a team to take care of patients.
You will spend much of your time with your fellow residents and should make every effort to maintain good relationships with them. Do not "dump" work on other residents. If it is part of your job description, make sure it gets done. If you cannot complete something that needs to get done, ask for help. You are not alone. It is better to ask for help than to leave things undone. Make sure that all sign-outs are complete and are appropriately communicated to the resident taking over your job. Do discharge summaries as they come up - do not leave them for someone else to do. If you have a conflict with another resident, do try and work it out with the other resident. If you have irreconcilable differences, contact the administrative chief resident for assistance.
Your interactions must also be professional when interacting with members of other services. You are representing our department. Consults should be seen within six hours. Emergency department patients need to be seen as soon as possible. Again, remember that you are serving as a consult and should never be demeaning or belittling of other people's knowledge. If appropriate, use the opportunity to teach. NEVER joust in the medical record. Even if you feel that the care that another service is providing is inappropriate, you must NEVER demean, detract or otherwise belittle other providers in the chart. It is completely inappropriate under any circumstances, and is fodder for medical legal nightmares.
Reading and Self-learning
To be a successful practitioner, you must read regularly and keep up with current literature. You should try to read one educational item every day. You should read the major OB/GYN journals (the Green Journal, and the Gray Journal) as well as the ACOG technical bulletins and Committee opinions. The Survey of Obstetrics and Gynecology is a very useful review of many journals and makes sure you don't miss anything important.
You should plan to read the major textbooks. However, reading them "cold" is never an effective way to get through a large amount of material and retain any information. The monthly chapter reviews will help you structure some of your reading. You should plan to read other chapters as they pertain to your training. During your month on Obstetrics is a great time to read chapters in William's Obstetrics.
Research
Residents are expected to complete at least one research project by June 1st of their senior year for presentation at Grand Rounds. The department will provide up to $1000.00 per resident once during the four years to be used to support a research project. The department will also provide up to $1000.00 for you to present a paper at a conference once during your residency.
Dr. Lynn Borgatta is the faculty member responsible for resident research. She will provide guidance and infinite wisdom for your research project. Residents must:
- Meet with Dr. Borgatta PRIOR to commencing a research project. You may be working with other attendings in this department or in another, but you must prepare a written summary of your research proposal and discuss it with Dr. Borgatta before you start the project
- If you are requesting research monies, you must present a formal, written description of the project and a budget to Dr. Borgatta, who will authorized release of funds. If IRB approval is required, this must be obtained prior to release of funds.
- You must meet with Dr. Borgatta yearly, at a minimum, to discuss progress on your research project.
- A Grand Rounds of your research project will be presented as Grand Rounds prior to your graduation.
You must notify Dr. Heffner of any bad outcome that may lead to a lawsuit. You should NEVER discuss any aspects of a case with any lawyer unless you have contacted Dr. Heffner and the hospital's legal department.
Sick Days
Everyone gets sick. It this happens to you, you MUST notify the administrative chief resident as soon as possible so that coverage can be arranged.
USMLE-3
You must arrange to take this examination during your internship year. It is possible to defer this exam to later in your program, however be aware that the USMLE is a general examination. As you get further away from medical school it will be more difficult to study and pass this test.
Vacations
You are permitted four weeks of vacation during each year of residency. All vacations must be selected and scheduled through the administrative chief resident at the beginning of the academic year. Taking two weeks of vacation consecutively is very difficult on the rest of the residents and will only be considered for unusual circumstances. Residents are expected to work until the end of the academic year.
Work Hours
The department of Obstetrics and Gynecology is committed to limiting work hours to 80 hours, as defined by the American College of Graduate Medical Education. The work week schedules are included in this manual. All non-night float work weeks are approximately 70 hours per week. This means that there are about 10 hours of flexibility in the work week, every week. This means that residents may provide continuity of care for patients, complete surgeries that they are scrubbed into, or assist in finishing the day work prior to leaving. The only three residents who have no leeway in the work week are the night float residents. They must leave precisely as scheduled. The maximum amount of time that can be worked consecutively is 24 hours, with an additional 6 hours for patient continuity and resident education. NO NEW PATIENTS may be seen during this additional 6 hours.
The 80-hour work week is a firm commitment by the department. If any resident encounters any resistance from any source, they are to contact Dr. Lee-Parritz or Dr. Hendessi immediately.
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