Roles and Responsibilities

Osler SAR

• The SAR is responsible for and manages clinical care on Osler Firms.  This responsibility requires that the SAR:
  
  • Know every admission; the SAR will at least eye-ball every patient on the day of admission
  • Ensure that correct diagnostic and therapeutic plans are instituted
  • Review patients' progress daily
  • Review management and progress with the ACS
  • Write a note on each patient admitted to the ACS, which includes:
    • any additions or corrections to intern's note
    • an impression and plan
  • A note will not be written on Firm Faculty Admissions unless the faculty specifically requests the ACS's and SAR's help
  • Discuss the evaluation with the intern
  • Review patients' progress daily with responsible intern
  • Organize chart rounds to review patient medications
  • Establish an atmosphere of respect for the dignity of all patients and all members of the staff
  • Make sure the team functions as a team (the resident serves as liaison for interns with the emergency department, nursing and social work)
  • Recognize the SAR and not the intern is ultimately responsible and accountable for the care of the patient 24 hours a day
  • Dictate the discharge summary on ACS patients within 24 hours
  • Ensure that interns notify the clinic physician at the time a patient is admitted
• The SAR is a housestaff leader for teaching.  This responsibility requires that the SAR:
  
  • Prepare and present to team one teaching point per patient
  • At the beginning of each month plans with the visiting Attending the organization and responsibilities for Attending Rounds
  • Prepares and plans for the conduct of each Attending Rounds
  • Be responsible for delineating students' responsibilities
  • Provide timely and effective feedback to intern
  • Supervise the clinical education of medical students
    • review write-ups and discuss with the student within 24 hours of admission
    • coach and critique student presentations each day
  • Attend and participate in noon teaching rounds and Afternoon Report
• The SAR is a crucial part of the patient care team (housestaff, nurses, social workers, substance abuse counselors) and whenever necessary ensures that the intern is not overwhelmed with patient care responsibilities.
  
  • This responsibility starts as soon as the patient is admitted
  • Day or night, the SAR must be an active participant in the care of critically ill patients
  • Institute and review discharge planning at the time of initial evaluation. It is the resident's responsibility to expedite evaluations and discharge in order to help keep the service from becoming unmanageably large.
  • The SAR invites and promotes the contributions of each member of the health care team
  • Make certain the intern does not perform the initial evaluation and work up of more than 5 patients per 24-hour period
  • Make certain the intern is not assigned more than 8 new patient admissions in a 48-hour period
  • Make certain the intern is not responsible for the ongoing care of more than 12 patients
  • The SAR must not be responsible for admitting more than a total of 10 new patients per admitting day or more than 16 new patients in a 48-hour period, which includes the interns patients being supervised
• In the outpatient areas, the SAR remains a leader for the firm in the delivery of high-quality care to the firm's patient panel and in teaching.
  
  • The SAR Block, in particular, is the linchpin for the firm group practice, providing continuity of care for patients whose physicians are unavailable
  • The SAR Block promotes the concept of the shared firm group practice, accepting referrals from colleagues, following-up acute patients, and facilitating communication with consultants
  • The SAR Block promotes the educational mission of the outpatient group practice by active participation in clinic conferences and mentoring of junior colleagues
  • The SAR Block promotes the concept of the health care team in the firm practice, modeling appropriate referrals to other resources in the clinic

Osler JAR

• The JAR is responsible for and manages clinical care on Nelson-Baker Units.  This responsibility requires that the JAR:
  
  • Know every admission; the JAR will at least eye-ball every patient on the day of admission
  • Ensure that correct diagnostic and therapeutic plans are instituted
  • Review patients' progress daily
  • Write a note on each patient admitted, which includes:
    • any additions or corrections to intern's note
    • an impression and plan
  • Discuss the evaluation with the intern
  • Review patients' progress daily with responsible intern
  • Organize chart rounds to review patient medications
  • Establish an atmosphere of respect for the dignity of all patients and all members of the staff
  • Make sure the team functions as a team (the resident serves as liaison for interns with the emergency department, nursing and social work)
  • Recognize the JAR and not the intern is ultimately responsible and accountable for the care of the patient 24 hours a day
  • Help make sure attendings are informed about important changes in their patients' status (e.g. MICU transfer, death)
• The JAR is a leader for teaching.  This responsibility requires that the JAR:
  • At the beginning of each month plans with the visiting Attending the organization and responsibilities for Attending Rounds
  • Prepare and plans for the conduct of each Attending Rounds
  • Be responsible for delineating students' and sub-interns responsibilities
  • Provide timely and effective feedback to intern
  • Supervise the clinical education of medical students
    • review write-ups and discuss with the student within 24 hours of admission
    • coach and critique student presentations each day
  • Attend and participate in noon teaching rounds and Afternoon Report
  • Assume responsibility for self-education
  • Prepare CASE I presentation, writes CASE II report
• The JAR is a crucial part of the patient care team (housestaff, nurses, social workers, substance abuse counselors) and whenever necessary ensures that the intern is not overwhelmed with patient care responsibilities.
  • This responsibility starts as soon as the patient is admitted
  • Day or night, the JAR must be an active participant in the care of critically ill patients
  • Institute and review discharge planning at the time of initial evaluation. It is the resident's responsibility to expedite evaluations and discharge in order to help keep the service from becoming unmanageably large.
  • The JAR invites and promotes the contributions of each member of the health care team
  • Make certain the admitting intern does not perform the initial evaluation and workup of more than 5 patients per 24-hour period
  • Make certain the first-year intern is not assigned more than 8 new patients admissions per 48-hour period
  • Make certain the first-year intern is not responsible for the ongoing care of more than 12 patients
  • When supervising more than one intern, the JAR resident must not be responsible for the ongoing care of more than 24 patients
  • The JAR must not be responsbile for admitting more than a total of 10 new patients per admitting day or more than 16 new patients ina 48-hour period, which include the first-year resident's patients being supervised period

Osler Intern

• The intern practices medicine.  This responsibility requires:
  • Serving as the patient's primary hospital physician
  • Being the initial evaluator of the patient
  • Obtaining all necessary data (history, physical, lab) required to formulate a clinical impression and plan. Seek information from outpatient and primary physician.
  • Communicating this impression and plan to the resident, recognizing that the resident is ultimately responsible to the ACS for the care of the patient.
  • Placing write-ups in the chart by 8 a.m. the morning after a call night
  • Maintaining flow sheets of clinical data
  • Expediting morning rounds by pre-rounding on all patients
  • Writing daily progress notes (including cross-cover notes)
  • Talking with the residents within one hour after a patient is admitted to review initial plans
  • Working on discharge planning from the day of admission
  • On average, the individual primary first-year resident will not be responsible for the initial evaluation and work up of more than 5 patients per 24-hour period
  • The upper limit for patient admissions per 48-hour period to an individual primary admitting first year resident is 8 patients
  • The upper limit for the ongoing care of patients for a first-year resident is 12 patients
• The intern learns medicine.  This responsibilty requires:
  • Attending teaching activities such as Attending Rounds, Noon Conferences, and Grand Rounds
  • Working with the resident to seek information pertinent to the care at hand
  • Solicits feedback from residents and attendings about his/her learning and performance
• The intern teaches medicine.  This responsibility requires:
  • Participating in the teaching of medical students and others on the team