1. Communication and Professionalism with Staff ORIENTATION DAY JULY 7 TH, 2013 PHILLIP WILLIAMS PGY-4

2. Overview of Expectations  Rotation Specific:  Before rotation  During rotation  Rounds  Clinical Rounds  Pathology Consensus Rounds  Day Specific:  Sign-out  Intraoperative Consultations (Frozens)  Grossing  Residents

3. Before you start a rotation  Review Goals and Objectives from website  Go see the Pathologist in charge of rotation  Breast: Dr. Gravel  Forensic: Dr. Walker  GI: Dr. Marginean  GU: Dr. Belanger  GYN : Dr. Lamba  Thoracic: Dr. Gomes  Introduce yourself, remind staff of your PGY level

4. During Rotation  Be aware of two types of rounds:  Clinical Rounds  Surgeons, med oncs and rad oncs  Pathology Consensus Rounds  Multihead room/Scanner Room

5. Royal College credit for rounds  Record your attendance by signing in and personally record the time spent, date etc!  New Royal College initiative as of this academic year  Can carry forward up to 75 hours of MOC (CME) credits forward  400 CME credits are required by staff physicians for every 5 year cycle  Rounds, conferences ($$$)

6. Clinical Rounds - Presentations (Depending on PGY level)  Pull cases (or Nikki if available)  Review reports and confirm diagnosis, margins, TNM etc  Review with staff the cases and possible issues in rounds  Acquire images for most rounds:  GYN rounds have a microscope  GI rounds are variable for images (check with staff)  Scanned slides are better  See my talk July 15 th, 2013 for how to scan slides  Template in shared google drive for.ppt for rounds

7. Clinical Rounds  GI:  Monday 0745  Cancer Center, 3 rd Floor  Breast:  Monday 1200  General, 7 th Floor  Tuesday 0800  Cancer Center, Room A/B, 2 nd Floor  GU:  Monday 1630  General, 7 th Floor  ENT:  Thursday 1215  Cancer Center, Room A/B, 2 nd Floor  Thoracic:  Friday 0745  Cancer Center, Room A/B, 2 nd Floor  Gyne:  Tuesday 0915  CAPE Room

8. Pathology Consensus Rounds  All in multi-head/scanner room  GI: Daily at 1300  GU: Daily/Variable (contact staff)  Gyne: Tuesday 1200

9. Sign-Out  Check in with your staff!!!  Day before is ideal, morning of is less ideal  Some staff already have cases for the next day  May be not arriving at same time as resident  Should you take the cases or not?  Maintain communication throughout day  Not just in once in morning and once in afternoon  Check with staff if you have finished your work, or are awaiting work  Carry pager for new slides  Check email for if slides are available

10. Intraoperative Consultations (Frozens)  OR List is available for the next day starting ~1500  MyTOH on desktop  Physician resident tab  Full list of OR including names  Will be prompted for confidentiality  Pull slides that are unusual/complex cases  This will come with experience

12. Intraoperative Consultations  Review clinical histories in vOacis the day before  Frequent IOC cases:  Ovarian masses  Lung resections and mediastinoscopy  Bladder Resections  Rare:  Breast  Prostate  Common but do not really need history until in frozen  Orthopedics for neutrophil counts

13. Intraoperative Consultations (Frozens)  On Service time is 0800-1630  Check in with Staff the day before or morning of service  Depending on staff and PGY-level some staff will request you complete the grossing and prepare the slides with histotechnologist  Can call histology and ask them to page only you, or have staff paged first and then you will page when you have made the diagnosis to confirm, or slides are imminent  Hand over at 1630  Contact resident on call regarding late ORs  May give list with annotated history if pending IOC

14. Intraoperative Consultations  Generally:  Histology will page you, you should proceed to the frozen section room located on the 2 nd floor of the Critical Care Wing (CCW, the same building Pathology is located in)  Record external examination and record dimensions (all PGY levels) until staff arrives, or proceed if senior  If expecting staff and no communication:  Call office or page  Pagers fail or may not be heard, you should not be waiting for >10 minutes when expecting staff  Patient is in OR under anesthesia with associated dangers

15. Grossing  Gross lab is very efficient! If you don’t pick a case there may be none there!  If you are grossing the next day, go to gross room and review specimens for interesting case  Talk to technicians for assistance if needed  Take next case in order if there are two similar cases (SP-##-######)  If you are on a specific rotation, can ask technicians/leave note requesting them to call you for interesting cases  Very busy and most of the time happy to have you tackle and challenging case  Review: At junior level a senior resident will be designated for each week to review/directly observe  point of contact for trouble  If extremely complex for senior and junior  call staff who is on service that day for sub- speciality

16. Residents Your best asset! Show slides to seniors if questions ◦If you are having difficultly, most likely everyone had the same difficulty at your level!! ◦Benefits everyone ◦Review for seniors if they haven’t been on a rotation for a while ◦Teaching opportunity!

17. Questions?