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PREREQUISITES
 
Prerequisites for Graduate Surgical Education: American College of Surgeons GME Committee - PGY I 
General Surgery Rotation Basics-Green Rotation (2 months); Red Rotation (4 months); Vascular Surgery (4 months); Trauma Surgery/Critical Care/Transplantation (2 months).

**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
PGY I: General Surgery Background Skills
PGY I: Professionalism Background


 

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