|
|
|
|
|
|
|
PGY I Rotations - General Information 1.1.General Surgery (5 months) 1.2.Vascular Surgery (2 months) 1.3.Trauma Surgery/Critical Care/Transplantation (5 months) PGY I Rotations - General Information ACS Prerequisites for Graduate Surgical Education: A Guide for Medical Students and PGY1 Surgical Residents
The American College of Surgeons/Graduate Medical Education Committee’s Prerequisites for Graduate Surgical Education: A Guide for Medical Students and PGY1 Surgical Residents provides background areas for: Knowledge, Skills, and Basics of Professionalism that are expected of residents as they enter residency and prepare to start their General Surgery rotations.
General Surgery Background Knowledge:
Upon entry into the General Surgery Training Program, the Intern is expected to know about these objective areas.
General Surgery Background Skills:
Upon entry into the General Surgery Training Program, the Intern is expected to perform these objectives.
Professionalism Background Skills:
Upon entry into the General Surgery Training Program, the Intern is expected to be knowledgeable about and display these objectives. Trauma and Surgical Critical Care Rotation: Competency-Based Goals and Objectives
These trauma rotation goals and objectives are utilized for resident expectations at PGY-I, II, IV, and VI of the curriculum. The format and content demonstrate program transition to build the six focus competencies into our residency curriculum. Residents are linked to this section in preparation for each of their rotations on Trauma and Surgical Critical Care. Junior Objectives for ALL PGY I Residents
The Association of Program Directors in Surgery (APDS)-East Carolina University, Department of Surgery Surgical Resident Curriculum. Junior-Level Topical Performance Outline for Each PGY I Rotation General Surgery Objectives for All PGY I Service Rotations
General Surgery Objectives for ALL PGY I Service Rotations, Includes what the resident learner is expected to have accomplished by completion of the PGY I training year. PGY I Rotations
ACGME Competencies are numbered and coded by number from 1-6 following each learning objective. - Patient Care that is compassionate, appropriate, and effective for the treatment of health problems and promotion of health
- Medical Knowledge about established and evolving biomedical, clinical, and cognate sciences and application of this knowledge to patient care
- Practice-Based Learning and Improvement that involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care
- Interpersonal and Communication Skills that result in effective information exchange and teaming with patients, their patients’ families, and other health professionals
- Professionalism as manifested through commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population
- Systems-Based Practice as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value
1.1.General Surgery - (5 months)
1.1-A.Rotation Knowledge PGY I Gastrointestinal Surgery Knowledge Objectives: - Specify characteristics of the history, physical examination findings, and mechanism of visceral and somatic pain for these processes: acute appendicitis, bowel obstruction, perforated ulcer, ureteral colic, diffuse peritonitis (Comp 2)
- Assess the following signs associated with the acute abdomen and describe their pathophysiology: referred pain, rebound tenderness, guarding, rigidity (Comp 2, 3)
- Recognize the clinical and radiologic features of bowel obstruction and its major causes (Comp 2)
- Know the pathophysiology of common GI diseases such as diarrhea, inflammatory bowel disease, peptic ulcer disease, pancreatic exocrine deficiency, delayed gastric emptying, reflux (Comp 2)
- Know the basic anatomy and physiology of the endocrine and exocrine pancreas (Comp 2)
- Recognize the clinical manifestations of acute and chronic pancreatitis (Comp 2)
- Understand clear concepts of inguinal anatomy, anatomy of hernia repair of both traditional repairs and mesh/plug repairs (Comp 2)
- Understand cholelithiasis, cholecystitis, and cholangitis and operative indications for each (Comp 2)
PGY I Surgical Oncology Knowledge Objectives: - Understand clear concepts of inguinal anatomy, anatomy of hernia repair of both traditional repairs and mesh/plug repairs (Comp 2, 3)
- Understand cholelithiasis, cholecystitis, and cholangitis and operative indications for each (Comp 2, 3)
- Know the normal function of the major endocrine organs (thyroid, parathyroid, adrenal cortex and medulla, pancreatic islets, pituitary, gonads) (Comp 2)
- Know the surgical anatomy and applied physiology of the major endocrine organs (Comp 2)
- Recognize endocrine diseases of hypo- and hyper- function (Comp 2)
- Verbalize acceptable algorithm for assessing and treating low urine output (Comp 2, 3)
- Understand basic principles of multidisciplinary approaches to the treatment of the patient with cancer (Comp 2, 3, 4, 6)
- Understand the implications of positive margins and the limitations of frozen section and biopsy techniques (Comp 2, 3)
- Understand the basic principles of tumor biology and carcinogenesis (Comp 2)
- Understand the workup of breast mass (Comp 2)
- Know the basics of staging neoplasms (Comp 2)
- Know the general applications for radiation therapy and the mechanisms of radiation effect, acute and chronic (Comp 2)
- Understand the basic mechanisms of metastasis (Comp 2)
- Know regional lymph node anatomy and the principles of a cancer operation (Comp 2, 3)
- Understand the acute and chronic complications of radiation therapy (Comp 2)
PGY I Endocrine Surgery-Thyroid Disease Knowledge Objectives: - Demonstrate normal thyroid anatomy in a cadaver or in the operating room, including the thyroid gland, its vascular supply and venous drainage, the parathyroid glands, recurrent laryngeal nerves, strap muscles, and platysma (Comp 2)
- Describe normal variants in recurrent laryngeal nerve anatomy including frequency (Comp 2)
- Describe normal thyroid embryogenesis and descent (Comp 2)
- Outline the normal thyroid hormone synthetic pathway including iodine metabolism and feedback mechanisms (Comp 2)
- Describe the impact of specific medications on the thyroid hormone synthetic pathway and thyroid function (Comp 2)
- Describe the impact of aging on the thyroid hormone synthetic pathway and thyroid function (Comp 2)
- Outline appropriate thyroid function testing for the following clinical scenarios, including interpretation of predicted test results: (Comp 2, 3)
- Thyroid nodule
- Goiter
- Hyperthyroidism
- Hypothyroidism
- Develop an algorithm that includes pertinent history, examination findings, and diagnostic evaluation of: (Comp 2, 3)
- A palpable thyroid nodule
- A nonpalpable nodule discovered on ultrasound performed for nonthyroid pathology
- Describe the recognition, evaluation, and management of the following early postoperative complications: (Comp 2, 3)
- Describe the outpatient management of the following postoperative conditions: (Comp 2, 3)
- Thyroid hormone replacement, postoperative
- Postoperative hypocalcemia
- Postoperative voice changes
1.1-B.Rotation Skills PGY I Gastrointestinal Surgery Skill Objectives: - Ability to perform: basic suturing, tying, and assistance at surgery (Comp 1)
- Be able to tie a two-handed square knot (Comp 1)
- Gain experience in central line placement, arterial lines, NG tubes, Foley catheters, gastrostomy tubes, basic surgical procedures including thoracentesis (Comp 1)
- Ability to perform basic laparoscopic skills such as pneumoperitoneum assistance with camera (Comp 1)
- Under supervision, complete the following: (Comp 1)
-
- Excise benign lesions of skin and subcutaneous tissues
- Perform lymph node biopsy
- Remove superficial foreign bodies
- Incise and drain abscesses
- Repair umbilical and simple groin hernias
- Perform appendectomy
- Perform port-a-cath placement (Comp 1)
- Determine the physical findings and differential diagnosis in a patient with abdominal pain (Comp 1, 2, 3)
- Manage data efficiently and record documentation (Comp 3)
- Perform appropriate laboratory evaluations of gastrointestinal, pancreatic, and hepatobiliary function (Comp 1, 2, 3)
- Provide basic interpretation of cholangiograms, CT, MRI, PET Scans (Comp 1)
- Understand the physiology of peritonitis and apply it to the general management of a patient (Comp 1, 2, 3)
- Recognize the need for surgical intervention (Comp 1, 2, 3)
- Manage a diabetic patient postoperatively, acutely, and chronically (Comp 1, 2, 3, 4)
- Know the pathophysiology, supportive care, and surgical indications in a patient with bowel obstruction (Comp 1, 3)
- Diagnose and acutely manage a patient with: ileus and bowel obstruction, inflammatory bowel disease, GI bleeding, volvulus, diarrhea, appendicitis, pancreatitis (Comp 1, 2, 3)
- Be an effective teacher for medical students (Comp 1, 2, 3, 4)
PGY I Surgical Oncology Skills Objectives: - Tie 2-handed square knot (Comp 1)
- Place a central venous catheter (Comp 1)
- Under supervision, complete the following: (Comp 1, 2, 3)
- Excise benign lesions of skin and subcutaneous tissues
- Perform lymph node biopsy
- Remove superficial foreign bodies
- Incise and drain abscesses
- Repair umbilical and simple groin hernias
- Perform appendectomy
- Perform lumpectomy
- Determine the physical findings and differential diagnosis in a patient with abdominal pain (Comp 1, 2, 3)
- Understand the physiology of peritonitis and apply it to the general management of a patient. Recognize the need for surgical intervention (Comp 1, 2, 3)
- Manage the perioperative care of a patient with hyperthyroidism (Comp 1, 2, 3)
- Manage a diabetic patient postoperatively, acutely, and chronically (Comp 1, 2, 3, 4)
- Recognize and treat hypoglycemia, and prevent its occurrence (Comp 1, 2, 3, 4)
- Recognize and treat postoperative hypocalcemia (Comp 1, 2)
- Be able to read a mammogram (Comp 1, 2)
- Be able to perform a breast biopsy under supervision (Comp 1, 2)
- Become proficient at core and fine-needle aspiration biopsy of palpable lesions (Comp 1)
- Do an appropriate metastatic workup of a patient with malignancy (Comp 1, 2, 3)
- Be an effective teacher of medical students (Comp 1, 2, 3, 4)
Endocrine Surgery-Thyroid Disease Skill Objectives: - Obtain a focused history, perform an examination, and institute the diagnostic evaluation of a patient with the following conditions: (Comp 1, 2, 3)
- Thyroid nodule
- Goiter
- Hyperthyroidism
- Palpate and describe a thyroid nodule (Comp 1)
- Palpate and describe a goiter (Comp 1)
1.2.Vascular Surgery (2 months) 1.2-A.Rotation Knowledge-PGY I-Vascular PGY I Vascular Knowledge Objectives: - Recognize critical vascular anatomy and have a clear understanding of inguinal anatomy (Comp 2)
- Obtain an understanding of vascular disease and appropriate workup of the outpatient (Comp 2)
- Understand perioperative risk assessment (Comp 2, 3)
- Understand cardiac risk assessment of vascular patients and optimal medical management (Comp 2, 3)
- Describe the pathogenesis of ischemic atherosclerotic and aneurismal disease (Comp 2)
- Describe potential problems of the lymphatic system (Comp 2)
- Describe manifestations of vascular insufficiency (Comp 2)
- Discuss manifestations of limb, cerebral, and renal ischemia (Comp 2)
- Understand vascular hemodynamics (Comp 2)
- Understand the pathophysiology of claudication (Comp 2)
- Know the basics of medical Rx of PVD (Comp 2)
- Differentiate between Doppler and duplex (Comp 2, 3)
- Be able to describe atheroembolic disease; recognize a cold extremity (Comp 2)
- Discuss operative options for vascular access (Comp 2, 3)
1.2-B.Rotation Skills PGY I Vascular Skills Objectives: - Acquire an introduction to the technical aspects of vascular surgical procedures (Comp 1, 2)
- Perform an accurate and complete vascular history and physical (Comp 1, 2, 3, 4, 5)
- Distinguish between symptoms that include rest pain, claudication, non-healing ulcerative disease (Comp 1, 2)
- Demonstrate systematic evaluation of an abdominal CT scan (Comp 1, 2)
- Debride wounds (Comp 1, 2)
- Demonstrate effective use of resources to acquire essential clinical data (Comp 1, 2, 3, 6)
- Interpret ankle brachial indices and duplex ultrasonography velocity reports (Comp 1)
- Organize and analyze laboratory and other consultative information (Comp 1, 2, 3, 4)
- Manage oliguria systematically (Comp 1)
- Obtain and interpret/discuss ABIs (Comp 1)
- Interpret non-invasive lower extremity WAVE forms (Comp 1)
- Insert a port-a-cath or Hickman (Comp 1)
- Demonstrate skills involved in common surgical procedures peripheral vascular/venous line placement (Comp 1, 2)
- Work up a postoperative MI (Comp 1, 2, 3, 4)
- Manage a diabetic patient perioperatively, acutely, and chronically (Comp 1, 2, 3, 4)
- Recognize and treat hypoglycemia, and prevent its occurrence (Comp 1, 2)
- Evaluate and acutely manage the diabetic foot. Counsel diabetic patients on foot care (Comp 1, 2, 3, 4)
- Know the venous anatomy of the legs and recognize acute signs of DVT (Comp 1)
- Recognize chronic venous insufficiency and its implications (Comp 1, 2)
- Diagnose and manage acute deep venous thrombosis (Comp 1)
- Apply effective preventive measures for DVT and PE (Comp 1, 2, 3, 4)
- Manage chronic deep venous insufficiency (Comp 1, 2)
- Differentiate between stroke, TIA, and non-cerebrovascular events causing neurological symptoms (Comp 1, 2)
- Tie a 2-handed square knot (Comp 1)
- Close inguinal incision (Comp 1)
- Perform AV dialysis graft as surgeon with supervision from attending surgeon (Comp 1)
1.3.Trauma Surgery/Critical Care/Transplantation (5 months)
Trauma and Surgical Critical Care Rotation: Competency-Based Goals and Objectives
These trauma rotation goals and objectives are utilized for resident expectations at PGY-I, II, IV, and VI of the curriculum. The format and content demonstrate program transition to display the six focus competencies in our residency curriculum. Residents are linked to this section in preparation for each of their rotations on Trauma and Surgical Critical Care. 1.3-A.Transplantation Knowledge PGY I Transplantation Knowledge Objectives:
- Background Knowledge
- Know normal renal anatomy and physiology, action of diuretic drugs, hormonal responses in salt and water metabolism
- Know the pathophysiology of the development of acute renal failure; the differentiation of prerenal, renal, obstructive types of renal failure; and the general concepts of prevention and treatment of ARF
- General Immunologic Principles
- Describe the basic concepts of human immune system (Comp 2)
- Describe the ontogeny, function, and role in cellular immunity and graft rejection of the T-lymphocyte; demonstrate understanding of the T-cell receptor and its interaction with the human leukocyte antigen (HLA) complex (Comp 2)
- Describe patient defenses against infection (Comp 2)
- Understand renal transplant physiology (Comp 2)
- Understand immunosuppressive regimen for kidney transplants (Comp 2, 3, 6)
- Describe the different types of rejection (Comp 2)
- Acquire knowledge relative to histocompatibility testing in immunologic monitoring, immunosuppressive medication (Comp 2, 3)
- Learn to recognize rejection as well as diagnose postoperative complications peculiar to renal transplantation (Comp 2, 3, 6)
- Discuss the importance of subclavian stenosis in vascular access workup for dialysis (Comp 2)
- Describe different types of arteriovenous access (Comp 2)
- Differentiate between agents used to treat acute transplant rejection (Comp 2, 3, 6)
- Organ-Specific Areas
- Know the pathophysiology of the development of acute renal failure; the differentiation of prerenal, renal, obstructive types of renal failure; and the general concepts of prevention and treatment of ARF (Comp 2, 3)
- Understand the mechanisms of acute transplant rejection and recognize its presentation. Be familiar with immunosuppressive therapy (Comp 2, 3)
1.3-B.Transplantation Skills
PGY I Skills Objectives:
- Demonstrate an understanding of general immunological principles and their application to surgical practice (Comp 1, 2, 3)
- Demonstrate an understanding of principles of care for patients with abnormal immune function who are undergoing general surgery procedures (Comp 1, 2, 3, 4)
- Demonstrate an understanding of the emerging field of molecular biology and the novel immune therapies having potential application to clinical surgery (Comp 2, 3, 6)
- Gain experience in the evaluation and management of surgical problems in patients with end stage renal disease (Comp 1, 2, 3)
- Participate in perioperative management of immunosuppressive agents in chronically-medicated patients undergoing general surgery (Comp 1, 2, 3, 4, 5, 6)
- Tie a two-handed square knot with either hand (Comp 1)
Organ-Specific Areas
- Apply knowledge of the pathophysiology of the development of acute renal failure; the differentiation of prerenal, renal, obstructive types of renal failure; and the general concepts of prevention and treatment of ARF (Comp 2)
- Function as a junior assistant resident with responsibilities in transplant for preoperative evaluation and postoperative management (Comp 1, 2, 3, 4, 5, 6)
- Interact effectively with higher level surgical residents on transplant service as well as nephrologists assigned to the service (Comp 2, 3, 4, 5, 6)
- Manage urinary tract infections (Comp 1, 2)
- Understand and apply the principles of bladder management (Comp 1, 2, 3, 4)
- Acquire operative skills necessary to establish access for peritoneal dialysis and vascular access (Comp 1, 2)
- Gain experience in the renal transplant procedure (Comp 1, 2)
|
|
|
|
|
