Page 9 - HPB Handbook - May 30 2022 (Flipbook) v2

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team. Discussions with the staff on the service are highly encouraged prior to the start of the rotation so both staff and
learner expectations regarding patient care are delineated including which clinics and ORs to attend.

It is understood that residents and fellows may interchange roles and responsibilities in order that each is able to participate in
the academic program of the University as per the Standards of Accreditation and in extenuating circumstances such as
unforeseen health issues, vacations etc. Typically fellows will round with the junior residents on Thursday morning when the
senior residents are at their academic sessions.

In addition, fellows will round on weekends alternating with the senior residents. Fellows and residents are entitled to two full
weekends off per month (at a minimum) with no clinical duties.

Clinical fellows should recognize and exercise their important educational responsibilities with respect to residents and medical
students, through fostering educational experiences and availing themselves for discussion of the more complex aspects of
patient care and decision-making, teaching in the operating room and emergency department. In this way, we expect clinical
fellows to enhance residents’ and students’ educational experiences beyond that provided solely by attending staff surgeons
and residents.

B. Intra-Operative Care

The attending surgeon is responsible for assigning appropriate components of the case to the appropriate learners. This
approach should be discussed by the staff with the residents and fellows at the beginning of the resident’s or fellow’s rotation
(with examples). Prior to each case, the specific parts of the operation should be reviewed with the operating team, and
“assigned” by the responsible staff surgeon, so that the appropriate expectations are understood and met. Some cases may only
be appropriate for the resident to complete (i.e. no fellow component). In addition, depending on the nature of the case there
may be opportunities for the fellow to lead the junior or senior resident through some or all of an operation.

Resident Roles
The Junior Resident’s role is to assist in implementing the treatment plan established at the daily ward round. Residents
should be well informed about all patients, including the relevant investigations. Residents should liaise with other hospital
staff to facilitate the treatment plan and must keep relevant and accurate medical notes. Residents should have a good
understanding of the patient’s co-morbidities and current illness as well as planned treatment. After seeing a patient the
resident must dictate a brief consult note. This is particularly important for emergency consults seen in the ED or in the
Ambulatory Care Clinic. If the patient arrives for a follow up clinic appointment, it is important that they have some
documentation of the surgical consultation.

The Senior Resident should know all details of every HPB patient. This includes recent blood results and imaging studies.
Most importantly, the Senior Resident must develop skills in assuming total care for their patients, including knowledge of
past treatment (e.g., surgery, chemotherapy, radiotherapy, interventional radiology procedures) and relevant comorbidities. It
is expected that a clear treatment plan, including future investigations and discharge plans can be articulated by the
senior resident, and communicated to the on-call staff, fellow and nursing staff at any time. A provisional discharge
date should always be communicated to the patient and nursing staff. It is the responsibility of the senior resident to ensure
the junior members of the team understand the patient’s co-morbidities, current illness issues, and management plan. Any
significant change in any patient’s condition should be communicated to the staff on-call for HPB. Similarly, the on-call staff
should be made aware of any new admissions that have come in from the emergency room or handed over to us from other
units. HPB consultations at Mount Sinai Hospital will be covered by the HPB Attending Staff and Fellow, not the Resident.

Clinical Fellow Roles
There will be one HPB Surgery Clinical Fellow attached to this service at all times. That fellow is expected to help in the OR
for complex and interesting HPB cases – both electively and emergently. They are also expected to be a source of
information and advice for the residents. They will attend the ward rounds with residents in the morning, with the
rounds led by the senior resident. The role of the fellow is to ensure that any complications of the HPB patients are
detected in a timely fashion and to provide advice and guidance in the management of these complications. The resident will
perform certain steps of the major HPB operative cases and the fellow will perform other steps. This will be discussed at the
start of the case by the staff, fellow and resident. It is expected that the presence of a fellow will enrich the experience of the
residents. Every effort will be made by the staff of this unit to ensure that each person on this team has their expectations met.