Beeson Aesthetic Surgery Institute FELLOWSHIP HANDBOOK. (written by the fellows, for the fellows) 1 st edition- John D. Rachel, MD

Transcription

1 Beeson Aesthetic Surgery Institute FELLOWSHIP HANDBOOK (written by the fellows, for the fellows) 1 st edition- John D. Rachel, MD William H. Beeson, M.D North Meridian Street Carmel, IN (317) Fax (317)

2 3 BASIC RULES AND GOALS FOR FELLOWSHIP YEAR 1) You have 365 days to complete fellowship requirements and learn the field of facial plastic surgery; use them wisely 2) You have spent $3,000 and five years to become a board-certified otolaryngologist - head and neck surgeon; pass the written and oral certification exams 3) Secure a job as a facial plastic surgeon 2

3 Requirements for fellowship are as follows: Indiana medical license Hospital privileges at St. Vincent Hospital 86th Street and St. Vincent Hospital in Carmel, Member Indiana State Medical Association and Indianapolis Medical Society Board of Otolaryngology eligibility or certification ACLS certification DEA certified Malpractice insurance will be provided by Beeson Aesthetic Surgery Institute (BASI) 3

4 FELLOWSHIP SUMMARY Fellowship is under the direction of Dr. William H. Beeson. The fellowship includes a full range of facial plastic surgery with emphasis on facial aesthetics. Procedures include facelift, rhinoplasty, blepharoplasty, full range of facial chemical peels, and hair transplants, scalp reductions, dermabrasion, otoplasty, and laser surgeries. Fellows have exposure to oculo-plastic, Moh s, dermatologic, and other facial surgeons in the community. Clinical and basic science research opportunities are available if desired. The Fellow actively participates in the Accreditation Association for Ambulatory Health Care accreditation process and management of the Fellows practice. Practice serves as regional director for facial surgery and endoscopic surgery. Practice is located in a freestanding facility, which includes conference center, research facilities, ambulatory surgery center, and recovery care center. Upon starting the fellowship, Dr. Beeson will review the fellowship responsibilities in detail in a checklist fashion, and he will also review the fellowship summary for completion at the end of the year. These are the responsibilities of the Fellow to complete and must be completed and turned in by the end of the year. The remainder of the handbook will describe the particulars of the fellowship and requirements in order to allow for a successful year for both the Fellow as well as Beeson Aesthetic Surgery Institute. 4

5 Fellowship Responsibilities and Details I. Term of Employment: July 1 - June 30 th The current Fellow should familiarize the incoming Fellow on the important aspects of day-to-day regimen in order to facilitate easy turnover between fellows. II. Purpose of Fellowship Purpose is to learn basic skills for performance of facial plastic and reconstructive surgery under the direction of William H. Beeson, M.D. III. Fellow Education Review the BASI website, review the consultation books, and review the postoperative instructions and instructional videos for each procedure a) Video library - there are over 300 videotapes which must be maintained and viewed by the Fellow. There are several tapes pertaining to each subject, and these should be reviewed prior to the respective surgeries with Dr. Beeson b) American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) core compendium - this is the basis for the written test at the end of the year and should be completed by that time c) Fellow file - A file maintained by the Fellow of current journal articles, as directed by Dr. Beeson d) The Fellow should become familiarized with the Indiana University Medical Library on the IUPUI campus. A library card is available to physicians and should be obtained near the beginning of the fellowship to have access to the ample journals and textbooks available at the library e) Fellow is encouraged to attend the IU educational meetings on a weekly basis pertaining to facial plastics f) Fellow is encouraged to attend yearly educational meeting at Indiana University in December for Department of Otolarynology - Division of facial plastics g) The Fellow will attend a risk management course provided by Medical Assurance and laser courses from St. Vincent h) Participate in the training of IU residents as they rotate through BASI as part of their facial plastics rotation 5

6 i) Participate in the education of Fellow applicants as they come through BASI on their interviews j) Fellow will be required to be involved in clinical research for the AAFPRS paper, to be turned in by June 1st, or the date dictated by AAFPRS in order to qualify for the clinical and basic science research awards. This research project should be discussed with Dr. Beeson in detail and all deadlines should be met for the abstract and the research awards k) The Fellow is required to turn in a weekly reading and viewing list, as directed by Dr. Beeson IV. General Information/Patient Care Duties, Surgery Duties, etc. a) Office days and hours Monday, Wednesday, Thursday, and Saturday morning approximately 8:00 a.m. - 6:00 p.m. b) Surgery days generally Tuesday and Friday (these days and hours may vary) c) All activities that are done as a Fellow will be under the direct supervision of Dr. Beeson d) The Fellow is expected to participate in all phases of the patient care provided to Dr. Beeson s patients. e) Office New patients of Dr. Beeson s will be seen in consultations in the consultation room by himself in order to gain the patient/doctor relationship. These patients will generally not be seen by the Fellow, but the Fellow should be aware of the consultations and cases that may potentially be boarded from these consultations f) Preoperative patients it is the responsibility of the Fellow to complete the preoperative evaluation, which includes completion of the orange preoperative sheet as well as a dictated history and physical. It is also important to review with the patient the preoperative evaluation, surgery, as well as the postoperative convalescence, and the benefits and risks of surgery. It is important for the Fellow to understand the procedures that are going to be performed on the patients, and that this matches with Dr. Beeson has told the patient, what the patient understands, as well as what is on the consent form, and be sure that the office consent is signed and witnessed. It is also imperative that the preoperative patients understand what labs are required and that these labs are required prior to surgery. The photographs will be taken at this time, and it is important to be sure that the photographs are available before surgery. Therefore, if the photo lab will not have the photos completed in time for surgery, it is important to have 1-hour photo complete these, so the photos are available. The medical and ophtho clearances are required prior to these visits. Occasionally, neurologic or 6

7 psychiatric clearances are needed. g) Postoperative patients The 1-day and 1-week postop patients will be seen by the Fellow. Dr. Beeson will go over the important aspects of the individual cases postoperatively. It is the Fellow s responsibility to help in taking down the dressings and removing the appropriate sutures and clips at the appropriate times. Immediate postoperative patients and recently discharged patients should have postoperative follow-up phone calls after their discharge at their home or where they are staying. Therefore, it is important to obtain the correct phone numbers of where these patients will be staying postoperatively in order to contact them on post-op day #1 and #2. h) Existing Clinical Patients these patients will be seen both by the Fellow and Dr. Beeson as appropriate. Reviewing the charts on these patients prior to their appointment will assist in determining the important aspects and previous surgeries that these patients have had. All patients seen by the Fellow or procedures performed by the Fellow in the office should be dictated, as well as noted in the office chart. i) Dictation handheld devices are the standard form of dictation at BASI/ASC. At the end of each day or at anytime the handheld is full, it should be uploaded on the computer to the transcription service. Copies of all operative reports during the fellowship year will be made available to the Fellow and put into a specially marked folder for the Fellow to access, review, and maintain for possible fellowship audit upon completion of the fellowship year. j) Surgical Duties the Fellow will assist with all cases performed by Dr. Beeson. The medical records should be reviewed prior to surgery. Specific needs for upcoming cases will be reviewed at that time. It is important to be sure that the entire grid is filled out to be sure that everything is completed prior to surgery as far as H&P, photos, labs, consents, sitters if needed, and payment. Check allergies; if patient is not allergic, go ahead and ask the anesthesiologist to administer Decadron and antibiotics IV if appropriate. It s also important to review with the patient prior to going in to surgery if there has been any changes in their medical status, and perform a physical exam to be sure there is no change. Be sure to ask the patient if there s been any changes in their medications and that they had stopped all aspirin-containing products, Vitamin E, and herbs. Prior to allowing the patient to go back to the OR, it s important to review the consent to be sure it matches with the office consent and that the contact person name and number is on the consent form and that you know where they are going to be after surgery. If the surgery is at the hospital under anesthesia, the patients will come to the office to obtain order, consents and H&P that they take with them to the hospital. All photographs should be obtained prior to surgery, both slides and prints, and it is the Fellow s responsibility to make certain the photographs are appropriate views and available for surgery. On surgery days, it is the responsibility of the 7

8 Fellow to know when the patients are arriving and what the procedures are, in order to plan for the surgery. For any visitors, including residents from the IU program rotating through, it is important that they sign a confidentiality agreement and that the patient sign a statement, which states that they aware that a visiting doctor will be observing the case and that confidentiality will be maintained. The Fellow will prepare the medications, including the local infiltrate, which should be a mixture of 50cc lidocaine with 1cc 1:1,000 units of epinephrine, which creates a 1:50,000 units of epinephrine mixture. This should be placed in 2-10cc syringes with 27-gauge needles appropriately marked out and available in surgery for infiltration. Also available should be 1-10cc syringe of.25% Marcaine with epinephrine, also with a 27-gauge syringe. For any eye cases, Pontocaine should be available in the room, as well as.5cc of 10% Cocaine for lower lid blepharoplasties if they are to be done transconjunctivally. For noses, 2cc of 10% Cocaine should be available. Any time a procedure is to be done under Tumescent IE (necklift, facelift, etc.), Tumescent fluid should be mixed up by the Fellow and the instructions for the recipe are available back in the surgery area. These need to be performed appropriately and placed into the pressure bag with the appropriate IV tubing and Tumescent syringe. Also available should be a #11 blade at that time. Photographs should be laid out in appropriate fashion on the back mayo stand. Also, prior to taking the patient back to surgery, the Reston foam dressing should be appropriate sized out and cut for the dressing at the end of the case. Dr. Beeson will review with the Fellow the appropriate dressing for each procedure. Prior to entering the OR, it is the Fellow s responsibility to be sure that the appropriate instruments that will be used for the procedure are laid out, as well as going through the anesthesia machine to be sure that the appropriate instruments are available for the anesthesiologist, including laryngoscope and appropriate airway instruments. The Fellow should become familiar with the procedures in order to assist Dr. Beeson in order to be efficient during the procedure and that the procedure is done in a timely fashion. The Fellow needs to take note of the start time and periodically will be asked the elapsed time of the surgery. The Fellow must also familiarize himself/herself with the appropriate settings for the laser cases in order to have the laser properly calibrated and set for each case. Surgical hospital cases it is the Fellow s responsibility to be sure to 1) bring the camera to the hospital; 2) bring all the forms, including history and physical, laser forms, consents from both BASI as well as the hospital, and the hospital orders; 3) It is also important that the Fellow bring the instruments that are going to be used at the hospital if it s going to be a surgical case and not a laser case. The Fellow is responsible for maintaining the black bag, which should have all the hard-to-find but frequently used equipment, such as the taping, dressing supplies, injection needles, and other appropriate equipment and forms, prescriptions, and postoperative instructions and templates of the OR dictations. These should all be maintained in the black bag. Office procedures May be done either in the treatment room or in the office, and these would include laser resurfacing, revision blepharoplasty, lesion removal, shave excisions, Botox and collagen injections, and other small procedures. All consents and treatment forms should be filled out by the Fellow; 8

9 prescriptions should be given to the patient by the Fellow; and phone numbers obtained for the more extensive procedures in order to call the patient postoperatively. Again, the laser should be checked and calibrated to the appropriate settings if procedure is going to be done, whether in the office or the treatment room. k) Photography is an important aspect of photo documentation as well as teaching purposes. The consultations are seen using the digital imaging, and the Fellow should be familiar with how to set up the digital images and how to manipulate them. Fellow should also know how to use the other cameras for prints and slides. The preoperative and postoperative photographs can be taken by the nurses, but the Fellow should be aware of which photos need to be taken, and these need to be reviewed between the Fellow and the nurse. Different procedures require different views, and these should be reviewed with Dr. Beeson, and these views should remain consistent for evaluation preoperatively and postoperatively. Consents for publication purposes are always obtained directly from the patient. At no times, will any of the patient s photographs be used by the Fellow, unless Dr. Beeson gives specific permission. If the patient is a Fellow s patient, then consent should be obtained so that the Fellow is able to receive a copy upon the completion of their fellowship. l) Overnight Responsibilities It is the Fellow s responsibility to have coverage for the overnight care of patients. The ASC is accredited and requires that a nurse and a physician stay with the patients. Therefore, it is important that the Fellow knows on which nights there will be overnight cases. Usually, patients will stay overnight on Tuesdays and Fridays; however, on any night of the week, there may be an overnight case, especially if there are overnight cases from other outside surgeons. It remains the Fellow s responsibility to have coverage, even for other surgeons cases. IU residents are available for overnight stays. Any physicians that stay for overnights need to be credentialed by the Credentialing Committee, which means that they all must have proper paperwork turned in and the committee has had the opportunity to review the paperwork and credential them. Both ENT residents and anesthesia residents have been credentialed for overnights in the past, and these two specialties have been able to appropriately cover the overnights without difficulty. The Fellow is responsible for staying overnight if coverage by the residents isn t available. It s the responsibility of the Fellow to discuss the responsibilities with the residents while they are here for their overnight. There is a copy of the resident responsibilities on the shared directory of the computer. m) During the fellowship year, it is important to obtain the full experience of being in a private practice. The educational and surgical activities are important, as well as understanding what it takes to be in a private practice and run a surgery center. Therefore, in many ways, the Fellow can help out by assisting Dr. Beeson and the nurses perform duties other than what would be expected of the Fellow. This would include helping out the nurses in any way possible to expedite the daily 9

10 events. This also would include understanding and helping maintain the drug count book and general facility maintenance, i.e., generator. Because the facility is AAAHC-accredited, both the office and surgery center are required to perform many tasks in order to maintain their accreditation, and these are important for the Fellow to understand as part of the credentialing process. Responsibilities AAAHC As stated above, the facility is AAAHC-accredited and maintaining its accreditation is important, and understanding the credentialing process is important for the Fellow. The Fellow is required to perform two (2) Quality Assurance studies as noted in the fellowship duties checklist. This should be reviewed with Dr. Beeson throughout the year. Also, other responsibilities are required in order to maintain the AAAHC accreditation, which would be reviewed by Dr. Beeson. Also, as part of the quality assurance studies, are included chart reviews. The chart review should be performed at the end of each surgical day to maintain an up-to-date file. This should be reviewed in detail from each Fellow to the next Fellow at the beginning of the subsequent fellowship year in order to maintain continuity in this chart review. These are located in the surgery area at the nurses station bottom right drawer. VI. Fellow Clinic Fellow will be able to obtain and run a Fellow Clinic. This is Fellow-dependent and is the opportunity to generate many good cases for the Fellow. The Fellow will see the patients in consultations, in the office, and perform the surgeries on the patients (still with the assistance of Dr. Beeson). Fellow patients will be passed on to the succeeding Fellow, so it is important to sign out the patients between Fellows at the beginning of the fellowship year. Procedures to be done by the Fellow need to be appropriately worked up in the same fashion that Dr. Beeson s patients are worked up, and consent should be obtained with the Fellow s, as well as Dr. Beeson s, name on the consent form. Dr. Beeson will be staffing all the cases; therefore, it is essential that Dr. Beeson has the opportunity to meet the patient prior to the time that the patient is to have surgery, which would mean during the preoperative visit. Photographs should be obtained so that the patient releases the photos to the Fellow for the Fellow s portfolio upon completion of the fellowship. The study that the Fellow does may include clinical study, which would allow the Fellow to obtain several patients for several procedures. These study patients should all have the notes and the charts highlighted, and the charts should have the appropriate study designation on the front of the chart. Surgical procedures need to be discussed with the nursing staff prior to arranging procedures, as the costs for the Fellow procedures vary dramatically and may be substantially less for specific procedures. VII. Call Protocols and Procedures The Fellow is expected to be on-call the entire year, which does not allow for time to get into too much trouble. It s important that the Fellow understands that if time is needed to be away under certain circumstances, then appropriate coverage must be obtained. The Fellow cannot be out of town when Dr. Beeson is out of town. The 10

11 Fellow does not have a pager; however, does carry a phone and the BASI answering service must be able to contact the Fellow at all times, either at home or on the phone, if there are any problems or if anything comes up. On certain occasions, the Fellow will need to be out of town, including for written and oral board exams for ENT and plastics. Other potential times to be out of town would include job search/home search. All arrangements must be made in advance with the nursing supervisor and Dr. Beeson in order to coordinate scheduling. Sometimes the Fellow will be asked to cover call by some of the other surgeons in town, i.e., Dr. Zeph. If calls comes in and cases need to be performed at the hospital, it is important that Dr. Beeson is aware so that he may choose to participate in the case. VIII. Rotations The Fellow has the opportunity to rotate with several surgeons in the community. This has been very beneficial in the past and good relationships have been maintained throughout the years in the community. 1. Dr. Richard Zeph - facial plastic surgeon 2. Dr. Bill Hanke - dermatologic cosmetic surgeon 3. Dr. Michael Welsh - occuloplastic surgeon 4. Dr. Robert Jackson - cosmetic surgeon Other rotations are available with surgeons in the community, including Dr. Greg Chernoff/facial plastic surgeon, Dr. Ron Hamaker/head and neck surgeon, as well as other potential surgeons for observation of cases. The Fellow should not scrub in on cases at hospitals that are outside of the St. Vincent network system. The Fellow should also not take part in any cases at the IU Medical Center that would deter from resident education. At times, Dr. Beeson is scheduled to staff cases at the downtown hospitals and this, along with other meetings that Dr. Beeson is at, is a good time for the Fellow to rotate with the other surgeons as noted above. 11

12 Appendix ASC: Back: Fax: Dr. Beeson Home: Dr. Beeson Cell: Answering Service: Fellow Cell: St. Vincent Dictation: Press physicians ID #, then follow instructions IU Paging Service: Dr. Zeph: Suite #140 Dr. Hanke: Suite #355 Dr. Jackson: St. Vincent Hospital page: IU resident overnight liaison Dr. Richard Castellano: Go to St. Vincent Hospital 86 th St. early in the year to obtain badge/parking and physician s ID# St. Vincent 86th Street Locker #8 (combination: ) 12