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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
2.1.General Surgery (3 months)
2.2.Vascular Surgery (2 months)
2.3.Trauma Surgery/Critical Care/Transplantation (2 months)
2.4.Cardiothoracic Surgery (3 months)
2.5.Plastic and Reconstructive Surgery (2 months)
2.1.General Surgery (3 months)
2.1-A.Rotation Knowledge
Gastrointestinal Surgery Knowledge Objectives: - Review Knowledge Objectives from the PGY I General Surgery Rotation (Comp2)
- Continue to develop base knowledge in critical care, pathophysiology, and pharmacology (Comp 2)
- Continue to develop base knowledge about surgical gastrointestinal disease and hernias (Comp 2)
- Understand GERD physiology, workup of reflux, and anatomy of esophagus and stomach (Comp 1, 2)
- Describe essential laparoscopic components (Comp 2)
- Describe port placement for laparoscopic cholecystectomy, Nissen, and laparoscopic appendectomy (Comp 2)
Surgical Oncology Knowledge Objectives:
- Demonstrate knowledge necessary to determine whether a surgical intervention is appropriate (Comp 1, 2, 3)
- Demonstrate increasing knowledge about surgical disease processes, especially for assessment of preoperative diagnostic factors and preoperative preparation (Comp 1, 2)
- Demonstrate understanding of concepts of continuity of care (Comp 1, 2, 3, 6)
- Demonstrate ability to discuss the impact of ethical, legal, economic, and/or social issues on an individual patient’s care (Comp 1, 2, 3, 4, 5, 6)
- Understand axillary anatomy (Comp 2)
- Review PGY I Knowledge Objectives for Endocrine Surgery (Comp 2)
2.1-B.Rotation Skills
Gastrointestinal Surgery Skills Objectives: - Review Skills Objectives from the PGY I General Surgery Rotation (Comp 1, 2, 3)
- Develop and practice basic skills in interpreting hemodynamic data and manipulation of hemodynamic variables with vasoactive drugs (Comp 1, 2, 3)
- Show improved competence in interpreting radiologic studies such as abdominal films and chest X-rays (Comp 1, 2)
- Display improved efficiency in pre- and post- operative care and evaluation of patients (Comp 1, 2, 3, 4, 5, 6)
- Master central venous access and placement of hemodynamic monitoring lines such as pulmonary artery catheters and arterial lines (Comp 1, 2)
- Master basic suture skills (Comp 1)
- Improve interpersonal skills and basic development of teaching skills when working with medical students (Comp 2, 4)
- Be able to perform a herniorrhaphy (Comp 1, 2)
- Be able to troubleshoot CO2 insufflation problems (Comp 1, 2, 3)
- Be able to diagnose symptomatic cholecystitis and discuss the operative indications, alternatives, and controversies (Comp 1, 2, 3, 6)
- Effectively utilize all essential laparoscopic components (Comp 1, 3)
- Be able to set up the equipment and initiate a laparoscopic procedure (Comp 1, 3)
- Perform two-handed square knot with both hands (Comp 1)
- Show skill at performing laparoscopic knots in Lap laboratory (Comp 1)
- Be able to perform laparoscopic cholecystectomy from the left side of the table (Comp 1)
Surgical Oncology Skills Objectives:
- Analyze data derived from history and physical examination and all components of laboratory evaluation (Comp 1, 2, 3)
- Demonstrate skills necessary to effectively use collaborative interaction with other residents, surgical faculty, and members of other health care professions (Comp 1, 2, 3, 4, 5, 6)
- Demonstrate the ability to manage surgical wounds and drains (Comp 1, 2)
- Demonstrate skills needed to implement surgical care interventions of more complex nature, such as central lines and PA catheters (Comp 1, 2)
- Teach principles of surgical intervention to more junior surgical house staff and other health care providers (Comp 1, 2, 4)
- Perform laparoscopic cholecystectomy with supervision from attending surgeon (Comp 1, 2)
- Tie two-handed square knots with both hands (Comp 1)
- Perform needle-localized breast mass excision (Comp 1, 2)
- Perform a sentinel lymph node biopsy (Comp 1, 2)
- Perform wound debridement (Comp 1, 2)
- Review PGY I Skills Objectives for Endocrine Surgery (Comp 1, 2)
2.2.Vascular Surgery (2 months)
2.2-A.Rotation Knowledge-Vascular
Vascular Knowledge Objectives: - Review Knowledge Objectives from the PGY I Vascular Rotation (Comp 2)
- Demonstrate ability to analyze data derived from history and physical exam as well as vascular laboratory evaluations (Comp 1, 2, 3)
- Understand the pathophysiology of atherosclerotic occlusive disease, aneurysm, thrombosis, venous insufficiency, renovascular hypertension, diabetes (Comp 2)
- Understand the natural history of PVD (Comp 2)
- Understand the workup, treatment, and associations of peripheral aneurysms, especially femoral and popliteal aneurysms (Comp 1, 2, 3)
- Demonstrate basic knowledge about standard types of vascular grafts (Comp 2)
- Demonstrate understanding of principles involved with specialized testing such as Doppler studies and duplex scans (Comp 1, 2, 3, 6)
- Understand basic concepts of angiography and available options such as contrast load, digital subtraction, CTA, MRA (Comp 1, 2, 3, 6)
- Have a clear understanding of projections needed (Comp 2)
- Demonstrate acquisition of knowledge necessary to determine appropriateness of surgical intervention (Comp 1, 2, 3)
- Understand instructions for operation of vascular patients (Comp 1, 2, 3)
- Become familiar with the technical aspects of vascular surgical procedures (Comp 2)
- Differentiate between urgent, acute, and chronic states, including manifestations of limb, cerebra, and/or renal ischemia (Comp 2)
- Demonstrate increasing knowledge about vascular surgical disease processes by distinguishing claudication, rest pain, or tissue loss (Comp 2)
- Demonstrate an understanding of the principles involved in care of patients with extremity amputations (Comp 1, 2, 3)
- Demonstrate an understanding of the principles involved in management of vascular wounds, graft failure, and graft infection (Comp 1, 2, 3)
- Understand the etiology and microbiology of diabetic food conditions (Comp 2)
- Understand possible complications from treatment (Comp 2)
- Show increased understanding of noninvasive vascular testing (Comp 2, 3, 6)
2.2-B.Rotation Skills-Vascular
Vascular Skills Objectives: - Review Skills Objectives from the PGY I Vascular Rotation (Comp 1, 2)
- Appropriately interact with the vascular team, participating fully with clinical activity of the service (Comp 1, 2, 3, 4, 5)
- Provide basic interpretation skills for CTA, MRA, angiograms, venograms (Comp 1, 2)
- Understand and appropriately workup the outpatient with preoperative preparation and postoperative care (Comp 1, 2, 3, 4, 6)
- Read a carotid duplex and interpret the velocities (Comp 1, 2)
- Interpret a lower extremity duplex venous study (Comp 1, 2)
- Evaluate acute/chronic mesenteric ischemia (Comp 1, 2)
- Evaluate renovascular hypertension (Comp 1, 2)
- Evaluate vertebral basilar insufficiency and subclavian occlusive disease (Comp 1, 2)
- Evaluate aortic dissection (Comp 1, 2)
- Evaluate TAAA (Comp 1, 2)
- Evaluate peripheral aneurysms (Comp 1, 2)
- Evaluate upper extremity vascular problems (Comp 1, 2)
- Evaluate venous insufficiency (Comp 1, 2)
- Evaluate and perform BKA/AKA with minimal assistance (Comp 1, 2)
- Demonstrate skill in implementing surgical care interventions of the more complex procedures such as central lines, PA catheters, jugular and subclavian vein access catheters (Comp 1, 2, 3)
- Care for extremity dialysis fistula (Comp 1, 2, 3)
- Perform dialysis access with minimal assistance (Comp 1, 2, 3)
- Perform vein stripping/phlebectomy with minimal assistance (Comp 1, 2, 3)
- Assist in dissecting out the groins and gaining control of the femoral arteries (Comp 1, 2, 3)
- Interact successfully with the vascular team; participate fully in clinical activities of the vascular service (Comp 1, 2, 3, 4, 5, 6)
2.3.Trauma Surgery/Critical Care/Transplantation (2 months)
2.3-A.Rotation Knowledge-Trauma Knowledge 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 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. Transplantation 2.3-A.Rotation Knowledge-Transplantation
PGY II Knowledge Objectives: - Review Knowledge Objectives from the PGY I Trauma-Transplantation Rotation (Comp2)
- Review and master renal transplant physiology (Comp 2)
- Review and understand the immunosuppressive regimen for kidney transplants (Comp 2)
- Gain knowledge and experience in the evaluation and management of surgical problems in patients with end stage renal disease (Comp 1, 2, 3)
- Acquire knowledge relative to histocompatibility testing, immunologic monitoring, immunosuppressive medication (Comp 2, 3)
2.3-B.Rotation Skills-Transplantation
PGY II Skills Objectives: - Review Skills Objectives from the PGY I Trauma-Transplantation Rotation (Comp 1, 2)
- Function as a junior assistant resident with corresponding responsibilities for evaluation and management (Comp 1, 2, 3, 4, 5, 6)
- Learn to recognize, diagnose, and treat rejection (Comp 1, 2)
- Participate in preoperative assessment of patients and their postoperative results (Comp 1, 2, 3, 4, 5, 6)
- Diagnose and manage postoperative complications peculiar to renal transplantation (Comp 1, 2, 3)
- Establish access for peritoneal dialysis and vascular access (Comp 1, 2)
- Gain experience in the full renal transplant procedure (Comp 1, 2)
- Participate in evaluation of shuntograms for patients during the preceding week (Comp 1, 2, 3)
2.4.Cardiothoracic Surgery (3 months)
2.4-A.Rotation Knowledge-Cardiothoracic Surgery includes Thoracic Surgery and Cardiac/Great Vessels Surgery
Cardiothoracic Knowledge Objectives: Thoracic Background Knowledge - Have fundamental knowledge of the cardiac and thoracic pathologies seen on service
- Review protocols and understand the conduct of cardiac and thoracic operations, including basic sequential steps in operation and principles of myocardial protection
Thoracic Knowledge Objectives: - Demonstrate an understanding of the anatomy, physiology, and pathophysiology of thoracic conditions (Comp 2)
- Effectively apply this understanding to the diagnosis, evaluation, and treatment of patients with thoracic problems (Comp 1, 2)
- Understand principles of preoperative preparation and postoperative care (Comp 2)
- Understand bypass pump connections and concepts (Comp 2)
- Understand sequential steps of pulmonary and esophageal resection (Comp 2)
- Understand basic pacemaker modes and manipulation (Comp 2)
- List and prioritize means for increasing cardiac output (Comp 2)
- Define in physiologic terms the adequacy of cardiac output (Comp 2)
- Understand the pathophysiology in the SICU postoperative patients on the service (Comp2)
- Know the manifestations-clinical and by laboratory testing-of obstructive pulmonary disease and pulmonary insufficiency, and their surgical perioperative management (Comp2)
- Summarize and discuss the embryological development of airways, lungs, esophagus (Comp 2)
- Review and analyze the basic principles and critical factors involved in ventilation, perfusion, respiration control, lung function tests, oxygen therapy, function of diseased lung (Comp 2)
- Summarize these modalities, stating their indications and limitations in thoracic surgical procedures: Endoscopy/thoracoscopy, standard and positional x-rays, arteriography, ultrasonography, CAT, MRI, PET, nuclear medicine (Comp 2, 6)
- Explain the various types of anesthetic agents and equipment used in thoracic surgery (Comp 2)
- Explain the mechanics and applications of pulmonary function studies in evaluating patients for thoracic surgery (Comp 2)
- Recommend when to use such diagnostic and therapeutic procedures as: bronchoscopy and esophagoscopy (flexible and rigid), thoracoscopy/Video Assisted Thoracoscopic Surgery (VATS), Emergency room thoracotomy, Aortic cross clamping, standard thoracotomy and median sternotomy (Chamberlain and book procedures), pericardial window/pericardiocentesis, lung biopsy/fine-needle aspiration (FNA) (Comp 2, 6)
- Demonstrate an understanding of the mechanics of ventilatory support and the clinical application of mechanical ventilation (Comp 1, 2)
Cardiac-Great Vessels Rotation Knowledge Objectives: - Demonstrate knowledge of the anatomy, physiology, and pathophysiologic conditions of the heart and great vessels which are amenable to surgical correction (Comp 2)
- Demonstrate the ability to clinically manage patients with pathologic conditions of the heart and great vessels (Comp 1, 2)
- Describe and demonstrate working knowledge of cardiac physiology, including electrophysiology, determinants of cardiac output, interactions and control mechanisms, determinants of myocardial oxygen consumption, normal pressures, waveforms, and oxygen saturation in cardiac chambers (Comp 2)
- Identify the control mechanisms and normal physiology of peripheral vessels (Comp 2)
- Consider the following for risk assessment and perioperative management: patient age, risk factors for cardiovascular disease, symptoms/signs associated with coronary artery disease, ventricular dysfunction, and valvular dysfunction, pulmonary dysfunction (Comp1, 2, 6)
- Demonstrate the use and principles associated with various cardiac monitoring methods (Comp 1, 2, 6)
- Discuss techniques, mechanisms of action, and potential complications for mechanical and pharmacologic support of the circulation (Comp 2)
- Describe and assess the operative indications, risk, and expected outcomes associated with several cardiac surgical procedures, including: coronary artery bypass and minimally invasive direct coronary artery bypass surgery, valvular replacement/repair, operations of the ascending aorta, aortic arch and descending thoracic aorta, permanent pacemaker/automatic defibrillator insertion, pericardial drainage procedure (Comp 1, 2, 3, 6)
- Discuss the complications of cardiac surgery and methods used to reduce their incidence. Complications: death, myocardial infarction, stroke, bleeding, arrhythmias, low cardiac output syndrome, cardiac tamponade, pneumothorax, sternal and extremity wound infections, respiratory and renal failure (Comp 1, 2)
- Review the management of postoperative cardiac surgery patients in intensive care unit (Comp 1, 2, 6)
2.4-B.Rotation Skills-Cardiothoracic Surgery
Cardiothoracic Background Skills - Interpret a routine ECG
- Place chest tubes in the operating room, ICU, and hospital wards
- Demonstrate ability to insert arterial and Swan-Ganz lines
Thoracic Rotation Skills Objectives: - Participate in clinics for pre- and post- operative care of cardiac and thoracic patients (Comp 1)
- Maintain appropriate medical records, timely dictation of operative notes and discharge summaries (Comp 1, 3, 4)
- Evaluate thoracic pathophysiology; order and interpret appropriate tests (Comp 1, 3, 6)
- Diagnose and provide initial management of fractures of ribs, clavicle, sternum, scapulae, and spine (Comp 1, 2)
- Evaluate patients for thoracic surgery with regard to risk factors, candidacy for surgical resection, pulmonary function studies, and possible postoperative disability (Comp 1, 2, 3, 6)
- Manage general thoracic perioperative procedures (Comp 1, 3, 6)
- Use, set, and regulate mechanical ventilators (Comp 1, 2)
- Observe and then perform these functions: insert chest tubes, perform thoracentesis, insert central venous access lines, execute simple endoscopic procedures, perform tracheostomies, institute naso-oropharyngeal/tracheal anesthesia for endoscopic procedures (Comp 1, 2, 3)
- Use data obtained from diagnostic and therapeutic procedures to assess and plan treatment for thoracic pathology (Comp 1, 2, 3)
- Perform bronchoscopy, esophagoscopy, nasotracheal, and orotracheal intubation, including double lumen tubes (Comp 1, 2)
- Manage empyemas surgically (Comp 1, 2)
- Insert Swan-Ganz catheter and perform cardiovascular monitoring calculations (Comp1)
- Supervise ventilator regulation (Comp 1)
- Prepare preoperative clinic evaluation of patients for operation and postoperative follow-up evaluation (Comp 1, 2)
- Recognize respiratory distress and institute appropriate workup and treatment (Comp 1, 2, 3)
- Prepare a hemodynamic profile and interpret hemodynamic data (Comp 1, 2, 3)
- Demonstrate ability to institute a complete regimen of pulmonary toilet strategy (Comp 1, 2)
- Obtain and use arterial blood gas measurement, oxygen saturation monitors, CVP measurements (Comp 1, 2)
- Recognize bronchoconstrictive disorders and their perioperative management (Comp 1, 2)
- Recognize rhythm disturbances, myocardial ischemia on EKG (Comp 1, 2)
- First assist during major cardiac procedures including thoracotomies and median sternotomies (Comp 1, 2)
- Assist in harvesting saphenous vein for bypass and thoracic surgeries (Comp 1, 2)
- Place pacing wires, chest tubes, and close sternotomy independently (Comp 1, 2)
- Diagnose and initiate treatment of dysrhythmias (Comp 1, 2)
- Manage tachyarrhythmias (Comp 1, 2)
- Know and apply appropriate treatment for supraventricular tachycardia (Comp 1, 2)
- Participate in the treatment of congestive failure and acute pulmonary edema (Comp 1, 2)
- Perform a pulmonary resection (Comp 1, 2)
- Evaluate thoracic pathophysiology; order and interpret appropriate tests (Comp 1, 2, 3, 6)
- Diagnose and provide initial management of fractures of ribs, clavicle, sternum, scapulae, and spine (Comp 1, 2)
- Evaluate patients for thoracic surgery with regard to risk factors, candidacy for surgical resection, pulmonary function studies, and possible postoperative disability (Comp 1, 2, 3)
- Manage general thoracic perioperative procedures (Comp 1, 2, 3)
- Observe and then perform these functions: insert chest tubes, perform thoracentesis, insert central venous access lines, execute simple endoscopic procedures, perform tracheostomies, institute naso-oropharyngeal/tracheal anesthesia for endoscopic procedures (Comp 1, 2, 3)
- Use data obtained from diagnostic and therapeutic procedures to assess and plan treatment for thoracic pathology (Comp 1, 2, 3)
- Perform bronchoscopy, esophagoscopy, nasotracheal, and orotracheal intubation, including double lumen tubes (Comp 1, 2)
- Insert Swan-Ganz catheter and perform cardiovascular monitoring calculations (Comp 1, 2)
- Supervise ventilator regulation (Comp 1, 2)
- Assist with patient and family counseling (Comp 1, 2, 3, 4, 5, 6)
Cardiac-Great Vessels Rotation Skills Objectives: - Perform preoperative evaluation, history, and physical examination of cardiac surgery patients (Comp 1, 2, 3)
- Obtain and interpret indicated diagnostic studies (Comp 1, 2, 3)
- Discuss diagnostic and therapeutic approaches to specific acquired and congenital cardiac diseases with the attending physicians (Comp 1, 2, 4)
- Assist with selected cardiac and general surgery cases, such as: pacemaker and defibrillator insertions, saphenous vein harvest and wound closure for coronary bypass operations, valve and coronary operations, pericardial drainage operations, tracheostomy, minor vascular repairs (Comp 1, 2)
- Provide postoperative cardiac surgery follow-up care (Comp 1, 2, 3, 4)
- Perform percutaneous insertion of chest tubes and intravenous, intra-arterial, and pulmonary artery catheters with supervision (Comp 1, 2, 3)
2.5.Plastic and Reconstructive Surgery (2 months)
2.5-A.Rotation Knowledge-Plastic Surgery Plastic Surgery Knowledge Objectives: - Outline the components of a comprehensive focused history and physical examination pertinent to the evaluation and correction of traumatic, congenital, or acquired defects and oncologic processes under the realm of plastic and reconstructive surgery (Comp 2)
- Discuss and compare skin and connective tissue according to pathophysiology of benign, premalignant, and malignant skin disorders (Comp 2)
- Explain the basic techniques for surgical repair of incisions and lacerations of the head, neck, trunk, and extremities (Comp 2)
- Describe the physiology of various techniques of skin and composite tissue transplantation with particular regard to component tissue circulation, flaps, and grafts (Comp 2)
- Categorize the pathophysiology of thermal, chemical, and electrical burns (Comp 2)
- Outline the components of a comprehensive examination of the naso-, oro-, and hyo- pharynx (Comp 2)
- Explain the assessment of facial skeletal trauma according to these classifications: LeFort, nasoethmoidal disruption, and zygomatic-orbital-mandibular fractures (Comp 2)
- Define the tumor, node, and metastases (TNM) classification system as used for neoplasms of skin, soft tissue, and head and neck (Comp 2)
- Discuss epidemiology, risk factors, treatment, and prevention of cutaneous malignancies in the pediatric, adult, and geriatric patient (Comp 2)
- Explain the methods for performing incisional and excisional biopsies of skin and oral cavity and extremities (Comp 2)
- Understand the systematic examination of the hand to assess skeletal, motor, and sensory function (Comp 2)
- Outline appropriate diagnostic studies needed to supplement the physical examination when developing a treatment plan for hand surgery, facial fractures, congenital structural anomalies (Comp 2, 3, 6)
- Summarize the evaluation of patients with head and neck cancer, and develop a treatment plan (Comp 2, 3, 6)
- Demonstrate a working knowledge of the safe use of nasopharyngoscopy, laryngoscopy, esophagoscopy, and other endoscopic procedures utilized in the evaluation of patients with head and neck cancer (Comp 2)
- Discuss the use of the reconstructive ladder (including skin grafts, local flaps, and regional and free microvascular flaps) in the definitive management of traumatic or excised wounds (Comp 2)
- Explain considerations in a geriatric patient undergoing major reconstructive operation (Comp 2, 3, 6)
- Analyze treatment options for the comprehensive care of the burn patient (Comp 2, 3, 6)
- Assess basic lines of research in plastic and reconstructive surgery (Comp 2)
- Summarize currently accepted surgical techniques for treating correction of congenital lesions, craniofacial anomalies, breast reconstruction, reconstruction and ablative head and neck surgery, and aesthetic rejuvenation of face and body (Comp 2)
- Discuss assessment of the patient with acute and chronic wounds; perform appropriate physical exam and assessment
- Understand and discuss current options for wound coverage, e.g., skin, allograft, xenograft
2.5-B.Rotation Skills-Plastic Surgery
Plastic Surgery Skills Objectives: - Complete a comprehensive physical examination and clinical data history, including pertinent diagnostic laboratory and radiographic findings (Comp 1, 2, 3, 4, 5)
- Evaluate and treat simple and intermediate abrasions, chemical burns, and burns of the face, trunk, and extremities (Comp 1, 2, 3)
- Perform simple incisional biopsies and excise small/intermediate lesions on the skin and subcutaneous tissue of the trunk or extremities and perform local closure including local flaps and grafts (Comp 1, 2)
- Provide definitive treatment plans for complex incised and lacerated wounds of the neck, trunk, and extremities (Comp 1, 2)
- Participate in the perioperative evaluation and management of congenital or acquired defects (traumatic and surgical) (Comp 1, 2, 3)
- Apply and remove dressings, casts, and splints of the head, neck, hand, trunk, and extremities (Comp 1, 2, 3)
- Debride wounds and burns (Comp 1, 2, 3)
- Participate in the acute resuscitation, evaluation, and initial, simple, and intermediate treatment of a burn and trauma patient (Comp 1, 2, 3)
- Harvest and apply split-thickness and full-thickness skin grafts (Comp 1, 2)
- Plan and perform simple, localized skin flaps for wound coverage (Comp 1, 2)
- Participate in the evaluation and formulation of treatment plans (Comp 1, 2, 3)
- Under the direction of a plastic surgeon, assist in the planning and performance of complex reconstructive operations (Comp 1, 2, 3, 6)
- Reconstruct defects with random flaps, composite flaps, and grafts under supervision (Comp 1, 2, 3)
- Act as first assistant and attending-supervised surgeon for major resectional and reconstructive surgery of the head, neck, breast, trunk and extremities (Comp 1, 2, 3)
- Raise muscle and skin-muscle flaps under direct supervision (Comp 1, 2, 3)
- Perform major excision of burns, escharotomy, and skin grafting under direct supervision (Comp 1, 2, 3)
- Assess and act as first assistant and attending-supervised surgeon for complex soft tissue injury, fractures, nerve-tendon-bone surgery of the hand, vascular injuries (Comp 1, 2, 3)
- Act as first assistant or attending supervised surgeon for: hand surgery, facial trauma repair, resection of neoplasms, resection of major skin and soft tissue neoplasms, repair of craniomaxillofacial congenital defects, breast reconstruction, complex wound reconstruction using local, regional, and free microvascular flaps (Comp 1, 2, 3, 4)
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