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Oncology

Team Structure AY 2019-2020

4 Day Teams: (1 solid team, 2 liquid teams, 1 BMT team).

  • Solid (Onc A): 1 resident (BI) and 2 interns (2 BWH)
  • Liquid/Heme Malignancy (Onc B): 1 resident (BWH) and 2 interns (BWH/BIDMC)
  • Liquid/Heme Malignancy (Onc C): 1 resident (BWH) and 2 interns (BWH)
  • BMT: 1 resident (BWH) and 2 interns (BWH)

NEW Twilight Team (beginning AY 2019-2020):

  • 1 twilight intern per day team (4 interns total)
  • 2 twilight residents total (Onc A/B twilight resident, Onc C/BMT twilight resident)

Overnight Team: 1 night resident, 1 night intern

Team Members

Day Interns

  • Work from 7AM-5PM, no admissions after 5 pm (single admission between 4-5 pm)
  • Meets with twilight team at 4pm for dedicated 30 minutes of teaching followed by sign out with all team members present
  • Weekends: Work 8AM-5PM on one day
  • If an admission page is received before 5 pm and the patient is located in BWH/ED then it is the day team’s responsibility. If the patient is an OSH transfer or direct admit (from outside clinic/home/DFCI) then the note can be prepped and patient passed off to the twilight intern. In this case the admission will be passed back to the same team the next morning

Twilight Interns

  • Work weekdays, 4 PM to 2 AM, admit until 12:30 am, signs out to night intern at 12 AM (but must remain in house to receive admissions until 12:30 AM)
  • Comes in at 12pm when either of the Day Interns has clinic. If you need to come in early more than twice per week for clinic coverage, please contact the CMRs. (see “Clinic” below)
  • Onc B twilight intern & Onc C twilight intern are off Saturday
  • On Onc A twilight intern & BMT twilight intern are off Sunday
  • Transition Days:
    • If a twilight intern is switching to a day rotation, the twilight resident is expected to ensure the twilight intern is out by 10 pm.

Nightfloat Intern

  • Weekdays: 11:59 PM to 7:30 AM; weekends: 11:59 PM to 8 AM
  • Accepts sign out from all four twilight interns starting at 12 AM
  • Nightfloat intern is off on Sunday
  • During the week, expected to attend morning report from 7:30-8:30 AM and then present admissions (as many as possible, time permitting) to day teams (night intern/resident should coordinate with day teams to devise a plan for presenting holdovers each morning, as the night team will likely have done admissions to multiple different teams overnight)
  • May not stay past 10 AM to present admissions

Day Residents

  • Weekdays: 7 AM – 5 PM
  • Covered by either dayfloat or the twilight resident while in clinic depending on the number of residents in clinic (see “Clinic” below)
  • On one weekend day, res-interns half of list
  • Covered by WER on one weekend day
  • Responsibilities:
    • Triages and supervises admissions until 5 PM
    • Leads morning huddle and rounds
    • Interdisciplinary rounds
    • Signs out to twilight resident

Twilight Residents

  • One twilight resident for Onc A/B, one twilight resident for Onc C/BMT
  • Onc A/B Twilight resident: Weekdays (Monday-Friday) and Sunday: 4 PM – 2 AM
  • Onc C/BMT Twilight resident: Weekdays (Monday-Thursday) and Saturday-Sunday 4 PM – 2 AM
  • Twilight Resident comes in at 12pm when both of the residents (i.e. Onc A/B or Onc C/BMT) have clinic. (see “Clinic” below)
  • Onc C/BMT Twilight resident is OFF Friday and covered by WER
  • Onc A/B Twilight resident is OFF Saturday and covered by WER
  • Responsibilities:
    • Takes over responsibility for admissions from 5 PM – 12:30 AM
    • Observes sign out from twilight interns to nightfloat intern (at midnight)
    • If the Oncology twilight intern is switching to a day rotation, the twilight resident is expected to ensure the twilight intern is out by 10 pm.

Nightfloat Resident

  • Works Monday – Friday and Sunday 11:59 PM – 7 AM, OFF on Saturday nights
  • No Nightfloat Intern on Sunday
  • Supervises admissions done by night intern, helps with admissions as needed
  • Helps twilight resident get out at midnight by helping to supervise the twilight interns after 12 AM
  • There is no cap for the number of admissions that the night team can be assigned. The Onc NF resident is to help with the admissions and if he/she is too busy, discuss with the PHYS who can help redistribute to other night teams.
    • Transition Day: If the Twilight resident is switching to a day rotation, the nightfloat resident is expected to come in at 9:30 pm to ensure the Flex resident is out by 10 pm.

BI interns/residents

  • BI resident: 1 resident on Onc A day resident year round
  • BI interns: 2 interns year round
    • 1 BI intern on Onc B day intern
    • 1 BI intern on Onc A twilight intern
  • BI interns: Please notify your BWH residents of clinic days to ensure no conflicts with internal clinic coverage.

Weekend Rounders

  • Onc Weekend Rounder 1: Covers residents’ day off for Oncology A and BMT
    • Takes pass off at 8 AM
    • On both Saturday and Sunday, will res-intern to cover interns who have the day off
    • Can sign out to twilight resident at 5 PM
  • Onc Weekend Rounder 2: Covers residents’ day off for Oncology B and C.
    • Takes pass off at 8 AM
    • On both Saturday and Sunday, will res-intern to cover interns who have the day off
    • Can sign out to twilight resident at 5 PM
  • Onc Twilight/Nightfloat Weekend Rounder:
    • 4 PM – 1 AM on Friday (note shorter than usual twilight shift, on Friday night), 5 PM – 8 AM on Saturday
    • On Friday, acts as Onc C/BMT Twilight Resident, overseeing admissions. Oversees twilight interns for Onc C and BMT, including sign out to nightfloat intern.
    • On Saturday, acts as Onc A/B Twilight Resident, as well as night float resident. Oversees twilight interns for Onc A and covers Oncology B . Will then supervise nightfloat intern.

Admitting Structure

Team Caps

  • Oncology A1: 14
  • Onc B/C: 16 (can uncap for acute leuks)
  • Intern cap: 9
  • Extreme Census: There is NO change to the team caps in Extreme Census. If oncology teams and PA oncology teams have capped, plan as per DFCI leadership, Joel Katz, and CMRs.

Daily Structure

  • Morning Report: 730 – 830 am M-Th Residents at Morning Report; interns pre-round or Morning Report
  • Rounds: 830 – 1100 am Rounds MUST be done by 11 am. Rounds should start at 9am on Fridays to allow for attendance at Grand Rounds.
    • 8:30-10:30 am – Bedside walk rounds
    • 1030-11 am – Card-flip on remaining patients
  • Care Coordination and Work Time: 11 am – 12 pm
    • Residents attend care coordination rounds; intern work time prioritizing discharges and critical tasks.
  • Resident Noon Conference: 12 – 1 pm Residents and interns expected to attend.
  • Work Time: 1 pm – 4 pm
  • NEW Sign Out Rounds & Daily Teaching: 4 – 5 pm: Day team and twilight team members to meet at 4 PM daily for sign out rounds and 30-minutes of dedicated teaching to be done by team resident, attending, twilight resident, and interns per teaching schedule outlined by team resident at the beginning of each 2 week rotation.
    • Wednesday: 15 minute slide rounds, by team, starting at 3PM at the microscope in the hematology lab, led by Dr. Aric Parnes. Submit patients to the CMRs on Tuesdays or review teaching slides.
    • Thursday: Oncology teaching for all teams, lookout for an email on Thursday morning with the location and teacher.
    • Friday: Feedback is an essential part of training; individual feedback between all team members should occur each Friday during teaching time.
    • All teams are expected to attend slide rounds and group oncology teaching, barring clinical emergencies

*Work Room Locations for Sign Out Rounds: *

Clinic

  • If both team residents covered by a twilight resident (i.e. Onc A/B or Onc C/BMT) have clinic, then that twilight resident should come in at 12PM. If only one team resident within a twilight dyad has clinic, Dayfloat covers. However, if there are several Dayfloat needs in the Tower and Shapiro, the CMRs may request that one or both twilight residents come in at 12PM, regardless of the above. Oncology twilight residents are expected to look at Amion ahead of their block to identify days when they will need to come in early.
  • If one of the team interns has clinic, twilight intern comes in at 12PM. If as the twilight intern you need to come in early more than twice per week for clinic coverage, please contact the CMRs.