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 OVERALL EDUCATIONAL GOALS FOR THE PROGRAM
 
Overall Curriculum Goals for Surgical Residents

Our curriculum goals were structured as summary goals descriptive of the desired outcomes of surgical education.  When competencies are viewed in conjunction with objective criteria, one has a combination of indicators of what is essential for resident learning, and one can employ these essentials in implementing the instructional program. The broad educational areas in our resident curriculum, for which competencies and instructional criteria exist, are these:

• Integration of theory and practice
• Application of surgical skills
• Increasing expertise in care for elderly patients
• Use of critical thinking
• Exercise of ethical judgment
• Use of appropriate communication
• Recognition of teaching responsibilities
• Development of management abilities
• Teaching and learning for a lifetime

The general competency areas for residents, in which residency programs are required by the Accreditation Council for Graduate Medical Education (ACGME), to define specific knowledge, skills, and attitudes are the following organizing principles.  These areas are specified throughout our curriculum and assessment instrumentation for day-to-day documentation of resident performance. (Please see the following section for how the competencies are integrated into the daily education of the surgical house staff.)

• 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

Expected Outcomes Expressed as Program Goals

It is important to consider that the educational areas and organizing principles listed above identify the content divisions that are critical for the comprehensive educational and professional preparation of a surgeon.  We regard these goals and objectives as the competency-based structure of our curriculum.  A competency-based education program, anchored by this structure, creates an educational back-up system of knowledge, skills, and attitudes that are helpful in assuring the public that a program graduate is competent to practice.

When these learning objectives have been met, the expected outcome is that core competencies, describing the abilities made possible by a professional education, can be performed acceptably.  The twelve competencies listed below specify what the resident should know, be able to do, or have an attitude about at the completion of a defined point during or immediately upon completion of surgical training.  These competencies are the basis of our program’s “Surgical Education Program Effectiveness Survey” administered to faculty in 1997, 1998, 2002, 2004, and 2005; administered to residents in 1998 and 2005.

The following statement should preface each of the core competencies listed below:

At the completion of training, the resident can:

• Make sound ethical and legal judgments appropriate for a qualified surgeon.
• Respect the cultural and religious needs of patients and their families, and provide surgical care in accordance with those needs.
• Manage surgical disorders based on a thorough knowledge of basic and clinical science.
• Utilize appropriate skill in those surgical techniques required of a qualified surgeon.
• Use critical thinking when making decisions affecting the life of a patient and the patient's family.
• Collaborate effectively with colleagues and other health professionals.
• Teach and share knowledge with colleagues, residents, students, and other health care providers.
• Teach patients and their families about the patient's health needs.
• Be committed to scholarly pursuits through the conduct and evaluation of research.
• Be prepared to manage complex programs and organizations.
• Provide cost-effective care to surgical patients and families within the community.
• Value lifelong learning as a necessary prerequisite to maintaining surgical knowledge and skill.

Integration of the Clinical Competencies into the daily education of the surgical house staff:


Patient Care
Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.

Patient Care Learning Activities during ECU surgical rotations which provide experience in this competency development include:

• Inpatient and outpatient patient care experiences
• Operative patient care experiences
• Operative log completion and review
• Case review at M&M conference
• Case discussion at weekly resident conferences
• Bedside teaching
• Ward rounds
• Operating room instruction
• Journal Club participation
     Patient care portfolio materials—credentialing and performance review
     Participation of junior-level residents on standardized patient OSCE

Residents are expected to:

• communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families
• gather essential and accurate information about their patients
• make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment
• develop and carry out patient management plans
• counsel and educate patients and their families
• use information technology to support patient care decisions and patient education
• perform competently all medical and invasive procedures considered essential for the area of practice
• provide health care services aimed at preventing health problems or maintaining health
• work with health care professionals, including those from other disciplines, to provide patient-focused care

Resident Assessment includes observation of performance in these areas:

• Medical Interviewing
• Physical Examination
• Procedural Skills
• Clinical  Judgment
• Ongoing Care


Medical Knowledge
Residents must demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care.

Medical Knowledge Learning Activities during ECU surgical rotations which provide experience in this competency development include:

• Weekly resident conferences
• Biweekly Surgical Grand Rounds
• Educational experiences in clinic, hospital, operating room
• Regularly scheduled weekly/monthly conferences (departmental and/or service specialized conferences)
• Resident self study using the ACS SESAP program
• Resident performance on the ABS In-Training Examination
• Senior-level resident performance during Oral Examination
• Journal Club

Residents are expected to:

• demonstrate an investigatory and analytic thinking approach to clinical situations
• know and apply the basic and clinically supportive sciences which are appropriate to their discipline

Resident Assessment includes observation of performance in these areas:

• Up-to-date knowledge
• Investigation of critical topics 


Practice-Based Learning and Improvement
Residents must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices.

Practice-Based Learning and Improvement Learning Activities during ECU surgical rotations which provide experience in this competency development include:

• Case review at weekly M&M Conference
• Case log review during rotation and at biannual performance reviews
• Case discussion at weekly resident conferences
• Case discussion in outpatient clinic, hospital, operating room
• Orientation to service (Trauma)

Residents are expected to:

• analyze practice experience and perform practice-based improvement activities using a systematic methodology
• locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems
• obtain and use information about their own population of patients and the larger population from which their patients are drawn
• apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness
• use information technology to manage information, access on-line medical information; and support their own education
• facilitate the learning of students and other health care professionals
 
Resident Assessment includes observation of performance in these areas:

• Appraisal of scientific evidence
• Knowledge of study designs, statistical methods
• Analysis of own practices
• Data gathering and feedback
• Use of information technology
• Student education
• Independent functioning, little need for faculty supervision 


Interpersonal and Communication Skills
Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patients families, and professional associates.

Interpersonal and Communication Skills Learning Activities during ECU surgical rotations which provide experience in this competency development include:

• Patient care experiences in outpatient clinic and hospital
• Role modeling by surgical faculty
• Senior-level resident performance during Oral Examination
• National exposure at professional meetings, networking opportunities
• Acceptance of scientific abstracts, papers, published manuscripts following critical review of resident scholarly performance
• M3 and M4 teaching interactions with student learners; analysis of student feedback on teaching 
• Each presentation at Surgical M&M is evaluated by 3 faculty members, in an effort to improve communication and presentation skills

Residents are expected to:

• create and sustain a therapeutic and ethically sound relationship with patients
• use effective listening skills and elicit and provide information using effective nonverbal, explanatory, questioning, and writing skills
• work effectively with others as a member or leader of a health care team or other professional group

Resident Assessment includes observation of performance in these areas:

• Compassion for patients and their families
• Counseling, education, informed consent instructions to patients
• Patient inclusion in treatment decisions
• Listens to patients
• Listens to other members of the health care team
• Records complete and accurate information   


Professionalism
Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.

Professionalism Learning Activities during ECU surgical rotations which provide experience in this competency development include:

• Monthly education sessions by School of Medicine
• Educational programs offered through medical school
• Surgical faculty and other role modeling
• Visiting professor schedule of formal and informal interactions
• Personal presentations at regional and national conferences
• Senior-level resident performance during Oral Examination
• Chief resident presentation at Surgical Grand Rounds
• Frequent practice through hosting resident applicants during Match activities
• Journal Club

Residents are expected to:

• demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients and society that supercedes self-interest; accountability to patients, society, and the profession; and a commitment to excellence and on-going professional development
• demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, and business practices
• demonstrate sensitivity and responsiveness to patients’ culture, age, gender, and disabilities

Resident Assessment includes observation of performance in these areas:

• Regard for welfare of others
• Adheres to a code of moral and ethical values
• Respectful of patients and their families
• Respectful of other members of the health care team
• Provides prompt consultations upon request
• Sensitive to patients’ cultural backgrounds
• Accountable for own actions
• Reliable
• Punctual
• Committed to excellence


Systems-Based Practice
Residents must 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.

Systems-Based Practice Learning Activities during ECU surgical rotations which provide experience in this competency development include:
*Case review at M&M Conference
*Chief resident attendance at departmental meetings
*Incorporation in weekly resident conference
*Journal Club
*Planning discharge of complicated patients using home health, nursing homes

Residents are expected to:

• understand how their patient care and other professional practices affect other health care professionals, the health care organization, and the larger society and how these elements of the system affect their own practice
• know how types of medical practice and delivery systems differ from one another, including methods of controlling health care costs and allocating resources
• practice cost-effective health care and resource allocation that does not compromise quality of care
• advocate for quality patient care and assist patients in dealing with system complexities
• know how to partner with health care managers and health care providers to assess, coordinate, and improve health care and know how these activities can affect system performance

Resident Assessment includes observation of performance in these areas:

• Provides cost-effective care
• Advocates for patients within the health care system
• Refers patients to appropriate practitioners and agencies
• Accesses assistance within the health care system for coordination and management of ongoing care
• Discharges patients in a timely and appropriate manner