**Background Knowledge, Skills, and Basics of Professionalism are expected of residents as they enter residency and prepare to start their General Surgery rotations.

PGY I: General Surgery Background Knowledge
Upon entry into the General Surgery Training Program, the Intern is expected to know about the following objective areas:

• Patient Evaluation, Assessment, and Management
• • Principles of patient evaluation, assessment, and management; including history and physical examination and documentation, and patient assessment and perioperative management
• Assessment of Basic Diagnostic Tests and X-Rays
• • Principles of assessment of basic diagnostic tests and radiographs
• Airway Management and Anesthesia
• • Principles of airway management and anesthesia
• Management of Fluid/Electrolyte and Acid/Base Balance
• • Principles of management of fluids, electrolytes, and acid/base balance
  • Understand the concept of third-spacing and the relationships of extracellular and intracellular fluid compartments
  • Know the normal body composition at various ages and genders
  • Understand Ca and Mg balance
• Fever, Microbiology, and Surgical Infection
• • Principles of fever, microbiology, and surgical infection; including principles of epidemiology and public health
• Nutrition
• • Principles of nutrition; including principles of perioperative preparation
• Coagulation and Anticoagulation
• • Have a working knowledge of the coagulation cascade and recognition and differential diagnosis of coagulapathies by history and laboratory tests
  • Know indications and drug regimens for therapeutic anticoagulation
• Pharmacology
• • Know basic pharmacology and doses of common drugs, including antibiotics, diuretics, gastric acid-reducing drugs, sedatives, laxatives, corticosteroids, antihypertensives, NSAIDS.
• Diagnostic Acumen
• • Know the types and differential diagnosis of anemia, and the proper choice of diagnostic tests
  • Understand the pathophysiology of acid aspiration, recognize patients at risk, and know the general methods of prevention of aspiration
  • Recognize the clinical and radiologic features of bowel obstruction and its major causes
  • Understand the pathophysiology of diabetes, the classification of the types of diabetes and the implications for management, and the pathophysiology of development of long-term complications
• Embryology and Anatomy
• • Know the normal embryologic development of the GI, GU, CNS, and CV systems and the relationship to common congenital abnormalities
  • Apply knowledge of embryology to understand the common congenital anomalies
• Pharmacology and Pharmacokinetics
• • Know basic pharmacology and doses of common drugs—antibiotics, diuretics, gastric acid-reducing drugs, sedatives, laxatives, corticosteroids, antihypertensives, NSAIDS
• Organ-Specific Areas
• • Have a working knowledge of normal hemodynamics and cardiac function
  • Know normal renal anatomy and physiology, action of diuretic drugs, hormonal responses in salt and water metabolism
  • Know the anatomy and normal physiology of the pulmonary system and basic principles of gas exchange
  • Understand the pathophysiology of diabetes the classification of the types of diabetes and the implications for management, and the pathophysiology of development of long-term complications
  • Know the anatomy and normal physiology of the gastrointestinal tract
  • Recognize and be aware of the surgical implications of the major GI tract diseases of surgical patients, including diarrhea, constipation, bleeding, jaundice, appendicitis, dysmotility, colitis, ulceration
  • Know the normal anatomy and physiology of the liver
  • Recognize normal organ histology
  • Know the basic pathology of malignancy, inflammation, granulomatous diseases, and other common gross and microscopic findings
  • Give a differential diagnosis of hypertension and know its basic management
  • Understand the normal physiology of pregnancy
  • Recognize the clinical manifestations of substance abuse n all age groups, and the risks to the health care providers.
  • Know the clinical manifestations of cerebrovascular events and differentiate between stroke and TIA
    

PGY I: General Surgery Background Skills
Upon entry into the General Surgery Training Program, the Intern is expected to perform the following objectives:

• Patient Evaluation, Assessment, and Management
• • Write routine orders for vital signs, diet, activity, sleep, sedation, pain management, constipation, urinary retention
  • Write progress notes in the SOAP format
  • Maintain a legally correct medical record
• Airway Management and Anesthesia
• • Obtain oropharyngeal control of the airway and provide Ambu ventilation
  • Perform orotracheal intubation
  • Obtain basic CPR certification
• Management of Fluid/Electrolyte and Acid/Base Balance
• • Understand and order routine maintenance fluid requirements, calculate I&O, make corrections in maintenance orders based on biochemical assessment
  • Perform venipuncture and insert peripheral IV catheters
  • Perform arterial stick and obtain arterial sample
• Surgical Skills
• • Scrub, gown, and glove properly
  • Know and apply proper OR protocols, conduct, attire
  • Remove sutures and staples
  • Maintain sterile technique in the ER, at bedside, in ICU, and in office
• Fever, Microbiology, and Surgical Infection
• • Recognize wound infections
  • Know basic principles of wound healing
  • Know risk factors and methods to prevent tetanus and rabies
  • Be familiar with common surgical instruments (e.g., scalpel, forceps, scissors, needle holders, hemostats, retractors, electrocautery) and suture materials and their proper uses
  • Recognize and provide differential diagnosis for fever in the surgical patient, and initiate simple investigations such as urinalysis and physical examination
  • Know venous anatomy of the legs and recognize acute signs of DVT
  • Recognize chronic venous insufficiency and its implications
  • Understand the mechanisms and pathophysiology of the allergic response. Recognize and be able to treat anaphylaxis, and know the acute and chronic management of the allergic patient
• Organ-Specific Areas
• • Interpret a routine ECG
  • Obtain and use arterial blood gas measurement, oxygen saturation monitors, CVP measurements
  • Determine the physical findings and differential diagnosis in a patient with abdominal pain
  • Understand the mechanisms and pathophysiology of the allergic response. Recognize and be able to treat anaphylaxis, and know the acute and chronic management of the allergic patient
  • Eye Diseases: Know how to use an ophthalmoscope, perform a funduscopic examination, and recognize common abnormalities such as hemorrhage, exudates, papilledema, tumors
    

PGY I: Professionalism Background
Upon entry into the General Surgery Training Program, the Intern is expected to be knowledgeable about and display the following objectives:

• Present medical information completely and appropriately focused
• Use library resources efficiently and perform a literature search
• Maintain confidentiality, compassion, and a respect for basic ethical concepts of autonomy, beneficence, nonmaleficence, justice, and respect for life
• Understand how ethical principles apply to the individual physician
• Know where to go for help—personal, professional
• Appreciate and participate in risk management activities
• Appreciate and be able to discuss issues of access to care, health maintenance and disease prevention, substance abuse, death and dying, and informed consent
• Be substance-free