Adult Gastroenterology Training Program

On-Call and Leave

ON-CALL

The objective of resident involvement in the call process is to develop skills in the efficient assessment and triage of patients in the Emergency Room while under supervision by GI attending staff. As part of this training, GI residents participate in home call and assessment will sometimes occur over the phone by communicating with a junior resident rotating through the GI service. In situations of diagnostic or therapeutic uncertainty, patients may require direct assessment by the GI resident in person. The frequency of call is designed to provide optimal and adequate exposure to urgent clinical problems and endoscopic procedures. In both years of the program, the resident is on-call approximately one night per week and one in four weekends.

Attending staff on-call remains available for advice either by phone or in person. Attending staff needs to be informed of all patients who have been seen or assessed by the GI resident. The timing of this notification depends on the resident’s stage of training, and subject to the judgment of the resident. Graduated responsibility applies as the resident’s knowledge and skills mature. Routine and uncomplicated consultations can usually be discussed with staff early on the next working day. Attending staff should be informed in a timely fashion in the following circumstances:

  1. Patients who require urgent after-hours endoscopy
  2. Patients who have complex management and triage issues, which the GI resident does not feel capable of handling without further advice
  3. Seriously ill patients
  4. Patient death

Several things to note:

  1. Patients who are being discharged from the Emergency Room need to have a satisfactory follow-up plan in place. This must be discussed with attending staff prior to discharge.
  2. The GI resident should not be functioning simply as a conduit of information between the junior medicine resident and the GI staff. All consults seen by the junior medicine resident are to be reviewed with the GI resident first either in person or over the phone. If the GI resident is not certain about appropriate course of management, the patient will need to be assessed by the GI resident in person before contacting the GI staff.
  3. Signover of GI admissions and consults should occur between 1630 h to 1700 h the afternoon before call starts and between 0800 h to 0830 h the following morning (or on Monday morning after weekend call). Patient lists should be updated in Citrix on a daily basis.
  4. After-hours consultations from inpatient services are the GI Resident’s responsibility.
  5. Request and consult for ERCP procedures need to be vetted first by the on-call team, which will then contact the ERCP staff (Drs. Lumb, Seaton, Tse).
  6. The operators are instructed to direct calls from the emergency department and inpatient services to the GI resident. Calls from outside referring doctors will be directed to the GI staff. This allows efficient assessment and triage of patients in the emergency room while under supervision by GI attending staff.
  7. Residents must be relieved of ALL clinical and academic responsibilities post call (home by 24 + 2 hours) when they are called into the hospital to perform duties between midnight and before 6 am or when they are called into the hospital to perform duties for at least 4 consecutive hours with at least one hour of which extends past midnight.
  8. Residents on home call may be reimbursed up to $70 per month for taxi charges if:
    • The resident does not have a parking pass
    • The resident is called in for clinical duties after 6 pm and before 6 am

    The travel allowance will be provided upon presentation of appropriate receipts and credit card statements

  9. Back-up weekend call schedules are prepared by the Chief Residents with each call schedule and are only circulated internally among GI residents and staff. The expectation is that normally the residents on weekend call will help each other out with coverage issues and the GI staff can provide back-up as necessary. Back-up residents are expected to be available by pagers between 0800 h to 0900 h each weekend day or holiday (e.g. Saturday, Sunday, long weekend Monday). Back-up residents are only activated when both residents on-call have been called into the hospital to perform duties between midnight and before 6 am or when they are called into the hospital to perform duties for at least 4 consecutive hours with at least one hour of which extends past midnight. It is the responsibility of the on-call residents to activate the back-up resident between 0800 h to 0900 h when necessary after discussion with each other. The GI staff should also be notified about the activation of the back-up resident. The back-up resident and the GI staff will then provide coverage for all sites until 1700 h when both residents return to call after adequate rest.

LEAVE

Vacation

The Postgraduate Medical Education Committee has drawn up guidelines relating to vacations in keeping with the terms of the PAIRO-CAHO Agreements:

  1. Residents are entitled to 4 weeks of paid vacation per year. Vacation time must be taken within the academic year July to June. A week of vacation is defined as 5 working days plus 2 weekend days (20 working days).
  2. Requests for vacation shall be submitted at least 4 weeks before the proposed commencement of the vacation and not later than March 1. As an exception, each resident taking a certification examination in June shall have until April 15 to make a written request for one week of his/her vacation entitlement.
  3. The Resident is to submit a request on medportal. Approval will need to be obtained first from the Chief Residents who is responsible for the resident call schedule, followed by the Clinical Supervisor, the Site Coordinator and the Program Director in this sequence.
  4. The PAIRO-CAHO agreement states that, “All vacation requests must be confirmed or alternative times agreed to within two weeks of the request being made.” This being recognized, it may not always be possible to confirm the request within two weeks. In these instances, the expectation would be that the Resident receives communication regarding the request within the two week period. For example, the Resident would receive an email stating that the request had been received and is then provided with a time when s/he can expect the approval. It is important that timely communication between all parties take place, in order that the Resident receives timely confirmation of the vacation request.
  5. Vacations may be taken by housestaff at any time; the timing of vacation may be delayed where necessary, having regard to the professional and patient responsibilities of the hospital department for the time the vacation is requested.
  6. All housestaff are entitled to the following recognized holidays:
  7. New Year’s Day

    Thanksgiving Day

    Family Day

    Christmas Day

    Victoria Day

    Boxing Day

    Canada Day

    New Year’s Day

    August Civic Holiday

    Floating Holiday

    Labour Day

     

    Please refer to Medportal for the dates of each holiday

    If a resident works on a recognized holiday, s/he is entitled to a paid day off in lieu at a mutually convenient time within 90 days.

  8. Over the Christmas-New Year’s break, each resident is allowed five consecutive days off during the 12 day period encompassing Christmas Day and New Year’s Day. These 5 days account for Christmas Day, New Year’s Day, Boxing Day and two weekend days. The residents will determine amongst themselves the division of holiday time, with overview by the Chief Residents. Residents do not get additional lieu days for working on any of the statutory holidays during the period.
  9. If a resident observes religious holidays that are not specifically listed in the PAIRO-CAHO Collective Agreement, our program will try to accommodate the religious practice to the point of undue hardship (“undue hardship” may include a number of factors, such as patient safety, the hospital’s service requirements, and the resident’s educational / training requirements). It is the resident’s responsibility to request accommodation. Any requests for time off to observe religious holidays must be submitted as vacation requests through medportal and are subject to the same mechanism of approval.
  10. Vacation entitlements do not carry over from one year to the next.
  11. Housestaff may arrange for their vacation to be taken in one continuous period or in one or more segments of at least one week in duration provide professional and patient responsibilities are met. If a trainee is requesting a vacation block of > 10 days, this request should be made well in advance, before the rotation schedules are drawn up for each academic year. In essence, any vacation block of > 10 days should be requested prior to the start of the academic year in order to enable the program to accommodate such requests wherever possible. It should be recognized that missing > 2 weeks in a 4-week mandatory rotation could impact on the resident’s program and should be discussed with the Program Director.

Professional Leave

  1. In addition to vacation entitlement, residents are entitled to additional paid leave (up to a maximum of seven working days per year) to attend educational events, such as medical conferences approved by the Program Director provided that professional and patient responsibilities are met to the satisfaction of the hospital department head.
  2. Residents are also entitled to paid leave for the purpose of taking any Canadian or American professional certification exam. This leave time shall include the date(s) of the exam and reasonable travel time to and from the exam site. This leave is in addition to other vacation or leave time.
  3. Professional leave will take priority over vacation leave, and priority will be given to residents presenting papers.

Leave of Absence
Interruptions in training which require a leave of absence may be granted by the Postgraduate Dean on recommendation of the Program Director. In order to request a leave of absence from the program, the Resident should complete a Request for Leave of Absence Form that can be obtained from the Postgraduate Medical Education Office website. This form is then submitted to the Program Director for approval and then forwarded to the Postgraduate Medical Education Office. Additional information regarding maternity leave, parental leave, and sick leave entitlements are available through the Postgraduate Medical Education Office website.

It is understood that residents will return to a residency program following the leave of absence and that residents are expected to maintain a standard of conduct in keeping with the standards of the residency program, the university and the medical profession at large. It is anticipated that the required time lost or rotations missed must be made up with equivalent extra time in residency upon the residents return to the program. Normally all residents will be required to complete all mandatory / elective components of the program.

All leaves are reported to the College of Physicians and Surgeons of Ontario by the Postgraduate Medical Education office.

Medical Leave

  1. A doctor’s note must be provided to the Program Director prior to taking a scheduled medical leave.
  2. The Postgraduate Medical Education Office must be notified of all leaves of absence.
  3. Ministry of Health funded residents on medical leave will receive full pay for 6 months and after 6 months are eligible to apply for Long Term Disability.
  4. To maintain your residency appointment with the University, the resident or his/her delegate will provide a report to the Postgraduate Dean on the resident’s status every 3 months.
  5. The Postgraduate Medical Education Office requires that a medical letter from the resident’s physician stating that the trainee is fit to resume training prior to return from medical leave (normally, a doctor’s’ note is not required for leaves of less than 2 weeks duration, provided the leave is not recurrent).

Compassionate/Personal Leave

  1. The resident must complete the leave form and attach a letter of support from the Program Director.
  2. The Postgraduate Medical Education Office normally does not need to be informed about leaves of less than 2 weeks. This is unpaid leave.

Maternity/Paternity Leave

  1. The total amount of time off for a maternity/parental leave is 52 weeks (2 weeks paid EI waiting period, 15 weeks of Maternity Leave, and 35 weeks of Parental Leave).
  2. Maternity benefits are paid to the birth mother. The mother can start collecting benefits up to 8 weeks prior to the expected birth. Parental benefits can be claimed by one parent or shared between the two parents but will not exceed a combined maximum of 35 weeks. Parental leave cannot be taken until the birth of the baby.
  3. EI will pay a maximum of 50 weeks at a basic benefit rate of 55% of average insured earning up to a maximum payment of $468 per week.
  4. For 25 weeks only, Hamilton Health Sciences will top-op salary to 75% of resident earnings based on what is received from EI. To receive top-op, EI stubs must be submitted to Frieda Gies, Payroll, Standard Life Building, 120 King Street West, Suite 200, Hamilton, ON L8P 4V2 or by fax to 905 393 2726.
  5. On the last day worked, Frieda Gies should be called (905 393 2700 or 1 877 667 2700). The resident’s Record of Employment can be either mailed to the resident or arrangements can be made to pick up.
  6. The resident should apply to EI as soon as work is stopped (1-800-206-7218 or www.hrdc-drhc.gc.ca under Employment Insurance.