The Department of Surgery has carried out comprehensive restructuring of the entire working environment over the past decade. The two acute care surgery teams at UL Hospital have been covered by the elective general surgery and critical care fellows two nights per week. There is a day float PGY-1 on the floor and PGY-2 in the ICUs to aid in work completion, as needed. This has allowed the post-call residents to sign out and leave early in the morning. This also has led to increased communication amongst the residents and compliance with the ACGME resident duty hour policy.

This year we have reorganized several rotations and created new surgical oncology and colorectal rotations that are service-based and involve three of the integrated hospitals. Junior residents continue to take in house call at these hospitals, so we do not use a night float system. These rotations have allowed a more focused educational experience, including clinics with these specialty faculty members. This also has decompressed the busy Norton general surgery rotation making it more manageable for the PGY-4 chief. Junior (PGY-1,2,3) residents take in-house call on most all rotations, while senior (PGY-4,5) residents are on call from home except at the level 1 trauma center at UL hospital. Residents often switch call around to fit their personal needs as long as patient care is not compromised.

The required core conferences: Grand Rounds, Quality Improvement, and Residents Clinical and Basic Science Conferences have been moved to Friday morning from 7-10AM. This has led to increased conference attendance by both the residents and faculty, well above the 80% RRC minimum. The QI conference involves traditional presentation of selected patient mortality and morbidities, which also includes a discussion of the basic patho-physiology and clinical characteristics of the disease process being discussed. A pertinent literature review is included, as well. The residents’ conference has been restructured to include some didactic material with emphasis on clinical management. Case presentations usually are included and select residents will be called on to advise clinical management to the group.

Internet access is available at all hospitals and dictation systems function by call in from any remote location. The SCORE curriculum has been incorporated with monthly assignment of modules. Completion of the weekly ACS curriculum is also mandatory.