Residency Programs: Policies & Procedures
Performance & Leave Policy
Resident performance is evaluated through direct and indirect observation by faculty and house staff as the residents perform their duties. The criteria used for these evaluations include cognitive and non-cognitive characteristics.
Seven areas are considered in the evaluation: 1) clinical performance, 2) knowledge, 3) judgment, 4) technical skill, 5) teaching and learning, 5) professional attitudes & behavior, 6) personal qualities, and 7) overall performance.
Presentations and attendance at weekly conferences (Grand Rounds, Intern Conference, Basic Science, Skills Lab, Journal Club, Technical Conduct Sessions, etc), research activities, and publications are also taken into account in evaluating overall performance, but the heaviest weight is given to performance on the clinical rotations.
- Clinical performance: Evaluation of clinical performance is based upon the proper execution of patient care duties, which includes work ups and preoperative and postoperative care. Important aspects of clinical performance are knowledge of assigned patients, interest in management of patients, skill in management of patients, history taking and physical examination skills, effective data gathering, problem identification, appropriate differential diagnosis, prioritization of clinical issues, appropriate use of laboratory tests, studies, consultants, performance under emergency conditions and awareness of limitations
- Knowledge: Evaluation of knowledge is based upon the individual's familiarity with medical facts, concepts, and processes and the ability to use this information in solving clinical problems. Knowledge is assessed by subjective and objective means. Examples of the former include the impressions made as a result of presentations at patient management conferences and discussions with members of the faculty. Each resident in the General Surgery residency is required to take the In-training examination yearly, and the results are used in the objective assessment of cognitive performance.
- Judgment: Judgment is assessed by observing the ability of the resident to choose between alternatives. This pertains to diagnostic as well as therapeutic decision-making. The resident must be able to integrate medical facts and clinical data, evaluate alternatives, assess and analyze risks and benefits and reason through ambiguous situations.
- Technical skill: This is evaluated by faculty and resident supervisors primarily based on performance of procedures in the operating room. However procedures performed in the outpatient setting and at the bedside also contribute to this assessment. Important elements are economy of motion, precision in use of instruments, selection of instruments/sutures, dexterity, effectiveness is basic skills, ability to build upon skills, ability to extrapolate common elements of movements or techniques to apply them to parallel situations, ability to plan the sequence of a procedure
- Teaching and learning: These activities are evaluated by faculty supervisors and other residents based on teaching ability at the bedside, on rounds and during conferences, as well as the resident's ability to organize and lead the resident team under his or her command. Important elements include study habits, evidence of independence in learning, motivation and effective supervision. Additionally faculty and other residents assess the resident’s interest in learning, as demonstrated by evidence of reading, questioning and investigating, attendance at required program and service conferences. All residents are required to attend a minimum of 75% of Grand Rounds sessions, excluding vacation periods or other excused absences.
- Professional Attitudes & Behavior: This includes the resident’s professional conduct and relationships with patients, families, nurses, peers, faculty and other hospital personnel. It includes reliability, dependability, responsibility, ability to function as a team member, communication skills, organization and time management skills. It also includes discharge of administrative responsibility as reflected in the timely and accurate completion of patient records, completion of dictations, as well as paperwork required for the residency program (completion of assigned evaluations, timely and accurate entry of work hours data)
- Personal Qualities:This includes evidence of integrity, interest, maturity, leadership, image and an appropriate attitude. It also includes evidence of a commitment to the patient as the primary focus
- Overall Performance:This is a compilation of all the performance elements listed above.
The results of the evaluation process are recorded on the evaluation form. ABSITE results and conference attendance records are collated by the Resident Education Office. The material in these files is provided to the SEC and the SEC conducts a formal review of each resident a minimum of twice during each academic year. The results of the formal review and the summary evaluation will be provided to the resident as well as the resident's advisor. The advisor is responsible for discussing it with the resident. Signed originals of the Summary Performance Review Sheet and the accompanying letter are included in resident personnel files in the Resident Education Office.
Feedback should also be provided directly by the service chief during a rotation via “exit interviews”. These discussions cover the areas where performance should be improved and advice on how to accomplish this. Areas of outstanding performance are also cited. If the level of a resident’s performance is judged by the SEC to fall below minimum standards, this will be communicated to the resident and his/her advisor. Inadequate performance may result in remediation, probation, or dismissal from the program, depending on each individual circumstance.
Residents are appointed on a yearly basis. Residents whose performance meets the expected standards will be promoted to the next level of training.
Probation is a conditional status that places specified requirements for improved performance on the resident, with dismissal from the residency as a possible result if the prescribed improvement does not occur. The requirements will be tailored to the individual situation, and they will prescribe the response expected of the resident and will include time limits for the probationary period. These requirements will be given to the resident in writing and discussed with the resident by his or her advisor, who must attend the SEC meeting when the resident is discussed. The resident is also required to speak directly with the Chair of the SEC. The performance of a resident on probation will be reviewed at least quarterly by the SEC, which may remove or extend probation and provide additional feedback to the resident and advisor. In general, residents will be expected to earn removal from probation within one or two quarters, but the maximum period of probation cannot exceed 8 consecutive quarters. At this point dismissal from the residency program would be likely unless there were compelling extenuating circumstances.
Any resident who scores below the 30th percentile on the in-training examination (ABSITE) is automatically placed on probation. The resident must submit, in writing, their study plan to improve their scores for the next ABSITE to the SEC. In order to have the probationary status lifted, the in-training exam score the following year must exceed the 30th percentile or increase by 20 percentile points. If the resident fails to meet these performance standards on the in-training examination, the SEC may consider asking the resident to repeat a year. In addition, any resident who is required to take the exam and fails to do so, will automatically be put on probation, unless the resident is on vacation or has received permission to be absent from the Program Director or the Associate Program Director(s).
Although rare, dismissal from the residency program is a potential consequence of poor performance. Dismissal may follow a period of probation, or in exceptional circumstances, it may occur without a preliminary probationary period. Examples of events that may instigate dismissal without prior probation include criminal behavior and some types of substance abuse, dishonesty, or immoral behavior.
Substance Abuse: Although the Department of Surgery will not tolerate substance abuse among its residents, substance abuse will not necessarily result in dismissal. Each case will be considered on its own merits. Residents troubled by substance abuse will be referred to the University of California, Faculty and Staff Assistance Program. In some cases, the recommendation may be for suspension (with pay and benefits) until the outcome of therapy can be determined.
The process for appeal of an adverse action such as remediation, probation or dismissal from the program is detailed in the House staff Handbook, and is available on the GME website. In general the resident will receive notice of a proposed adverse action and will have an opportunity to meet with the SEC, with his/her advisor present, to provide the resident’s perspective on the performance issues. Following that meeting, the SEC will decide on a course of action. Should the SEC determine that an adverse action is warranted, the resident will have the opportunity to appeal through the office of the Vice Dean for Education.
- PGY1s: 2 weeks of vacation and two weeks of educational leave.
- Ortho and NS PGY1 categorical receive (4) one week blocks.
Rules for the 1 week vacation block for the interns
- Each intern MUST notify the rotation from which they are taking their 1 week of uncovered vacation at least 30 days prior to the start of the rotation regarding which week they will take off. Failure to notify the service in advance as required may mean the resident will not be able to take the week off. (The only exception to this rule is the resident who has to take this week from his July rotation. )
- The week is from Monday to Monday and MAY NOT include 2 weekends.
- In those circumstances where there are 2 residents assigned to the same service, THE WEEKS OFF MAY NOT OCCUR AT THE SAME TIME.
*Please note: Some services may require a more advanced notice (i.e. 60 days prior to start of rotation). If this is the case, the service administrator will contact you directly. Please be sure to respond to them asap.
- PGY-2 ,3, 4, &5's: One month annual leave which must be taken as a one month block which is two weeks of vacation and 2 weeks of educational leave.
Maternity and Paternity Leave
Since the birth of a child is not usually an unexpected event, notification of the Department in writing of the resident’s intent to go on leave should be made at least 5 months in advance. Typical maternity leave is two weeks paid leave prior to the anticipated due date and one month post delivery. Vacation can be scheduled as additional paid leave in conjunction with maternity leave. In addition, up to 60 days unpaid leave can be added to the paid leave mentioned above. Typical paternity leave is one week, prior to or after the birth of a child.
Sick Leave & Disability Leave
Each resident is entitled to use up to twelve (12) days per academic year for personal illness or disability. In addition, any remaining educational or vacation leave may be used to cover illness or disabilities, which exceed twelve (12) days of sick leave. Should a resident exhaust all paid time leaves (sick, educational, and vacation), the resident may be placed on an unpaid leave until the end of the illness or disability. The total length of the leave (paid and unpaid together) may not exceed four (4) calendar months unless expressly extended in writing by the Chair or Program Director with the Chair’s approval. Any sick leave balance does not carry over from year to year.
Leave of Absence
Any resident who required a leave of absence that exceeds one month in a calendar year, MAY be required to make up the lost time. If the leave of absence occurs prior to the research component of the training program, this additional time would be taken from the research allotment. If the leave of absence occurs after the research component of the training program, this additional time would be added on at the end of the chief resident year. The decision to require makeup time will be individualized and will reflect the resident’s overall performance, case volume, etc.
Please visit Resident Research Objectives & Policies on the resident research website.
Residents in the clinical general surgery residency training program may not moonlight.
Residents in the research component of the training program (basic science research, clinical research, international health program, health policy research, postgraduate degree program) may moonlight. Effective July 1998, residents who choose to moonlight are expected (i.e. required) to moonlight internally and participate in the UCSF Nightfloat Program. This Program is an essential component of the program’s work hours compliance system. The commitment to the UCSF Nightfloat Program will take precedence over any other moonlighting activities. It is expected that the regular participation of all lab residents will allow the commitment to be approximately 1 night per week. The frequency of moonlighting is not strictly defined, but should not have an adverse impact on the research program in which the resident is enrolled. Compensation for nightfloat residents will be competitive with reimbursement at other Bay area institutions that utilize moonlighting physicians.
All categorical general surgery and plastic surgery residents PGY1 and above are eligible to receive $200 in education fund reimbursement thanks to UCSF surgery alumni and faculty donations. The following items are applicable: educational books, software, journal subscriptions and D/Surgery laparoscopic training boxes. Items not clearly falling into one of those categories must be approved by Dr. Reilly or Farmer.
Turn original receipts and/or bank statements into the Education Office for reimbursement. Please allow 3-6 weeks for reimbursement processing.
Additionally, The City & County of San Francisco, in cooperation with CIR, administers Educational Expense Reimbursement requests. Reimbursements are based on the number of hours the resident appears on SFGH payroll in a fiscal year (e.g. July 1-June 30). You can request a form from Wenia Lee (WLee@sfghsurg.ucsf.edu) at SFGH, or contact the Education Office, S-321. The request form submitted MUST be printed on Pink Paper.
SFGH Reimbursement Form - updated August 2011
Residents on duty have access to food services 24 hours/day at all institutions.
Moffitt / Long and Mount Zion
UCSF Medical Center supports eligible residents and clinical fellows by offering meals when working in the hospital at UC Moffitt/Long, Mission Bay and Mount Zion sites. Electronic meal cards (FastPay program) are distributed to each individual resident and funds allocated based on call schedules. Funds for the upcoming month are available for use on the first day of the eligible rotation. The FastPay cards can be used in the Shorenstein Family Café, Moffitt Café, Mount Zion Cafe, all Millberry Union food vendors and LunchStop at Mount Zion. Lost or Stolen cards must be reported to the Surgery Education Office immediately by calling (415) 476-1239. Residents are responsible for paying the difference at the cashier, should purchases exceed the monthly card limit. Funds do not roll over from month to month. All unused funds are revoked each month. All residents and fellows will be funded $200 a month when rotating at UC Medical Center (Parnassus, Mission Bay or Mt. Zion) on the GENERAL SURGERY rotations listed below:
- MB Gold/Scope
- MB Peds
- MZ BEST--ST
- MZ BEST--B
- MZ BEST--E
- MZ Plastic
- UC Cardiac
- UC HPOB
- UC KTU
- UC LTU
- UC On Call-CT
- UC On Call-LTU
- UC On Call-Vascular
- UC Plastic
- UC Red
- UC Thoracic
- UC Vascular
Meal Card Program Guidelines:
- Money will be available on the first day of each rotation.
- Unused meal money will not be carried over after your last day on the rotation.
- Unused balances will be revoked after your last day on the rotation.
SFGH Medical Center
Food Services are provided for Housestaff who are on-call at the hospital. Housestaff must present an ID badge that indicating that they are a “Resident”. Temporary meal passes may be obtained from the Dean’s Office at SFGH through the individual’s Department. The hours of operation of the cafeteria may vary, but are well advertised. If the cafeteria is closed for an extended period, alternative food services are provided to Housestaff.
Veterans’ Administration Medical Center
The VA has a cafeteria that is open Monday thru Friday from 7 am-4 pm. For residents staying for overnight call, there is a meal program utilizing delivery from several participating outside restaurants. Vouchers are available from the service administrator. Tickets for breakfasts in the cafeteria are also provided to post call residents.
Housestaff have access to a variety of systems for supportive intervention for dependency treatment and to obtain counseling services for a broad range of personal problems (e.g., workplace stress, anxiety management, personal or work relationships, depression, grief and loss, caregiver concerns, etc)
- The UCSF Physician Well-Being Committee is dedicated to recognizing and offering assistance to staff and physicians who have problems with substance abuse or physical and mental illness which impair their ability to practice safely and effectively. Confidentiality will be assured if possible, depending upon the severity of the situation and the immediate risk to patient safety. If you are anxious about making the first call, you may contact the committee initially, just to learn more about how the committee can offer help. To contact the Physician Well-Being Committee Chair, call the Medical Staff Office: (415) 885-7268
- Physicians' Confidential Assistance Line (California Medical Association)
- Faculty & Staff Assistance Program (FSAP), 3333 California Street (Laurel Heights campus)
These and other options are described on the GME website. In addition, the Dean's Office is currently exploring additional well-being programs. Housestaff are urged to provide input to the Operations Manager of Graduate Medical Education or the Senior Associate Dean for Graduate Medical Education.
(Revised Mar 2013)
- Work hours are defined as that time spent in all clinical and academic activities related to the training program. This includes all aspects of patient care in both the inpatient and outpatient settings, as well as all procedural activities in the operating room. It also includes time spent in the administrative aspects of patient care, the time spent transferring patient care (rounds), time spent in-house during assigned call and time spent in scheduled academic conferences such as Grand Rounds, Basic Science Conference and the scheduled Surgical Skills Lab sessions. Time spent reading and studying off-site and practicing in the Skills Lab outside of scheduled training sessions is not included in duty hours.
- In-house call is defined as that interval when the resident is required to be immediately available in the assigned institution.
- Call from home is defined as that interval when the resident is required to be available to return to the assigned institution within a reasonable period of time, but does not need to remain in the assigned institution.
- A day is defined as a continuous 24-hour period.
- A new patient is defined as one who has not previously received care from the surgery department.
- These definitions apply to all of the integrated and affiliated sites participating in the UCSF General Surgery Residency Training Program.
- Residents will work no more than 80 hours per week, averaged over a 4-week interval.
- Residents will have 1 day in 7 free of all educational and clinical responsibilities, averaged over a 4-week interval.
- Residents will be assigned to in-house call no more often than every third night, averaged over a 4-week interval.
- Interns will not work more than 16 consecutive hours.
- Following a 24-hour work session, residents will work no more than 4 additional hours. Activities during the additional 4 hours may include didactic activities, maintaining continuity of patient care, transferring patient care, operating on patients—including the first operation of the day or an operation on a patient admitted during the 24-hour tour of duty.
- The resident may not have primary responsibility for the care of any new patient during this additional 4- hour interval.
- Call taken from home is NOT subject to the every third night limitation. However when residents taking call from home return to the hospital for some indicated clinical activity, the hours spent in that clinical activity will count in the 80-hour limit. Additionally the frequency of call from home shall NOT prevent reasonable rest and personal time and shall NOT prevent 1 day in 7 free from all educational and clinical responsibilities (see B.2. above).
- Residents should have a 10-hour time period between assigned work sessions, and MUST have an 8 hour interval between shifts.
- In unusual circumstances, residents may stay beyond these limits to care for a single patient. All such exceptions must be reported to the Program Director.
- Residents in the clinical years of the UCSF General Surgery Residency Training Program MAY NOT moonlight. Residents in the laboratory years MAY moonlight.
- All residents will enter their work hours daily in the E*Value Workhours Database. Residents who fail to enter their hours for the prior day by 9:00am the following morning will be relieved of duty.
- Each service will develop a system for weekly workhours monitoring that includes the following elements:
- a. Review of the workhours data to the Residency Office WEEKLY for those services/rotations with incomplete compliance, MONTHLY for those services/rotations with complete compliance.
- b. Identify the member of the service/rotation administrative staff who is responsible for this process and who will be communicating the data to the Residency Office weekly.
- Intermediate-level residents should have 10 hours free of duty, and must have eight hours between scheduled duty periods.
- Intermediate-level residents must have at least 14 hours free of duty after 24 hours of in-house duty.
- Failure to submit a timely report will result in the residents being relieved of duty from that service until the report is received.
- Falsification of data will result in immediate termination of all resident assignments to that service/rotation.
Stress and Fatigue Monitoring
- The faculty and residents will be instructed in the signs of fatigue by annual review of the American Academy of Sleep Medicine “Sleep, Alertness and Fatigue Education in Residency (SAFER)" module. See Department of Surgery Workhours Policy/Fatigue Monitoring (2014 – 2015)
- The residents are in close contact with faculty during each day, allowing the faculty to assess the resident for signs of fatigue by direct observation.
- If resident fatigue is present and action is needed, the resident will be sent home or sent to sleep and resume clinical duties when rested.
- Fatigue Module Attestation ("Sleep, Alertness, and Fatigue Education In Residency" by American Academy of Sleep Medicine)
- Impairment Module ("Doctors and Addiction: Helping Good People with a Bad Disease")
- Deviations from the workhours policy are to be reported to the Residency Office, any faculty member, the faculty mentor for any involved resident, any of the resident members of the Departmental Resident Council, any member (faculty or resident) of the Departmental Education Committee, the Program Director, or the Chair.
- In addition deviations can be reported to any member of the institutional Graduate Medical Education Committee (resident member or faculty member), to the Graduate Medical Education office or to the UCSF Duty Hours Compliance Officer. Reporting to the GME Office can be totally anonymous if desired by calling 502-9400.
Surgery Grand Rounds & Clinical Case Conferences
Policy: Attendance (minimum 75%) is required for faculty, residents and interns. The only exception are the categorical ORTHO, NS, OMF and OHNS residents who may have conflicting grand rounds. Residents on vacation are excused from attending.
Intern Survival Skills & Basic Science Series
Policy: PGY1 residents are required to attend a minimum of 75% of the sessions. This includes ALL PGY1s, categorical and preliminary. The only exception are the categorical ORTHO, NS, OMF and OHNS residents who may have conflicting conferences. Attendance is closely monitored. Residents on vacation are excused from attending. The intern conferences are open to other junior residents and medical students.
Skills Lab Series
Policy: Attendance is required for all PGY1, PGY2 and PGY3 residents, approximately every other week, or as scheduled, by the Surgical Skills Center Director. (Click here for current schedule) Residents on vacation are excused from attending.
Journal Club Sessions
Policy: PGY4 and PGY5 residents are required to attend a minimum of 75% of the sessions. Residents on vacation are excused from attending.
Technical Conduct Sessions
Policy: PGY4 and PGY5 residents are required to attend a minimum of 75% of the sessions. Residents on vacation are excused from attending.
Fundamentals of Clinical Surgery Series ("Schecter Conference")
Policy: PGY2 and PGY3 residents are required to attend a minimum of 75% of the sessions. Residents on vacation are excused from attending.
Request for Travel Reimbursement Form
The Department encourages residents to submit their clinical and basic science research efforts to significant meetings in the United States and Canada for presentation. The Department will endeavor to help fund domestic and Canadian travel for categorical general, plastic, and vascular surgery residents who are presenting authors of abstracts accepted for oral/podium presentation, providing certain provisions and expectations are met.
Abstracts may be submitted to international meetings, but the Department does not fund expenses for foreign travel.
The Department will sponsor up to two trips in total to the Academic Surgical Congress (of the Association for Academic Surgery and Society of University Surgeons), American College of Surgeons Clinical Congress, and/or the Pacific Coast Surgical Association for categorical general, plastic, and vascular surgery residents who are first authors to present their oral/podium presentations and/or attend professional development courses. The Department will not provide reimbursement for a resident to attend a meeting for a poster presentation. These trips must occur during each resident's research year(s) and is limited to one per year.
In addition, for all other national and Canadian scientific and surgical meetings, the Department will sponsor categorical general, plastic, and vascular surgery residents to attend the meeting if the resident submitted an abstract that was accepted for an oral/podium presentation. The Department will not provide reimbursement for a resident to attend a meeting for a poster presentation. This commitment is limited to $7,500/resident in total for their entire residency and will be limited to no more than two trips/year. If the resident has travel support/funding through their mentor, lab, or research award (e.g., T32, professional society award), then those monies should be used first rather than application to the Department.
Specific Guidelines & Limits
Travel assistance is a privilege, not a given. We need residents to be good stewards of the Department's resources, and to meet the Department at least halfway in using common sense and cost saving measures. All travelers are expected to exercise good judgment on behalf of the Department and follow UCSF policies and procedures.
For reimbursement purposes, requests and notification for meetings and travel need to be approved in advance by both the Residency Program Director and the Department's Vice-Chair of Research. It is expected that each resident will work together with their mentor and the Vice-Chair to assure that there is appropriate stewardship that goes into planning research-related travel.
Pre-travel approval is required prior to the booking of any travel expenses. Travel expenses made prior to approval are the financial responsibility of the traveler and may not be reimbursed.
Connexxus must be used to book flights. Airline travel upgrades are considered a personal expense and are not reimbursable expenses. Flight changes must be approved before any change is made.
The conference website or hotel block may be used to book a room, or by some other reasonable means. UCSF limits hotel expenses to $275/night before taxes. The hotel folio (bill) must reflect a $0 balance and include the last four digits of the credit card used to pay. If there are in-room meal/mini bar charges, itemized receipts must be provided. The proof of payment will be the hotel folio itself.
Registration fees for the conference should be paid by the traveler with a personal credit card after receiving pre-travel approval.
Most of the time, it is more economical to use shared rides, taxi cabs, and public transportation rather than a rental car for professional travel. Automobile rental will not be reimbursed without clear justification (before the trip) of the need for a rental instead of another mode of transportation. Keep in mind that fuel tax and insurance will not be reimbursed.
Meal reimbursement is based on actual expenses and should not exceed UCSF's daily per-diem of $62/day. Original, itemized receipts and proof of payment must accompany any request for reimbursement for meals.
Reporting of Time:
Both the ABS and ACGME have guidelines on how to report time away for attending a conference. Please contact Rachelle Bresnahan (Rachelle.Bresnahan@ucsf.edu) on instructions for reporting your time away.
Entertainment, health club expenses, video rentals, valet parking, and tips and not allowable and thus will not be reimbursed.
Requests for reimbursement for travel should be submitted as soon as possible but no later than 45 days after return from travel. Reimbursements for travel will be reported as taxable income if they are not finalized and approved within 60 days of return from travel.
When to Notify an Attending Policy
For All UCSF Surgical Housestaff
Call an Attending directly (or positively ascertain that an Attending has been notified) upon the following situations:
- Death (even if expected)
- Cardiac arrest
- Respiratory failure either requiring intubation or significantly increased O2 demands
- Severe respiratory distress
- Airway issues
- Transfer to ICU or higher level of care
- Concern that patient needs a procedure or operation
- A new need for acute dialysis
- Bleeding requiring transfusion
- Hypotension/hemodynamic instability
- Symptomatic and severe hypertension
- Significant new arrythmia
- Suspected MI
- Suspected PE
- New onset severe chest pain
- New onset severe abdominal pain
- Abrupt deterioration in neurologic exam or profound decreased mental status
- Significant change in neurovascular exam of extremity
- Patient or family wishes to speak to the attending
- Patient wishes to be discharged AMA
And In addition
- Any other significant change in clinical status of patient that is of major concern.
- Any new admission.
- The arrival of a patient accepted in transfer from another institution.
Service specific criteria, e.g.
- KTU: abrupt loss of urine output in recent kidney transplant pt that was previously making urine; ultrasound showing vascular/ureteral problem.
- LTU: ultrasound showing absence of hepatic arterial flow
- VASCULAR: loss of a pulse or Doppler signal that was present earlier
- PLASTICS: abrupt change in signal /duskiness of free flap
If you are called for jury duty, we can provide a letter to the court excusing you from service.
Simply fill out the juror information section on the back of the form that you received (you can leave the employer section blank) and sign and date the bottom. Please bring in your form as soon as possible after you receive it so that your letter of excuse can arrive at the court before your summons date.
When the court receives this letter from UCSF, they will excuse you for one year—the maximum length of time possible. If you are summoned again while you are still in residency, you can write on your form that you are still a physician in training and the court will excuse you again.
If you are called to serve in any county besides San Francisco and you live in San Francisco (even if your permanent address is elsewhere), simply check off the box on the form that says you do not reside in that county and mail it in.