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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
4.1.General Surgery (3 months)
4.2.Trauma Surgery/Critical Care/Transplantation (6 months)
4.3.Pediatric Surgery (3 months)
4.1.General Surgery (3 months)
4.1-A.Rotation Knowledge
PGY IV Knowledge Objectives: Background Knowledge - Demonstrate in-depth knowledge of surgical pathophysiology, emphasizing surgical oncology
- Discuss basic management and surgical procedures for the service
- Review Knowledge Objectives from the PGY I-II General Surgery Rotation
Knowledge Objectives - Be familiar with applicable surgical literature and know how to complete literature searches (Comp 2)
- Have extensive understanding of pathophysiologic principles of general surgical diseases; study controversial areas in these diseases (Comp 2)
- Analyze and discuss neoadjuvant and adjuvant therapies for neoplasms of the breast (Comp 1, 2)
- Demonstrate an understanding of endoscopic procedures such as: upper endoscopy, colonoscopy, flexible sigmoidoscopy (Comp 2)
- For each endoscopic procedure know: indications for use, risk of complications from use, safe use of conscious sedation, diagnostic accuracy, significance of findings, basic setup of endoscopy suite (Comp 1, 2, 3, 6)
- Understand the rationale and implementation of colorectal cancer screening (Comp 1, 2)
Endocrine Surgery-Thyroid Disease Knowledge Objectives: - Review the previous objectives for PGY I and II (Comp 2)
- Outline algorithms for the evaluation and treatment of: well-differentiated thyroid cancer, medullary thyroid cancer, thyroid lymphoma, anaplastic thyroid cancer (Comp 1, 2, 3)
- Describe risk factors for well-differentiated thyroid cancer, medullary thyroid cancer, and anaplastic thyroid cancer (Comp 1, 2)
- Outline algorithms for the evaluation and treatment of hyperthyroidism due to Graves’ disease, toxic nodule, medications, pregnancy (Comp 2)
- Describe the clinical presentation of thyroid storm and outline the treatment of thyroid storm (Comp 2)
- Outline an algorithm for the evaluation and management of nontoxic multinodular goiter, including substernal goiter with and without airway involvement (Comp 2)
- Outline the pathophysiology of: multinodular goiter, Grave’s disease, thyroid cancer (Comp 2)
- Demonstrate in-depth knowledge of the anatomy of the neck with regard to the thyroid and parathyroids and operations for each (Comp 2)
- Describe operative approaches to thyroid pathology (Comp 1, 2, 3)
- Outline the staging and prognosis in thyroid cancer (Comp 1, 2)
- Be able to recognition and treat common postoperative complications such as: hematoma, hypocalcemia, thyroid storm, voice changes (Comp 1, 2, 3)
4.1-B.Rotation Skills
PGY IV Skills Objectives: Background Skills - Master basic laparoscopic procedures such as cholecystectomy, appendectomy, and diagnostic laparoscopy
- Assist in major surgical procedures with ability to perform standard abdominal wall and breast procedures
- Demonstrate competence in utilizing surgical stapling instruments
- Review Skills Objectives from the PGY I-II General Surgery Rotation
Rotation Skills Objectives: - Initiate consultations on newly referred patients warranting a surgical opinion in timely, appropriate manner (Comp 1, 2, 3, 4, ,5, 6)
- Organize the surgical team and coordinate consultations to medical and other services (Comp 1, 2, 3, 4, 5, 6)
- Evaluate the patient with an acute abdomen; direct diagnostic workup and outline therapeutic options (Comp 1, 2, 3, 4)
- Order appropriate investigations and other studies (Comp 1, 2, 3)
- Prepare appropriate differential diagnoses and treatment plans (Comp 1, 2, 3)
- Initiate care and proceed with operation under supervision by the attending (Comp 1, 2, 3)
- Perform mastectomy, herniorrhaphy, cholecystectomy, right hemicolectomy (Comp 1, 2)
- Manage ill and/or unstable postoperative patients utilizing sound knowledge of hemodynamic monitoring and vasoactive drugs (Comp 1, 2, 3)
- Evaluate patients in the critical care unit, place appropriate invasive monitoring devices, and initiate fluid and pharmacologic care (Comp 1, 2, 3)
- Show further expertise in teaching junior-level residents and medical students (Comp 1, 2, 3, 4)
- Demonstrate mastery in the use of ventilators and pressors (Comp 1, 2)
- Provide care for fiberoptic endoscopy equipment including setup, disinfection, storage (Comp 1, 2)
- Practice basic techniques for safe and effective diagnostic endoscopy (Comp 1, 2)
- Become proficient in basic endoscopic techniques including examination of rectum and left colon by flexible endoscopy (Comp 1, 2)
- Assist in colonoscopy and upper endoscopy to include esophageal intubation in the patient with conscious sedation (Comp 1, 2, 3, 4)
- Perform PEG tube placements (Comp 1, 2)
- Perform colon resection, including hand-sewn anastomoses with direction from attending (Comp1, 2)
- Interpret hemodynamic data in the SICU (Comp 1, 2)
- Demonstrate advanced skill in teaching medical students (Comp 1, 2, 3, 4, 5, 6)
- Show improved skills in interpersonal relationships with patients and families (Comp 1, 2, 3, 4, 5, 6)
- Assist in sentinel node mapping and biopsy in patients with melanoma and breast cancer (Comp 1, 2, 3)
- Perform a breast quadrantectomy or mastectomy under supervision with axillary sampling or dissection (Comp 1, 2, 3)
- Demonstrate increased skill in patient communication and documentation including how to discuss operations and risks (Comp 1, 2, 3, 4, 5, 6)
- Be recognized as an excellent educator of medical students and junior-level residents on service (Comp 1)
- Actively participate in service clinics and conferences (Comp 1)
Endocrine Surgery-Thyroid Disease Rotation Skills Objectives: - Demonstrate normal anatomy in the operating room (Comp 1, 2)
- Palpate and describe a thyroid nodule (Comp 1, 2)
- Perform a fine needle aspiration biopsy of a palpable thyroid nodule (Comp 1, 2)
- Perform the initial steps in thyroid surgery, including: patient positioning and marking, skin incision and raising subplatysmal flaps, opening strap muscles, closing strap muscles, platysma, and skin (Comp 1, 2)
4.2-A.Rotation Knowledge-Trauma Surgery/Critical Care/Transplantation
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 4.1-A.PGY IV Transplantation Rotation Knowledge Review Knowledge Objectives from the PGY I-II Trauma-Transplantation Rotation (Comp 2) 4.2-B.Skills-Critical Care/Transplantation
Skills Objectives: - Review Skills Objectives from the PGY I-II Trauma-Transplantation Surgery Rotation (Comp 1, 2)
- Function with senior resident responsibilities for admissions and scheduling oerations (Comp 1, 2, 3)
- Demonstrate increased knowledge and experience in evaluating and managing surgical problems in patients with end-stage renal disease (Comp 1, 2, 3, 4)
- Evaluate and locate dialysis access (Comp 1, 2)
- Recognize and treat possible complications of dialysis access (Comp 1, 2)
- Evaluate potential transplant recipients with exposure to histocompatibility data (Comp 1, 2, 3)
- Determine need for immunosuppressive medications; recognize, diagnose, and treat rejection (Comp 1, 2, 3)
- Diagnose and manage postoperative complications peculiar to renal transplantation (Comp 1, 2)
- Show skill in establishing access for peritoneal dialysis and vascular access (Comp 1, 2)
- Demonstrate increased skill in technical aspects necessary to perform a renal transplant such as vascular anastomoses and ureteroneocystostomy (Comp 1, 2)
- Participate in transplant clinic to evaluate preoperative patients, both dialysis access and kidney transplant, for operation and establish follow-up care for patients having had access (Comp 1, 2, 3, 4, 5, 6)
- Demonstrate follow-up to complications with discussion and care of patients with any long-term complications under the guidance of the attending surgeon (Comp 1, 2, 3, 4, 5, 6)
- Perform venous and arterial anastomoses of kidney transplants (Comp 1, 2)
- Perform dissection and gain control of the iliac artery and vein (Comp 1, 2)
- Set up retractor for exposure of the iliac fossa (Comp 1, 2)
- Independently expose antecubital vessels for creation of an AVF (Comp 1, 2)
- Independently expose radial artery and cephalic vein at the wrist for Cimino (Comp 1, 2)
4.3.Pediatric Surgery (3 months)
4.3-A.Rotation Knowledge-Pediatric Surgery
Knowledge Objectives: Background Knowledge - Understand general principles of care of children with surgical conditions
- Understand fluid and electrolyte and nutritional management in children
- Demonstrate an understanding of pain control for children
- Demonstrate understanding of pathophysiology of common surgical conditions in children including pyloric stenosis, intestinal obstruction, appendicitis, foreign body of esophagus and airway
Neonatal Surgery Knowledge - Understand the unique anatomic, pathophysiologic, and genetic conditions that affect the fetus and neonate (Comp 2)
- Classify congenital malformations of the newborn by type (Comp 2)
- Learn principles of stabilization, appropriate preoperative diagnosis, and preparation of the sick neonate (Comp 2)
- Understand the anatomic and physiologic principles which guide successful operative repair of neonatal diseases (Comp 2)
- Learn principles of routine postoperative care and postoperative critical care management (Comp 2)
- Describe capabilities and limitations of various diagnostic modalities used in neonatal care (Comp 2)
- Formulate a care plan for neonates with problems such as respiratory distress, gastroesophageal reflux, jaundice, bilious emesis, bloody diarrhea, abdominal distention (Comp 2)
- Understand how new techniques such as fetal surgery may offer alternatives for treatment of certain neonatal diseases (Comp 2)
- Diagnose common neonatal problems and describe surgical procedures for their correction (Comp 2)
Knowledge Objectives:
- Understand the unique anatomic, pathophysiologic, and genetic conditions that affect children (Comp 2)
- Learn the principles of stabilization, appropriate preoperative diagnosis, and preparation of the sick child (Comp 2)
- Understand the anatomic and physiologic principles which guide successful operative repair of pediatric diseases (Comp 2)
- Describe the development of children in terms of: weight, length, head size; nutritional requirements; renal function; hormonal influences on development; response to stress and infection (Comp 2)
- Demonstrate knowledge of anatomic variations of anal atresia and malrotation (Comp 2)
- Differentiate between pediatric and adult trauma resuscitation (Comp 2)
- Summarize the basic approach to the diagnosis and management of more common surgical problems of infancy and childhood such as: pyloric stenosis, perforated appendix, intussusception (Comp 2)
- Understand pathophysiology of surgical conditions in children including esophageal arrests, congenital diaphragmatic hernia (Comp 2)
- Differentiate characteristics of Hirschprung’s disease, intestinal atresia, intussusception, Wilms tumor, neuroblastoma (Comp 2)
- Explain the approach to surgical management of more complex surgical procedures such as: large skin grafts and musculocutaneous flaps; thoracotomy for pulmonary resection and vascular cardiac repair; flexible endoscopy; antireflux procedure; bowel resection; repair of hepatic, biliary, and pancreatic injury (Comp 2)
- Analyze the pathophysiology, diagnosis, and management options in the treatment of short-gut syndrome (Comp 2)
- Understand the principles of early and late follow-up for complex surgical problems of childhood (Comp 2)
- Understand the differences between omphalocele and gastroschisis (Comp 2)
4.3-B.Rotation Skills-Pediatric Surgery
Skills Objectives: Neonatal Surgery Skills - Perform a comprehensive evaluation of a neonate with suspected surgically correctable conditions (Comp 1, 2)
- Establish percutaneous venous and arterial access in neonates over 2 kg (Comp 1, 2)
- Assist or perform under supervision: peripheral venous and arterial cutdown access, placement of umbilical catheters, placement of central venous access, tube thoracostomy, incision and drainage of cysts and abscesses, hernia reduction (Comp 1, 2)
- Participate in perioperative care of the neonate by recording appropriate assessments and treatment plans in daily progress notes (Comp 1, 2, 3, 4)
- Manage illnesses including airway obstruction, necrotizing enterocolitis, congenital anomalies of the abdominal wall, GI tract, chest and diaphragm, solid tumors (Comp 1, 2)
- Demonstrate management of gastrostomy tubes and advancement of feeds (Comp 1, 2)
- Assist or perform surgical repairs of congenital diseases (Comp 1, 2)
- Serve as an effective consultant to the nursery, providing expertise in evaluation and definitive treatment of selective surgical conditions (Comp 1, 2, 3, 4, 5, 6)
- Perform or assist in all major surgical procedures performed on the pediatric surgical service (Comp 1, 2, 3)
- Conduct comprehensive preoperative evaluation and postoperative management for all critically ill neonates (Comp 1, 2, 3)
Skills Objectives: - Participate in preoperative assessment involving regular attendance of the outpatient clinic, provision if inpatient and emergency room consultation (Comp 1, 2)
- Provide preoperative assessment of all pediatric surgical patients, both inpatient and outpatient (Comp 1, 2, 3)
- Organize assessment protocols for patients with abdominal pain, abdominal mass, respiratory distress, gastrointestinal bleeding (Comp 1, 2, 3)
- Manage the stable neonate (Comp 1, 2, 3)
- Manage critically ill children (Comp 1, 2, 3)
- Stabilize and assess pediatric trauma patient airway management in older children (Comp 1, 2, 3)
- Provide venous access in younger children (Comp 1, 2)
- Interpret specialized radiologic studies including upper GI series, barium enema, CT scan, MRI, radionuclide scans (Comp 1, 2)
- Assist in surgery for pyloric stenosis and inguinal hernia in infants (Comp 1, 2)
- Demonstrate appropriate examination for appendicitis (Comp 1, 2, 3, 4)
- Perform complicated appendectomy and vascular access in infants; intestinal obstruction in older children (Comp 1, 2, 3)
- Participate in preoperative, operative, and postoperative care of more complex problems in pediatric surgery such as: pedicle graft, large skin grafts for burns, subcutaneous mastectomy; branchial cleft and thyroglossal duct cysts, cystic hygroma; laryngoscopy, bronchoscopy, esophagoscopy; tracheostomy; thoracotomy for biopsy, lung resection; diaphragm reapir (Comp 1, 2, 3)
- Assure continuity of care including active participation in preoperative assessment and diagnostic workup, postoperative care, and long-term follow-up in outpatient clinics and emergency room for more severe and urgent surgical problems (Comp 1, 2, 3, 4, 5, 6)
- Develop a working relationship with members of the pediatric intensive care unit in managing postoperative pediatric patients (Comp 1, 2, 3, 4, 5, 6)
- Develop a system to provide cost-efficient surgical care for children (Comp 1, 3, 6)
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