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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
6.1.General Surgery (4 months)
6.2.Vascular Surgery (4 months)
6.3.Trauma Surgery/Critical Care (4 months) 6.1.General Surgery (4 months) 6.1-A.Gastrointestinal Surgery Knowledge Objectives: - Review Knowledge Objectives from the PGY V General Surgery Rotation (Comp2)
- Demonstrate a thorough knowledge of the significance of natural history of surgical disease, the consequence of surgical care, the influence of continuity of care on surgical outcomes (Comp 1, 2, 3)
- Demonstrate capacity to integrate surgical continuity of care principles into the total care plan for all surgical patients (Comp 1, 2, 3)
- Know the essentials of both inpatient and outpatient diagnosis and work-up of all major general surgical problems (Comp 1, 2, 3, 6)
- Work through diagnostic and therapeutic pathways (Comp 1, 2, 3, 6)
- Lead and participate in discussions about various operative and non-operative options and techniques in the treatment of the general surgical patient (Comp 1, 2, 3, 4, 5, 6)
- Discuss areas of controversy and risks; benefits of operative versus non-operative treatment for surgical disorders encountered (Comp 1, 2, 3, 4, 5, 6)
- Incorporate knowledge of ethical, legal, economic, and/or social factors into the activities of the entire surgical team for all components of surgical care (Comp 1, 2, 3, 4, 5, 6)
- Demonstrate the capacity to evaluate knowledge and skill of others by evaluating parameters that contribute to a competent performance for superior surgical care (Comp1, 2, 3, 4, 5, 6)
- Review and understand significant aspects of surgical pathophysiology and critical care, pharmacology, physiology, and hemodynamic data (Comp 1, 2, 3)
- Be familiar with basic surgical literature and extensive areas of basic surgical disease (Comp 2, 3)
- Demonstrate increased knowledge of common hepatobiliary diseases such as hepatic and biliary tumors, benign strictures, portal hypertension, hepatic failure, biliary stone disease (Comp 2, 3)
- Be knowledgeable about controversial areas in general and gastrointestinal surgery (Comp 2, 3)
- Increase level of knowledge of biliary tract anatomy, pathology, and surgical protocols (Comp 2, 3)
- Increase level of knowledge of inflammatory bowel disease pathology and treatment (Comp 2, 3)
- Increase level of knowledge of disorders of foregut pathophysiology including GERD, achalasia, and PUD (Comp 2, 3)
- Understand decision making for recurrent colorectal and recurrent anal cancer (Comp 2, 3)
6.1-A.Surgical Oncology Knowledge Objectives: - Review Knowledge Objectives from the PGY IV Red General Surgery Rotation (Comp2)
- Demonstrate a thorough knowledge of the significance of natural history of surgical disease, the consequence of surgical care, the influence of continuity of care on surgical outcomes (Comp 1, 2, 3)
- Know the essentials of both inpatient and outpatient diagnosis and work-up of all major general surgical problems (Comp 1, 2, 3, 6)
- Work through diagnostic and therapeutic pathways (Comp 1, 2, 3, 6)
- Lead and participate in discussions about various operative and non-operative options and techniques in the treatment of the general surgical patient (Comp1, 2, 3, 4, 5, 6)
- Discuss areas of controversy and risks; benefits of operative versus non-operative treatment for surgical disorders encountered (Comp 1, 2, 3, 4, 5, 6)
- Incorporate knowledge of ethical, legal, economic, and/or social factors into the activities of the entire surgical team for all components of surgical care (Comp 1, 2, 3, 4, 5, 6)
- Demonstrate the capacity to evaluate knowledge and skill of others by evaluating parameters that contribute to a competent performance for superior surgical care (Comp 1, 2, 3, 4, 5, 6)
- Demonstrate capacity to integrate surgical continuity of care principles into the total care plan for all surgical patients (Comp 1, 2, 3, 4, 5, 6)
- Incorporate knowledge of ethical, legal, economic, and/or social factors into the activities of the entire surgical team for all components of surgical care (Comp 1, 2, 3, 4, 5, 6)
- Review and understand significant aspects of surgical pathophysiology and critical care, pharmacology, physiology, and hemodynamic data (Comp 2, 3)
- Be familiar with basic surgical literature and extensive areas of basic surgical diseases such as oncologic surgery and endocrine surgery (Comp 2, 3)
- Be knowledgeable and conversant in the evaluation and management of the patient with cancer (Comp 1, 2, 3, 6)
Endocrine Surgery Knowledge Objectives: - Review the previous Knowledge Objectives for PGY IV (Comp 2)
- Outline the complete evaluation and management of patients with thyroid cancer (papillary, follicular, medullary, anaplastic) including: (Comp 2, 3 all)
- Preoperative evaluation including radiographic studies
- Operative approaches including discussion of lobectomy vs. total thyroidectomy
- Indications for and extent of neck dissection
- Incidental finding of cancer in resected specimen
- Metastatic thyroid cancer
- Large remnant in patient with thyroid cancer
- Tracheal invasion
- Esophageal invasion
- Postoperative treatment, surveillance, and monitoring
- Outline the complete evaluation and management of nontoxic multinodular goiter and substernal goiter (Comp 2, 3)
- Describe approaches for reoperative thyroid surgery (Comp 2, 3)
- Describe the management of intraoperative recurrent nerve injury (Comp 2, 3)
6.1-B.Gastrointestinal Surgery Skills Objectives: - Review Skills Objectives from the PGY V Green General Surgery Rotation (Comp 1, 2, 3)
- Teach junior house staff the introductory-level surgical cases (Comp 1, 2, 3, 4, 5, 6)
- Teach medical students the principles of surgical diseases and surgical care (Comp 1, 2, 3, 4, 5, 6)
- Demonstrate leadership skills and ability to run an effective multilevel service (Comp 1, 2, 3, 4, 5, 6)
- Develop rapport and gain the confidence of the patient and family members; speak to the family on a daily basis regarding the patient’s progress (Comp 1, 2, 3, 4, 5, 6)
- Develop organizational and time management skills and administrative skills in managing a large number of health care professionals (Comp 1, 2, 3, 4, 5, 6)
- Initiate management decisions in conjunction with staff physicians and surgeons (Comp 1, 2, 3, 4, 5, 6)
- Demonstrate increased expertise in management of surgical problems in the geriatric patient (Comp 1, 2, 3, 6)
- Mobilize stomach; takedown short gastrics (Comp 1, 2, 3)
- Master basic laparoscopic skills for cholecystectomy, appendectomy, diagnostic laparoscopy (Comp 1, 2, 3)
- Perform a variety of more advanced laparoscopic procedures such as fundoplication and hernia repair; antireflux procedure, knot tying skills (Comp 1, 2, 3)
- Demonstrate ability to assist and perform under supervision: major resections for cancers of the GI tract such as pancreatoduodenectomy, low anterior resection of the rectum (Comp 1, 2)
- Perform two-handed laparoscopic cholecystectomy (Comp 1, 2)
- Mobilize splenic flexure (Comp 1, 2)
- Complete pelvic dissection of an APR (Comp 1, 2)
- Gain adequate exposure for excision of anal masses (Comp 1, 2)
- Construct ostomies independently (Comp 1, 2)
- Perform abdominal dissection of transhiatal esophagectomy (Comp 1, 2)
- Mobilize duodenum during Whipple (Comp 1, 2)
- Perform complete dissection of Lap Nissen and cholecystectomy (Comp 1, 2)
- Expose all parts of GI tract and perform small bowel and colon resections and anastomoses (Comp 1, 2)
- Perform lap appendectomy fully (Comp 1, 2)
- Demonstrate increased understanding of pancreatic disorders such as common pancreatitis and pseudocyst (Comp 1, 2)
- Be prepared to describe the process for pancreaticoduodenectomy (Comp 1, 2)
- Understand the work-up for pancreatic mass (Comp 1, 2, 3)
- Manage pancreatitis, encephalopathy, hemorrhage, coagulopathy, immunosuppression, prophylactic antibiosis (Comp 1, 2, 3)
- Demonstrate understanding of concepts of IBD, basic medical management, and surgical options/pitfalls (Comp 1, 2, 3, 6)
- Manage intraabdominal sepsis or pancreatitis in the SICU (Comp 1, 2, 3)
6.1-B.Skills Objectives: - Review Skills Objectives from the PGY IV General Surgery Rotation (Comp 1, 2, 3)
- Teach junior house staff the introductory-level surgical cases (Comp 1, 2, 3, 4, 5, 6)
- Teach medical students the principles of surgical diseases and surgical care (Comp 1, 2, 3, 4, 5, 6)
- Demonstrate leadership skills and ability to run an effective multilevel team and service (Comp 1, 2, 3, 4, 5, 6)
- Develop organizational and time management skills and administrative skills in managing a large number of health care professionals (Comp 1, 2, 3, 4, 5, 6)
- Initiate management decisions in conjunction with staff physicians and surgeons (Comp 1, 2, 3, 4, 5, 6)
- Demonstrate the capacity to supervise total care of patients with complicated surgical disease processes (Comp 1, 2, 3, 4, 5, 6)
- Demonstrate effective integration of knowledge and skills into surgical performance and competency for inpatients and outpatients with both acute and chronic disease (Comp 1, 2, 3, 4, 5, 6)
- Develop rapport and gain the confidence of the patient and family members; speak to the family on a daily basis regarding the patient’s progress (Comp 1, 2, 3, 4, 5, 6)
- Evaluate and care for patients with cancers of the alimentary tract, applying knowledge of neoadjuvant, operation, and adjuvant options and treatments (Comp 1, 2, 3)
- Master basic laparoscopic skills for cholecystectomy, appendectomy, diagnostic laparoscopy (Comp 1, 2, 3)
- Perform two-handed laparoscopic cholecystectomy (Comp 1, 2)
- Mobilize splenic flexure (Comp 1, 2)
- Perform mastectomy (Comp 1, 2)
Endocrine Surgery Skills Objectives: - Review the previous Skills Objectives for PGY IV (Comp 1, 2, 3)
- Interpret thyroid ultrasound images (Comp 1, 2)
- Perform the critical steps of thyroid lobectomy including: (Comp 1, 2, 3 all)
- Identification of recurrent laryngeal nerve
- Identification of parathyroid glands
- Ligation of superior pole vessels
- Ligation of inferior thyroid artery branches
- Mobilization of thyroid lobe
6.2.Vascular Surgery (4 months) 6.2-A.Knowledge Objectives: - Review Knowledge Objectives from the PGY V Vascular Rotation (Comp 2)
- Understand preoperative, intraoperative, and postoperative care of vascular patients (Comp 2)
- Develop a comprehensive understanding for managing arterial and venous disease in outpatient care, indications for treatment, non-operative and operative options, complex preoperative assessment, and postoperative care and follow-up (Comp 2, 3)
- Demonstrate understanding, through leadership and teaching, of the significance of the natural history of surgical disease, the consequence of surgical care, the influence of continuity of care on vascular surgical outcomes (Comp 1, 2, 3, 4, 5, 6)
- Be prepared to utilize significant surgical knowledge and advanced skill to achieve a performance that produces appropriate and anticipated outcomes for vascular surgical patients (Comp 1, 2, 3, 4, 5, 6)
- Review critical factors for decision making in vascular surgery including risk/reward ratio, morbidity and mortality probability, preoperative and postoperative assessment, non-invasive laboratory data, role of advanced radiologic techniques such as CT and MR (Comp 1, 2, 3, 6)
- Categorize the prevention and management of operative and postoperative complications including graft infections, ischemic bowel, graft thrombosis, and extremity ischemia; stress manifestations of failing vascular grafts in order to prepare to lead prompt and proper diagnosis and management of these vascular emergencies (Comp 1, 2, 3)
- Demonstrate a high level of knowledge about different treatment options available such as medical, percutaneous, operative (Comp 1, 2)
- Understand management of vascular trauma (Comp 1, 2)
- Understand risks/benefits, outcome, quality of life issues regarding AAA, CEA, operations for acute/chronic limb ischemia (Comp 1, 2, 3, 6)
- Be prepared to lead lower-level surgical residents on the service (Comp 1, 2, 3, 4, 5, 6)
6.2-B.Skills Objectives: - Review Skills Objectives from the PGY V Vascular Rotation (Comp 1, 2)
- As chief resident accept consultation and provide consultation to department and outpatient services with guidance from faculty (Comp 1, 2, 3, 4, 5, 6)
- Integrate surgical continuity of care principles into the total care plan for vascular surgical patients (Comp 1, 2, 3, 4, 5, 6)
- Demonstrate effective collaborative interactions with the patients’ families, faculty, and other health care providers (Comp 1, 2, 3, 4, 5, 6)
- Participate in selection and accomplishment of the most complex vascular procedures and management including complications of such care (Comp 1, 2, 3, 6)
- Analyze complex vascular problems, showing efficient decision making for such problems as cerebral vascular disease, peripheral arterial occlusive disease, chronic venous insufficiency states, aneurismal disease, renovascular hypertension, portal hypertension, mesenteric ischemia (Comp 1, 2, 3, 6)
- Demonstrate independent clinical decision making for management of AAA, carotid occlusive disease, acute/chronic limb ischemia, acute/chronic mesenteric ischemia, renovascular hypertension, DVT/PE (Comp 1, 2, 3)
- Take responsibility for responsibly teaching and evaluating lower-level surgical residents and medical students on the service (Comp 1, 2, 3, 4, 5, 6)
- Evaluate the knowledge and skill of others by evaluating parameters that contribute to a competent performance for superior vascular surgical care (Comp 1, 2, 3, 4, 5, 6)
- Incorporate knowledge of ethical, legal, economic, and/or social factors into the activities of the entire surgical team (Comp 1, 2, 3, 4, 5, 6)
- Demonstrate competence in the most complex surgical procedures including vascular control of major vessels such as aorta and vena cava to stop hemorrhage (Comp 1, 2, 3)
- Select and use proper advanced techniques for managing ruptured aortic hypertension, portal hypertension, or procedures distal to carotid, vertebral or tibial vessels (Comp 1, 2, 3)
- Demonstrate proficiency and appropriate timing for performance of alternative methods of bypass grafting such as extra-anatomic bypass, in situ techniques, or sequential and composite techniques (Comp1, 2, 3)
- Participate in radiologic and endovascular procedures such as diagnostic peripheral arteriography, balloon angioplasty, placement of intraarterial stents, placement of vena cava filters, and placement of aortic endografts (Comp 1, 2, 3)
- Manage prosthetic graft infections including diagnosis, selection of alternative routes for revascularization, and selection of appropriate graft materials (Comp 1, 2, 3)
- Manage DVT and indications for IVC interruption (Comp 1, 2)
- Perform lower extremity bypass with minimal assistance (Comp 1, 2)
- Perform AAA repair with minimal assistance (Comp 1, 2)
- Perform CEA with minimal assistance (Comp 1, 2)
6.3.Trauma Surgery/Critical Care (3 months) 6.3-A.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 experiences are not a part of this rotation. |
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