Download U M 2014-2015

UNIVERSITY OF MINNESOTA
GRADUATE MEDICAL EDUCATION
2014-2015
RESIDENT
PROGRAM POLICY &
PROCEDURE MANUAL
DEPARTMENT OF SURGERY
GENERAL SURGERY RESIDENCY
TRAINING PROGRAM
Table of Contents
INTRODUCTION
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Introduction to Program Manual .......................................................................................5
Department of Surgery Mission Statement ......................................................................5
General Surgery Training Program Mission Statement....................................................5
SECTION 1 - STUDENT SERVICES
(Please refer to Institution Policy Manual at
GME Institution Manual
Or http://med.umn.edu/gme/InstitutionPolicyManual2013/index.htm
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University Pagers .............................................................................................................5
Email and Internet Access ...............................................................................................6
University Mailboxes and Campus Mail ...........................................................................6
Laboratory Coats and Laundry Service............................................................................6
UMMC Photo ID Badge ...................................................................................................7
HIPAA Privacy Regulations .............................................................................................7
SECTION 2 - BENEFITS
(Please refer to Institution Policy Manual at
GME Institution Manual or
http://med.umn.edu/gme/InstitutionPolicyManual2013/index.htm
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Stipends .....................................................................................................................7
Health and Dental Insurance Coverage ......................................................................7
Life Insurance, Standard and Voluntary .....................................................................7
Short Term Disability Insurance .................................................................................7
Long Term Disability Insurance .................................................................................7
Professional Liability Insurance ..................................................................................7
Employee Health Services .........................................................................................7
Meal Tickets ...............................................................................................................8
Parking ..................................................................................................................... 10
Time Away Policy for General Surgery Residents .................................................... 10
Policy on Effect of Leave for Satisfying Completion of Program ............................... 10
Academic and Vacation Leave ................................................................................. 11
Parental Leave ......................................................................................................... 12
Sick Leave Policy ..................................................................................................... 13
Bereavement Leave ................................................................................................. 13
Extended Illness/Injury Leave ................................................................................... 13
Jury/Witness Duty..................................................................................................... 13
Military Leave .......................................................................................................... 13
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Personal Leave of Absence ...................................................................................... 13
SECTION 3 – INSTITUTION RESPONSIBILITY
(Please refer ti Institution Policy Manual at
GME Institution Manual or
http://med.umn.edu/gme/InstitutionPolicyManual2013/index.htm
SECTION 4 - DISCIPLINARY AND GRIEVANCE PROCEDURES
(Please refer to Institution Policy Manual at
SECTION 5 - GENERAL POLICIES AND PROCEDURES
(Please refer to Institution Policy Manual at GME Institution Manual or
http://med.umn.edu/gme/InstitutionPolicyManual2013/index.htm
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Surgical Education Council……………………………………………………… ............ 14
Program Goals and Objectives and Resident Advancement .................................... 16
Resident Evaluation System ..................................................................................... 20
Rotation Specific Plans ............................................................................................. 32
Teaching Medical Students .................................................................................... 137
American Board of Surgery - Requirements for Certification in Surgery................. 142
ACGME Program Requirements for Residency Education in Surgery ................... 142
ACGME Surgical Operative Log Program .............................................................. 142
Surgery Research Resident Manual……………………………………………… ...... 144
Residency Management Suite ................................................................................ 144
Duty Hours Policy ................................................................................................... 145
Resident Duty Hours in the Learning and Working Environment ............................ 145
Supervision of Residents ........................................................................................ 146
On-Call Schedule ................................................................................................... 149
Moonlighting Policy................................................................................................. 149
Resident Rotation Dates ......................................................................................... 149
ABSITE Performance Standards Department of Surgery Policy ............................ 151
Communication Policy ............................................................................................ 151
Grand Rounds Compliance .................................................................................... 151
Dress Code Policy .................................................................................................. 152
UMMC On Call Rooms ........................................................................................... 152
UMMC General Surgery Resident Workroom......................................................... 152
UMMC Resident Lounge ........................................................................................ 152
Support Services .................................................................................................... 153
Visa Sponsorship Policy……………………………………………… …………………153
Laboratory/Pathology/Radiology Services .............................................................. 153
Medical Records ..................................................................................................... 154
Security/Safety University of Minnesota Medical Center ........................................ 154
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Monitoring of Resident Well-Being ......................................................................... 154
SECTION 6 DEPARTMENT AND PROGRAM ADMINISTRATIVE CONTACTS
(Please refer to Institution Policy Manual at GME Institution Manual or
http://med.umn.edu/gme/InstitutionPolicyManual2013/index.htm
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Administrative Contact List ..................................................................................... 156
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Introduction to Program Manual
The majority of information contained in this Program Manual pertains to general surgery
residents in the Department of Surgery. Please contact the individual fellowship program
coordinators for the fellowship Program Manuals.
For information that applies to all residents/fellows in a residency/fellowship training program at
the University of Minnesota, please consult the Institution Manual,
GME Institution Manual or
http://med.umn.edu/gme/InstitutionPolicyManual2013/index.htm
Information in the Institution Manual takes precedence over that in Program Manual, in
cases where there is conflict.
Department of Surgery Mission Statement
Vision
To be the preeminent Department of Surgery in Minnesota serving patients of the world where
ground breaking research and exceptional training come together to produce the unrivaled care
we demand for our loved ones.
Mission
Driven to deliver:
Clinical excellence
Compassionate patient care
Pioneering research
Education of surgical leaders
General Surgery Training Program Mission Statement
The academic charge of the Department of Surgery at the University of Minnesota is to provide
a superb environment to facilitate the training of individuals at all levels – medical student,
resident, and fellow – in the discipline of clinical surgery and surgical sciences.
Section 1 Student Services
University Pager Your UMMC pager assigned to you remains the same for the duration of your
training. Do not turn it in when you rotate off site. For malfunctioning pagers please contact
Niea or Michelle in the Surgical Education Office or go to the UMMC main Information Desk for
assistance. New batteries can be obtained from the Department of Surgery Education, 11-145
Phillips-Wangensteen Building.
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Email and Internet Access
To set up email account:
Check to make sure you are in the University of Minnesota system. You can do this by going to
the U of MN-Twin Cities home page at http://www1.umn.edu/twincities/. Click on Search
icon. Under search for people, type in your name and click on search. If you are not
registered, you won’t be in the system, and you should contact the Surgical Education Office
at 612-626-2590 to make sure all of your paperwork is complete.
Go to the website https://www.umn.edu/initiate. Enter your University of Minnesota ID number
and birthday (you do not need to enter your Social Security number). You then need to set
your Internet Account Password that needs to be at least six characters long.
To access your email account:
Any computer with Internet access can be used to access your email. (See below for
setting up access from home.)
1. Go to http://www.mail.umn.edu/ (if you forget this address, there is a link to this page on the
Department of Surgery homepage at http://www.surg.umn.edu ).
2. Click on Check your email via your Web browser.
3. Enter your X500 ID, NOT YOUR EMAIL ADDRESS.
Ex: If your email address is smith999@ umn.edu, your X500 ID is smith999.
4. Enter your password.
5. Click on Login.
Forwarding email:
If you want to forward your University email address to your personal email address, please go
to http://www.mail.umn.edu/. You will be asked to enter your X500 and password. After you are
logged in, select “Settings” in the drop-down gear menu. Once you are there, go to “Forwarding
and POP/IMAP.” Select “Add a forwarding address” and enter your personal email address and
submit.
University Mailboxes and Campus Mail
Mailboxes have been assigned to you. They are located on the 11th floor of the PhillipsWangensteen Building. You will have access to these boxes 24 hours a day. It is essential that
you pick up your mail at least 2-3 times per month. These boxes are not locked.
Your campus mail address is:
420 Delaware St. SE, MMC 195,
Minneapolis, MN 55455.
Laboratory Coats and Laundry Services
Categorical residents in the Department of Surgery, receive 3 laboratory coats, embroidered
with their name and the Department of Surgery, they will also receive lab coats as needed when
they enter their PGY-4 year. PGY-1 preliminary residents receive 2 lab coats embroidered with
their name and the Department of Surgery.
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Soiled coats can be dropped off in the hamper in the Surgery Department, not in the hospital.
Clean coats may be picked up one to two weeks later at the same location.
UMMC Photo ID Badge
You can obtain a UMMC photo ID badge on either the Riverside campus or the University
campus. To obtain a badge on the Riverside campus go to the Parking Office MB218, East
Building. They are open Monday- Friday, 8:00-4:30. To get there, board the shuttle to the
Riverside campus at the entrance of Dwan Variety and Research Center Bldg. (DVRC) — you
may obtain the schedule from the UMMC Information Desk. The shuttle drops you off at the
West Building. Follow directions to the East building. Go in the main entrance or the East
Building and follow the signs to the Main Parking Office. The office will have a list of
Department of Surgery residents. You will be required to fill out a form giving your name,
address, Social Security Number, etc. On the University campus, go to the Mayo Building,
B340. Hours at the University location are 7:30-4:00. You must have either a driver’s license
or state ID with photo. You will receive your badge right away if you go to the Riverside
campus. If you go to the University campus, normally you can pick it up the next day. For
further information, call 612-672-4544.
HIPAA Privacy Regulations
There are new privacy standards reflected in the HIPAA legislation. In order to be in
compliance with the new HIPAA privacy regulations, every University of Minnesota student,
faculty member, researcher, and staff person are required to complete at least three on-line
courses about privacy and data security.
To access training, log on to http://www.myu.umn.edu. Everyone will need to complete the
HIPAA courses found on the “Work Life” tab in myU.
Step-by-step instructions can be found on the Privacy and Security Projects Web Site at
http://www.privacysecurity.umn.edu. Follow the link entitled “Privacy and Security Training”.
Section 2 Benefits
Stipends
It is mandatory that all residents /fellows set up direct deposit the Employee Self-Service
website www.hrss.umn.edu.
When direct deposit is used, paychecks will be posted to the bank accounts on the pay dates
listed on the following website. http://www.med.umn.edu/gme/residents/stipendinfo/home.html
Insurance
Benefits including: Health, Dental, And Life standard and voluntary Short and Long Term
Disability are facilitated through the Office of Student Health Benefits:
http://www.med.umn.edu/gme/residents/benefits/home.html
Professional Liability Insurance
Information regarding professional Liability Insurance can be located at:
http://www.med.umn.edu/gme/instpolicyman/beneprofliabilins/home.html
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Employee Health Services
Employee Health Services at UMMC Fairview (University Campus – Mayo B364, Riverside East
– MB247A), Regions Hospital, Hennepin County Medical Center, and the Veterans Affairs
Medical center are open for immunization services for residents and fellows at no cost to you.
These services include annual Mantoux updates, hepatitis B vaccinations, chicken pox, and
other immunizations.
When you receive an email notice from AHC UTrack, the immunization database, that you are
noncompliant:
• Present a hard copy of the email to the Employee Health staff at the hospital
training site
• Request walk-in immunization service or make an appointment
If you are unable to print the email or need information for the Employee Health Services staff,
you will be permitted to use a computer in the Employee Health Service office to access your U
of M portal at www.myu.umn.edu (login using your x.500 and password) to obtain your latest
immunization information. Employee Health staff must have this information to provide
immunization services.
If you have questions, please contact Carol Sundberg via email at [email protected] or by
phone at 612-626-3317 or visit the Office of Occupational Health and Safety.
Meal Tickets
Meal Tickets will be provided for you on all rotations. Meal tickets are electronic in the UMMC
cafeteria and the Eastside Market Cafeteria (Riverside). At the VA, you will receive an envelope
with your meal allotment for the block. At all other sites, the on-site Education Office will provide
you with the details of your meal allowances.
University of Minnesota Medical Center, Fairview
Meal Card Policy and Procedure
I.
PURPOSE
To provide food service for resident and fellows who have been assigned to provide on-call
services in the hospital on either campus, Riverside or University, for a specific period of time
other than a normal work day.
II.
POLICY
A. On-call meals (dinner & breakfast) will be provided for residents and fellows who work
24 consecutive hours on site, interns that are scheduled to work the maximum number
hours allowed(16 hrs.), are pre-scheduled 5 or more 12 hour night shifts (night float), or
are called from home to return to the hospital while on home call. No meal will be
provided if they are on call from home or stay at home.
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B. ID Badge Requirement - Residents and fellows are required to have a Fairview ID badge
visible and present in order to obtain on-call meals.
C. Bulk Purchase Limitation – Bulk purchases (i.e...Extra sodas/waters, bags of candy) are
not allowed. Limit of 3 bottles and one half pound of candy or snacks may be purchased
at one time.
D. Sharing Restriction – This privilege is for the resident use in the hospital and may not be
shared with medical students, families, or other hospital staff.
III. PROCEDURE
A.
Each resident involved in clinical duties and meets the above criteria will receive a
meal card at the start of the academic year. The dollar amount on each card will be
determined by the number of on-call months the department designates to the
resident.
B.
Changes to a resident schedule throughout the academic year that increases the
amount of time spent on-call will be eligible for an increase in their meal card
allotment. The department will contact the GME office at UMMC with the resident
name and increase request for approval.
C.
Non-compliance with this policy may result in short-term suspension of meal card
privileges or termination of privileges. The Vice President of Medical Affairs at
UMMC reserves the right to suspend or terminate meal card privileges at any time,
without notice.
D.
Each resident eligible for meal card privileges must sign the statement of
understanding (attachment A), in order to receive their meal card for the academic
year.
E.
Questions and/or issues regarding meal cards at UMMC may be directed to the
UMMC GME office at 612-273-7482.
University of Minnesota Medical Center, Fairview
Meal Card Policy and Procedure
Attachment A
STATEMENT OF ACKNOWLEDGEMENT OF ON-CALL MEAL POLICY
This is to acknowledge that I have read the On-Call Meal Card Policy and understand that this is
a privilege provided in recognition of my on-call responsibilities. I also understand the limits of
the policy and I agree to honor the limits within the policy. I understand that the on-call meal is
provided for my benefit and not to be shared with others or to be used at times when I am not
on-call. I understand not complying with this policy can result in suspension or termination of my
meal card privileges.
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Program Name
Signature
Printed Name
Date
Parking
The Department of Surgery provides a parking contract for the Oak Street Ramp on Oak Street
and Delaware for residents on service at UMMC. Parking cards at UMMC are service and
resident-level designated. It is the resident’s responsibility to exchange parking cards
properly. Parking at Regions is available through the Surgical Education Office at Regions; at
the VA no parking card is required, the surface lot is open to all. At all other sites, the on-site
Education Office will provide you with the details of how and where to park. When not on
service at UMMC, parking is provided for you in the Washington Avenue Ramp and East
River Road Garage when attending Department of Surgery Grand Rounds. Parking
vouchers can be obtained from the Surgical Education Office.
Time Away Policy for General Surgery Residents 2014-2015
American Board of Surgery Requirements for Time in Training
Based on the requirements set forth by the American Board of Surgery (ABS) for Board
Eligibility, the number of weeks of full-time surgical experience needed to complete residency
training is as follows:
1. First three clinical years; 144 weeks completed of 156 calendar weeks.
Time Away permitted: 3 weeks/year (9 weeks over 3 years). Three additional days over the
holidays are provided (nine days over three years). This allows an additional 12 days
available for academic leave (meetings, interviews, USMLE exams, etc.)
2. Fourth and Fifth clinical years; 96 weeks completed of 104 calendar weeks.
Time Away permitted: 3 weeks/year (6 weeks over 2 years). Three additional days over the
holidays are provided (six days over two years). This allows an
additional 9 days
available for academic leave (meetings, interviews, etc.)
3. The ABS endorses one additional 2-week period within the first three clinical years
for
Family Leave and one additional 2-week period in the last two clinical years for Family Leave.
Any additional time taken may require additional training time in order to meet the ABS
requirements for certification.
Time Away Leave is allowed in one week blocks only, Monday through Sunday.
The one week block, 7 days, Monday-Sunday, must be taken during each of the 4-month
periods:
July 1 - October 27
October 28- February 23
February 24- June 30
Time Away not taken during a 4-month period may not be carried forward. Greater than 7
days of Time Away may be taken only under special circumstances (e.g., marriage,
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overseas travel, etc.) with a maximum of 14 days, and must be split at the end of one
rotation and the beginning of another.
Time Away requests MUST be submitted in writing/email using the Department of Surgery
Time Away form and will be approved if the Resident has days available and the service and the
service and on-call schedule is covered. Academic Leave includes but is not limited to:
fellowship interviews, conferences, USMLE exams, meetings, teaching ATLS, etc. Academic
Leave and Parental Leave requests MUST be submitted as soon as you know the dates.
Maternity/Paternity leave dates are scheduled using the projected date of delivery. All residents
in the General Surgery Training program must submit all time away requests in writing/e-mail to
Niea Johnson (email address is [email protected]) in the Surgical Education Office. Time
Away requests CANNOT be prearranged with other departments/services.
Academic Leave
Academic leave for presenting papers/posters will be allowed within reason and in compliance
with the American Board of Surgery time in the program requirements. However, residents
asking for academic leave to attend a meeting in which no poster/paper is presented will be
allowed to attend under special circumstances and at the discretion of the Program Director.
Written approval must be obtained prior to registering for the meeting and booking airline and
hotel reservations. Residents must use their personal vacation time or their weekly day off.
At a minimum, time away requests must be submitted by the last working day of the
month two months prior to the intended month of vacation, ex. May 31, 2014 is the last
date to submit for a July vacation. We encourage Residents to plan ahead so as not to lose
allowed days. For compliance of the Duty Hour Restrictions as outlined by the ACGME, our
program will maintain a minimum of one-in-four call for all residents whenever possible. These
criteria may result in leave request denials. Any exception to this policy will be reviewed on an
individual basis.
Time Away and Rotation Schedule 2014-2015
Materials
Provided
Rotation/Vacation
Schedule Due to
Niea
Vacation Schedule
Closed for PGY level
Chiefs
2/20/2014
2/28/2014
3/2/2014
PGY-4
3/5/2014
3/12/2014
3/14/2014
PGY-3
3/19/2014
3/27/2014
3/29/2014
PGY-2
4/2/2014
4/10/2014
4/12/2014
PGY-1
Vacation Schedule
open for all 5/21/2014
4/16/2014
4/24/2014
4/26/2014
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Time Away and Rotation Schedule for the Academic Year may be submitted in advance
according to the schedule listed above. Requests submitted by the due date will be granted
according to availability and seniority.
Beginning May 21, 2014 remaining vacation blocks will be granted on a first come, first serve
basis with consideration to service coverage and rotation call schedules.
Blackout periods:
There will be no leave allowed during the period between December 23-January 1, see below
Holiday Vacation, the last week of January (In-Training exam) and the last two weeks of June
and the week of the Annual Surgery Course.
No Time Away will be allowed for the following rotations:
PGY-1 UMMC & Regions Night Float
PGY-2 UMMC Acute Care Surgery Rotation
PGY-3 Regions Night Float
Holiday Vacation
If you choose the program will arrange for you to have three days off, these days will count
against up to 3 of your 1 in 7 days off during the rotation period, for the period of December 23January 1. Holidays that occur during a leave of absence run concurrent with the leave and are
NOT in addition to the leave.
Graduate Medical Education Policy:
Policy: Parental Leave
Policy #
Original Approval: 2003; 04.24.07
Approved by GM EC: 02.26.08
Effective Date:
Revision Date:
01.29.08
Distribution: R/F; PD; PC; Institution Policy Manual;
GME website
3.27.07
Policy Owner:
GME
Administration
Policy
The resident/fellow (trainee) as defined below must give notice, in writing, of intent to use
parental leave and other leaves used in conjunction with parental leave to their program director
at least four (4) weeks in advance, except under unusual circumstances.
Please see your Program Manual for specific departmental policies and procedures.
Birth mother:
A birth mother shall be granted, upon request to the program director, up to six weeks parental
(maternity) leave for the birth of a child. The maternity leave shall begin at the time requested
by the trainee, although the leave may not begin more than six weeks after the birth. The leave
must be consecutive and without interruption.
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Trainees on maternity leave will receive the first two weeks of their leave as paid parental
leave. This paid parental leave shall not be charged against the trainees’ vacation, sick or PTO
allocation.
Note: The first two weeks of this paid parental leave covers the required fourteen day wait
period before they may be eligible to receive the short-term disability benefit.
Birth father:
A birth father shall be granted, upon request to the program director, up to two weeks paid
parental leave for the birth of a child. The leave must commence no sooner than two weeks
prior to the anticipated delivery date and no later than six weeks after the delivery. The leave
must be consecutive and without interruption. This paid parental leave shall not be charged
against the trainees’ vacation, sick or PTO allocation.
Registered same sex domestic partner:
Registered same sex domestic partner of someone giving birth shall be granted, upon request
to the program director, up to two weeks paid parental leave. The leave must commence no
sooner than two weeks prior to the anticipated delivery date and no later than six weeks after
the delivery. The leave must be consecutive and without interruption. This paid parental leave
shall not be charged against the trainees’ vacation, sick or PTO allocation.
Adoption:
An adoptive parent shall be granted, upon request to the program director, up to two weeks paid
parental leave for the adoption of a child. Trainees who are registered same sex domestic
partners of someone adopting a child shall be granted two weeks paid leave. The leave must
commence no sooner than two weeks prior to the anticipated adoption date and no later than
six weeks after the adoption. The leave must be consecutive and without interruption. This paid
parental leave shall not be charged against the trainees’ vacation, sick or PTO allocation.
Clarification:
Holidays that occur during a leave of absence run concurrent with the leave and are NOT in
addition to the leave.
Please see the Institution Policy Manual for additional information on the following leave
policies: GME Institution Manual or
http://med.umn.edu/gme/InstitutionPolicyManual2013/index.htm
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Parental Leave
Family Medical Leave Act (FMLA)
Medical Leave
Personal Leave
Professional Leave
Vacation and Sick Leave
Witness/Jury Duty
Date Approved: 2/14/2013 by the Surgical Education Council (SEC)
Section 3 - Institution Responsibilities
(Please refer to Institution Policy Manual at GME Institution Manual or
http://med.umn.edu/gme/InstitutionPolicyManual2013/index.htm
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Section 4 – Disciplinary and Grievance Procedures
Please refer to Institution Policy Manual at GME Institution Manual or
http://med.umn.edu/gme/InstitutionPolicyManual2013/index.htm
Section 5 - General Policies and Procedures
Surgical Education Council
The Surgical Education Council (SEC) is composed of surgeons from the four integrated
institutions and one affiliated institution, a Resident Representative, and the Residency
Coordinator. This council is responsible for management of all aspects of the teaching program.
The Program Director, Dr. Jeffrey G. Chipman, has overall responsibility for the teaching
program and the SEC reports directly to him. There are four levels in the hierarchy of
responsibility:
Program Director
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Surgical Education Council
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Integrated Site Directors of Education
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Surgical Services Directors of Education
Specifically the council includes:
Name
Acton, Robert
Brunsvold, Melissa
Chipman, Jeff
Chow, Christopher
Deveney, Gina
Dunn, Ty
Harmon, James
John, Ranjit
Kwaan, Mary
Larson, Cathy
Lee, Janet
Leslie, Dan
Lunden, Michelle
McGonigal, Michael
Melin, Mark
Mohr, William
Ramaswamy, Archana
Rothenberger, David
Rosenthal, Gary
Schmitz, Connie
Role on SEC
Medical Student Course Director
Associate Program Director & PGY-2/3 Mentor
Program Director
Administrative Chief Resident
GME Associate Administrator
UMMC Transplant Surgery
UMMC General Surgery & SICU
UMMC Cardiovascular Surgery
UMMC Colorectal Surgery
Surgical Residency Coordinator
Administrative Chief Resident
UMMC Minnimally Invasive Surgery
Surgical Education Office Support Staff
Regions TACS
Methodist Site Director
Regions Burn
VAMC Site Director
Department Chair
Regions Vascular Surgery
Professional Educator
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Tuttle, Todd
Willis, David
Wolpert, Seth
UMMC Surgical Oncology
Methodist Hospital
Regions Site Director
The specific responsibilities of the SEC are:
Development, modification, and implementation of the core teaching program
Ensure compliance with ACGME/RRC requirements
Meet to review:
Faculty evaluations of residents
Resident operative/patient experience
Ongoing issues of importance to the teaching program
Review American Board of Surgery In-Training Examination Scores
Review and recommend options for residents with poor academic and/or clinical
performance
Encourage and promote excellence among trainees and teachers
Apart from their responsibilities as members of the SEC, the Integrated Site Directors of
Education also are responsible for implementation of and compliance with policies and
directives that constitute the departmental teaching program at their integrated institutions, as
outlined by the Program Director and the SEC. The specific responsibilities of the Integrated
Site Directors are:
Implementation of core teaching program at their integrated site
Work with Service Directors of Education to:
Oversee, troubleshoot, rectify problems, and modify the core teaching program on an
iterative basis
Review evaluations of residents completing rotations at their institutions
Ongoing assessment and refining of integrated site teaching goals
Implement other SEC directives
The next level of responsibility, the Service Director of Education, is a designated surgeon on
each surgical service at each integrated site who is selected and appointed based upon their
commitment to surgical education. The specific responsibilities of the Service Directors of
Education are:
Implementation of the portion of core didactic program assigned to their surgical service
Conduct exit interviews with individual residents at the end of their rotation as follows:
o
o
o
Review evaluations of the residents by service faculty
Confirm completion of operative reports and discharge summaries
Review resident operative experience (updated operative log) for service
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o
o
Discuss other pertinent issues related to service, program, career plans
Organization and oversight of patient teaching round
Department of Surgery
University of Minnesota
General Surgery Training Program
Goals and Objectives and Resident Advancement
By Service and PGY Level
Overview of the UM General Surgery Training Program
Our goal is to train academic general surgeons who will provide the highest level of clinical care
and advance the frontiers of surgical science through research and education.
To achieve this goal, we engage residents in a planned curriculum delivered via lectures and
conferences, simulation (standardized patient encounters, inanimate and animate labs), online
course materials, at bedside and in the operating room during structured rotations. Most
residents also spend two years in a research lab, acquiring knowledge of basic and translational
science and associated research skills under the guidance of a faculty mentor. Through
appropriate supervision and guidance and a structured evaluation system, residents develop a
high level of professionalism, as well as the requisite clinical and surgical skills.
Throughout the course of training, residents receive multiple layers of supervision. The staff
physician is available daily for patient care and the formulation of treatment plans. Newer
residents will be constantly relying on more senior residents for assistance, supervision, and
reassurance.
The rotation schedule is designed to allow maximum exposure to both the Core General
Surgery Requirements and the important Additional Components outlined by the Surgery
Residency Review Committee (RRC). Our program comprises training take at four core facilities
(University of Minnesota Medical Center, the Veterans Administration Medical Center, Regions
Hospital, and Methodist Hospital) and several affiliated private hospitals. This experience
exposes residents to the full range of surgical care environments, running the gamut from busy
community hospitals to tertiary referral centers.
Education Goals
Our goal is to train residents so that they are competent in the six core competency areas as
defined by the Accreditation Council of Graduate Medical Education (ACGME) and the RRC:
1. Patient Care that is compassionate, appropriate, and effective for the treatment of health
problems and the promotion of health. Surgical residents must:


Specifically demonstrate technical proficiency and manual dexterity appropriate for their
training level
Develop and execute patient care plans appropriate for their level.
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2. Medical Knowledge about established and evolving biomedical, clinical, and cognate (e.g.,
epidemiological and social-behavioral) sciences, as well as the application of this knowledge
to patient care. Surgical residents are expected to:

Critically evaluate and demonstrate knowledge of pertinent scientific information.
3. Practice-Based Learning and Improvement that involves the investigation and evaluation
of care for their patients, the appraisal and assimilation of scientific evidence, and
improvements in patient care. Surgical residents are expected to:


Critique personal practice outcomes
Demonstrate recognition of the importance of lifelong learning in surgical practice.
4. Interpersonal and Communication Skills that result in effective exchange of information
and collaboration with patients, their families, and other health professionals. Surgical
residents are expected to:



Communicate effectively with other health care professionals
Counsel and educate patients and families
Effectively document practice activities
5. Professionalism, as manifested through a commitment to carrying out professional
responsibilities, adherence to ethical principles, and sensitivity to patients of diverse
backgrounds. Surgical residents are expected to:



Maintain high standards of ethical behavior
Demonstrate a commitment to continuity of patient care
Demonstrate sensitivity to age, gender and culture of patients and other health care
professionals
6. Systems-Based Practice, as manifested by actions that demonstrate an awareness of an
responsiveness to the larger context and system of health care, as well as the ability to call
effectively on other resources in the system to provide optimal health care. Surgical
residents are expected to:



Practice high quality, cost-effective patient care
Demonstrate a knowledge of risk-benefit analysis
Demonstrate an understanding of the role of different specialists and other health care
professionals in overall patient management.
Education Components
Education activities occur in four main components: Lectures and Conferences, Simulation,
Online Education, and Structured Surgical Rotations.
1. Lectures and Conferences
Tuesday mornings constitute our formal “Education Day.” Each Tuesday hosts a
Complications Conference, a Grand Rounds presentation, and Core Curriculum sessions for
junior (PGY 1-2) and senior (PGY 3-5) residents. Attendance for the entire morning is
mandatory for all residents at all training levels and sites, including those in the research lab,
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17
and is recorded. If the junior (PGY 1-2) Core Curriculum is cancelled those residents are
asked to join the PGY 3-5 Core Curriculum.

Core Curriculum sessions are one hour in length; they focus on basic science and
clinical management and follow a case-based format. Prior reading assignments and
resident interaction is expected. Session topics comprise a two-year cycle; they follow
the Association of Program Directors in Surgery (ADPS) national core curriculum and
topics in identified textbooks. Assigned readings may be found in the RMS conference
calendar. A required textbook is supplied by the Department to categorical residents.
Residents are free to supplement with other texts on their own. In addition, textbooks
are available from the U of MN library.

Surgery Grand Rounds (45 minutes) provide a forum for national and local guest
speakers, faculty members, and senior residents to present on important topics related
to basic science research, clinical best practices, ethics, patient safety, health care
systems, and the like. This venue also allows for spirited debate and in-depth instruction
for attendees.

Complications Conferences (45 minutes) are conducted at all integrated institutions in
addition to the Tuesday morning conference at the University main campus. These
conferences emphasize patient safety, systems analysis of root causes, and institutional
NSQIP data as well as pertinent aspects of surgical basic science and clinical care.
2. Simulation
Simulation constitutes one of the fastest growing training approaches to emerge in recent years.
At the University of Minnesota, we use standardized patients to prepare and assess residents’
interpersonal and communications skills and professionalism. We also have a comprehensive
schedule of inanimate and animate labs in which we develop and assess basic technical skills,
critical response and team skills, and more advanced surgical procedures (open and
laparoscopic). Residents in their first through third years of training participate regularly in
planned curricula delivered in the SimPORTAL, a fully-accredited Education Institute (Level 1)
by the American College of Surgeons. Some of the curriculum elements are unique to the
University of Minnesota; some are drawn from the ACS Surgical Simulation Skills curriculum
available online. We also rely on the Fundamentals of Surgery (FLS) curriculum as developed
and certified by SAGES. Residents in their second through fifth year of training also participate
in animate labs focusing on minimally invasive procedures. The content of simulation training is
shown below by PGY training level:

PGY-1 Residents
o ATLS
o ACLS
o Asepsis + skin prep
o Instrument identification and handling
o Knot tying
o Suturing
o Excision of a skin lesion
o Surgical airway management
o Central lines
o Chest tubes and thoracentesis
o Ultrasound
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o
o
o
o
o
o
o
Managing hypoxia and hypotension
Responding to dysrhythmias
Glucose + electrolyte management
Nasogastric tube placement
Arterial line placement
Wound care
Introduction to Fundamentals of Laparoscopic Surgery

PGY-2 Residents
o Critical response review (ATLS)
o Critical response review (ACLS)
o Critical response review (ICU, Sepsis)
o Introduction to endoscopy
o Knot tying (revisited)
o Suturing (complex)
o Stapled bowel anastomosis
o Hand bowel anastomosis
o Vascular anastomosis
o Animate labs covering: lap Nissen, lap jejunostomy, lap hernia repair

PGY 3-5 Residents
o Animate labs covering: lap Nissen, lap jejunostomy, lap hernia repair
3. Online Education
In 2005, our Department developed the “Rotation as a Course” (RAC) program. Selected
rotations were developed as hybrid, online / on-ground courses supported by Moodle online
course management system. The goal of RAC is to organize teaching and support learning, as
it occurs during a rotation. RAC courses include rotation-specific learning objectives, pre- and
post-tests, online lecture presentations, electronic links to assigned readings and other
resources, weekly case-based discussion topics (face to face), and end-of-rotation oral exams.
Current RAC rotations (listed below) are all based at the University campus.





Thoracic + Foregut Surgery
Surgical Critical Care
Surgical Oncology
MIS + Bariatric Surgery
Pediatric Surgery
Our Department was one of the first in the nation to experiment with web-based learning as an
adjunct to specifically defined curriculum at the rotation level. Our 2005-07 “Rotation as a
Course” (RAC) pilot program preceded the SCORE Website Portal by about two years. In
2010-11, faculty representing 18 core rotations on the Surgical Education Council spent several
months realigning the core topics taught on rotations with the SCORE Curriculum. The result is
a formalized education plan for each rotation, complete with a syllabus (list of core topics),
assigned readings and other resources; a schedule for weekly seminars and specialty
conferences as well as teaching rounds; and an end-of-rotation oral exam based on core topics.
For 14 of these rotations, faculty members created websites via the University’s Moodle system
for managing these resources.
4. Structured Surgical Rotations
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All rotations in the residency program have been structured to help residents achieve specific
learning objectives aligned with the ACGME core competency areas. These objectives are
delineated by training level as well as training site and rotation in the following sections.
Education activities vary by training site and by rotation, but all contain the following elements:


Daily clinical rounds
Site and specialty conferences
Department of Surgery
Surgical Residency Training Program
Resident Evaluation System
University of Minnesota
General Surgery Residency Training Program
Program Mission and Goals
Description of the Training Program
Evaluation of Resident Performance
1. Program Mission and Goals
As stated in our 2014 Education Excellent Committee Action Plan, our mission is to educate
surgeon leaders. We seek to achieve:
•
•
•
•
•
•
Positive faculty engagement and sense of ownership in the education mission
High quality rotations and faculty teaching
High performance by residents on American Board of Surgery in-training exams, written
and oral boards
High standards of professionalism and resident leadership in patient care, education,
and service
Scholarly accomplishment by residents in biomedical and clinical research, as well as
surgical education research
Local innovation in surgical education methods and collaboration with national partners
Education Goals
Specifically, we train residents so that they are competent in the six core competency areas
as defined by the Accreditation Council of Graduate Medical Education (ACGME) and the
Residency Review Committee (RRC):
1. Patient Care that is compassionate, appropriate, and effective for the treatment of
health problems and the promotion of health. Surgical residents must:
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

Specifically demonstrate technical proficiency and manual dexterity appropriate for
their training level
Develop and execute patient care plans appropriate for their level.
2. Medical Knowledge about established and evolving biomedical, clinical, and cognate
(e.g., epidemiological and social-behavioral) sciences, as well as the application of this
knowledge to patient care. Surgical residents are expected to:

Critically evaluate and demonstrate knowledge of pertinent scientific information.
3. Practice-Based Learning and Improvement that involves the investigation and
evaluation of care for their patients, the appraisal and assimilation of scientific evidence,
and improvements in patient care. Surgical residents are expected to:


Critique personal practice outcomes
Demonstrate recognition of the importance of lifelong learning in surgical practice.
4. Interpersonal and Communication Skills that result in effective exchange of
information and collaboration with patients, their families, and other health professionals.
Surgical residents are expected to:



Communicate effectively with other health care professionals
Counsel and educate patients and families
Effectively document practice activities
5. Professionalism, as manifested through a commitment to carrying out professional
responsibilities, adherence to ethical principles, and sensitivity to patients of diverse
backgrounds. Surgical residents are expected to:



Maintain high standards of ethical behavior
Demonstrate a commitment to continuity of patient care
Demonstrate sensitivity to age, gender and culture of patients and other health care
professionals
6. Systems-Based Practice, as manifested by actions that demonstrate an awareness of
an responsiveness to the larger context and system of health care, as well as the ability
to call effectively on other resources in the system to provide optimal health care.
Surgical residents are expected to:



Practice high quality, cost-effective patient care
Demonstrate a knowledge of risk-benefit analysis
Demonstrate an understanding of the role of different specialists and other health
care professionals in overall patient management.
2. Description of the Training Program
Residents receive training at five core facilities and one affiliated hospital:
•
•
•
University of Minnesota Medical Center
Veterans Administration Medical Center
Regions Hospital
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•
•
•
Methodist Hospital
Essentia Health (Duluth, MN)
North Memorial (affiliated)
This experience exposes residents to the full range of surgical care environments, from busy
community hospitals to tertiary referral centers. The rotation schedule is designed to allow
maximum exposure to both the Core General Surgery Requirements and the important
Additional Components outlined by the Surgery Residency Review Committee (RRC).
Several components, described below, help us to achieve these program and education
goals:
1.
2.
3.
4.
5.
6.
7.
Extended PGY-1 Resident Orientation (“Boot Camp”)
Enrollment in the SCORE General Surgery Resident Curriculum Website Portal
Weekly M+M, Grand Rounds, and Core Curriculum sessions for all residents
Structured simulation skills labs and standardized patient assessment
Structured (online) curricula at the rotation level
A one or two-year research lab after the PGY-3 clinical year
A robust resident evaluation and remediation system
Extended PGY-1 Orientation
Scheduled the week prior to residents’ first day on rotation, the PGY-1 Orientation consists
of approximately 24 hours of didactic and experiential learning and baseline skills testing.
Residents who perform well in the Baseline PGY-1 OSATS may be excused from some of
the simulation skills labs.
Enrollment in SCORE
All residents (except Orthopedic and Neurosurgery PGY-1 residents) are enrolled in the
SCORE Website Portal. The Portal contains weekly assignments for Department Core
Curriculum sessions, as well as suggested readings for rotation conferences and teaching
sessions.
Weekly M+M / Quality Improvement Conferences, Grand Rounds, and Core
Curriculum
Tuesday mornings constitute our formal “Education Day” with protected time for residents.
Attendance for these sessions is mandatory for all residents at all training levels and sites.
Attendance (including those in the research lab) is taken and is recorded.

M+M / Quality Improvement Conferences
Three Tuesdays a month the Department holds an M+M conference which is attended
by all residents, students, and faculty from the University along with other professional
staff. These conferences run 30-45 minutes in length. On the fourth Tuesday, we hold a
longer (1 hour) QI Conference which is attended by hospital staff as well as faculty and
residents from the Department of Surgery and other departments. Case information is
sent out to attendees prior to each conference. Started in 2011, M+M case data has
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been logged in a new database classification system that supports further quality
improvement efforts. In addition to the Department’s M+M conferences, individual
hospitals also hold weekly M+M sessions.

Grand Rounds Sessions
Our Department hosts approximately 40 CME accredited Grand Rounds speakers a
year, including six that are national speakers sponsored by endowed chairs and
services. Faculty members within the University (at least one per Division per year) are
also asked to present. Senior residents give several case presentations per year.
Topics range from basic science research and clinical best practices to ethics and
medical mission work; patient safety, health care systems, and practice management;
and education (e.g., simulation-based teaching).
•
Core Curriculum
These sessions are one hour in length; they focus on basic science and clinical
management and follow a case-based format. Prior reading assignments and resident
interaction is expected. Session topics cover a two-year cycle based on the Association
of Program Directors in Surgery (ADPS) Core Curriculum and the more recent SCORE
Curriculum modules. Assigned readings are posted in the RMS conference calendar
and on the SCORE Website Portal.
Structured Simulation Skills Labs and Assessments
Since 2007, we’ve used a research-based standardized patient OSCE to prepare and
assess residents’ interpersonal and communications skills and professionalism. We also
have a comprehensive schedule of inanimate labs in which we develop and assess basic
technical skills, critical response and team skills, and more advanced surgical skills.
Residents in their first through third years of training participate regularly in planned curricula
delivered in the SimPORTAL, a fully-accredited Education Institute (Level 1) by the
American College of Surgeons. Some of the curriculum elements are unique to our
Department; some are drawn from the ACS Surgical Simulation Skills curriculum. We also
rely on the Fundamentals of Surgery (FLS) curriculum as developed and certified by
SAGES. The content of simulation training is shown below and on the following page by
PGY training level:
Department of Surgery: Simulation Curriculum across the Training Continuum
MS3
Clerkship
PGY-1
Orientation
Course
7500
(“Boot
Camp”)
PGY-1
Curriculum
Asepsis,
sterile
technique,
universal
precautions
OSATS
Asepsis
Asepsis
Scrubbing,
OSATS
Scrubbing,
PGY 2+3
Curriculum;
FLS
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gowning,
gloving
Clerkship
Scrubbing,
gowning,
gloving
gowning,
gloving
PGY-1
Orientation
PGY-1
OSATS Skin
prep
Skin prep
OSATS
Instruments
Instruments
Knot tying
OSATS Knot
tying
Knot tying
G2 Knots
revisited
Suturing
OSATS
Suturing
Suturing
G2-G3
Anastomosis
Unit: (3
sessions)
OSATS
Excisions
Excisions
Skin prep
PGY 2-3
Local
anesthetics
Arterial
puncture for
blood gas
sampling
Arterial line
(w/central
line)
Peripheral
IVs
Foley
catheters
NG tubes
Central lines
+ ultrasound
Central line
(w/ arterial)
ACS
Ultrasound
Course (2
sessions)
Chest tubes
Chest tube +
thoracentesis
Critical
response
Lecture
G2 Critical
response
(ATLS)
Hypoxia,
hypotension
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Critical
response
G2 Critical
response
(ACS)
Glucose +
electrolyte
Critical
response
G2 Critical
response
(Sepsis)
Cardiac,
LVAD
Surgical
airway
Laparoscopy
(4+
sessions)
Intro to FLS
/ FLS Chiefs
Pt Care Tasks:
• Patient tracking
• Patient handoffs
• Post-op care
• Patient
discharge
• Basic
operations
• Pre-op
evaluation
• Medical dosing
• IV fluids +
nutrition
• Post-op care
cardiac
• Radiologic tests
Team
STEPPS
Teaching:
Coaching
and
Supervision
Family
Conference
OSCE
Family
Conference
OSCE
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Structured (online) Curricula at the Rotation Level
Our Department was one of the first in the nation to experiment with web-based learning as
an adjunct to specifically defined curriculum at the rotation level. Our 2005-07 “Rotation as
a Course” (RAC) pilot program preceded the SCORE Website Portal by about two years. In
2010-11, faculty representing 18 core rotations on the Surgical Education Council spent
several months realigning the core topics taught on rotations with the SCORE Curriculum.
The result is a formalized education plan for each rotation, complete with a syllabus (list of
core topics), assigned readings and other resources; a schedule for weekly seminars and
specialty conferences as well as teaching rounds; and an end-of-rotation oral exam based
on core topics. For 14 of these rotations, faculty members created websites via the
University’s Moodle system for managing these resources.
Research Lab
Our mission is to train academic surgeons. Most residents matched into our program
choose to take advantage of the opportunity to spend one or two years in a funded research
lab with an assigned mentor. This program has long been a part of the Department’s
history, and it continues to be a hallmark of our training. A resident career development
plan, begun in the second year of training, helps the Department match residents to
appropriate labs. In addition to basic science and clinical research labs organized under the
Department’s Basic and Translational Research Division, the Surgical Education Division
hosts a 1-2 year lab program for residents interested in surgical education research.
3. Evaluation of Resident Performance
The General Surgery Training Program is committed to comprehensive, regular and timely
evaluation of the educational and professional performance of surgical residents. This
section presents the goals, components, and processes of the resident evaluation system.
The Goals of the Evaluation System are to:
1. Promote professionalism and the maintenance of a life-long portfolio of career
accomplishments
2. Provide information on resident progress and performance in order to:





Make informed decisions on resident promotion
Provide data to specialty boards for certification
Write letters of recommendations
Identify performance deficits and thereby improve performance
Identify program strengths and weaknesses and target areas for modification in
the training curriculum or program structure
General Expectations
Residents are expected to achieve at high standards of performance. Further, we consider
residents to be adult learners, and as such, responsible for self-directed, proactive learning
throughout their training. We expect them to monitor their own progress, and to consciously
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work to acquire the habits of mind, the professional attitudes and demeanor, as well as the
knowledge and skills of a consummate surgeon. We expect residents to:
1. Develop a personal program of self-study and professional growth with guidance
from faculty advisors.
2. Participate in safe, effective and compassionate patient care under supervision,
commensurate with their level of responsibility.
3. Participate fully in the education activities of the program and, as required, assume
responsibility for teaching and supervising other residents and students.
4. Participate in institutional programs and activities involving the medical staff; and
adhere to established practices, procedures, and policies of the institutions.
5. Serve on institutional committees and councils, especially those that relate to
education and patient care review activities.
6. Annually, compose elements of an electronic portfolio and present this portfolio to
members of the Surgical Education Council (SEC) and Program Director for review.
Components of the Evaluation System
The evaluation system is based on the ACGME core competencies as presented previously:







Patient Care
Technical Skills
Medical Knowledge
Practice-Based Learning + Improvement
Interpersonal Skills + Communication
Professionalism
Systems-Based Practice
The Department has developed evaluation tools that provide the program, as well as the
residents, with information pertinent to these areas. We use a Portfolio-based, Biannual
Evaluation system. The elements listed below are to be reported in resident portfolios.
Unless indicated, they apply to all residents during their clinical years.











Personal essay summarizing learning highlights from the past year, self-assessment
of their strengths and areas for improvement, and their professional and personal
goals for the coming year
American Board of Surgery In-Training Exam (ABSITE) scores
Faculty clinical evaluations, for each rotation assignment
Peer evaluations of resident teaching and leadership
Medical student evaluations of resident teaching in skills lab and on rotation
Operative logs
Tuesday conference attendance
Family Conference OSCE (Objective Structured Clinical Exam) (PGY 1 + 3 only)
OSATS (Objective Structured Assessment of Technical Skills) (PGY 1 + 2 only)
Mock oral exams (PGY 4 + 5 only)
Certification in the Fundamentals of Laparoscopic Skills by chief year
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Other elements that may comprise a resident’s portfolio include:





Presentations at M+M and Grand Rounds
Lecture materials, teaching presentations, or curricula
Participation in professional development courses, conferences
Membership in professional organizations
List of papers, abstracts, posters, presentations
Biannual Review Process
Members of the SEC meet twice a year to review resident progress. For the first review,
they meet without the resident present and review data from the previous six months. After
reviewing key evaluation elements, they write a brief summary of feedback. Residents meet
individually with their assigned advisors to review this feedback.
Adviser Assignments
1.
2.
3.
4.
PGY 1 residents:
PGY 2 + 3 residents:
Laboratory residents:
PGY 4 + 5 residents:
PGY-1 Director
PGY-2/3 Mentor
Laboratory Mentor
Program Director and Surgical Education Council faculty.
.
Annual Promotion
There is no single criterion for successful promotion and no single criterion for academic
probation or dismissal. Rather, the SEC looks at the totality of the resident’s progress and
becomes concerned only if there is a pattern of “red flags.” In reviewing the mid-year or
end-of-year portfolios, the SEC becomes concerned if:



Faculty evaluations fall consistently below average for any ACGME competencies.
Professional indiscretions are identified by faculty, nurses, students, or peers.
ABSITE scores (Total Test Percentile Score) fall below the 30th percentile.
ABSITE Performance Standards
Because of the centrality of medical knowledge as a foundation for surgical competency, the
Department has adopted a clear set of expectations regarding performance on the ABSITE.
The Department desires to “leave no resident behind,” and requires remediation if
performance falls bellows the 30th percentile. This cut-point has been shown to be
predictive of performance on the ABS written boards (Qualifying Exam). The ABSITE
performance expectations are as follows:

Scoring below the 30th percentile (Total Test Score) on the ABSITE for the first time
places a resident at risk for academic probation. The at-risk status is removed if the
resident’s subsequent year’s performance exceeds the 30th percentile.
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
Scoring two times in a row below the 30th percentile results in automatic academic
probation. The probationary status is removed from the resident’s file if the subsequent
year’s performance exceeds the 30th percentile.

Scoring below the 30th percentile for a second time in three or more years, after one or
more years of improved performance, places the resident back in the at-risk status for
academic probation.

Scoring three times below the 30th percentile (either sequentially or intermittently),
despite attempts at remediation, and in combination with poor performance in other
areas, places a resident at risk for dismissal from the program. The ABSITE score will
never constitute the sole criterion for promotion decisions or dismissal, however it has
been shown to be a valid predictor of performance on the written ABS board exam, and
as such will be taken very seriously in determining satisfactory progress towards
graduation.

Residents at-risk for academic probation, and those on probation due to their
performance on the ABSITE, are required to participate in remediation as directed by the
Department.

Residents who are at risk or on academic probation during any year they are scheduled
for the research lab will have their moonlighting privileges significantly reduced or
removed. Privileges will be regained if performance on the subsequent year’s ABSITE
exceeds the 30th percentile.
Review Decisions
The Surgical Education Council concludes its discussion of each resident with one of the
following recommendations:
1. Advancement with statement of exemplary performance and any areas to develop.
2. Advancement with statement of deficiencies to be improved.
3. Advancement with notification of one-year probation and statement of deficiencies to
be improved.
4. No advancement with one-year probation and discussion of alternative career
choices.
5. Unsatisfactory performance and dismissal from program.
Appeal Process
A resident may exercise the right to appeal any decision regarding plans for non-renewal of
contract or dismissal from the program. This process is outlined in the resident contract as
well as the resident manual. The Department of Surgery, General Surgery Residency
Training Program in such case will carefully follow the University of Minnesota, School of
Medicine appeal guidelines.
Overview of Expectations, by Resident Level
The first two years of residency training are designed to produce a surgical trainee who can
thoroughly evaluate patients for elective and emergency operations, and who can
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29
competently manage nonsurgical illness (e.g., acute pancreatitis, trauma, portal
hypertension, acute renal failure, acute respiratory failure, sepsis syndrome) by applying a
broad knowledge of basic and applied physiology. The PGY-1 and PGY-2 resident is
exposed to a wide number of surgical subspecialties to promote an understanding of wound
healing and management (burns, plastics), general and cardiac critical care, fracture care
and hand evaluation (trauma, plastics), care of neurological trauma and emergencies
(neurosurgery), urology, and gynecology.
•
The PGY-1 resident will be expected to do a complete preoperative evaluation and
postoperative care plan, using his or her mastery of physical examination skills, fluid
and electrolyte management, nutrition, wound healing, microbiology, and metabolic
response to stress. During each rotation, the resident will accomplish these goals
through structured lecture material, clinical experience, and self-motivated learning.
By the end of the first year of training, the resident should be competent in
performing bedside procedures (central venous catheterization, pulmonary artery
catheterization, tube thoracostomy, pericardiocentesis, fine-needle aspiration),
advanced cardiac life support, and advanced trauma life support protocols. PGY-1
residents are tested on many of these skills in the SimPORTAL.
•
The PGY-2 resident will build on a foundation of knowledge in physiology, anatomy,
microbiology, and clinical patient care to care for increasingly complex general
surgery, cardiovascular, transplantation, and critical care patients. Skills will include:
opening and closing the abdomen, obtaining abdominal access for laparoscopy, and
performing open hernia repair, appendectomy, and gastrointestinal anastomoses.
•
The PGY-3 resident will focus on the general surgery services. Advanced surgical
skills will be developed. The resident will independently evaluate surgical consults
and emergency room patients, and prepare patients for elective surgery. He or she
will be expected to independently formulate differential diagnoses and develop
diagnostic evaluations for complex surgical problems. Surgical skills will include
increasingly complex operations (e.g., thyroidectomy, tracheostomy, small and large
bowel resection, laparoscopic cholecystectomy, splenectomy, Nissen fundoplication),
performed with appropriate assistance. In addition, the PGY-3 resident will develop
increasing responsibility in the education of more junior residents and medical
students, through both formal and informal teaching sessions.
•
During the laboratory years, the resident will be devoted to surgical research, with
careful mentoring. He or she will develop the skills necessary to independently
generate and test hypotheses, apply for and obtain extramural research funding, and
critically evaluate published literature. For many of our residents, this experience
has a profound impact on the direction of their future research careers.
•
The PGY-4, or senior, resident will perform core surgery procedures with the
assistance of staff. He or she will have an understanding of the medical and surgical
literature beyond textbooks and review articles, as well as advanced knowledge of
available diagnostic tests and nonsurgical therapeutic alternatives. Beyond this, the
resident will develop the skills and confidence to function independently in evaluating
and caring for general surgery patients and their families. The PGY-4 resident will
function with the highest degree of professionalism and integrity in all interactions
with all levels of hospital staff. By the end of the fourth year, the resident will have
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developed all the skills necessary to function as a chief resident.
•
The PGY-5, or chief, resident will develop an ability to function in accordance with
independent surgical practice. He or she will become facile in the conduct of all
aspects of surgical care, will coordinate the service, and will serve as the first-line
leader and role model for residents and medical students. The chief resident will
build on the skills formalized during the fourth year, gaining additional independence
and experience in patient evaluation, decision-making, operative conduct, and postoperative and follow-up care. The chief resident will conduct complex multistep
procedures (e.g., esophago- gastrectomy, abdominoperineal resection, low anterior
resection, pancreatico-duodenectomy) with minimal direction and intervention by the
supervising surgeon. The chief resident will be able to anticipate and treat the
complications of general surgery procedures and synthesize an understanding of
these complications through morbidity and mortality conference presentations. The
chief resident will be able to speak publicly in an authoritative, articulate manner,
serving as a repository of knowledge for more junior residents.
Rotation Specific Plans
ROTATION PLAN FOR 2014-15
ROTATION NAME UNIVERSITY OF MINNESOTA,
TRAINING LEVELS ON SERVICE: PGY -5; PGY-2; PGY-1
SERVICE DIRECTOR: James Harmon, M.D., Ph.D.
TEACHING FACULTY:
Kaysie Banton, M.D.
Gregory Beilman, M.D.
Melissa Brunsvold, M.D.
Jeffrey Chipman, M.D.
H. Tracy Davido, M.D.
Raja Kandaswamy, M.D.
William Payne, M.D.
General/Vascular
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Roshni Venugopal, M.D.
ROTATION’S WEEKLY EDUCATION SCHEDULE
Monday
Tuesday at
UMMC
6:30 G4+G5
7:00 M+M
7:45 Grand
Rounds
8:30 Core
Curriculum
9:45-noon Skills
Lab
Wednesday
Thursday
7:00 Teach.
Confer.
Activity
Who is responsible?
Orientation to the Rotation
Bedside Teaching Rounds
Weekly Core Topic Teaching
Mid-Rotation Review
End-of-Rotation Oral Exam
End-of-Rotation Meeting w/
Resident
Dr. James Harmon
Attending on call
Dr. James Harmon
Dr. James Harmon
Dr. James Harmon
Dr. James Harmon
Friday
2:00 Bedside
rounds
When does this
occur?
First day of rotation.
Fridays 2:00 pm
Thursdays 7:00 am
Mid rotation
Last day of rotation
Last day of rotation
ROTATION GOALS AND OBJECTIVES FOR MEDICAL KNOWLEDGE AND PATIENT
CARE, BY CORE TOPIC AND RESIDENT TRAINING LEVEL
Core Topic 1: Nutrition
Medical Knowledge
G-Level Objectives
PGY-1
Understand the selection of GVS patients who will benefit from nutritional
assessment and the initiation of supplemental nutrition.
PGY-2
Supervise the management of supplemental nutrition for appropriate GVS patients.
PGY-5
Demonstrate an understanding of the nutritional options, the indications and the
potential complications for General Surgery patients.
Patient Care
G-Level Technical / Procedural Skills
PGY-1
Place NJ tubes and evaluate proper
position and function of NG tubes.
Understand the elements of wound care
including the opening of infected surgical
wounds. Initiate wet to dry dressings.
Care Plans
Select and follow appropriate GVS
patients for supplemental nutritional
support.
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PGY-2
PGY-5
Perform bedside procedures including
the placement of central venous
catheters with supervision.
Teach and supervise the placement of
central line placement. Teach and
supervise the placement of open G-tube
or J-tubes and the placement of PEG
tubes in appropriate GVS patients.
Provide leadership for the GVS service
regarding evaluation of appropriate
intravenous access. Provide direct
supervision, and teach safe central line
placement techniques. Manage technical
complications. Interpret unexpected
radiologic imaging findings associated
with line placements.
Supervise nutritional support for the
appropriate GVS patients. Evaluate and
manage over and under feeding
syndromes in GVS patients.
Prioritize, organize, and implement care
plans for complex General Surgical
patients with regard to their nutritional
management, assessment, and support.
Core Topic 2: Septic Shock
Medical Knowledge
G-Level Objectives
PGY-1
Understand the pathophysiology of shock. Identify and classify shock with the
understanding of the initial treatment with IV fluids, central venous monitoring, and
electrolyte evaluation and replacement.
PGY-2
Supervise the intitial resuscitation, evaluation, and characterization of shock in GVS
patients. Understand the pathophysiology and evidence based practice guideline for
early goal directed resuscitation of sepsis.
PGY-5
To be able to clearly communicate an understanding of the clinical and physiological
mechanisms associated with septic shock in the General Surgery patient. To
teaching and communicate the relationship between the fundamental clinical science
associate was shock and the evaluation and treatment appropriate for General
Surgery patients in shock.
Patient Care
G-Level Technical / Procedural Skills
Care Plans
PGY-1
Place central venous catheters in
Identify and evaluate patient in shock.
appropriate GVS patients with
Initiate care and communicate the need
supervision.
for urgent care for GVS patient in shock.
PGY-2
Perform and supervise the placement of
Coordinate and supervise the care for
central venous catheters in appropriate
GVS patient in shock. Balance the use
GVS patients.
of goal directed fluid resuscitation and
pressor physiologic support in septic
GVS patients.
PGY-5
To provide direct supervision and
Implement, coordinate, and re-evaluate
leadership for the GVS Service by
patient’s care plans regarding IV fluid
prioritizing, coordinating, initiating, and
resuscitation, source control, and
evaluating all technical procedures
administration of antibiotic and advanced
associated with the treatment of General medical therapies for General Surgery
Surgery patients in shock.
patients in shock.
Core Topic 3: Acute Appendectomy
Medical Knowledge
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G-Level
PGY-1
PGY-2
PGY-5
Objectives
Understand the clinical presentation and the pathophysiology of acute appendicitis.
Teach and instruct in the assessment of patient with acute appendicitis.
Demonstrate an understanding and provide instruction to medical students and
Surgery residents regarding the pathophysiology, the regional anatomy, the
expected clinical course, and the surgical decision-making associate with the
diagnosis of acute appendicitis. To provide leadership for the General Surgery
Service regarding the triage and coordination of acute surgical care for multiple
General Surgical patients.
Patient Care
G-Level Technical / Procedural Skills
PGY-1
Perform, as assistant surgeon, both
open and laparoscopic appendectomies.
PGY-2
Perform, as surgeon, both open and
laparoscopic appendectomy procedures.
PGY-5
Supervise, teach, and coordinate open
and laparoscopic appendectomy
procedures.
Care Plans
Initiate care plans for GVS patient with
acute appendicitis. Provide postoperative care and management for GVS
patients following appendectomy.
Understand and triage GVS patients who
require urgent surgery, non-operative
care or observation, and those patients
who would benefit from nonsurgical
interventions complex problems
associated with acute appendicitis such
as peri-appendicieal abscess.
Provide leadership for the GVS Service:
prioritize, coordinate, and evaluate care
plans for patients with both
straightforward acute appendicitis and
for patients with usual problems
associated with complicated acute
appendicitis.
Core Topic 4: Cancer of the Appendix
Medical Knowledge
G-Level Objectives
PGY-1
Appreciate the various types and incidents of cancer of the appendix.
PGY-2
Understand the surgical approach and indications for additional surgical procedures
in the setting of cancer of the appendix. To appreciate the need for additional
oncology consultation and adjuvant therapy. To be aware of the prognosis for
carcinoid tumors of the appendix, mucoceles of the appendix, and adenocarcinoma
of the appendix.
PGY-5
Demonstrate a clear understanding of the types of malignancy and the types of
benign neoplasia that can present in association with the appendix, the cecum, and
the mesentery of the distal small bowel. To be able to communicate the
relationships between the pathology and the recommended surgical care to patients,
to the patient’s family members, and to the members of the GVS Service. To
discuss treatment options and formulate treatment plans with the GVS faculty
members for patients with malignancy.
Patient Care
G-Level Technical / Procedural Skills
Care Plans
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PGY-1
PGY-2
PGY-5
Assist in open and laparoscopic
appendectomy. To assist in open and
laparoscopic right hemicolectomy.
Function as surgeon for laparoscopic
and open right hemicolectomy.
Supervise and teach the performance of
open and laparoscopic right
hemicolectomy as a surgical option for
patients with tumors of the appendix.
Understand the very operative care plan
for patients undergoing right
hemicolectomy.
Appreciate the indications for right
hemicolectomy in the setting of
carcinoma the appendix, or for advanced
carcinoid tumors of the appendix.
Coordinate oncology consultation for
patients with cancer of the appendix.
Effectively coordinate and evaluate care
plans for patients with tumors of the
appendix.
Core Topic 5: Acute Pancreatitis
Medical Knowledge
G-Level Objectives
PGY-1
Identify the risk factors and diagnostic findings associated with acute pancreatitis. To
know the classical criteria for grading the severity of acute pancreatitis (Ranson
criteria).
PGY-2
Understand the surgical indications and need for surgical critical care for patients
with acute pancreatitis. To understand the therapeutic options and effectiveness of
the use of a octriotide and IV antibiotics in the setting of acute pancreatitis. To
identify the setting for ERCP for patients with acute pancreatitis. To understand the
indication for percutaneous aspiration and culture in the setting of acute pancreatitis.
To appreciate the surgical options in the setting of infected pancreatic necrosis.
PGY-5
Demonstrate a firm understanding of the pathophysiology of acute pancreatitis and
the various underlying causes of acute pancreatitis. Demonstrate an understanding
of both the open and minimally invasive surgical options for patients with acute
pancreatitis. To use evidence based surgical decision making to optimize patient
outcomes.
Patient Care
G-Level Technical / Procedural Skills
PGY-1
Perform central line placement under her
supervision.
PGY-2
Teach and supervise the placement of
central lines. Perform open and
laparoscopic pancreatic necrosectomy
under supervision. Perform as surgeon
re-operative washout procedures in the
setting of pancreatic necrosis. Perform
temporary abdominal closure
procedures. Participate in performing
split thickness skin grafts in the setting of
complex open abdominal wounds
associated with severe and advanced
Care Plans
Appreciate the admission status and
orders associated with patients with
acute pancreatitis. To be able to identify
patients who fail standard nonoperative
surgical care.
Care for and coordinate multidisciplinary
care for patients with acute pancreatitis.
Identify and coordinate the care of
patients who fail standard nonoperative
care for in the setting of acute
pancreatitis. Coordinate consultation for
percutaneous aspiration of infected
pancreatic necrosis. To coordinate
urgent ERCP procedures. To coordinate
urgent surgical interventions in the
setting of acute pancreatitis.
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PGY-5
pancreatic necrosis.
Supervise and coordinate and evaluate
performance of both laparoscopic and
open necrosectomy for patients with
advanced acute pancreatitis associated
with infected necrosis.
Prioritize, supervise, and evaluate care
plans for patients with acute pancreatitis.
Identify and manage patients with
complications associated with acute
pancreatitis.
Core Topic 6: Acute Diverticulitis
Medical Knowledge
G-Level Objectives
PGY-1
Identify and diagnose acute diverticulitis. To appreciate the CT scan findings
associated with acute diverticulitis. To understand the criteria for the clinical grading
of acute pancreatitis. (Hinchey classification). To identify patients who fail to
improve with non-operative care.
PGY-2
Identify and appropriately characterize the severity of disease in patients with acute
diverticulitis. To understand the surgical options and surgical approaches for patients
with acute diverticulitis. To appreciate the potential complications and need for
surgical intensive care in the setting of acute diverticulitis.
PGY-5
Demonstrate an understanding of the clinical and pathophysiologic issues
associated with acute diverticulitis.
Patient Care
G-Level Technical / Procedural Skills
PGY-1
Participate as assistant in open and
laparoscopic sigmoid resections for
patients with acute severe diverticulitis.
To participate as assistant in colostomy
formation.
PGY-2
Participate in surgeon in open and
laparoscopic sigmoid resections and
related colon procedures in the setting of
acute diverticulitis.
PGY-5
To supervise and teach open and
laparoscopic surgical procedures for
patients with acute diverticulitis and
chronic surgical problems associated
with diverticulitis.
Care Plans
Understand the perioperative
assessment of patients with acute
diverticulitis.
Coordinate and care for patients with
acute diverticulitis. To coordinate
multidisciplinary care for patients with
severe in advanced diverticulitis.
Provide leadership regarding the safe
and effective care for patients with
surgical problems associated with
diverticulitis.
Core Topic 7: Management of Post-Op Complications
Medical Knowledge
G-Level Objectives
PGY-1
Understand and appreciate methods to decrease the chances of postoperative
complications in the setting of General Surgery. To know and identify common
postoperative complications in the setting of general surgery.
PGY-2
Understand the postoperative care, the evaluation and diagnosis of postoperative
complications, the surgical and nonsurgical options for the care of patients with
postoperative complications in the setting of general surgery.
PGY-5
Demonstrate a clear understanding of the clinical presentation, the evaluation, and
the surgical and nonsurgical treatment options for a wide variety of postoperative
complications that can occur in General Surgery patients.
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Patient Care
G-Level Technical / Procedural Skills
PGY-1
Perform the placement of nasogastric
tubes. Perform under supervision the
placement of central lines. Perform the
placement of Foley catheters.
PGY-2
PGY-5
Perform as assistant re-operative
laparotomy, abdominal washout, and
temporary abdominal closure, dressing
changes associated with complex
abdominal wounds.
Perform as surgeon or first assistant for
abdominal explorations, abdominal
washouts, and the application of
temporary abdominal closures
procedures used in the management of
complex postoperative complications in
General Surgery.
Care Plans
Understand the need for and coordinate
postoperative IV fluid resuscitation. To
understand the need for additional
diagnostic evaluation in the setting of
postoperative complications.
Understand and coordinate
multidisciplinary care for patients with
severe postoperative complications.
Coordinate, reassess, and redesign
care plans used to provide
multidisciplinary care for patients with
complex surgical complications.
Participate in family meetings and
discussions related to unexpected
surgical complications.
Core Topic 8: Short Gut
Medical Knowledge
G-Level Objectives
PGY-1
Understand the definition of intestinal failure. Appreciate the need for nutritional
support in the setting of intestinal failure.
PGY-2
Understand the pathophysiology of intestinal failure. Appreciate the surgical and
nonsurgical options in caring for patients with intestinal failure.
PGY-5
Demonstrate an understanding of the clinical scenarios associated with intestinal
failure and appreciate the surgical and nonsurgical options associated with the care
of patients who develop intestinal failure.
Patient Care
G-Level Technical / Procedural Skills
PGY-1
Perform under supervision the
placement of central lines.
PGY-2
Perform under supervision surgical
STEP procedures.
PGY-5
Demonstrate a clear understanding of
the STEP procedure and the other
surgical approaches and alternatives for
patients with intestinal failure.
Care Plans
Understand and coordinate nonsurgical
care for patients with intestinal failure.
Coordinate multidisciplinary care for
patients with intestinal failure.
Prioritize and supervise multidisciplinary
care plans appropriate for patients with
intestinal failure.
Core Topic 9: Carotid Artery Disease (Open and Endo)
Medical Knowledge
G-Level Objectives
PGY-1
Resident should be able to demonstrate understanding of the epidemiology and
pathophysiology of ischemic stroke, related to carotid artery disease. Also should
describe and define stroke, transient ischemic attack, and amaurosis fugax.
Understand the diagnostic testing for patients with suspected carotid artery disease.
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PGY-2
PGY-5
To understand and describe the medical and surgical management of carotid artery
disease
To understand and describe the surgical management of patients with carotid artery
disease, incorporating evidence based data/literature.
Demonstrate an understanding of the clinical scenarios and pathophysiology of
advanced carotid artery disease and acute stroke. Understand, identify, evaluate,
and treat other types of carotid artery disease such as carotid dissection and trauma
to the carotid artery.
Patient Care
G-Level Technical / Procedural Skills
PGY-1
Assist in the performance of carotid
endarterectomy. Be able to identify
carotid artery and jugular vein when
using the portable ultrasound device.
PGY-2
Assist in the performance of carotid
endarterectomy. Be able to identify
carotid artery and jugular vein when
using the portable ultrasound device
PGY-5
Function as surgeon or first assist for
carotid artery endarterectomy
procedures.
Care Plans
Understand the perioperative risk
assessment for patients with carotid
disease.
Recognize and anticipate complications
following carotid endarterectomy.
Prioritize, coordinate, and re-evaluate
care plans for patients with carotid artery
disease and for patients following carotid
endarterectomy.
Core Topic 10: Abdominal Aortic Aneurysms (Open and Endo)
Medical Knowledge
G-Level Objectives
PGY-1
Define the epidemiology and pathophysiology of AAA. Demonstrate an
understanding of the diagnostic work-up for patients with AAA. Describe the risk of
rupture related to AAA size. Describe a treatment algorithm for management of
AAA.
PGY-2
Describe a treatment algorithm for management of AAA. Describe the morbidity and
mortality related to the surgical management of AAA. Understand and recognize
potential complications of AAA surgery and their management.
PGY-5
Demonstrate an understanding of the pathophysiology of aortic aneurysm and the
assessment of abdominal aortic aneurysms. Demonstrate an understanding of the
criteria used for endovascular and vascular repairs for abdominal aortic aneurysms.
Patient Care
G-Level Technical / Procedural Skills
PGY-1
Assist in the performance of open and
endovascular repair of AAA.
PGY-2
PGY-5
Assist in the performance of open and
endovascular repair of AAA.
Function as surgeon or first assist for
open or endovascular AAA repairs.
Care Plans
Understand the perioperative risk
assessment for patients with abdominal
aortic disease.
Recognize and anticipate complications
following repair of AAA.
Coordinate and assess multidisciplinary
care plans for patients with abdominal
aortic aneurysm.
Core Topic 11: Mesenteric Vascular Disease
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Medical Knowledge
G-Level Objectives
PGY-1
Describe the anatomy of the vascular supply to the small bowel and colon. Describe
the presentation of ischemic bowel, both chronic and acute. Demonstrate an
understanding of the pathophysiology of ischemia and reperfusion.
PGY-2
Describe the evaluation and the medical and surgical management of acute and
chronic mesenteric ischemia. Demonstrate and understanding of the potential
complications in patients treated with mesenteric ischemia.
PGY-5
Demonstrate an understanding of the pathophysiology and the clinical presentation
and initial assessment of patients with ischemic bowel.
Patient Care
G-Level Technical / Procedural Skills
PGY-1
Resident must be able to assist in the
exposure of the mesenteric vasculature.
PGY-2
Resident must be able to assist in the
exposure of the mesenteric vasculature.
PGY-5
Function as first assistant or surgeon for
revascularization procedures for patients
with mesenteric ischemia.
Care Plans
Understand the perioperative risk
assessment for patients with mesenteric
vascular disease.
Recognize and anticipate complications
following surgery for acute mesenteric
ischemia.
Prioritize coordinate and evaluate care
plans for patients with ischemic bowel.
Core Topic 12: Peripheral Artery Disease
Medical Knowledge
G-Level Objectives
PGY-1
Describe the anatomy of the aorta, iliac, and lower extremity arterial tree. Define the
presentation of claudication and ischemic rest pain. Describe the physical exam
findings consistent with PAD. Understand the diagnostic evaluation for patients with
PAD.
PGY-2
Understand the diagnostic evaluation for patients with PAD. Understand and
describe the indications for surgery and intervention in patients with PAD.
PGY-5
Demonstrate an understanding of the clinical presentation, the assessment, and the
treatment options for patients with peripheral vascular disease.
Patient Care
G-Level Technical / Procedural Skills
PGY-1
Assist in the exposure of the arterial tree
including common femoral artery. Also
must be able to perform bedside ankle
brachial index measurements.
PGY-2
Assist in the exposure of the arterial tree
including common femoral artery. Also
must be able to perform bedside ankle
brachial index measurements.
PGY-5
Function as a surgeon for peripheral
artery bypass procedures for patients
with severe peripheral vascular disease.
Function as surgeon and teach
amputation procedures as indicated for
Care Plans
Understand the perioperative risk
assessment for patients with PAD.
Recognize and anticipate complications
following intervention for PAD.
Coordinate and assess care plans for
patients with peripheral vascular
disease. Integrate and involved multiple
members of the care team to provide
optimal patient care for patients with
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patients with advanced peripheral
vascular disease.
peripheral vascular disease.
Core Topic 13: Anal Fistula
Medical Knowledge
G-Level Objectives
PGY-1
By the end of the rotation PGY-1 residents should know:
• The clinical features of a variety of perianal issues including:
• Perianal abscess
• Anal fissure
• Pilonidal cyst
• Hemorrhoids
PGY-2
By the end of the rotation PGY-2 residents should know:
• Indications for exam under anesthesia
• Placement of seton in the setting of complex perianal fistulas.
PGY-5
Demonstrated and be able to communicate a clear understanding of anal
pathologies and functional anatomy. Appreciate the clinical presentation of
advanced anal surgical conditions. Be able to discuss the surgical and non-surgical
options for advanced anal issues.
Patient Care
G-Level Technical / Procedural Skills
PGY-1
Recognize the perianal landmarks for
acute surgical management. Perform
acute perianal surgical procedures under
supervision.
PGY-2
Supervise the acute perianal surgical
procedures with staff supervision.
Participate in the use of sedation and
analgesia for perianal surgical
procedures with staff supervision.
PGY-5
Supervise, teach, and perform both
routine and complex anal surgical
procedures.
Care Plans
Organize an appropriate pre-op and
post-op care plans for patient with
perianal surgical disease.
Supervise the pre and post-op care for
patients with peri-anal surgical problems.
Coordinate and assess care plans for
patients with anal disease. Anticipate
common problems associated with the
care for patients following the surgical
care of anal disease.
Core Topic 14: Diverticulitis
Medical Knowledge
G-Level Objectives
PGY-1
Know the clinical features of acute diverticulitis.
Appreciate the abdominal CT features of acute diverticulitis.
PGY-2
Identify and classify clinical acute diverticulitis.
Be very comfortable interpreting the abdominal CT features of acute diverticulitis.
Properly identify and select patients with acute diverticulitis for percutaneous, open,
or laparoscopic interventions. Appreciate the surgical options or open procedures in
the acute diverticulitis.
PGY-5
Demonstrate an understanding of the relationship between the pathophysiology of
diverticulitis and the clinical presentation and grading systems for patients with acute
diverticulitis.
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Patient Care
G-Level Technical / Procedural Skills
PGY-1
Participate in open and laparoscopic
surgical procedures in the setting of
acute diverticulitis.
PGY-2
PGY-5
Perform and assist open and
laparoscopic surgical procedures in the
setting of acute diverticulitis with staff
supervision.
Perform as surgeon both open and
laparoscopic procedures for acute
diverticulitis. Recognize, evaluate, and
treat complications associated with
surgical procedures used to treat
patients with complex or advanced
diverticulitis.
Care Plans
Recognize the patient needs and
organize the plan the follow up and
surgical options for patients with routine
surgical issues related to acute
diverticulitis.
Recognize plan the follow up and
surgical options for patients with complex
surgical issues related to acute
diverticulitis.
Provide leadership for the GVS Service
by communicating and directing the care
of patients with acute diverticulitis.
Coordinate, prioritize, and assess care
plans for patients with acute diverticulitis.
ROTATION GOALS AND OBJECTIVES FOR PROBLEM-BASED LEARNING AND
IMPROVEMENT, INTERPERSONAL SKILLS AND COMMUNICATION, PROFESSIONALISM,
AND SYSTEMS BASED PRACTICE
Problem-Based Learning and Improvement
G-Level Objectives
PGY-1
• Identify own learning needs or goals at the onset of the rotation.
• Following a surgical procedure, debrief what went well, and what could have
been improved.
• Identify differences in incidence, prognosis, and outcomes of cancer treatment
according to race and gender.
• Diagnose personal learning needs associated with any medical errors,
complications, or “near misses” that occurred during your watch.
• Use feedback gained from others, and the experience gained on this rotation,
to formulate future learning goals and steps.
PGY-2
Same as above
PGY-5
Same as above
Interpersonal Skills and Communication
G-Level Objectives
PGY-1
• Communicate patient information clearly to other health providers in written
notes and oral presentations.
• Apply appropriate communication skills with patients and families (i.e. effective
listening, awareness of nonverbal cues, and use of open-ended questions).
• Counsel and educate patients and families on their treatment options, their
surgical outcomes and prognosis, and home care needs.
• Explain to medical students / junior residents the fundamentals of your job, as
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PGY-2
PGY-5
well as their jobs.
Same as above
Same as above
Professionalism
G-Level Objectives
PGY-1
• Adhere to patient privacy and informed consent policies at all times.
• Adhere to University behavior policies (e.g., sexual harassment, duty hours,
dress code) at all times.
• Demonstrate respect, compassion, integrity, and honesty in all interactions with
patients, families, and other health care providers.
• Demonstrate personal responsibility for patient welfare.
Articulate ethical issues underlying clinical decisions made for at least once
complex case seen during this rotation.
PGY-2
Same as above
PGY-5
Same as above
Systems-Based Practice
G-Level Objectives
PGY-1
• Know when to call for help from attending physicians.
• Understand when, how, and why to request a consult from medical oncology
and radiation oncology, and how to use the information gained as a result.
• Provide timely and pertinent consultation when asked by medical or surgical
colleagues.
• Use the talents and skills of other health providers in the OR and ward.
• Estimate the costs / benefits of cancer screening (mammography,
colonoscopy), staging (CT, PET, etc.), and treatment.
• Consider patient characteristics (e.g., age, race and ethnicity, family support,
socio-economic status, type of insurance) in evaluating treatment options and
developing an appropriate care plan.
• Discuss the distinction between medically necessary care and over care, and
its implications for our patients.
Diagnose any “systems issues” associated with medical errors, complications,
and “near misses” that occurred during this rotation.
PGY-2
Same as above
PGY-5
Same as above
LEARNING RESOURCES FOR TRAINEES
SCORE Website Portal:
•
•
•
Modules, chapters, videos, and radiographic images (STAT dx) pertinent to the core
topics enumerated above
Evidence-Based Reviews in Surgery
MD Content Course on Health Care (economics, operations, legal/financial, leadership)
UMMC GENERAL VASCULAR SURGERY Moodle Website
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•
See assignments and additional resources
ROTATION PLAN FOR 2014-15
ROTATION NAME
UMMC Acute Care Surgery
TRAINING LEVELS ON SERVICE: PGY-1 & PGY-2 (night float)
SERVICE DIRECTOR: James Harmon, M.D., Ph.D.
TEACHING FACULTY:
Kaysie Banton M.D.
Greg Beilman, M.D.
Melissa Brunswald, MD
Tracy Davido, M.D.
James Harmon, M.D., Ph.D.
Torfi Hoskuldson, M.D.
Roshni Venugopal, M.D.
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ROTATION’S WEEKLY EDUCATION SCHEDULE
Monday
Tuesday at
Wednesday
UMMC
6:30 G4+G5
1st Wed/month
7:00 M+M
7:00 Fellows
7:45 Grand
conference
Rounds
(journal
8:30 Core
club/topic)
Curriculum
4th Wed/month
9:45-noon Skills
7:30 Combined
Lab
MICU/SICU
conference
12:00 SICU
Conference
Activity
Who is responsible?
Orientation to the Rotation
Bedside Teaching Rounds
Weekly Core Topic Teaching
Mid-Rotation Review
End-of-Rotation Oral Exam
End-of-Rotation Meeting w/
Resident
Resident (online)
Call Person
All
Faculty will vary
Faculty will vary
Faculty will vary
Thursday
Friday
7:00 General
Surgery
Teaching
conference
When does this
occur?
First day or before
Daily, 8:00 a.m.
Friday 7:00 a.m.
Critical Care/Acute Care
Office will remind you to
set up.
ROTATION GOALS AND OBJECTIVES FOR MEDICAL KNOWLEDGE AND PATIENT CARE, BY CORE
TOPIC AND RESIDENT TRAINING LEVEL
Core Topic 1: Shock
Medical Knowledge
PGY-1
By the end of the rotation PGY-1 residents
should know:
• The clinical appearance of shock
• Examples of distributive, cardiogenic,
neurogenic, obstructive, and
hypovolemic shock
• How to determine oxygen delivery
(DO2)
PGY-2
By the end of the rotation PGY-2 residents
should know:
• The PGY-1 objectives
• Early, goal-directed treatment of shock
• How to restore oxygen delivery
• Relationship of oxygen delivery (DO2)
to oxygen consumption (VO2)
• Endpoints of resuscitation
Patient Care
PGY-1
By the end of the rotation PGY-1 residents
should be able to perform:
• A history and physical exam to identify
the shock state
• Write and initiate orders to treat the
shock state and achieve resuscitative
end-points including: intravenous fluid
rates and boluses, DVT & ulcer
prophylaxis, blood transfusions
PGY-2
By the end of the rotation PGY-2 residents
should be able to perform:
• The PGY-1 objectives
• Recognize the proper indication for
vasoactive agents and initiate their use
• Prescribe proper antibiotic coverage
• Recognize the emergence of organ
failure
•
•
Recognize the need for antibiotics
Recognize the need for vasoactive
agents
Core Topic 2: Role of Intensivist
Medical Knowledge
PGY-1
By the end of the rotation PGY-1 residents
should know:
• What an intensivist does
Patient Care (Role of Intensivist)
PGY-1
N/A
PGY-2
By the end of the rotation PGY-2 residents
should know:
• How an intensivist can improve patient
outcome and supportive data from the
literature
PGY-2
N/A
Core Topic 3: Ventilator Management and Lung Injury
Medical Knowledge
PGY-1
PGY-2
By the end of the rotation PGY-1 residents
By the end of the rotation PGY-2 residents
should know:
should know:
• The clinical and laboratory indicators of
• The PGY-1 objectives
acute respiratory failure
• Indicators for intubation and
mechanical ventilation
• Basic ventilator modes (CMV, SIMV,
PC, PS)
• Indications for different methods of
mechanical ventilation
• Predictors of successful liberation from
the ventilator
Patient Care
PGY-1
By the end of the rotation PGY-1 residents
should be able to:
• Order basic ventilator settings (tidal
volume, respiratory rate, mode, and
PEEP)
• Interpret blood gases and recognize
acute and compensated, respiratory
and metabolic acid base disorders
Core Topic 4: Sepsis
Medical Knowledge
PGY-1
By the end of the rotation PGY-1 residents
should know:
• The distinction between the systemic
PGY-2
By the end of the rotation PGY-2 residents
should be able to:
• PGY-1 objectives
• Modify the ventilator based on blood
gas interpretation by changing rate,
tidal volume, and PEEP
• Recognize potentially lung damaging
situations such as high peak airway
pressures
• Troubleshoot patient-ventilator
disynchrony
PGY-2
By the end of the rotation PGY-2 residents
should know:
• PGY-1 objectives
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•
•
inflammatory response syndrome
(SIRS), bacteremia, and sepsis.
SIRS criteria
The physiologic response that defines
sepsis
•
•
•
The distinction between sepsis, severe
sepsis, and septic shock
The SIRS response and the
compensatory anti-inflammatory response
syndrome (SIRS)
How sepsis leads to multisystem organ
dysfunction and failure
Patient Care
PGY-1
By the end of the rotation PGY-1 residents
should be able to:
• Recognize SIRS and when it becomes
sepsis
• Resuscitate from sepsis (see
objectives for Shock)
Core Topic 5: Blood Transfusion
Medical Knowledge
PGY-1
By the end of the rotation PGY-1 residents
should know:
• Risks and benefits of blood transfusion
• Current opinions of “transfusion
triggers”
PGY-2
By the end of the rotation PGY-2 residents
should be able to perform:
• PGY-1 objectives
• Escalate care from sepsis to septic
shock
• Initiate vasoactive and inotropic agents
PGY-2
By the end of the rotation PGY-2 residents
should know:
• PGY-1 objectives
• Contribution of hemoglobin level to
oxygen delivery
• Indications for fresh frozen plasma,
platelets, and cryoprecipitate
Patient Care
PGY-1
By the end of the rotation PGY-1 residents
should be able to:
• Order proper blood products
Core Topic 6: Renal Failure
Medical Knowledge
PGY-1
By the end of the rotation PGY-1 residents
should know:
• Biochemical indicators of renal failure
PGY-2
By the end of the rotation PGY-2 residents
should be able to:
• Recognize the need for blood
transfusion
• Recognize the ability to avoid blood
transfusions
PGY-2
By the end of the rotation PGY-2 residents
should know:
• PGY-1 objectives
• Distinguish and diagnose
Patient Care
PGY-1
By the end of the rotation PGY-1 residents
should be able to perform:
NA
PGY-2
By the end of the rotation PGY-2 residents
should be able to perform:
NA
Core Topic 7: Family Conferences
Medical Knowledge
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PGY-1
By the end of the rotation PGY-1 residents
should know:
• The meaning of DNR/DNI and comfort
care
PGY-2
By the end of the rotation PGY-2 residents
should know:
• PGY-1 objectives
• Controversies regarding end-of-life
care, specifically the definition of futility
Patient Care
PGY-1
By the end of the rotation PGY-1 residents
should be able to:
• Recognize the signs and symptoms of
pain, anxiety or other discomfort at
end-of-life
Core Topic 8: Tracheostomy
Medical Knowledge
PGY-1
By the end of the rotation PGY-1 residents
should know:
• Indications for tracheostomy
• Risks and benefits of tracheostomy
PGY-2
By the end of the rotation PGY-2 residents
should be able to:
• PGY-1 objectives
• Write orders for anxiolytics, analgesics,
and other drugs for the relief of pain
and suffering at end-of-life
• Perform an end-of-life discussion with a
family member
PGY-2
By the end of the rotation PGY-2 residents
should know:
• PGY-1 objectives
• Advantages and disadvantages of
percutaneous versus open
tracheostomy
Patient Care
PGY-1
By the end of the rotation PGY-1 residents
should be able to:
• Recognize the landmarks both
bronchoscopically and externally for a
tracheostomy location
PGY-2
By the end of the rotation PGY-2 residents
should be able to perform:
• Percutaneous tracheostomy
• Provide sedation and analgesia for
percutaneous tracheostomy
ROTATION GOALS AND OBJECTIVES FOR PROBLEM-BASED LEARNING AND IMPROVEMENT,
INTERPERSONAL SKILLS AND COMMUNICATION, PROFESSIONALISM, AND SYSTEMS BASED
PRACTICE
Problem-Based Learning and Improvement
PGY-1
By the end of the rotation PGY-1 residents
should be able to:
• Recognize his/her limitations
• Utilize available resources to answer
questions regarding critical illness and
patient care issues
PGY-2
By the end of the rotation PGY-2 residents
should:
• Present a list of deaths and
complications (readmissions within 24
hours of discharge, procedural
complications) occurring during the
rotation.
• Present some data from the literature
to address the specific complication
Interpersonal Skills and Communication
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PGY-1
By the end of the rotation PGY-1 residents
should:
• Have witnessed an end-of-life exam
• Have communicated a status update to
family
• Present effectively and organized on
daily rounds
• Use SBAR to communicate
PGY-2
By the end of the rotation PGY-2 residents
should be able to perform:
• PGY-1 objectives
• A family conference to update a
patient’s condition or discuss
alternative care plans
• Communicate critical events (see when
to call the attending card) with SICU
Fellows and attendings
• Respectfully communicate status
changes with primary surgical services
• Comprehend the rationale for primary
service patient care requests
• Collaborate with nursing
Professionalism
PGY-1
By the end of the rotation PGY-1 residents
should be able to perform:
• Resolve conflict with nursing
• Be prepared for rounds
• Take ownership of all patients on
service, not just the ones “you are
covering”
Systems-Based Practice
PGY-1
By the end of the rotation PGY-1 residents
should:
• Recognize the need for timely order
writing and SICU discharge
• Communicate ongoing care needs to
services providing care after SICU
discharge, including to other facilities
PGY-2
By the end of the rotation PGY-2 residents
should be able to perform:
• PGY-1 objectives
• Resolve conflict with primary services
• Solve critical issues with other service’s
patients in the ICU
• Respond to requests for SICU transfer
with respect and in a timely manner
(may need to go see the transfer on
the floor)
PGY-2
By the end of the rotation PGY-2 residents
should:
• PGY-1 objectives
LEARNING RESOURCES FOR TRAINEES
SCORE Website Portal:
• Modules, chapters, videos, and radiographic images (STAT dx) pertinent to the core topics enumerated
above
• Surgical Critical Care, Second Edition. Jerome Abrams, Paul Druck, and Frank B Cerra Eds. Taylor &
Francis, 2005,
UMMC Surgical Critical Care Moodle site
UMMC Acute Care Surgery Moodle site
SPECIFIC READING ASSIGNMENTS
See Moodle site
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ROTATION PLAN FOR 2014-15
ROTATION NAME
SURGICAL ONCOLOGY, UMMC
TRAINING LEVELS ON SERVICE: 1 Chief; 1 PGY-3
SERVICE DIRECTOR: Todd Tuttle, M.D., M.S.
TEACHING FACULTY:
Maria Evasovich, M.D.
Erik Jensen, M.D.
ROTATION’S WEEKLY EDUCATION SCHEDULE
Monday
Tuesday at
Wednesday
UMMC
12:00 Noon
6:30 G4+G5
7:00 Surgical
G1 Tumor
7:00 M+M
Oncology
Conference
7:45 Grand
Teaching
Rounds
Conference
8:30 Core
Curriculum
9:45-noon Skills
Lab
Thursday
7:00 Sarcoma
conference
Activity
Who is responsible?
Orientation to the Rotation
Bedside Teaching Rounds
Weekly Core Topic Teaching
Mid-Rotation Review
End-of-Rotation Oral Exam
End-of-Rotation Meeting w/
Resident
Tuttle
Attending on call
All
Tuttle
Not routinely performed
Tuttle
Friday
7:00 Breast
Tumor
Conference
8:00 Teaching
rounds
When does this
occur?
Week 1, Day 1 (varies)
Friday 8 am
Wednesday 7am
Week 4 (varies)
Week 8 (varies)
ROTATION GOALS AND OBJECTIVES FOR MEDICAL KNOWLEDGE AND PATIENT CARE, BY CORE
TOPIC AND RESIDENT TRAINING LEVEL
Core Topic 1: BREAST CANCER
Medical Knowledge
G-Level Objectives
G3 and
By the end of the rotation PGY-3 residents should know:
G5
• History of breast cancer treatment
• Risk factors for breast cancer
• Types of hereditary breast cancer
• The evaluation of palpable mass
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•
•
•
•
•
•
The evaluation of abnormal mammogram
The management of ductal carcinoma in situ
The management of lobular carcinoma in situ
The management of invasive breast cancer
Role of sentinel lymph node staging
Role of partial breast irradiation
Patient Care
G-Level Technical / Procedural Skills
G3 and
By the end of the rotation PGY-3 residents should be able to perform:
G5
• Skin-sparing mastectomy
• Lumpectomy
• Standard mastectomy
• Axillary lymph node dissection
• Port-a-cath placement
• Sentinel lymph node biopsy
Core Topic 2: MELANOMA
Medical Knowledge
G-Level Objectives
G3
By the end of the rotation PGY-3 residents should know:
• Risk factors for melanoma
• Melanoma staging
• Width of surgical margins
• Regional lymph node staging
• The adjuvant therapy for melanoma
Patient Care
G-Level Technical / Procedural Skills
G3
By the end of the rotation PGY-3 residents should be able to perform:
• Wide local excision
• Sentinel lymph node biopsy
G5
By the end of the rotation PGY-5 residents should be able to perform:
• Wide local excision
• Sentinel lymph node biopsy
• Femoral lymph node dissection
Core Topic 3: GASTRIC MALIGNANCIES
Medical Knowledge
G-Level Objectives
G3 and
By the end of the rotation PGY-3 residents should know:
G5
• Epidemiology of adenocarcinoma of the stomach
• Controversies in surgical management of adenocarcinoma
o D1 vs. D2, total vs. subtotal, pouch vs. no pouch reconstruction
• Adjuvant therapy for adenocarcinoma
• Diagnosis and treatment of GIST
• Role of Imitanib for GIST
• Management of gastric lymphoma
Patient Care
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G-Level
G3
G5
Technical / Procedural Skills
By the end of the rotation PGY-5 residents should be able to perform:
• Subtotal gastrectomy
• Total gastrectomy
• D2 lymphadenectomy
• Resection of gastric GIST
Core Topic 4: PANCREATIC MALIGNANCIES
Medical Knowledge
G-Level Objectives
G3
By the end of the rotation PGY-3 residents should know:
• Epidemiology of pancreatic cancer
• Evaluation of jaundice
• Treatment for adenocarcinoma of pancreas
• Cystic neoplasms of the pancreas
• Endocrine tumors
G5
By the end of the rotation PGY-5 residents should know:
• Epidemiology of pancreatic cancer
• Evaluation of jaundice
• Treatment for adenocarcinoma of pancreas, including: surgery, adjuvant
treatment, results
• Cystic neoplasms of the pancreas
• Endocrine tumors
Patient Care
G-Level Technical / Procedural Skills
G3
By the end of the rotation PGY-3 residents should be able to perform:
• Cholecystectomy
G5
By the end of the rotation PGY-5 residents should be able to perform:
• Whipple
• Distal pancreatectomy
• Pancreatic ultrasound
Core Topic 5: HEPATIC MALIGNANCIES
Medical Knowledge
G-Level Objectives
G3 and
By the end of the rotation PGY-3 residents should know:
G5
• Hepatic anatomy
• Indications for hepatic resection for hepatocellular carcinoma and colorectal
liver metastases
• Neuroendocrine liver metastases
Patient Care
G-Level Technical / Procedural Skills
G3
G5
By the end of the rotation PGY-5 residents should be able to perform:
• Intra-operative hepatic ultrasound
• Major and minor hepatic resections
• Hepatic RFA
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Core Topic 6: SARCOMA
Medical Knowledge
G-Level Objectives
G3 and
By the end of the rotation PGY-3 residents should know:
G5
• Histologic subtypes
• Evaluation
• Extremity-sparing resection
• Retroperitoneal sarcoma
• Adjuvant therapy
Patient Care
G-Level Technical / Procedural Skills
G3
G5
By the end of the rotation PGY-5 residents should be able to perform:
• Resection of extremity sarcoma
• Resection of retroperitoneal sarcoma
Core Topic 7: PERITONEAL METASTASES
Medical Knowledge
G-Level Objectives
G3 and
By the end of the rotation PGY-3 residents should know:
G5
• Natural history of peritoneal metastases
• Results of cytoreductive surgery and hyperthermic intraperitoneal
chemotherapy
Patient Care
G-Level Technical / Procedural Skills
G3
G5
By the end of the rotation PGY-5 residents should be able to perform:
• Cytoreductive surgery, plus hyperthermic intraperitoneal chemotherapy
Core Topic 8: CLINICAL RESEARCH
Medical Knowledge
G-Level Objectives
G3 and
By the end of the rotation PGY-3 residents should know:
G5
• Elements of informed Consent
• Clinical trial designs
Patient Care (NA)
Core Topic 9: THYROID
Medical Knowledge
G-Level Objectives
G3 and
By the end of the rotation PGY-3 residents should know:
G5
• Anatomy of thyroid
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•
•
•
•
•
•
Work-up of thyroid nodule
Non-surgical thyroid problems
Thyroid cancers (well-differentiated and undifferentiated)
Prognostic scoring
Management of post-thyroidectomy hypocalcemia
Neck Metastasis
Patient Care
G-Level Technical / Procedural Skills
G3 and
By the end of the rotation, residents should be able to perform:
G5
• Total thyroidectomy
• Thyroid lobectomy and isthmusectomy
• Central neck dissection
• Modified neck dissection
• Re-implantation of parathyroid gland
Core Topic 10: PARATHYROID
Medical Knowledge
G-Level Objectives
G3 and
By the end of the rotation, residents should know:
G5
• Anatomy and physiology
• Diagnostic Tools
• Imaging options
• Primary, secondary and tertiary hyperparathyroidism
• Work-up of missed or second parathyroid adenoma
Patient Care
G-Level Technical / Procedural Skills
G3
By the end of the rotation PGY-3 residents should be able to perform:
• Parathyroidectomy
G5
By the end of the rotation PGY-5 residents should be able to perform:
• Minimally invasive parathyroidectomy
• Central neck dissection or exploration for parathyroid glands
• Use of gamma probe and / or intraoperative PTH testing
• Substernal / mediastinal parathyroidectomy
Core Topic 11: ADRENAL GLAND
Medical Knowledge
G-Level Objectives
G3 and
By the end of the rotation PGY-3 residents should know:
G5
• Anatomy and physiology
• MEN 1/2
• Evaluation of incidental adrenal mass
• Management of functional adrenal tumors
• Management of adrenocortical carcinoma
• Surgical approaches to the adrenal gland
Patient Care
G-Level Technical / Procedural Skills
G3
G5
By the end of the rotation PGY-5 residents should be able to perform:
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•
Laparoscopic adrenalectomy
ROTATION GOALS AND OBJECTIVES FOR PROBLEM-BASED LEARNING AND IMPROVEMENT,
INTERPERSONAL SKILLS AND COMMUNICATION, PROFESSIONALISM, AND SYSTEMS BASED
PRACTICE
Problem-Based Learning and Improvement
G-Level Objectives
G3 and
• Identify own learning needs or goals at the onset of the rotation.
G5
• Following a surgical procedure, debrief what went well, and what could have
been improved.
• Identify differences in incidence, prognosis, and outcomes of cancer treatment
according to race and gender.
• Diagnose personal learning needs associated with any medical errors,
complications, or “near misses” that occurred during your watch.
• Use feedback gained from others, and the experience gained on this rotation,
to formulate future learning goals and steps.
Interpersonal Skills and Communication
G-Level Objectives
G3 and
• Communicate patient information clearly to other health providers in written
G5
notes and oral presentations.
• Apply appropriate communication skills with patients and families (i.e. effective
listening, awareness of nonverbal cues, and use of open-ended questions).
• Counsel and educate patients and families on their treatment options, their
surgical outcomes and prognosis, and home care needs.
• Explain to medical students / junior residents the fundamentals of your job, as
well as their jobs.
Professionalism
G-Level Objectives
G3 and
• Adhere to patient privacy and informed consent policies at all times.
G5
• Adhere to University behavior policies (e.g., sexual harassment, duty hours,
dress code) at all times.
• Demonstrate respect, compassion, integrity, and honesty in all interactions with
patients, families, and other health care providers.
• Demonstrate personal responsibility for patient welfare.
• Articulate ethical issues underlying clinical decisions made for at least once
complex case seen during this rotation.
Systems-Based Practice
G-Level Objectives
G3 and
• Know when to call for help from attending physicians.
G5
• Understand when, how, and why to request a consult from medical oncology
and radiation oncology, and how to use the information gained as a result.
• Provide timely and pertinent consultation when asked by medical or surgical
colleagues.
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•
•
•
•
•
Use the talents and skills of other health providers in the OR and ward.
Estimate the costs / benefits of cancer screening (mammography,
colonoscopy), staging (CT, PET, etc.), and treatment.
Consider patient characteristics (e.g., age, race and ethnicity, family support,
socio-economic status, type of insurance) in evaluating treatment options and
developing an appropriate care plan.
Discuss the distinction between medically necessary care and over care, and
its implications for cancer patients.
Diagnose any “systems issues” associated with medical errors, complications,
and “near misses” that occurred during this rotation.
LEARNING RESOURCES FOR TRAINEES
SCORE Website Portal:
• Modules, chapters, videos, and radiographic images (STAT dx) pertinent to the core topics enumerated
above
• Evidence-Based Reviews in Surgery
• MD Content Course on Health Care (economics, operations, legal/financial, leadership)
The M.D. Anderson Surgical Oncology Handbook; 4th edition (given to all residents at start of rotation)
ROTATION PLAN FOR 2014-15
ROTATION NAME UNIVERSITY OF MINNESOTA,
TRAINING LEVELS ON SERVICE: PGY-3; PGY-1
SERVICE DIRECTOR: Rafael Andrade, M.D.
TEACHING FACULTY:
Rafael Andrade, M.D.
Eitan Podgaetz, MD
Thoracic Surgery
ROTATION’S WEEKLY EDUCATION SCHEDULE
Monday
Tuesday at
UMMC
6:30 G4+G5
7:00 M+M
7:45 Grand
Rounds
8:30 Core
Curriculum
9:45-noon Skills
Lab
12 noon
Thoracic
Oncology
Clinical
Conference
Wednesday
Thursday
7am Rotation
Teaching
Conference
Friday
7am Once per
Month
Teleconference
with Mexico
7am Once per
Month
Multidisciplinary
Pulmonary
Nodule
Conference
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Activity
Who is responsible?
Orientation to the Rotation
Staff on call
Bedside Teaching Rounds
Weekly Core Topic Teaching
Mid-Rotation Review
Staff on call
Rotating basis on schedule
Staff on call
End-of-Rotation Oral Exam
Staff on call
End-of-Rotation Meeting w/
Resident
Staff on call
When does this
occur?
Within the first week of
starting the rotation
Weekly
Thursdays at 7am
Scheduled mid-rotation
with faculty
Scheduled with faculty
at exit interview
Scheduled with faculty
ROTATION GOALS AND OBJECTIVES FOR MEDICAL KNOWLEDGE AND PATIENT CARE, BY CORE
TOPIC AND RESIDENT TRAINING LEVEL
Core Topic 1: Pre-Op Assessment
Medical Knowledge
G-Level Objectives
PGY-1
General principles of surgery
• Describe the work-up of a patient being prepared for pulmonary surgery with
attention to the pre-operative details that enable one to make a decision on
whether the patient is "fit" for a particular surgery
• Interpret cardiopulmonary fitness and the risk assessment for pulmonary
resection
• Interpret pulmonary function tests accurately to determine whether a patient may
safely undergo a procedure
• Understand the natural history of emphysema and the confounding variables it
creates in the thoracic patient being prepared for the operating room
PGY-3
•
•
•
•
•
•
•
•
Describe the work-up of a patient being prepared for pulmonary surgery with
attention to the pre-operative details that enable one to make a decision on
whether the patient is "fit" for a particular surgery
Interpret cardiopulmonary fitness and the risk assessment for pulmonary
resection
Interpret pulmonary function tests accurately to determine whether a patient may
safely undergo a procedure
Interpret chest CAT scan in the context of the disease process
Describe the various imaging or diagnostic options for a patient undergoing
pulmonary resection and ensuring that they may safely undergo the procedure
Understand the natural history of emphysema and the confounding variables it
creates in the thoracic patient being prepared for the operating room
Utilize scientific literature in patient management questions.
Apply the concepts of “best practice” and “evidence-based medicine” as it relates
to pre-operative assessment
Patient Care
G-Level Technical / Procedural Skills
PGY-1
Using a patient(s) on rotation:
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•
•
PGY-3
Make an accurate assessment of cardiopulmonary fitness for a patient
undergoing a thoracic procedure
Interpret PFTS and DLCO in a patient being prepared for operation
Using a patient(s) on rotation:
•
•
•
•
•
Make an accurate assessment of cardiopulmonary fitness for a patient
undergoing a thoracic procedure
Interpret PFTS and DLCO in a patient being prepared for operation
Interpret a perfusion scan in a patient that is a questionable candidate for surgery
Interpret exercise testing as it relates to selection of the marginal patient
undergoing pulmonary resection
Describe the echo findings signaling pulmonary hypertension and relate why it is
a contraindication to major pulmonary resection
Core Topic 2: Non-Small Cell Lung Cancer
Medical Knowledge
G-Level Objectives
PGY-1
Know the stages of NSCLC
Explain the following elements of NSCLC:
• Cell types
• Clinical vs. pathologic staging
• Staging system and TNM designations
• Surgical treatment based on clinical stage
• Survival based on stage and surgery
• Standards for use of chemotherapy and radiation
• Assessment for lung resection and interpretation of tests
PGY-3
Know the stages and be able to categorize new cases of NSCLC
Know the OR procedure associated with each stage
Explain the following elements of NSCLC:
• Cell types
• Clinical vs. pathologic staging
• Staging system and TNM designations
• Surgical treatment based on clinical stage
• Survival based on stage and surgery
• Standards for use of chemotherapy and radiation
• Pulmonary assessment for lung resection and interpretation of tests
Patient Care
G-Level Technical / Procedural Skills
PGY-1
• Function as an independent operating of the flexible bronchoscope and
adequately evaluate the normal airway and a pathologic airway
• Function as a first assistant to a patient undergoing any procedure for lung
cancer
PGY-3
• Independently perform flexible bronchoscopy
• Perform endobronchial ultrasound staging of the mediastinum with assistance
• Perform mediastinoscopy with assistance
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•
Know the steps and function as an first surgeon to a lobectomy or other cancer
resection
Core Topic 3: Gastroesophageal Reflux Disease
Medical Knowledge
G-Level Objectives
PGY-1
Know the diagnosis and treatment of GERD
Know the indications for operative intervention
Know the complications associated with a fundoplication
Explain the following aspects of GERD:
• Typical vs. atypical symptoms
• Complications of GERD
• Evaluation for possible surgery
• Types of antireflux operations
• Complications of antireflux operations
PGY-3
Know the diagnosis and treatment of GERD
Know the indications for operative intervention
Know the steps of a fundoplication
Explain the types of antireflux operations and approaches for each
Know the complications associated with a fundoplication and treatment
Patient Care
G-Level Technical / Procedural Skills
PGY-1
• Function as a first assistant during a
fundoplication
• Perform
esophagogastroduodenoscopy with
assistance
PGY-3
• Function as a first surgeon to a
fundoplication
• Perform
esophagogastroduodenoscopy
independently
Care Plans
Core Topic 4: Esophageal Cancer
Medical Knowledge
G-Level Objectives
PGY-1
Know the pathology and etiology of esophageal cancer
Know the work-up and differential diagnosis for dysphagia/esophageal mass
Know the stages and treatment of esophageal ca
Barrett’s esophagus
• Definition/Incidence
• Diagnosis
• Management
Explain the following elements of esophageal carcinoma:
• Cell types and etiologic differences
• Clinical vs. pathologic staging
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•
•
•
•
•
•
PGY-3
Tests/exams used in evaluation and staging
Staging system and TNM designations
Surgical treatment based on clinical stage
Survival based on stage and surgery
Standards for use of chemotherapy and radiation
General principles of esophagectomy:
o Anatomy
o Gastric conduit construction
o Functional results
o Approaches to esophagectomy:
 Ivor Lewis
 Three-port
 Transhiatal
 Minimally invasive
Know the pathology and etiology of esophageal cancer
Know the work-up and differential diagnosis for dysphagia/esophageal mass
Know the stages and treatment of esophageal ca
Describe the different approaches to an esophagectomy
Know the adjuvant therapy for esophageal cancer
Barrett’s esophagus
• Definition/Incidence
• Diagnosis
• Management
PGY-3
(cont.)
Explain the following elements of esophageal carcinoma:
• Cell types and etiologic differences
• Clinical vs. pathologic staging
• Tests/exams used in evaluation and staging
• Staging system and TNM designations
• Surgical treatment based on clinical stage
• Survival based on stage and surgery
• Standards for use of chemotherapy and radiation
• General principles of esophagectomy:
o Gastric conduit construction
o Functional results
o Approaches to esophagectomy:
 Ivor Lewis
 Three-port
 Transhiatal
 Minimally invasive
Patient Care
G-Level Technical / Procedural Skills
PGY-1
 Function as a first assistant to the abdominal portion of an esophagectomy
 Perform esophagogastroduodenoscopy with assistance
PGY-3
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


Function as a first surgeon for an esophagectomy including the thoracic portion
Perform esophagogastroduodenoscopy independently
Perform endoscopic ultrasound with assistance
Core Topic 5: Pleural Effusion
Medical Knowledge
G-Level Objectives
PGY-1
Know the etiology and pathology of pleural effusions
Know the differential diagnosis and treatment of pleural effusions
Understand malignant pleural effusion and the treatment options Perform a work-up
on a patient with a pleural effusion and interpret pleura fluid studies
PGY-3
Know the etiology and pathology of pleural effusions
Know the differential diagnosis and treatment of pleural effusions
Understand malignant pleural effusion and the treatment options Perform a work-up
on a patient with a pleural effusion and interpret pleural fluid studies
Patient Care
G-Level
PGY-1
 Be able to place a chest tube
 Function as first assistant on a VATS procedure to address a pleural effusion
PGY-3


Be able to place a chest tube
Function as surgeon on a VATS procedure to address a pleural effusion
Core Topic 6: Solitary Pulmonary Nodule
Medical Knowledge
G-Level Objectives
PGY-1
Know the etiology and pathology of pulmonary nodules
Know the diagnosis and work-up of pulmonary nodules
Know the treatment of different pulmonary nodules
PGY-3
Know the etiology and pathology of pulmonary nodules
Know the diagnosis and work-up of pulmonary nodules
Know the treatment of different pulmonary nodules
Describe the various diagnostic approaches to the pulmonary nodule
Correctly characterize distinct radiographic features which leads one to suggest a
more narrowed differential diagnosis
Provide definitive therapy for the undiagnosable pulmonary nodule and explain the
risks/benefits of the approach
Patient Care
G-Level Technical / Procedural Skills
PGY-1
 Function as a first assistant to a wedge biopsy
PGY-3

Function as first surgeon to a wedge biopsy
Core Topic 7: Mediastinal Mass
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Medical Knowledge
G-Level Objectives
PGY-1
Know the diagnosis and work-up for mediastinal mass
Diagnose a mediastinal mass from a CT scan
PGY-3
Know the diagnosis and work-up for mediastinal mass
Diagnose a mediastinal mass from a CT scan
Know the treatment for different medistinal masses
Patient Care
G-Level Technical / Procedural Skills
PGY-1
 Function as a first assistant to a thymectomy (or other mediastinal mass)
PGY-3

Function as a first surgeon to an thymectomy (or other mediastinal mass)
Core Topic 8: Perforated Esophagus
Medical Knowledge
G-Level Objectives
PGY-1
Know the diagnosis and work-up for a perforated esophagus
Know the a treatment option of a perforated esophagus
PGY-3
Know the diagnosis and work-up for a perforated esophagus
Know the various treatment options of a perforated esophagus
Describe the operative details of the standard approach to a lower third esophageal
perforation
Patient Care
G-Level Technical / Procedural Skills
PGY-1
 Place a chest tube
PGY-3

Assist in sewing an esophageal perforation, know type of suture and closure
Core Topic 9: Leiomyoma
Medical Knowledge
G-Level Objectives
PGY-1
Know the diagnosis and treatment for leiomyoma
PGY-3
Know the diagnosis and treatment for leiomyoma
Patient Care
G-Level Technical / Procedural Skills
PGY-1
 Function as a first assistant during an enucleation
 Assist with flexible esophagoscopy
PGY-3


Function as a first surgeon during an enucleation
Perform esophagoscopy independently
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Core Topic 10: Achalasia
Medical Knowledge
G-Level Objectives
PGY-1
Know the etiology and diagnosis of achalsia
Know the treatment of achalasia (non-operative and operative)
PGY-3
Know the etiology and diagnosis of achalsia
Know the treatment of achalasia (non-operative and operative)
Describe steps in a Heller myotomy Dor Fundoplication
Patient Care
G-Level Technical / Procedural Skills
PGY-1
 Be able to function as a first assistant to a botox injection
 Be able to function as a first assistant to a LES dilation
PGY-3



Be able to function as a first surgeon to a botox injection
Be able to function as a first surgeon to a LES dilation
Be able to function as an assistant on a Heller/Dor
Core Topic 11: Thoracic Trauma
Medical Knowledge
G-Level Objectives
PGY-1
Understand the etiology and work-up for thoracic trauma
Know the mechanism of thoracic trauma
Understand the treatments of various thoracic trauma cases with attention to the
operative approaches
PGY-3
Understand the etiology and work-up for thoracic trauma
Know the mechanism of thoracic trauma
Understand the treatments of various thoracic trauma cases with attention to the
operative approaches and complicated ventilatory situations
Patient Care
G-Level Technical / Procedural Skills
PGY-1
 Be able to place a chest tube
 Perform flexible bronchoscopy with assistance
PGY-3


Be able to place a chest tube
Independently perform flexible bronchoscopy
ROTATION GOALS AND OBJECTIVES FOR PROBLEM-BASED LEARNING AND IMPROVEMENT,
INTERPERSONAL SKILLS AND COMMUNICATION, PROFESSIONALISM, AND SYSTEMS BASED
PRACTICE
Problem-Based Learning and Improvement
G-Level Objectives
All
• Identify own learning needs or goals at the onset of the rotation.
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•
•
•
•
Following a surgical procedure, debrief what went well, and what could have
been improved.
Identify differences in incidence, prognosis, and outcomes of cancer treatment
according to race and gender.
Diagnose personal learning needs associated with any medical errors,
complications, or “near misses” that occurred during your watch.
Use feedback gained from others, and the experience gained on this rotation,
to formulate future learning goals and steps.
Interpersonal Skills and Communication
G-Level Objectives
All
• Communicate patient information clearly to other health providers in written
notes and oral presentations.
• Apply appropriate communication skills with patients and families (i.e. effective
listening, awareness of nonverbal cues, and use of open-ended questions).
• Counsel and educate patients and families on their treatment options, their
surgical outcomes and prognosis, and home care needs.
• Explain to medical students / junior residents the fundamentals of your job, as
well as their jobs.
Professionalism
G-Level Objectives
All
• Adhere to patient privacy and informed consent policies at all times.
• Adhere to University behavior policies (e.g., sexual harassment, duty hours,
dress code) at all times.
• Demonstrate respect, compassion, integrity, and honesty in all interactions with
patients, families, and other health care providers.
• Demonstrate personal responsibility for patient welfare.
• Articulate ethical issues underlying clinical decisions made for at least once
complex case seen during this rotation.
• Work collegially with a physician assistant.
Systems-Based Practice
G-Level Objectives
All
• Know when to call for help from attending physicians.
• Understand when, how, and why to request a consult from pulmonary
medicine, medical oncology, radiation oncology, palliative medicine and how to
use the information gained as a result.
• Provide timely and pertinent consultation when asked by medical or surgical
colleagues.
• Use the talents and skills of other health providers in the OR and ward.
• Estimate the costs / benefits of cancer staging (CT, PET, etc.) and treatment.
• Consider patient characteristics (e.g., age, race and ethnicity, family support,
socio-economic status, type of insurance) in evaluating treatment options and
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•
•
•
developing an appropriate care plan.
Discuss the distinction between medically necessary care and over care, and
its implications for our patients.
Discuss the importance of palliative care for the end stage thoracic oncology
patient
Diagnose any “systems issues” associated with medical errors, complications,
and “near misses” that occurred during this rotation.
LEARNING RESOURCES FOR TRAINEES
SCORE Website Portal:
•
•
•
Modules, chapters, videos, and radiographic images (STAT dx) pertinent to the core topics enumerated
above
Evidence-Based Reviews in Surgery
MD Content Course on Health Care (economics, operations, legal/financial, leadership)
UMMC THORACIC AND FORGUT SURGERY Moodle Website
•
See assignments and additional resources
ROTATION PLAN FOR 2014-15
UNIVERSITY OF MINNESOTA,
Minimally Invasive and Bariatric Surgery
ROTATION NAME
TRAINING LEVELS ON SERVICE: PGY-5; PGY-2; PGY-1
SERVICE DIRECTOR: Sayeed Ikramuddin, M.D.
TEACHING FACULTY:
Henry Buchwald, M.D., Ph.D.
Daniel Leslie, M.D.
ROTATION’S WEEKLY EDUCATION SCHEDULE
Monday
8:00 Dr. Leslie
follow-up and
consultation
clinic
Tuesday at
UMMC
6:30 G4+G5
7:00 M+M
7:45 Grand
Rounds
8:30 Core
Curriculum
9:45-noon Skills
Lab
Wednesday
3:00 Core Topic
Teaching
Thursday
7:00 Bedside
Teaching
Rounds
Friday
7:00 first Friday
of month; MIS
video conference
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Activity
Who is responsible?
Orientation to the Rotation
Bedside Teaching Rounds
Weekly Core Topic Teaching
Mid-Rotation Review
End-of-Rotation Oral Exam
End-of-Rotation Meeting w/
Resident
Leslie
All
Ikramuddin
Leslie
Ikramuddin
Leslie
When does this
occur?
Mon
Thurs am
Wed pm
Mon pm
Thurs am
Fri pm
ROTATION GOALS AND OBJECTIVES FOR MEDICAL KNOWLEDGE AND PATIENT CARE, BY CORE
TOPIC AND RESIDENT TRAINING LEVEL
Core Topic 1: Overview of Obesity
Medical Knowledge
G-Level Objectives
PGY-1
• Identify / diagnose obesity classification and treatment of obesity.
PGY-2
• Identify / qualification for bariatric surgery and treatment options.
PGY-5
• Know the medical and surgical alternatives for achieving weight loss.
• Understand the epidemiology and etiology of the obesity epidemic.
• Understand the basic science principles of weight maintenance in the normal and
obese state.
• Understand the natural history of morbid obesity including the associated
comorbidities.
Patient Care
G-Level Technical / Procedural Skills
PGY-1
N/A
PGY-2
• Peritoneal access laparoscopically.
PGY-5
• Explain basic laparoscopic principles
and types of equipment used.
Care Plans
• Review and understand care plans
• Review and understand care plans
Core Topic 2: Obesity and Diabetes
Medical Knowledge
G-Level Objectives
PGY-1
• Identify / diagnose metabolic conditions related to obesity.
PGY-2
• Identify therapies for diabetes control.
PGY-5
• Evaluate and compare/contrast outcomes of different surgical interventions for
treatment of type 2 diabetes.
Patient Care
G-Level Technical / Procedural Skills
PGY-1
N/A
PGY-2
• Perform enteroenterostomy
PGY-5
• Perform performs or all of upper
endoscopy.
• Interpret impedance manometry and
Care Plans
• Treat type 2 dm post-bariatric surgery
• Understand dynamics of glucose
control post-bariatric surgery
Same as above.
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pH probe test.
• Open and close open operations
independently.
Core Topic 3: Primary Bariatric Operations
Medical Knowledge
G-Level Objectives
PGY-1
• Identify principles and anatomy of accepted bariatric procedures, including RouxPGY-2
en-Y gastric bypass, adjustable gastric banding, and duodenal switch.
PGY-5
• View videos of bariatric procedures and learn steps of laparoscopic and open
bariatric procedures.
Patient Care
G-Level Technical / Procedural Skills
PGY-1
• Assist with laparoscope manipulation
and skin closure.
• Perform portions of intestinal stapling
procedures.
PGY-2
• Learn laparoscopic port placement for
bariatric operations.
• Perform portions of upper endoscopy.
• Interpret impedance manometry and
pH probe tests.
• Open and close open abdominal
procedures with increasing sense of
independence.
• Construct jejunojejunostomy during
open bariatric operation.
• Construct portions of laparoscopic
gastrojejunostomy and
jejunojejunostomy.
PGY-5
• Understand appropriate access, port
placement, and conduct of the primary
bariatric operations.
• Construction of a gastro-jejunostomy
and jejuno-jejunostomy during open
operations.
• Construction of a gastric pouch, gastrojejunostomy, and jejuno-jejunostomy
during advanced laparoscopic
procedures.
• Perform adjustable band implantation.
• Adhesiolysis in complex revision
operations.
Care Plans
• Recognize clinical needs of various
procedures.
• Coordinate care plans for patients with
different bariatric anatomy.
• Supervise MIS team members in
appropriate care plans.
Core Topic 4: Bariatric Complications
Medical Knowledge
G-Level Objectives
PGY-1
• Recognize spectrum of inpatient adverse events.
PGY-2
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PGY-5
• Recognize, diagnose, and manage post-bariatric complications.
• Understand the fundamental complications and treatment of stapled bariatric
operations:
Deep venous thrombosis and pulmonary embolism
Gastric remnant distention
GI leak
Wound infection
Internal hernia
Gastro-jejunal anastomosis stricture
Adverse metabolic sequelae
• Understand the fundamental complications and treatment of adjustable band
surgery:
Acute gastric prolapse
Concentric dilatation
Band erosion
Overtightened band
Port rotation; port or tubing leak; port infection
Band intolerance
Patient Care
G-Level Technical / Procedural Skills
PGY-1
• Perform fluid removal from band.
PGY-2
PGY-5
Care Plans
• Communicate with surgical team
regarding complication treatment plan.
• Treat complications under supervision.
• Assist with exploratory laparoscopy,
endoscopy, and adjustments of the
band in band assessment clinic. Use
wire-guided and radiologic/endoscopic
approaches for treating bariatric
complications.
• Definitively treat surgical complications • Diagnose, manage, and treat
related to bariatric surgery. Place
complications preoperatively and
minimally invasive gastrostomy tube for
postoperatively.
malnutrition.
ROTATION GOALS AND OBJECTIVES FOR PROBLEM-BASED LEARNING AND IMPROVEMENT,
INTERPERSONAL SKILLS AND COMMUNICATION, PROFESSIONALISM, AND SYSTEMS BASED
PRACTICE
Problem-Based Learning and Improvement
G-Level Objectives
PGY-1
• Identify own learning needs or goals at the onset of the rotation.
• Following a surgical procedure, debrief what went well, and what could have
been improved.
• Identify differences in incidence, prognosis, and outcomes of cancer treatment
according to race and gender.
• Diagnose personal learning needs associated with any medical errors,
complications, or “near misses” that occurred during your watch.
• Use feedback gained from others, and the experience gained on this rotation,
to formulate future learning goals and steps.
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PGY-2
PGY-5
Same as above.
Same as above.
Interpersonal Skills and Communication
G-Level Objectives
PGY-1
• Communicate patient information clearly to other health providers in written
notes and oral presentations.
• Apply appropriate communication skills with patients and families (i.e. effective
listening, awareness of nonverbal cues, and use of open-ended questions).
• Counsel and educate patients and families on their treatment options, their
surgical outcomes and prognosis, and home care needs.
• Explain to medical students / junior residents the fundamentals of your job, as
well as their jobs.
PGY-2
Same as above.
PGY-5
Same as above.
Professionalism
G-Level Objectives
PGY-1
• Adhere to patient privacy and informed consent policies at all times.
• Adhere to University behavior policies (e.g., sexual harassment, duty hours,
dress code) at all times.
• Demonstrate respect, compassion, integrity, and honesty in all interactions with
patients, families, and other health care providers.
• Demonstrate personal responsibility for patient welfare.
Articulate ethical issues underlying clinical decisions made for at least once
complex case seen during this rotation.
PGY-2
Same as above.
PGY-5
Same as above.
Systems-Based Practice
G-Level Objectives
PGY-1
• Know when to call for help from attending physicians.
• Understand when, how, and why to request a consult from gastroenterology,
and how to use the information gained as a result.
• Understand the concept of the Bariatric Surgery Center of Excellence and the
need for all bariatric patients to have ongoing chronic care in a bariatric center.
• Provide timely and pertinent consultation when asked by medical or surgical
colleagues.
• Use the talents and skills of other health providers in the OR and ward.
• Estimate the costs / benefits of undergoing bariatric surgery compared to
remaining morbidly obese.
• Consider patient characteristics (e.g., age, race and ethnicity, family support,
socio-economic status, type of insurance) in evaluating treatment options and
developing an appropriate care plan.
• Discuss the distinction between medically necessary care and over care, and
its implications for our patients.
Diagnose any “systems issues” associated with medical errors, complications,
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PGY-2
PGY-5
and “near misses” that occurred during this rotation.
Same as above.
Same as above.
LEARNING RESOURCES FOR TRAINEES
SCORE Website Portal:
•
•
•
Modules, chapters, videos, and radiographic images (STAT dx) pertinent to the core topics enumerated
above
Evidence-Based Reviews in Surgery
MD Content Course on Health Care (economics, operations, legal/financial, leadership)
UMMC MIS & BARIATRIC SURGERY Moodle Website
•
See assignments and additional resources
ROTATION PLAN FOR 2014-15
UNIVERSITY OF MINNESOTA, Transplant Service
ROTATION NAME
TRAINING LEVELS ON SERVICE: PGY -1
SERVICE DIRECTOR: Ty Dunn, M.D.
TEACHING FACULTY:
Srinath Chinnakotla, M.D.
Eric Finger, M.D.
Raja Kandaswamy, M.D.
William Payne, M.D.
Timothy Pruett, M.D.
Arthur Matas, M.D.
ROTATION’S WEEKLY EDUCATION SCHEDULE
Monday
11:00 Transplant
Curriculum
Tuesday at
UMMC
6:30 G4+G5
7:00 M+M
7:45 Grand
Rounds
8:30 Core
Curriculum
9:45-noon Skills
Lab
3:00 Liver
Conference
Wednesday
1:00 K/P Listing
Meeting
3:30 M&M
4:00 Transplant
Conference
Thursday
Friday
3:00 Pancreas
Patient Review
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Activity
Who is responsible?
Orientation to the Rotation
Bedside Teaching Rounds
Weekly Core Topic Teaching
Mid-Rotation Review
End-of-Rotation Oral Exam
End-of-Rotation Meeting w/
Resident
Dr. Dunn
MD of the Week on Kidney
Assigned Faculty
MD on Kidney Service
MD on Kidney Service
MD on Kidney Service
When does this
occur?
1st Day of rotation
Mid-Day Thursday
Monday
Mid-Rotation Week
Last Week of Rotation
Last Week of Rotation
ROTATION GOALS AND OBJECTIVES FOR MEDICAL KNOWLEDGE AND PATIENT CARE, BY CORE
TOPIC AND RESIDENT TRAINING LEVEL
1. Fluid, Electrolyte, and Glucose management in surgical patients with organ
failure
2. Side effects and Drug interactions of Immunosuppressants
3. Vascular Access (short term, long-term, and permanent) - indications and
complications
4. Recognition and management of common postoperative complications of
kidney transplantation
5. Be able to describe at least 2 surgical techniques for ureteral, biliary, and
duodenal anastomoses
Core Topic 1:
Fluid, Electrolyte, and Glucose management in surgical patients with organ
failure
Medical Knowledge
G-Level Objectives
PGY-1
Exhibit knowledge and thought process in discussing organ failure patients with Core
Topic Problem.
Patient Care
G-Level Technical / Procedural Skills
PGY-1
N/A
Care Plan
Demonstrate ability to form appropriate
treatment plan.
Core Topic 2: Side effects and Drug interactions of Immunosuppressants Medical Knowledge
G-Level Objectives
PGY-1
Exhibit knowledge and thought process in discussing organ failure patients with Core
Topic Problem.
Patient Care
G-Level Technical / Procedural Skills
PGY-1
N/A
Care Plans
Demonstrate ability to form appropriate
treatment plan.
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Core Topic 3: Vascular Access (short term, long-term, and permanent) - indications and complications
Medical Knowledge
G-Level Objectives
PGY-1
Exhibit knowledge and thought process in discussing organ failure patients with Core
Topic Problem.
Patient Care
G-Level Technical / Procedural Skills
PGY-1
N/A
Care Plans
Demonstrate ability to form appropriate
treatment plan.
Core Topic 4: Recognition and management of common postoperative complications of kidney transplantation
Medical Knowledge
G-Level Objectives
PGY-1
Exhibit knowledge and thought process in discussing organ failure patients with Core
Topic Problem.
Patient Care
G-Level Technical / Procedural Skills
Care Plans
PGY-1
Demonstrate safe and effective NGT
Demonstrate ability to form appropriate
placement, troubleshooting, and Foley
treatment plan.
Irrigation.
Core Topic 5: Be able to describe at least 2 surgical techniques for ureteral, biliary, and duodenal
anastomoses
Medical Knowledge
G-Level Objectives
PGY-1
Exhibit knowledge and thought process in discussing indications, contraindications,
advantages and disadvantages unique to each technique.
Patient Care
G-Level Technical / Procedural Skills
PGY-1
Participate in vascular, ureteral and
bowel anastomoses during rotation
Care Plans
N/A
ROTATION GOALS AND OBJECTIVES FOR PROBLEM-BASED LEARNING AND IMPROVEMENT,
INTERPERSONAL SKILLS AND COMMUNICATION, PROFESSIONALISM, AND SYSTEMS BASED
PRACTICE
Problem-Based Learning and Improvement
G-Level Objectives
PGY-1
• Identify own learning needs or goals at the onset of the rotation.
• Following a surgical procedure, debrief what went well, and what could have
been improved.
• Identify differences in incidence, prognosis, and outcomes of cancer treatment
according to race and gender.
• Diagnose personal learning needs associated with any medical errors,
complications, or “near misses” that occurred during your watch.
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•
Use feedback gained from others, and the experience gained on this rotation,
to formulate future learning goals and steps.
Interpersonal Skills and Communication
G-Level Objectives
PGY-1
• Communicate patient information clearly to other health providers in written
notes and oral presentations.
• Apply appropriate communication skills with patients and families (i.e. effective
listening, awareness of nonverbal cues, and use of open-ended questions).
• Counsel and educate patients and families on their treatment options, their
surgical outcomes and prognosis, and home care needs.
• Explain to medical students / junior residents the fundamentals of your job, as
well as their jobs.
Professionalism
G-Level Objectives
PGY-1
• Adhere to patient privacy and informed consent policies at all times.
• Adhere to University behavior policies (e.g., sexual harassment, duty hours,
dress code) at all times.
• Demonstrate respect, compassion, integrity, and honesty in all interactions with
patients, families, and other health care providers.
• Demonstrate personal responsibility for patient welfare.
Articulate ethical issues underlying clinical decisions made for at least once
complex case seen during this rotation.
Systems-Based Practice
G-Level Objectives
PGY-1
• Know when to call for help from attending physicians.
• Understand when, how, and why to request a consult from medical oncology
and radiation oncology, and how to use the information gained as a result.
• Provide timely and pertinent consultation when asked by medical or surgical
colleagues.
• Use the talents and skills of other health providers in the OR and ward.
• Estimate the costs / benefits of cancer screening (mammography,
colonoscopy), staging (CT, PET, etc.), and treatment.
• Consider patient characteristics (e.g., age, race and ethnicity, family support,
socio-economic status, type of insurance) in evaluating treatment options and
developing an appropriate care plan.
• Discuss the distinction between medically necessary care and over care, and
its implications for our patients.
Diagnose any “systems issues” associated with medical errors, complications,
and “near misses” that occurred during this rotation.
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LEARNING RESOURCES FOR TRAINEES
ASTS Academic Universe:
• >100 web-based modules specific to transplant, with posttest quizzes.
SCORE Website Portal:
•
•
•
Modules, chapters, videos, and radiographic images (STAT dx) pertinent to the core topics enumerated
above
Evidence-Based Reviews in Surgery
MD Content Course on Health Care (economics, operations, legal/financial, leadership)
UMMC TRANSPLANT Moodle Website
•
See assignments and additional resources
ROTATION PLAN FOR 2014-15
UNIVERSITY OF MINNESOTA, Cardiovascular Service
ROTATION NAME
TRAINING LEVELS ON SERVICE: PGY -3
SERVICE DIRECTOR: Ranjit John, M.D.
TEACHING FACULTY:
Kenneth Liao, M.D.
Sara Shumway, M.D.
Herb Ward, M.D., Ph.D.
ROTATION’S WEEKLY EDUCATION SCHEDULE
Monday
Tuesday at
UMMC
6:30 G4+G5
7:00 M+M
7:45 Grand
Rounds
8:30 Core
Curriculum
9:45-noon Skills
Lab
Wednesday
7:00 Heart
Failure
Conference
Thursday
Friday
7:00 Lung
Transplant
Conference
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Activity
Who is responsible?
Orientation to the Rotation
Bedside Teaching Rounds
Dr. John
Faculty of the week (Drs
John, Liao or Shumway)
Dr. John
Dr. John
Dr. John
Weekly Core Topic Teaching
Mid-Rotation Review
End-of-Rotation Oral Exam
End-of-Rotation Meeting w/
Resident
Dr. John
When does this
occur?
1st three days of rotation
Once per week
Once per week
Mid rotation
Within last 7 days of
rotation
Within last 7 days of
rotation
ROTATION GOALS AND OBJECTIVES FOR MEDICAL KNOWLEDGE AND PATIENT CARE, BY CORE
TOPIC AND RESIDENT TRAINING LEVEL
Core Topic 1: Post-Op Management
Medical Knowledge
G-Level Objectives
PGY-3
Know the management physiologic response of patients that have undergone
procedures requiring cardiopulmonary bypass
Know the concepts important in heart failure and how this differs from the post-op
patient with valvular or ischemic disease
Know the post op physiologic differential diagnosis of the cardiac surgery patient that
includes: septic shock, cardiogenic shock, hypovolemic/hemorrhagic shock
Patient Care
G-Level Manual Dexterity
PGY-3
Correctly manage the acute and sub-acute physiologic changes post-operative
patient following cardiopulmonary bypass (ischemic/valvular) or ventricular assist
device placement
Core Topic 2: Coronary Artery Disease
Medical Knowledge
G-Level Objectives
PGY-3
Accurately diagram the anatomy of the coronary system
Describe the correct pre-operative work-up of the ischemic patient
Describe the operative and non-operative approaches to the patient with
atherosclerotic coronary vascular disease
Know the indications for coronary revascularization
Know the steps to a coronary revascularization procedure using cardiopulmonary
bypass
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Patient Care
G-Level Manual Dexterity
PGY-3
Perform a sternotomy
Assist in performance of cardiopulmonary bypass
Assist with sternal closure
Core Topic 3: Post-Op Complications
Medical Knowledge
G-Level Objectives
PGY-3
Describe the most common post-operative complications for the cardiac surgery
patient and the various options for management (including sub-acute conditions
such as mediastinitis)
Patient Care
G-Level Manual Dexterity
PGY-3
Correctly and efficiently manage post-operative bleeding in a cardiac surgery
patient.
Understand the indication for surgical re-exploration
Recognize and initiate treatment for life-threatening conditions such as tamponade
Core Topic 4: Valvular Heart Disease
Medical Knowledge
G-Level Objectives
PGY-3
Learn the anatomy of the mitral and aortic valve
Understand the indications for surgical valve replacement
Learn the alternatives to surgical treatment
Describe the differences in the approach to surgery in that patient with valvular
disease (when compared to coronary artery surgery alone)
Patient Care
G-Level Manual Dexterity
PGY-3
Perform a sternotomy
Assist in performance of cardiopulmonary bypass
Assist with sternal closure
Core Topic 5: Cardiogenic Shock
Medical Knowledge
G-Level Objectives
PGY-3
Understand the presentation of patients with cardiogenic shock
Learn the surgical and non-surgical management of patients with cardiogenic shock
Learn the indications of placement of intraaortic balloon pump (IABP)
Understand the complications associated with placement and removal of IABP
Describe how a IABP works and recognize basic trouble-shooting maneuvers
Patient Care
G-Level Manual Dexterity
PGY-3
Observe placement of IABP
Perform removal of IABP
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Core Topic 6: LVAD / Heart Transplant
Medical Knowledge
G-Level Objectives
PGY-3
Understand indications for LVAD and heart transplantation
Understand post op management of patients undergoing LVAD and heart
transplantation
Describe the basic immunosuppression for the heart transplant patient
Patient Care
G-Level Manual Dexterity
PGY-3
Perform a sternotomy
Assist in performance of cardiopulmonary bypass
Assist with sternal closure
Core Topic 7: Aortic Disease
Medical Knowledge
G-Level Objectives
PGY-3
Describe the pathophysiology of aortic disease
Describe the presentation of the patient with aortic dissection and the indications for
operative and non-operative management based on anatomy of aortic dissection
Understand diagnosis and management of patients with aortic dissection
Patient Care
G-Level Manual Dexterity
PGY-3
Perform a sternotomy
Assist in performance of cardiopulmonary bypass
Assist with sternal closure
Core Topic 8: Pericardial Disease
Medical Knowledge
G-Level Objectives
PGY-3
Understand diagnosis and management of pericardial effusion and tamponade
Patient Care
G-Level Manual Dexterity
PGY-3
Learn performance of pericardial window (subxiphoid approach)
ROTATION GOALS AND OBJECTIVES FOR PROBLEM-BASED LEARNING AND IMPROVEMENT,
INTERPERSONAL SKILLS AND COMMUNICATION, PROFESSIONALISM, AND SYSTEMS BASED
PRACTICE
Problem-Based Learning and Improvement
G-Level Objectives
PGY-3
• Identify own learning needs or goals at the onset of the rotation.
• Following a surgical procedure, debrief what went well, and what could have
been improved.
• Identify differences in incidence, prognosis, and outcomes of cardiovascular
disease treatment according to race and gender.
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•
Diagnose personal learning needs associated with any medical errors,
complications, or “near misses” that occurred during your watch.
Use feedback gained from others, and the experience gained on this rotation,
to formulate future learning goals and steps.
Interpersonal Skills and Communication
G-Level Objectives
PGY-3
• Communicate patient information clearly to other health providers in written
notes and oral presentations.
• Apply appropriate communication skills with patients and families (i.e. effective
listening, awareness of nonverbal cues, and use of open-ended questions).
• Counsel and educate patients and families on their treatment options, their
surgical outcomes and prognosis, and home care needs.
• Explain to medical students / junior residents the fundamentals of your job, as
well as their jobs.
Professionalism
G-Level Objectives
PGY-3
• Adhere to patient privacy and informed consent policies at all times.
• Adhere to University behavior policies (e.g., sexual harassment, duty hours,
dress code) at all times.
• Demonstrate respect, compassion, integrity, and honesty in all interactions with
patients, families, and other health care providers.
• Demonstrate personal responsibility for patient welfare.
Articulate ethical issues underlying clinical decisions made for at least once
complex case seen during this rotation.
Systems-Based Practice
G-Level Objectives
PGY-3
• Know when to call for help from attending physicians.
• Understand when, how, and why to request a consult from cardiology, critical
care, and how to use the information gained as a result.
• Provide timely and pertinent consultation when asked by medical or surgical
colleagues.
• Use the talents and skills of other health providers in the OR and ward.
• Consider patient characteristics (e.g., age, race and ethnicity, family support,
socio-economic status, type of insurance) in evaluating treatment options and
developing an appropriate care plan.
• Discuss the distinction between medically necessary care and over care, and
its implications for our patients.
Diagnose any “systems issues” associated with medical errors, complications,
and “near misses” that occurred during this rotation.
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LEARNING RESOURCES FOR TRAINEES
SCORE Website Portal:
•
•
Evidence-Based Reviews in Surgery
MD Content Course on Health Care (economics, operations, legal/financial, leadership)
UMMC CARDIOVASCULAR Moodle Website
•
See assignments and additional resources
ROTATION PLAN FOR 2014-15
ROTATION NAME
UMMC Surgical Critical Care
TRAINING LEVELS ON SERVICE: 1 Fellow; 1 PGY-2; 1 PGY-1; a medical ICU fellow; 4th year medical
students
SERVICE DIRECTOR: Jeffrey Chipman, M.D.
TEACHING FACULTY:
Kaysie Banton M.D.
H. Tracy Davido, M.D.
James Harmon, M.D., Ph.D.
Melissa Brunsvold, M.D.
Torfi Hoskuldson, M.D.
Roshni Venugopal, M.D.
ROTATION’S WEEKLY EDUCATION SCHEDULE
Monday
Tuesday at
Wednesday
UMMC
6:30 G4+G5
1st Wed/month
7:00 M+M
7:00 Fellows
7:45 Grand
conference
Rounds
(journal
8:30 Core
club/topic)
Curriculum
4th Wed/month
9:45-noon Skills
7:30 Combined
Lab
MICU/SICU
conference
12:00 SICU
Conference
Activity
Who is responsible?
Orientation to the Rotation
Bedside Teaching Rounds
Weekly Core Topic Teaching
Mid-Rotation Review
End-of-Rotation Oral Exam
Resident (online)
Call Person
All
Faculty will vary
Faculty will vary
Thursday
Friday
When does this
occur?
First day or before
Daily, 8:00 a.m.
Daily
Critical Care/Acute Care
Office will remind you to
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End-of-Rotation Meeting w/
Resident
Faculty will vary
set up.
ROTATION GOALS AND OBJECTIVES FOR MEDICAL KNOWLEDGE AND PATIENT CARE, BY CORE
TOPIC AND RESIDENT TRAINING LEVEL
Core Topic 1: Shock
Medical Knowledge
PGY-1
PGY-2
By the end of the rotation PGY-1 residents
By the end of the rotation PGY-2 residents
should know:
should know:
• The clinical appearance of shock
• The PGY-1 objectives
• Examples of distributive, cardiogenic,
• Early, goal-directed treatment of shock
neurogenic, obstructive, and
• How to restore oxygen delivery
hypovolemic shock
• Relationship of oxygen delivery (DO2)
• How to determine oxygen delivery
to oxygen consumption (VO2)
(DO2)
• Endpoints of resuscitation
Patient Care
Greg Beilman, M.D.
PGY-1
By the end of the rotation PGY-1 residents
should be able to perform:
• A history and physical exam to identify
the shock state
• Write and initiate orders to treat the
shock state and achieve resuscitative
end-points including: intravenous fluid
rates and boluses, DVT & ulcer
prophylaxis, blood transfusions
• Recognize the need for antibiotics
• Recognize the need for vasoactive
agents
Core Topic 2: Role of Intensivist
Medical Knowledge
PGY-1
By the end of the rotation PGY-1 residents
should know:
• What an intensivist does
PGY-2
By the end of the rotation PGY-2 residents
should be able to perform:
• The PGY-1 objectives
• Recognize the proper indication for
vasoactive agents and initiate their use
• Prescribe proper antibiotic coverage
• Recognize the emergence of organ
failure
PGY-2
By the end of the rotation PGY-2 residents
should know:
• How an intensivist can improve patient
outcome and supportive data from the
literature
Patient Care
PGY-1
N/A
PGY-2
N/A
Core Topic 3: Ventilator Management and Lung Injury
Medical Knowledge
PGY-1
PGY-2
By the end of the rotation PGY-1 residents
By the end of the rotation PGY-2 residents
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should know:
• the clinical and laboratory indicators of
acute respiratory failure
• Basic ventilator modes (CMV, SIMV,
PC, PS)
should know:
• The PGY-1 objectives
• Indicators for intubation and
mechanical ventilation
• Indications for different methods of
mechanical ventilation
• Predictors of successful liberation from
the ventilator
Patient Care
PGY-1
By the end of the rotation PGY-1 residents
should be able to:
• Order basic ventilator settings (tidal
volume, respiratory rate, mode, and
PEEP)
• Interpret blood gases and recognize
acute and compensated, respiratory
and metabolic acid base disorders
Core Topic 4: Sepsis
Medical Knowledge
PGY-1
By the end of the rotation PGY-1 residents
should know:
• The distinction between the systemic
inflammatory response syndrome
(SIRS), bacteremia, and sepsis.
• SIRS criteria
• The physiologic response that defines
sepsis
PGY-2
By the end of the rotation PGY-2 residents
should be able to:
• PGY-1 objectives
• Modify the ventilator based on blood
gas interpretation by changing rate,
tidal volume, and PEEP
• Recognize potentially lung damaging
situations such as high peak airway
pressures
• Troubleshoot patient-ventilator
disynchrony
PGY-2
By the end of the rotation PGY-2 residents
should know:
• PGY-1 objectives
• The distinction between sepsis, severe
sepsis, and septic shock
• The SIRS response and the
compensatory anti-inflammatory
response syndrome (SIRS)
• How sepsis leads to multisystem organ
dysfunction and failure
Patient Care
PGY-1
By the end of the rotation PGY-1 residents
should be able to:
• Recognize SIRS and when it becomes
sepsis
• Resuscitate from sepsis (see
objectives for Shock)
PGY-2
By the end of the rotation PGY-2 residents
should be able to perform:
• PGY-1 objectives
• Escalate care from sepsis to septic
shock
• Initiate vasoactive and inotropic agents
Core Topic 5: Blood Transfusion
Medical Knowledge
PGY-1
By the end of the rotation PGY-1 residents
should know:
PGY-2
By the end of the rotation PGY-2 residents
should know:
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•
•
Risks and benefits of blood transfusion
Current opinions of “transfusion
triggers”
•
•
•
PGY-1 objectives
Contribution of hemoglobin level to
oxygen delivery
Indications for fresh frozen plasma,
platelets, and cryoprecipitate
Patient Care
PGY-1
By the end of the rotation PGY-1 residents
should be able to:
• Order proper blood products
Core Topic 6: Renal Failure
Medical Knowledge
PGY-1
By the end of the rotation PGY-1 residents
should know:
• Biochemical indicators of renal failure
PGY-2
By the end of the rotation PGY-2 residents
should be able to:
• Recognize the need for blood
transfusion
• Recognize the ability to avoid blood
transfusions
PGY-2
By the end of the rotation PGY-2 residents
should know:
• PGY-1 objectives
• Distinguish and diagnose
Patient Care
PGY-1
By the end of the rotation PGY-1 residents
should be able to perform:
•
Core Topic 7: Family Conferences
Medical Knowledge
PGY-1
By the end of the rotation PGY-1 residents
should know:
• The meaning of DNR/DNI and comfort
care
PGY-2
By the end of the rotation PGY-2 residents
should be able to perform:
•
PGY-2
By the end of the rotation PGY-2 residents
should know:
• PGY-1 objectives
• Controversies regarding end-of-life
care, specifically the definition of futility
Patient Care
PGY-1
By the end of the rotation PGY-1 residents
should be able to:
• Recognize the signs and symptoms of
pain, anxiety or other discomfort at
end-of-life
PGY-2
By the end of the rotation PGY-2 residents
should be able to:
• PGY-1 objectives
• Write orders for anxiolytics, analgesics,
and other drugs for the relief of pain
and suffering at end-of-life
• Perform an end-of-life discussion with a
family member
Core Topic 8: Tracheostomy
Medical Knowledge
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PGY-1
By the end of the rotation PGY-1 residents
should know:
• Indications for tracheostomy
• Risks and benefits of tracheostomy
PGY-2
By the end of the rotation PGY-2 residents
should know:
• PGY-1 objectives
• Advantages and disadvantages of
percutaneous versus open
tracheostomy
Patient Care
PGY-1
By the end of the rotation PGY-1 residents
should be able to:
• Recognize the landmarks both
bronchoscopically and externally for a
tracheostomy location
PGY-2
By the end of the rotation PGY-2 residents
should be able to perform:
• Percutaneous tracheostomy
• Provide sedation and analgesia for
percutaneous tracheostomy
ROTATION GOALS AND OBJECTIVES FOR PROBLEM-BASED LEARNING AND IMPROVEMENT,
INTERPERSONAL SKILLS AND COMMUNICATION, PROFESSIONALISM, AND SYSTEMS BASED
PRACTICE
Problem-Based Learning and Improvement
PGY-1
By the end of the rotation PGY-1 residents
should be able to:
• Recognize his/her limitations
• Utilize available resources to answer
questions regarding critical illness and
patient care issues
Interpersonal Skills and Communication
PGY-1
By the end of the rotation PGY-1 residents
should:
• Have witnessed an end-of-life exam
• Have communicated a status update to
family
• Present effectively and organized on
daily rounds
• Use SBAR to communicate
PGY-2
By the end of the rotation PGY-2 residents
should:
• Present a list of deaths and
complications (readmissions within 24
hours of discharge, procedural
complications) occurring during the
rotation.
• Present some data from the literature
to address the specific complication
PGY-2
By the end of the rotation PGY-2 residents
should be able to perform:
• PGY-1 objectives
• A family conference to update a
patient’s condition or discuss
alternative care plans
• Communicate critical events (see when
to call the attending card) with SICU
Fellows and attendings
• Respectfully communicate status
changes with primary surgical services
• Comprehend the rationale for primary
service patient care requests
• Collaborate with nursing
Professionalism
PGY-1
PGY-2
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By the end of the rotation PGY-1 residents
should be able to perform:
• Resolve conflict with nursing
• Be prepared for rounds
• Take ownership of all patients on
service, not just the ones “you are
covering”
Systems-Based Practice
PGY-1
By the end of the rotation PGY-1 residents
should:
• Recognize the need for timely order
writing and SICU discharge
• Communicate ongoing care needs to
services providing care after SICU
discharge, including to other facilities
By the end of the rotation PGY-2 residents
should be able to perform:
• PGY-1 objectives
• Resolve conflict with primary services
• Solve critical issues with other service’s
patients in the ICU
• Respond to requests for SICU transfer
with respect and in a timely manner
(may need to go see the transfer on
the floor)
PGY-2
By the end of the rotation PGY-2 residents
should:
• PGY-1 objectives
LEARNING RESOURCES FOR TRAINEES
SCORE Website Portal:
• Modules, chapters, videos, and radiographic images (STAT dx) pertinent to the core topics enumerated
above
• Surgical Critical Care, Second Edition. Jerome Abrams, Paul Druck, and Frank B Cerra Eds. Taylor &
Francis, 2005,
UMMC Surgical Critical Care Moodle site
• Specific readings and resources
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ROTATION PLAN FOR 2014-15
UNIVERSITY OF MINNESOTA, Colorectal Surgery
ROTATION NAME
TRAINING LEVELS ON SERVICE: PGY -1
SERVICE DIRECTOR: Mary Kwaan, M.D.
TEACHING FACULTY:
Robert Madoff, M.D.
Genevieve Melton-Meaux, M.D.
James W. Ogilvie, Jr., M.D., M.S.
David Rothenberger, M.D.
ROTATION’S WEEKLY EDUCATION SCHEDULE
Monday
12 noon Rectal
Cancer
Conference
every other week
Tuesday at
UMMC
7:00 M+M
7:45 Grand
Rounds
8:30 Core
Curriculum
9:45-noon Skills
Lab
Wednesday
Surgical
Oncology
Colorectal
conference
(SOCR)
(every other
week)
Thursday
Gen and
vascular surgery
y (GVS) core
conference
(every 6 weeks)
Activity
Who is responsible?
Orientation to the Rotation
Service director
Bedside Teaching Rounds
All attendings
Weekly Core Topic Teaching
Service Director
RDM, GMM, MRK, DAR
Rectal Cancer Conference
Mid-Rotation Review
End-of-Rotation Oral Exam
End-of-Rotation Meeting w/
Resident
Service Director
Service Director
Service Director
Friday
When does this
occur?
The first week of the
rotation
Mon-Fri
When the PGY1 is
available and when the
attending is not out of
town
At the PGY-1’s
discretion (take home
quiz).
Every other Wednesday
(SOCR).
Every 6 weeks on
Thursday (GVS).
Every other Monday
Last week of rotation
Last week of the rotation
Last week of rotation
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ROTATION GOALS AND OBJECTIVES FOR MEDICAL KNOWLEDGE AND PATIENT CARE, BY CORE
TOPIC AND RESIDENT TRAINING LEVEL
Core Topic 1: Anorectal Abscess and Fistula
Medical Knowledge
G-Level Objectives
PGY-1
Anatomy of the anus, rectum, and surrounding soft tissue structures. Clinical
presentation of anorectal abscess. Treatment options.
Patient Care
G-Level Technical / Procedural Skills
PGY-1
Dressing changes, Proctoscopy, Seton
selection and placement
Care Plans
Develop a treatment plan for patients in
the emergency room with an anorectal
abscess.
Core Topic 2: Inflammatory Bowel Disease
Medical Knowledge
G-Level Objectives
PGY-1
Differential diagnosis, clinical presentation, work up, surgical treatment options.
Patient Care
G-Level Technical / Procedural Skills
PGY-1
Dressing changes, Drain removal,
Proctoscopy, Enterostomy pouching and
care, Skin and fascia closure
Care Plans
Management of post-operative
hypotension, oliguria, bleeding, DVT
prophylaxis, surgical site infection, postoperative ileus, discharges planning.
Core Topic 3: Diverticular Disease
Medical Knowledge
G-Level Objectives
PGY-1
Differential diagnosis, clinical presentation, work up, surgical treatment options.
Patient Care
G-Level Technical / Procedural Skills
PGY-1
Dressing changes, Drain removal,
Proctoscopy, Skin and fascia closure
Care Plans
Management of post-operative
hypotension, oliguria, bleeding, DVT
prophylaxis, surgical site infection, postoperative ileus, discharges planning.
Core Topic 3: Colon and Rectal Cancer
Medical Knowledge
G-Level Objectives
PGY-1
Differential diagnosis, clinical presentation, work up, surgical treatment options.
Patient Care
G-Level Technical / Procedural Skills
PGY-1
Care Plans
Management of post-operative
hypotension, oliguria, bleeding, DVT
prophylaxes, surgical site infection, postoperative ileus, discharge planning.
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ROTATION GOALS AND OBJECTIVES FOR PROBLEM-BASED LEARNING AND IMPROVEMENT,
INTERPERSONAL SKILLS AND COMMUNICATION, PROFESSIONALISM, AND SYSTEMS BASED
PRACTICE
Problem-Based Learning and Improvement
G-Level Objectives
PGY-1
• Identify own learning needs or goals at the onset of the rotation.
• Diagnose personal learning needs associated with any medical errors,
complications, or “near misses” that occurred during your watch.
• Use feedback gained from others, and the experience gained on this rotation,
to formulate future learning goals and steps.
Interpersonal Skills and Communication
G-Level Objectives
PGY-1
• Communicate patient information clearly to other physicians and nurses in
written notes and oral presentations.
• Apply appropriate communication skills with patients and families (i.e. effective
listening, awareness of nonverbal cues, and use of open-ended questions).
• Effectively communicate needs when calling an inpatient consultation to
physicians from other specialties.
• Explain to medical students the fundamentals of your job, as well as their jobs.
Professionalism
G-Level Objectives
PGY-1
• Adhere to patient privacy and informed consent policies at all times.
• Adhere to University behavior policies (e.g., sexual harassment, duty hours,
dress code) at all times.
• Demonstrate respect, compassion, integrity, and honesty in all interactions with
patients, families, and other health care providers.
• Demonstrate personal responsibility for patient welfare.
Articulate ethical issues underlying clinical decisions made for at least once
complex case seen during this rotation.
Systems-Based Practice
G-Level Objectives
PGY-1
• Know when to call for help from attending physicians.
• Understand how to order and negotiate prioritization of advanced testing (i.e.
Endoscopy, image based procedures) for patients in the hospital
• Provide timely and pertinent consultation when asked by medical or surgical
colleagues.
• Use the talents and skills of other health providers in the OR and ward.
• Consider patient characteristics (e.g., age, race and ethnicity, family support,
socio-economic status, type of insurance) in evaluating treatment options and
developing an appropriate care plan.
• Discuss the distinction between medically necessary care and over care, and
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•
its implications for our patients.
Diagnose any “systems issues” associated with medical errors, complications,
and “near misses” that occurred during this rotation.
LEARNING RESOURCES FOR TRAINEES
SCORE Website Portal:
• Modules, chapters, videos, and radiographic images (STAT dx) pertinent to the core topics enumerated
above
• Evidence-Based Reviews in Surgery
• MD Content Course on Health Care (economics, operations, legal/financial, leadership)
UMMC COLORECTAL Moodle Website
• Modules, articles, videos, and radiographic images pertinent to the core topics enumerated above and
supplementary topics
• See assignments and additional resources
ROTATION PLAN FOR 2014-15
UNIVERSITY OF MINNESOTA, Pediatric Surgery
ROTATION NAME
TRAINING LEVELS ON SERVICE: PGY -4; PGY-1
SERVICE DIRECTOR: Daniel Saltzman, M.D., Ph.D.
TEACHING FACULTY:
Robert Acton, M.D.
Donavon Hess, M.D., Ph.D.
Arnold Leonard, M.D, Ph.D.
Brad Segura, M.D., Ph.D.
ROTATION’S WEEKLY EDUCATION SCHEDULE
Monday
Tuesday at
UMMC
6:30 G4+G5
7:00 M+M
7:45 Grand
Rounds
8:30 Core
Curriculum
9:45-noon Skills
Lab
Wednesday
Thursday
Friday
7:00 – Weekly
Teaching Conf
Noon -Surgery /
GI Conference –
every other
week
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Activity
Who is responsible?
Orientation to the Rotation
Bedside Teaching Rounds
Weekly Core Topic Teaching
Mid-Rotation Review
End-of-Rotation Oral Exam
End-of-Rotation Meeting w/
Resident
All
Call Person
All, Dr Leonard
All
All
Acton
When does this
occur?
First day
Daily
Thursday 7am
Last week
ROTATION GOALS AND OBJECTIVES FOR MEDICAL KNOWLEDGE AND PATIENT CARE, BY CORE
TOPIC AND RESIDENT TRAINING LEVEL
Core Topic 1: Abdominal Wall Defects
Medical Knowledge
G-Level Objectives
PGY-1
Difference between a gastroschisis and omphalocele
Treatment options and plan for both.
Associated anomalies
PGY-4
Above and
Syndromes that contain omphaloceles and their treatment
Long term outcomes of both
Patient Care
G-Level Technical / Procedural Skills
Care Plans
PGY-1
Daily reduction of silos
Be able to recognize bowel ischemia
Suture close the defect
PGY-4
Same
Core Topic 2: Bowel Obstructions: Atresias
Medical Knowledge
G-Level Objectives
PGY-1
Understand the theory of jejunal / ileal / colonic atresia and how it differs from
duodenal atresia and imperforate anus.
Associated anomalies with all atresias
Categorize the various atresias
PGY-4
Above and
Know the history behind the description of jejunal / ileal atresia
Describe and categorize esophageal atresia
Patient Care
G-Level Technical / Procedural Skills
PGY-1
Repair a straight forward type 1 jejunal
atresia under direct supervision
PGY-4
Be able to sew the repairs under direct
supervision.
Care Plans
Understand and be able to describe the
work-up and evaluation.
Describe the operative plan for repair of
all atresia
Core Topic 3: Bowel Obstructions: Hirschprings and GI Bleeds
Medical Knowledge
G-Level Objectives
PGY-1
Understand the physiology of Hirschsprung’s
List the differential diagnosis for Pediatric GI Bleeds and how they differ for age
PGY-4
Above and
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Describe the various causes of pediatric bowel obstruction and their treatments
Patient Care
G-Level Technical / Procedural Skills
PGY-1
Assist in an open rectal biopsy and lysis
of adhesions
PGY-4
Be able to identify and treat operatively a
patient with midgut volvulus
Perform a suction rectal biopsy
Care Plans
Develop treatment plans for postoperative patients
Be able to develop appropriate pre and
post op plans for pediatric patients with
GI obstructions.
Core Topic 4: Congenital Diaphragmatic Hernia
Medical Knowledge
G-Level Objectives
PGY-1
Understand and describe the development of the diaphragm.
Compare and contrast the two most common forms of CDH.
PGY-4
Above and
Describe the clinical treatment of CDH and associated issues.
Patient Care
G-Level Technical / Procedural Skills
PGY-1
Correctly interpret a CXR of a patient
with a CDH
PGY-4
Be able to reduce the viscera from a
chest and decide about primary or patch
repair.
Care Plans
Participate in the post-operative care of a
CDH patient.
Make decisions about when it is
appropriate to repair a CDH
Core Topic 5: Pectus
Medical Knowledge
G-Level Objectives
PGY-1
Understand and describe the cardiopulmonary physiology of pectus excavatum and
how it differs from pectus carinatum.
PGY-4
Describe the most common operative repairs of all types of pectus.
Patient Care
G-Level Technical / Procedural Skills
Care Plans
PGY-1
Evaluate a patient with pectus carinatum Demonstrate proper pain management
for a pectus brace. Participate in a
of a post-op patient.
pectus operation.
PGY-4
Participate in dissection and repair of
Same as above
pectus
Core Topic 6: Congenital Cystic Adenoid Malformation
Medical Knowledge
G-Level Objectives
PGY-1
Understand and describe the various congenital lung masses and how they differ.
PGY-4
Describe the clinical treatment of the above lung masses
Patient Care
G-Level Technical / Procedural Skills
PGY-1
Correctly interpret a CXR of a patient
with a CCAM and describe the changes
from normal
PGY-4
Same
Care Plans
Proper care of a post-op thoracotomy
patient.
Same
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Core Topic 7: Abdominal Mass and Tumors
Medical Knowledge
G-Level Objectives
PGY-1
Develop and describe the differential diagnosis of pediatric abd masses
PGY-4
Same as above and describe their treatment and pre-operative management.
Patient Care
G-Level Technical / Procedural Skills
PGY-1
Demonstrate the proper physical exam
of an abd mass.
PGY-4
Assist in the operation for removal of a
mass
Care Plans
Describe the labs need for diagnosis
Proper pre and post-operative care of
the patient.
ROTATION GOALS AND OBJECTIVES FOR PROBLEM-BASED LEARNING AND IMPROVEMENT,
INTERPERSONAL SKILLS AND COMMUNICATION, PROFESSIONALISM, AND SYSTEMS BASED
PRACTICE
Problem-Based Learning and Improvement
G-Level Objectives
PGY-1
• Identify own learning needs or goals at the onset of the rotation.
• Following a surgical procedure, debrief what went well, and what could have
been improved.
• Identify differences in incidence, prognosis, and outcomes of cancer treatment
according to race and gender.
• Diagnose personal learning needs associated with any medical errors,
complications, or “near misses” that occurred during your watch.
• Use feedback gained from others, and the experience gained on this rotation,
to formulate future learning goals and steps.
PGY-4
Same as above
Interpersonal Skills and Communication
G-Level Objectives
PGY-1
• Communicate patient information clearly to other health providers in written
notes and oral presentations.
• Apply appropriate communication skills with patients and families (i.e. effective
listening, awareness of nonverbal cues, and use of open-ended questions).
• Counsel and educate patients and families on their treatment options, their
surgical outcomes and prognosis, and home care needs.
• Explain to medical students / junior residents the fundamentals of your job, as
well as their jobs.
PGY-4
Same as above
Professionalism
G-Level Objectives
PGY-1
• Adhere to patient privacy and informed consent policies at all times.
• Adhere to University behavior policies (e.g., sexual harassment, duty hours,
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PGY-4
dress code) at all times.
• Demonstrate respect, compassion, integrity, and honesty in all interactions with
patients, families, and other health care providers.
• Demonstrate personal responsibility for patient welfare.
Articulate ethical issues underlying clinical decisions made for at least once
complex case seen during this rotation.
Same as above
Systems-Based Practice
G-Level Objectives
PGY-1
• Know when to call for help from attending physicians.
• Understand when, how, and why to request a consult from medical oncology
and radiation oncology, and how to use the information gained as a result.
• Provide timely and pertinent consultation when asked by medical or surgical
colleagues.
• Use the talents and skills of other health providers in the OR and ward.
• Estimate the costs / benefits of cancer screening (mammography,
colonoscopy), staging (CT, PET, etc.), and treatment.
• Consider patient characteristics (e.g., age, race and ethnicity, family support,
socio-economic status, type of insurance) in evaluating treatment options and
developing an appropriate care plan.
• Discuss the distinction between medically necessary care and over care, and
its implications for our patients.
Diagnose any “systems issues” associated with medical errors, complications,
and “near misses” that occurred during this rotation.
PGY-4
Same as above
LEARNING RESOURCES FOR TRAINEES
SCORE Website Portal:
•
•
•
Modules, chapters, videos, and radiographic images (STAT dx) pertinent to the core topics enumerated
above
Evidence-Based Reviews in Surgery
MD Content Course on Health Care (economics, operations, legal/financial, leadership)
UMMC PEDIATRIC SURGERY Moodle Website See assignments and additional resources
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ROTATION PLAN FOR 2014-15
REGIONS HOSPITAL, Trauma
ROTATION NAME
TRAINING LEVELS ON SERVICE: 1 PGY-2, 1 to 2 PGY-1
SERVICE DIRECTOR: Michael D. McGonigal, M.D.
TEACHING FACULTY:
Kaysie Banton, M.D.
Bruce Bennett, M.D.
Gary Collins, M.D.
ROTATION’S WEEKLY EDUCATION SCHEDULE
Monday
Tuesday at
UMMC
7:00 M+M
7:45 Grand
Rounds
8:30 Core
Curriculum
9:45-noon Skills
Lab
Wednesday
Thursday
6:30 M+M
7:30 Trauma
Conference
Activity
Who is responsible?
Orientation to the Rotation
Bedside Teaching Rounds
Weekly Core Topic Teaching
Mid-Rotation Review
End-of-Rotation Oral Exam
End-of-Rotation Meeting w/
Resident
Dr. McGonigal
Attending on service
Dr. McGonigal
Dr. McGonigal
Trauma faculty member
Dr. McGonigal
Friday
11:00 Core
Curriculum
When does this
occur?
1st weekday 11:00 am
Daily 9:30 am
Fridays 11:00 am
3rd Monday 11:00 am
Last 3 days of rotation
Last weekday 11:00 am
ROTATION GOALS AND OBJECTIVES FOR MEDICAL KNOWLEDGE AND PATIENT CARE, BY CORE
TOPIC AND RESIDENT TRAINING LEVEL
Core Topic 1: Trauma Mechanism and Physiology
Medical Knowledge
G-Level Objectives
All
Understand normal and abnormal responses to shock
All
Describe classes of hemorrhage and physiologic responses
All
List basic mechanisms of injury
All
Describe common injury patterns based on mechanism
All
Understand basic concepts of ballistics and firearm injury
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All
All
Review management of DVT and PE in trauma patients
Describe the concepts of damage control surgery
Core Topic 2: Resuscitation
Medical Knowledge
G-Level Objectives
All
Describe classes of hemorrhage and their physical manifestations
All
Understand the differences between commonly used resuscitation fluids
All
List uses for commonly administered blood products
All
Describe causes and treatment of coagulopathy due to trauma
Patient Care
G-Level Technical / Procedural Skill
I
Participate in Trauma Team Activations
as MD1
II-III
Participate in Trauma Team Activations
as MD2
V
Participate in Trauma Team Activations
as Team Leader
Care Plans
Core Topic 3: Head & Neck Trauma
Medical Knowledge
G-Level Objectives
All
Review the anatomic types of brain injury
All
Understand manifestations of concussion and post-concussive syndrome
All
Describe airway management principles in trauma
All
Review findings in and management of cervical spine and cord injury
Patient Care
G-Level Technical / Procedural Skill
II-III
Perform cervical spine clearance
V
Perform percutaneous tracheostomy in
ventilated patients
Care Plans
Core Topic 4: Chest Trauma
Medical Knowledge
G-Level Objectives
All
Describe the 12 major chest injuries and their management
All
Understand the implications and management of cardiac contusion
Patient Care
G-Level Technical / Procedural Skill
All
Insert chest tube
Care Plans
Implement chest tube management
protocol when appropriate
Core Topic 5: Abdominal Trauma
Medical Knowledge
G-Level Objectives
All
Describe the principles of solid organ injury management
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All
Recognize signs and symptoms of hollow viscus injury and detail their management
Patient Care
G-Level Technical / Procedural Skill
All
Care Plans
Implement solid organ injury protocol
when appropriate
Core Topic 6: Specialty Surgery
Medical Knowledge
G-Level Objectives
All
Describe management of injuries to kidney, ureter, bladder and urethra
All
Review diagnosis and management of pelvic fractures
All
Review diagnosis and management of spine fractures and spinal cord injury
All
List signs and symptoms of extremity compartment syndrome and detail
management
ROTATION GOALS AND OBJECTIVES FOR PROBLEM-BASED LEARNING AND IMPROVEMENT,
INTERPERSONAL SKILLS AND COMMUNICATION, PROFESSIONALISM, AND SYSTEMS BASED
PRACTICE
Problem-Based Learning and Improvement
G-Level Objectives
All
• Identify own learning needs or goals at the onset of the rotation.
• Following a trauma activation, debrief what went well, and what could have
been improved.
• Following a surgical procedure, debrief what went well, and what could have
been improved.
• Diagnose personal learning needs associated with any medical errors,
complications, or “near misses” that occurred during your watch.
• Use feedback gained from others, and the experience gained on this rotation,
to formulate future learning goals and steps.
Interpersonal Skills and Communication
G-Level Objectives
All
• Communicate patient information clearly to other health providers in written
notes and oral presentations.
• Work constructively with all members of the trauma care team, including nurse
clinicians, floor nurses, social workers and therapists.
• Apply appropriate communication skills with patients and families (i.e. effective
listening, awareness of nonverbal cues, and use of open-ended questions).
• Counsel and educate patients and families on their treatment options, their
surgical outcomes and prognosis, and home care needs.
• Explain to medical students / junior residents the fundamentals of your job, as
well as their jobs.
Professionalism
G-Level Objectives
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All
•
•
•
•
•
Adhere to patient privacy and informed consent policies at all times.
Adhere to Regions Hospital behavior policies (e.g., sexual harassment, duty
hours, dress code) at all times.
Demonstrate respect, compassion, integrity, and honesty in all interactions
with patients, families, and other health care providers.
Demonstrate personal responsibility for patient welfare.
Articulate ethical issues underlying clinical decisions made for at least once
complex case seen during this rotation.
Systems-Based Practice
G-Level Objectives
All
• Know when to call for help from attending physicians.
• Understand when, how, and why to request a consult from medical and
surgical specialists, and how to use the information gained as a result.
• Provide timely and pertinent consultation when asked by Emergency Medicine
physicians.
• Use the talents and skills of other health providers in the OR and ward.
• Diagnose any “systems issues” associated with medical errors, complications,
and “near misses” that occurred during this rotation.
LEARNING RESOURCES FOR TRAINEES
SCORE Website Portal:
•
•
•
Modules, chapters, videos, and radiographic images (STAT dx) pertinent to the core topics enumerated
above
Evidence-Based Reviews in Surgery
MD Content Course on Health Care (economics, operations, legal/financial, leadership)
TACS Moodle Website
•
See assignments and additional resources
The Trauma Professional’s Blog
•
www.regionstraumapro.com
Regions Hospital Trauma Wiki
•
www.regionstrauma.org/wiki
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ROTATION PLAN FOR 2014-15
REGIONS HOSPITAL, General Surgery Service
ROTATION NAME
TRAINING LEVELS ON SERVICE: PGY -5; PGY-4; PGY-1
SERVICE DIRECTOR: Seth Wolpert, M.D.
TEACHING FACULTY:
Ryan Carlson, M.D.
Todd Morris, M.D.
ROTATION’S WEEKLY EDUCATION SCHEDULE
Monday
Tuesday at
UMMC
6:30 G4+G5
7:00 M+M
7:45 Grand
Rounds
8:30 Core
Curriculum
9:45-noon Skills
Lab
Wednesday
Service
Teaching
Rounds (7:30am
unless cases ,
then after cases)
Thursday
Friday
6:30 M + M
12:00 SICU
Conf
1:00pm Rotation
teaching hour
(Regions)
Activity
Who is responsible?
Orientation to the Rotation
Bedside Teaching Rounds
Weekly Core Topic Teaching
Mid-Rotation Review
End-of-Rotation Oral Exam
End-of-Rotation Meeting w/
Resident
Dr. Wolpert
Assigned by Dr. Wolpert
Assigned by Dr. Wolpert
Drs. Wolpert, Morris
Drs. Wolpert, Morris
Drs Wolpert, Morris
When does this
occur?
Moodle
Wed
Tues
Tues
Tues
Tues at Mock Oral
ROTATION GOALS AND OBJECTIVES FOR MEDICAL KNOWLEDGE AND PATIENT CARE, BY CORE
TOPIC AND RESIDENT TRAINING LEVEL
Core Topic 1: Hernia: Open Inguinal Repair
Medical Knowledge
G-Level Objectives
PGY-1,2 Understand inguinal anatomy
Understand hernia presentation
Describe indications for hernia repair
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PGY-4,5
Understand alternatives to hernia repair
Demonstrate competence of the above points
Understand different operative approaches to inguinal hernia
Understand how to deal with complications of hernia
Patient Care
G-Level Technical / Procedural Skills
PGY-1,2 Understand how to perform hernia repair
PGY-4,5
Be able to perform hernia repair and
demonstrate understanding of different
approaches
Care Plans
Be able to diagnose inguinal hernia
Be able to understand how to advise
patients about treatment options
As above
Core Topic 2: Small Bowel Obstruction
Medical Knowledge
G-Level Objectives
PGY-1,2 Understand pathophysiology of SBO
Be able to differentiate ileus from SBO
Understand how to categorize SBO
Describe etiologies of SBO
Understand diagnostic algorithms
Understand therapeutic objectives
PGY-4,5 As above
Patient Care
G-Level Technical / Procedural Skills
PGY-1,2 Begin to understand concepts in lysis of
adhesions
PGY-4,5
Be proficient at lysis of adhesions
Be proficient at other therapies for SBO
Care Plans
Understand patient presentation
Understand patient resuscitation
Begin to be understand treatment
decisions
As above
Be able to formulate a treatment strategy
Be able to identify different SBO
presentations and the adjustments in
treatment
Core Topic 3: Breast: Cancer, Ductal Carcinoma In Situ
Medical Knowledge
G-Level Objectives
PGY-1,2 Understand pathology of benign breast disease
Understand pathology of breast cancer
Understand screening recommendations
Understand risk factors for breast cancer
PGY-4,5 As above
Understand breast cancer risk management strategies
Understand the care of patients with advanced breast cancer
Patient Care
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G-Level
PGY-1,2
Technical / Procedural Skills
Be proficient at breast bx
Be proficient at lumpectomy
Be proficient at mastectomy
Be proficient at sentinel node biopsy
PGY-4,5
As above
Be proficient at axillary dissection
Be proficient at image guided breast
excision
Care Plans
Understand presentation of a breast
mass
Understand evaluation and imaging of a
breast mass
Formulate an understanding of
therapeutic options
As above
Understand and be able to explain
therapeutic options
Describe care for locally advanced
breast cancer
Understand adjuvant and neoadjuvant
options
Core Topic 4: Endocrine: Thyroid, Adrenal, and Parathyroid
Medical Knowledge
G-Level Objectives
PGY-1,2 Understanding of endocrine physiology
Understanding of endocrine anatomy
Understanding of endocrine pathophysiology
PGY-4,5 As above
Patient Care
G-Level Technical / Procedural Skills
PGY-1,2 Introduction to operative principles
PGY-4,5
Become proficient at open and minimally
invasive endocrine surgery.
Care Plans
Understanding of clinical (history,
physical exam and lab) evaluation of
adrenal and thyroid nodules
Role of surgery in goiter
Understanding of patient evaluation
(history, physical exam and lab) of
hyperparathyroidism
As above
Role of imaging in endocrine surgery
Understanding of pre-op preparation and
postoperative care in endocrine surgery
Management of complications in
endocrine surgery
ROTATION GOALS AND OBJECTIVES FOR PROBLEM-BASED LEARNING AND IMPROVEMENT,
INTERPERSONAL SKILLS AND COMMUNICATION, PROFESSIONALISM, AND SYSTEMS BASED
PRACTICE
Problem-Based Learning and Improvement
G-Level Objectives
PGY-1
• Identify own learning needs or goals at the onset of the rotation.
through
• Following a surgical procedure, debrief what went well, and what could have
PGY-5
been improved.
• Identify differences in incidence, prognosis, and outcomes of cancer treatment
according to race and gender.
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•
•
Diagnose personal learning needs associated with any medical errors,
complications, or “near misses” that occurred during your watch.
Use feedback gained from others, and the experience gained on this rotation,
to formulate future learning goals and steps.
Interpersonal Skills and Communication
G-Level Objectives
PGY-1
• Communicate patient information clearly to other health providers in written
through
notes and oral presentations.
PGY-5
• Apply appropriate communication skills with patients and families (i.e. effective
listening, awareness of nonverbal cues, and use of open-ended questions).
• Counsel and educate patients and families on their treatment options, their
surgical outcomes and prognosis, and home care needs.
• Explain to medical students / junior residents the fundamentals of your job, as
well as their jobs.
Professionalism
G-Level Objectives
PGY-1
• Adhere to patient privacy and informed consent policies at all times.
through
• Adhere to University behavior policies (e.g., sexual harassment, duty hours,
PGY-5
dress code) at all times.
• Demonstrate respect, compassion, integrity, and honesty in all interactions
with patients, families, and other health care providers.
• Demonstrate personal responsibility for patient welfare.
• Articulate ethical issues underlying clinical decisions made for at least once
complex case seen during this rotation.
Systems-Based Practice
G-Level Objectives
PGY-1
• Know when to call for help from attending physicians.
through
• Understand when, how, and why to request a consult from medical oncology
PGY-5
and radiation oncology, and how to use the information gained as a result.
• Provide timely and pertinent consultation when asked by medical or surgical
colleagues.
• Use the talents and skills of other health providers in the OR and ward.
• Estimate the costs / benefits of cancer screening (mammography,
colonoscopy), staging (CT, PET, etc.), and treatment.
• Consider patient characteristics (e.g., age, race and ethnicity, family support,
socio-economic status, type of insurance) in evaluating treatment options and
developing an appropriate care plan.
• Discuss the distinction between medically necessary care and over care, and
its implications for our patients.
• Diagnose any “systems issues” associated with medical errors,
complications, and “near misses” that occurred during this rotation.
LEARNING RESOURCES FOR TRAINEES
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SCORE Website Portal:
• Modules, chapters, videos, and radiographic images (STAT dx) pertinent to the core topics enumerated
above
• Evidence-Based Reviews in Surgery
• MD Content Course on Health Care (economics, operations, legal/financial, leadership)
REGIONS GENERAL SURGERY Moodle Website
• See assignments and additional resources
ROTATION PLAN FOR 2014-15
ROTATION NAME REGIONS HOSPITAL, Acute
TRAINING LEVELS ON SERVICE: PGY-1 and PGY-3
SERVICE DIRECTOR: Michael D. McGonigal, M.D.
TEACHING FACULTY:
Kaysie Banton, M.D.
Bruce Bennett, M.D.
Gary Collins, M.D.
Care Surgery Night
ROTATION PLAN FOR 2014-15
ROTATION NAME REGIONS HOSPITAL, Acute
TRAINING LEVELS ON SERVICE: PGY-1 and PGY-5
SERVICE DIRECTOR: Michael D. McGonigal, M.D.
TEACHING FACULTY:
Kaysie Banton, M.D.
Bruce Bennett, M.D.
Gary Collins, M.D.
Care Surgery Day
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ROTATION PLAN FOR 2014-15
ROTATION NAME REGIONS HOSPITAL, Vascular
TRAINING LEVELS ON SERVICE: 1 PGY-4 resident
SERVICE DIRECTOR: Gary Rosenthal, M.D.
TEACHING FACULTY:
Joel Barbato, M.D.
Lan Tan Nguyen, M.D.
Surgery
ROTATION’S WEEKLY EDUCATION SCHEDULE
Monday
Tuesday at
UMMC
6:30 G4+G5
7:00 M+M
7:45 Grand
Rounds
8:30 Core
Curriculum
9:45-noon Skills
Lab
Wednesday
Thursday
Friday
6:30 – 7:30
Vascular
conference
Regions
Activity
Who is responsible?
Orientation to the Rotation
Bedside Teaching Rounds
Weekly Core Topic Teaching
Mid-Rotation Review
End-of-Rotation Oral Exam
End-of-Rotation Meeting w/
Resident
Rosenthal
Rosenthal, Nguyen, Barbato
Rosenthal, Nguyen, Barbato
Rosenthal
Rosenthal, Nguyen, Barbato
Rosenthal
When does this
occur?
First day of rotation
daily
Thursdays
4th week
Final week
Final week
ROTATION GOALS AND OBJECTIVES FOR MEDICAL KNOWLEDGE AND PATIENT CARE, BY CORE
TOPIC AND RESIDENT TRAINING LEVEL
Core Topic 1: Open Elective and Ruptured Aortic Aneurysm
Medical Knowledge
G-Level Objectives
G4
For iliac aneurysm, understand:
• Epidemiology, risk of rupture
• Evaluation of operative risk, determination of suitability for open or endovascular
repair
• Diagnosing ruptured aneurysm
• Appropriate testing for elective and ruptured aneurysm repair
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• Morbidity and mortality of both open elective and ruptured aortic aneurysm
Patient Care
G-Level Technical / Procedural Skills
G4
1. Know what is the appropriate field to prep
2. Understand both the midline and lateral
retroperitoneal approach to the aorta
3. Dissection to obtain supra celiac and
infra-renal aortic control
4. Dissection for control of the iliac arteries
5. End-to-end and end-to-side suturing
techniques
6. Choose appropriate graft material and
size
Care Plans
1. Pre-operative risk testing for
elective aneurysm repair
2. Post-operative management of
open elective and ruptured
aneurysm patient including fluid and
electrolyte management
3. Recognize and manage
postoperative complications,
including intestinal ischemia,
cardiac abnormalities, and
incisional problems
Core Topic 2: Peripheral Artery Aneurysms and DVT
Medical Knowledge
G-Level Objectives
G4
Understand:
• Epidemiology of peripheral artery aneurysms and DVT
• Signs and symptoms of both urgent and non-urgent peripheral artery aneurysms
• Risk of coexisting peripheral aneurysms and abdominal aortic aneurysms
• Signs and symptoms of deep venous thrombosis, phlegmasia cerulea dolens,
phlegmasia alba dolens, and superficial thrombophlebitis
Patient Care
G-Level Technical / Procedural Skills
G4
1. Field preparation
2. Perform medial and posterior approach to
the popliteal artery
3. Dissection of the common femoral artery
4. Harvesting greater saphenous vein for
repair
5. End-to-end and end-to-side vein to artery
suturing techniques
6. Perform both four compartment calf
fasciotomies and thigh fasciotomies for
phlegmasia
7. Perform femoral vein thrombectomy
8. Perform embolectomies in cases of
complicated peripheral aneurysms with
distal embolization
Care Plans
1. Preoperative cardiac risk
assessment for aneurysm patients
2. Understand post-operative incision
care and appropriate long-term
follow up including intermittent
functional and ultrasound testing
Core Topic 3: Dialysis Access and Mesenteric Ischemia
Medical Knowledge
G-Level Objectives
G4
Understand:
• The importance of rapid fistula or graft surgery to avoid central catheters
• Temporary dialysis options
• Multiple dialysis techniques and how to choose among them appropriately
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• Complications of access and how to manage them
• How to make the diagnosis of both acute and chronic mesenteric ischemia and to
conduct appropriate tests
• Preoperative cardiac risk evaluation
• How to determine the appropriate procedure in terms of percutaneous stenting or
open surgical repair
• How to determine intra-operatively embolic disease reverse thrombotic disease
Patient Care
G-Level Technical / Procedural Skills
G4
Perform:
1. All aspects of radiocephalic,
brachiocephalic, and basilic transposition
fistulas
2. Forearm and upper arm loop dialysis
grafts
3. Dialysis access revision; no help to
ligate a bleeding fistula
4. Transabdominal and lateral
thoracoabdominal retroperitoneal
approach to the mesenteric portion of the
aorta
5. Dissection of the celiac axis and superior
mesenteric artery
6. Antegrade and retrograde aorto
mesenteric bypasses
7. Superior mesenteric artery embolectomy
8. Bowel resection related to ischemic
events as well as performing a second
look operation
Care Plans
1. Evaluation of post-dialysis
procedure patient in terms of
determining maturity inability to use
2. Testing needed to assess failing
dialysis access
3. Manage the patient after
mesenteric bypass in terms of
ventilator management, and fluid
and electrolyte balance
4. Understand long-term follow up of a
mesenteric bypass patient
Core Topic 4: Vascular Trauma
Medical Knowledge
G-Level Objectives
G4
Understand:
• Diagnosis and management of cervical, thoracic, abdominal, and extremity arterial
injuries
• Repair techniques for arterial injuries and operative exposure
• Repair of the vena cava
Patient Care
G-Level Technical / Procedural Skills
G4
1. Obtain proximal distal control of
extremity or intra-abdominal vessels
2. Perform interposition vein grafting or
bypass vein grafting
3. Perform completion angiography
4. Perform four compartment lower
extremity fasciotomies
Care Plans
1. Post-operative electrolyte and fluid
management
2. Perform post-operative
revascularization assessment
3. Examine patient for compartment
syndrome
4. Understand long-term follow up of
vascular repair
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Core Topic 5: Endovascular AAA Repair
Medical Knowledge
G-Level Objectives
G4
Understand:
• Indication for AAA repair and requirements for endograft placement
• Complete femoral artery dissection
• Types of endoleaks and management
Patient Care
G-Level Technical / Procedural Skills
G4
1. Perform bilateral femoral groin
dissections
2. Perform retroperitoneal iliac artery
exposure
3. Perform arteriotomy repair
Care Plans
1. Understand immediate postoperative
care including incision management
and determination of peripheral
perfusion
2. Perform appropriate interval CT scan
follow up for determination of endoleak
3. Determine which endoleak will need
repair and how to perform this
Core Topic 6: Atherosclerotic Disease
Medical Knowledge
G-Level Objectives
G4
Understand:
• Diagnosis and management of claudication, rest pain, and tissue loss
• Which claudication patients need intervention
• That rest pain and tissue loss needs immediate revascularization
• The significance of foot and toe ulceration and how to evaluate ability to heal
• Revascularization options in terms of percutaneous angioplasty and stenting as
well as arterial bypass surgery
Patient Care
G-Level Technical / Procedural Skills
G4
1. Perform femoral popliteal and femoral
tibial bypass
2. Complete dissection of the greater
saphenous vein
3. Complete dissection of the common
femoral, superficial femoral, popliteal,
and tibial vessel.
4. Perform vein to artery anastomoses
5. Exposure of the pararenal and
infrarenal aorta both transperitoneally
and retroperitoneally
6. Perform exposure of the iliac arteries
both transperitoneal and
retroperitoneal
Care Plans
1. Understand immediate postoperative
management including electrolytes
and fluid, incisions, and evaluation of
perfusion
2. Perform appropriate interval follow up
with ultrasound and pressure
measurements
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ROTATION GOALS AND OBJECTIVES FOR PROBLEM-BASED LEARNING AND IMPROVEMENT,
INTERPERSONAL SKILLS AND COMMUNICATION, PROFESSIONALISM, AND SYSTEMS BASED
PRACTICE
Problem-Based Learning and Improvement
G-Level Objectives
G4
1. Analyze personal strengths and weakness and create methods to improve.
2. Learn to accept constructive criticism.
3. Apply scientific literature in patient management decision making.
4. Critically review the literature using principles of biostatistics, study design, and
epidemiology.
5. Develop practice patterns using the concepts of “best practice” and “evidencebased medicine.”
Interpersonal Skills and Communication
G-Level Objectives
G4
1. Function as surgical team leader.
2. Teach ethical and appropriate patient relationships.
3. Demonstrate effective listening skills, including observing nonverbal cues and
using explanatory questioning.
4. Demonstrate effective, complete, and legible note writing skills.
5. Teach effective medical presentations.
6. Assure effective and thorough patient hand-off/sign out.
Professionalism
G-Level Objectives
G4
1. Demonstrate respect, compassion, integrity and honesty.
2. Demonstrate patient care that supersedes personal self-interest.
3. Demonstrate personal responsibility for patient problems.
4. Understand and utilize privacy policies, informed consent, business and
medical ethics.
5. Understand and follow institutional behavior policies (i.e. Sexual harassment,
etc.).
Systems-Based Practice
G-Level Objectives
G4
1. Understand cost-effective health care delivery
2. Organize and manage the surgical service
a. Hospital and clinic patient care
b. Resident and medical student teaching
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LEARNING RESOURCES FOR TRAINEES
SCORE Website Portal:
•
•
•
Modules, chapters, videos, and radiographic images (STAT dx) pertinent to the core topics enumerated
above
Evidence-Based Reviews in Surgery
MD Content Course on Health Care (economics, operations, legal/financial, leadership)
Regions Vascular Moodle Website
•
See assignments and additional resources
ROTATION PLAN FOR 2014-15
ROTATION NAME REGIONS HOSPITAL,
TRAINING LEVELS ON SERVICE: PGY -1
SERVICE DIRECTOR: Bruce Bennett, M.D.
TEACHING FACULTY:
Robert Bulander, M.D.
David Dries, M.D.
Gary Collins, M.D.
Surgical Intensive Care Unit
ROTATION’S WEEKLY EDUCATION SCHEDULE
(List: required site or specialty-specific education conferences, scheduled weekly rotation teaching hour.)
Monday
Tuesday at
Wednesday
Thursday
Friday
UMMC
6:30 G4+G5
7:00 M+M
7:45 Grand
Rounds
8:30 Core
Curriculum
9:45-noon Skills
Lab
Activity
Who is responsible?
Orientation to the Rotation
Bedside Teaching Rounds
Weekly Core Topic Teaching
Mid-Rotation Review
End-of-Rotation Oral Exam
End-of-Rotation Meeting w/
Resident
Bennett
All
All
Bennett
Bennett
Bennett
When does this
occur?
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ROTATION GOALS AND OBJECTIVES FOR PROBLEM-BASED LEARNING AND IMPROVEMENT,
INTERPERSONAL SKILLS AND COMMUNICATION, PROFESSIONALISM, AND SYSTEMS BASED
PRACTICE
Problem-Based Learning and Improvement
G-Level Objectives
• Identify own learning needs or goals at the onset of the rotation.
• Following a surgical procedure, debrief what went well, and what could have
been improved.
• Identify differences in incidence, prognosis, and outcomes of cancer treatment
according to race and gender.
• Diagnose personal learning needs associated with any medical errors,
complications, or “near misses” that occurred during your watch.
• Use feedback gained from others, and the experience gained on this rotation,
to formulate future learning goals and steps.
Interpersonal Skills and Communication
G-Level Objectives
• Communicate patient information clearly to other health providers in written
notes and oral presentations.
• Apply appropriate communication skills with patients and families (i.e. effective
listening, awareness of nonverbal cues, and use of open-ended questions).
• Counsel and educate patients and families on their treatment options, their
surgical outcomes and prognosis, and home care needs.
• Explain to medical students / junior residents the fundamentals of your job, as
well as their jobs.
Professionalism
G-Level Objectives
• Adhere to patient privacy and informed consent policies at all times.
• Adhere to University behavior policies (e.g., sexual harassment, duty hours,
dress code) at all times.
• Demonstrate respect, compassion, integrity, and honesty in all interactions with
patients, families, and other health care providers.
• Demonstrate personal responsibility for patient welfare.
Articulate ethical issues underlying clinical decisions made for at least once
complex case seen during this rotation.
Systems-Based Practice
G-Level Objectives
• Know when to call for help from attending physicians.
• Understand when, how, and why to request a consult from medical oncology
and radiation oncology, and how to use the information gained as a result.
• Provide timely and pertinent consultation when asked by medical or surgical
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•
•
•
colleagues.
Use the talents and skills of other health providers in the OR and ward.
Estimate the costs / benefits of cancer screening (mammography,
colonoscopy), staging (CT, PET, etc.), and treatment.
Consider patient characteristics (e.g., age, race and ethnicity, family support,
socio-economic status, type of insurance) in evaluating treatment options and
developing an appropriate care plan.
Discuss the distinction between medically necessary care and over care, and
its implications for our patients.
Diagnose any “systems issues” associated with medical errors, complications,
and “near misses” that occurred during this rotation.
LEARNING RESOURCES FOR TRAINEES
SCORE Website Portal:
• Modules, chapters, videos, and radiographic images (STAT dx) pertinent to the core topics enumerated
above
• Evidence-Based Reviews in Surgery
• MD Content Course on Health Care (economics, operations, legal/financial, leadership)
[Rotation Name] Moodle Website
• See assignments and additional resources
SURGICAL CRITICAL CARE (SICU)
Regions Hospital
Patient Care
PGY-1
Manual Dexterity
Perform bedside procedures:
Central venous catheterization
Pulmonary artery catheterization
Arterial line placement
Endotracheal intubation
Observe bedside procedures:
Percutaneous gastrostomy,
tracheostomy, other minor procedures
Care Plans
Understand Advanced Cardiac Life
Support protocols.
Identify and evaluate by history and
physical examination.
Formulate differential diagnoses for
common ICU problems.
Apply standard ventilator management and
weaning.
Initiate treatment plan and management
for:
Sepsis
Hypoxemia
PGY-2
Manual Dexterity
Supervise and instruct bedside
procedures.
Central venous catheterization
Pulmonary artery catheterization
Arterial line placement
Perform bedside procedures:
Endotracheal intubation
Percutaneous gastrostomy,
tracheostomy, other minor
procedures
Care Plans
Identify and evaluate by history and
physical examination.
Formulate differential diagnoses for ICU
problems.
Apply ventilator management in the
patient with acute lung injury.
Initiate treatment plan and management
for:
Severe sepsis
Multisystem organ dysfunction
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Hypotension
Shock
Cardiogenic
Distributive
Hypovolemic
Obstructive
Renal failure
Respiratory failure
Gastrointestinal bleeding
Understand appropriate utilization of:
Antibiotics
Sedatives
Blood component therapy
Therapy for treatment of disorders of
coagulation including aspirin,
heparins
CNS dysfunction (e.g. intracranial
bleed)
Acute GI bleed
Hepatic failure
Myocardial ischemia
Understand appropriate utilization of:
Vasoactive agents
Antibiotics and other antimicrobials
Paralytics and sedatives
Understand therapy for treatment of
disorders of coagulation including
nonheparin anticoagulants, and
fibrinolytic therapy.
Appropriately interpret and utilize
invasive hemodynamic data.
SICU (Regions) cont.
Medical Knowledge
PGY-1
PGY-2
Explain:
Pathophysiology of sepsis
Principles of Antimicrobial therapy
Evaluation of fever in the
immunosuppressed patient
Introductory interpretation of
radiographs
Common surgical conditions leading to
ICU admission
Interpretation of common laboratory
tests (e.g. Arterial blood gasses,
electrolytes)
Basic principles of nutritional support
Principles of resuscitation from shock
states
Hormonal, biochemical, and metabolic
response to tissue injury.
Explain:
Pathophysiology of organ failure
(pulmonary, renal, GI, cardiac)
Appropriate indications for radiographic
evaluation of critically-ill patients
Appropriate interpretation of advanced
diagnostics (e.g. CT scans)
Pathophysiology of nosocomial
infections in the critically-ill
Principles of nutritional support
including advanced nutritional
monitoring techniques (e.g. respiratory
quotient) and specialized issues
(refeeding syndrome, Rx of hepatic
and renal failure) Common disorders
of coagulation in the ICU (e.g. deep
venous thrombosis, thrombocytopenia)
Practice-Based Learning & Improvement
PGY-1
PGY-2
Demonstrate insight into contributing
Perform critical evaluation of
factors associated with ICU and
complications of ICU care by
surgical complications by participation
preparation and presentation of
in monthly morbidity and mortality
complications at monthly ICU morbidity
conference.
and mortality conference.
Demonstrate commitment to personal
Continue commitment to personal lifelong
lifelong learning by initiating directed
learning by initiating reading using
reading regarding patient issues in the
advanced sources (e.g. source
ICU.
literature) regarding patient issues in
the ICU.
Interpersonal Communication Skills
PGY-1
PGY-2
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Understand proper interaction skills with
regards to communication with other
services in care of complex, critically ill
patients (in other words,
communication, communication,
communication!) .
Develop tools for proper family
communication skills, understanding
nuances of communication with
patient’s families in the setting of
critical illness. Relate proper
techniques for communicating “bad
news” to patient’s family in the ICU.
Participate as an observer in family care
conferences.
Understand principles of effective
documentation as a tool for
communication.
Develop supervisory skills by providing
oversight and supervision of junior
members of the Surgical ICU team
(e.g. anesthesia and surgery residents,
medical students).
Demonstrate facility with family
communication skills, understanding
nuances of communication with
patient’s families in the setting of
critical illness. Demonstrate proper
techniques for communicating “bad
news” to patient’s family in the ICU.
Participate as appropriate in family care
conferences.
Demonstrate knowledge of current uses
of medical documentation, including
interactions with 3rd party payer
system.
SICU (Regions) cont.
Professionalism
PGY-1
PGY-2
Explain principals of informed consent.
Understand nuances of withholding or
Discuss the issues of patient rights in the
withdrawing life support in the criticallysetting of critical illness.
ill patient.
Understand the process for implementation Relate the role of advanced directives in
of DO NOT RESUSCITATE orders in
the critically-ill patient.
the critically ill.
Experience the effects of critical illness on
Demonstrate appropriate transfer of patient
families of different backgrounds (age,
care to primary services caring for the
culture, etc.).
critically-ill patient in transition to
Understand methods of coping with stress
hospital care.
of caring for critically ill (and dying)
patients.
System-Based Practice
PGY-1
Relate techniques for cost-effective,
appropriate perioperative evaluation.
Demonstrate principles of infection control
(prevention of health care associated
and blood borne infections).
Demonstrate ability to provide ongoing
care of patients with chronic critical
illness (e.g. appropriate transfer of
patients to chronic hospital, ventilator,
and advanced nursing facilities).
Understand the role of other services in
proper care of complex, critically ill
patients.
PGY-2
Understand cost-effective health care
delivery in the ICU.
Appropriate ability to utilize triage and
bed-control to provide for critically ill
patients.
Relate the role (and cost) of ICU care in
the setting of the North American
medical system.
Demonstrate knowledge of current uses
of medical documentation, including
interactions with 3rd party payer
system.
Understand the role of other services in
proper care of complex, critically ill
patients.
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ROTATION PLAN FOR 2014-15
REGIONS HOSPITAL, Burn Service
ROTATION NAME
TRAINING LEVELS ON SERVICE: PGY -3; PGY-1
SERVICE DIRECTOR: William Mohr, M.D.
TEACHING FACULTY:
David Ahrenholz, M.D.
Frederick Endorf, M.D.
ROTATION’S WEEKLY EDUCATION SCHEDULE
Monday
8:30 Burn team
rounds
1p Resident
lecture
1.
2.
3.
4.
Tuesday at UMMC
Wednesday
6:30 G4+G5
Trauma conf (1)
7:00 M+M
Burn Roundtable
7:45 Grand Rounds
(2)
8:30 Core
Burn M&M (3)
Curriculum
2p Burn Pt care
9:45-noon Skills Lab conf
3rd , 4th, & 5th WED each month at 7:30.
1st WED each month at 11:30.
3rd WED each month at 11:30.
1st & 2nd THR each month at 7:30.
Activity
Thursday
6:30 Surgery
M&M
Trauma/ ICU conf
(4)
Friday
OR
teaching
Who is responsible?
When does this
occur?
Orientation to the Rotation
Mohr
First 1-2 days
Bedside Teaching Rounds
Attending on call
Monday 8:30, daily
Weekly Core Topic Teaching
Attending on call
Monday 1300, & prn
Mid-Rotation Review
Mohr
Middle week of rotation
End-of-Rotation Oral Exam
Mohr
Last week of rotation
End-of-Rotation Meeting w/
Mohr
Same time as Oral
Resident
Exam
ROTATION GOALS AND OBJECTIVES FOR MEDICAL KNOWLEDGE AND PATIENT CARE, BY CORE
TOPIC AND RESIDENT TRAINING LEVEL
Core Topic 1: Burn Resuscitation
Medical Knowledge
G-Level Objectives
PGY-1
Understand the pathophysiology of burn injury
Describe what factors impact the volume of resuscitation
Describe the benefits and detriments of different resuscitation strategies
• When to use colloids, blood, diuretics
Understand the difference between pediatric and adult burn shock resuscitation
Understand the principles of vascular access
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PGY- 3
Describe the complications associated with massive resuscitation
Understand the pathophysiology of burn injury
Describe what factors impact the volume of resuscitation
Describe the benefits and detriments of different resuscitation strategies
• When to use colloids, blood, diuretics
Understand the difference between pediatric and adult burn shock resuscitation
Understand the principles of vascular access
Describe the complications associated with massive resuscitation
Describe how different interventions impact on burn shock resuscitation
Patient Care
G-Level Technical / Procedural Skills
PGY-1
Perform central venous access
Perform escharotomy
Perform/interpreted bladder pressure
measurements
PGY-3
Perform central venous access
Perform escharotomy
Perform/interpreted bladder pressure
measurements
Blood use determination
Care Plans
Identify/evaluate by history and exam
Initiate resuscitation plan and
management:
• Adult < 20% BSA burn
• Adult > 20% BSA burn
• Child < 15% BSA burn
• Child > 15% BSA burn
Identify/evaluate by history and exam
Initiate resuscitation plan and
management:
• Adult < 20% BSA burn
• Adult > 20% BSA burn
• Child < 15% BSA burn
• Child > 15% BSA burn
• Electrical injury
Core Topic 2: Skin Substitutes & Burn Dressings
Medical Knowledge
G-Level Objectives
PGY-1
Understand the structure and function of the skin
Describe the consequences of loss of barrier function
Differentiate between skin substitutes and dressings
• Categorize by synthetic, biologic or combination
• Categorize by temporary, permanent or combination
List types of permanent skin substitutes
PGY-3
Understand the structure and function of the skin
Describe the consequences of loss of barrier function
Differentiate between skin substitutes and dressings
• Categorize by synthetic, biologic or combination
• Categorize by temporary, permanent or combination
List types of permanent skin substitutes
Understand the differences, utility and complications of topical wound management
Patient Care
G-Level Technical / Procedural Skills
PGY-1
Assess the burn wound
• Identify infection
• Identify conversion to fullthickness
Care Plans
Identify/evaluate by history and exam
Initiate treatment plan and management:
• Partial thickness burns
• Full-thickness burns
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PGY-3
Identify side effects from
dressings
Perform/assist basic burn dressings
Assess the burn wound
• Identify infection
• Identify conversion to fullthickness
• Identify side effects from
dressings
Perform/assist basic burn dressings
Perform skin grafts utilizing artificial
dermis
Prepare artificial dermis for autografting
•
Burns covered with artificial
dermis
• Burns covered with autograft
Identify/evaluate by history and exam
Initiate treatment plan and management:
• Partial thickness burns
• Full-thickness burns
• Burns covered with artificial
dermis
• Burns covered with autograft
• Extended-wear dressings
Core Topic 3: Electrical Injury
Medical Knowledge
G-Level Objectives
PGY-1
Understand the pathophysiology of electrical injuries
Understand the potential for secondary traumatic injuries
Describe the difference between low and high voltage and air injuries
Describe how electrical burns differ from thermal injury
Understand the principles of resuscitation for electrical injury
Understand complications associated with electrical injury
• Physical
• Neurobehavioral
• Psychological
Describe monitoring and diagnostic measures for electrical injuries
PGY-3
Understand the pathophysiology of electrical injuries
Understand the potential for secondary traumatic injuries
Describe the difference between low and high voltage and air injuries
Describe how electrical burns differ from thermal injury
Understand the principles of resuscitation for electrical injury
Understand complications associated with electrical injury
• Physical
• Neurobehavioral
• Psychological
Describe monitoring and diagnostic measures for electrical injuries
Describe pain management for electrical injuries
Patient Care
G-Level Technical / Procedural Skills
PGY-1
Interpret monitoring for myoglobinuria
Interpret compartment pressure
evaluation
Interpret cardiac monitoring/evaluation
Perform wound assessment on electrical
burns
PGY-3
Interpret monitoring for myoglobinuria
Interpret compartment pressure
evaluation
Perform compartment pressure
evaluation
Care Plans
Identify/evaluate by history and exam
Initiate treatment plan and management:
• Low-voltage injury
• High voltage injury
Initiate treatment plan for
rhabdomyolysis
Identify/evaluate by history and exam
Initiate treatment plan and management:
• Low-voltage injury
• High voltage injury
Initiate treatment plan for
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Perform fasciotomy
Interpret cardiac monitoring/evaluation
Perform wound assessment on electrical
burns
Assess for neuropsychological
complications
rhabdomyolysis
Initiate treatment plan for neuropathic
pain
Initiate treatment plan for PTSD
Initiate treatment for neuropsychological
Sx
Core Topic 4: Chemical Injury
Medical Knowledge
G-Level Objectives
PGY-1
Understand the pathophysiology of chemical injuries
• The difference between acids and bases
Describe the typical locations for chemical burns and the impact on care
Identify specific agents of concern
Describe initial treatment of chemical burns
Understand potential complications from chemical injury treatment
PGY-3
Understand the pathophysiology of chemical injuries
• The difference between acids and bases
Describe the typical locations for chemical burns and the impact on care
Identify specific agents of concern
Describe initial treatment of chemical burns
Understand decision making or hospitalized vs. outpatient chemical burn care
Understand potential complications from chemical injury treatment
Understand critical care aspects of chemical injuries
Patient Care
G-Level Technical / Procedural Skills
PGY-1
Perform chemical burn assessment
Perform adequate excision
PGY-3
Perform chemical burn assessment
Determination of admit vs. home burn
care
Perform adequate excision
Treat electrolyte imbalance with HF
burns
Manage hydrofluoric acid treatment plan
Care Plans
Identify/evaluate by history and exam
Initiate treatment plan and management:
• Common acid and base burns
• Hydrofluoric acid
• Ocular burns
• Chemical inhalation
• Tar burns
Identify/evaluate by history and exam
Initiate treatment plan and management:
• Common acid and base burns
• Hydrofluoric acid
• Ocular burns
• Chemical inhalation
• Tar burns
Care plan for outpatient chemical burns
Core Topic 5: Inhalation Injury
Medical Knowledge
G-Level Objectives
PGY-1
Understand the pathophysiology of smoke inhalation
• Toxic smoke compounds and Metabolic poisons (carbon monoxide, cyanide)
• Anatomic injuries (Oropharynx , tracheobronchial, lung parenchyma)
Understand the diagnosis and treatment of smoke inhalation
Understand the diagnosis and treatment of metabolic poisons
Ventilatory management of inhalation injury
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PGY-3
Complications of inhalation injury
• In hospital complications
Understand the pathophysiology of smoke inhalation
• Toxic smoke compounds and Metabolic poisons (carbon monoxide, cyanide)
• Anatomic injuries (Oropharynx , tracheobronchial, lung parenchyma)
Understand the diagnosis and treatment of smoke inhalation
Understand the diagnosis and treatment of metabolic poisons
Ventilatory management of inhalation injury
Complications of inhalation injury
• In hospital complications
• Chronic pulmonary complications
Patient Care
G-Level Technical / Procedural Skills
PGY-1
Perform (chest) escharotomy
Interpret bronchoscopy
PGY-3
Perform (chest) escharotomy
Interpret/Perform bronchoscopy
Manage ventilator for inhalation injury
Care Plans
Identify/evaluate by history and exam
Initiate treatment plan and management:
• Fluid resuscitation
• Ventilator strategies
• Diagnosis/treatment of
pneumonia
Identify/evaluate by history and exam
Initiate treatment plan and management:
• Fluid resuscitation
• Ventilator strategies
• Diagnosis/treatment of
pneumonia
• Diagnosis/treatment of ARDS
Core Topic 6: Necrotizing Soft-tissue Infection
Medical Knowledge
G-Level Objectives
PGY-1
Understand the pathophysiology of necrotizing soft tissue infection (NSTI)
Demonstrate knowledge of diagnostic criteria
• Define infections based on level of involvement
Identify primary surgical pathogens
• Streptococcus
• Staphylococcus
• Clostridium
• Mixed gram-negative
Understand treatment modalities
PGY-3
Understand the pathophysiology of necrotizing soft tissue infection (NSTI)
Identify primary surgical pathogens
• Streptococcus
• Staphylococcus
• Clostridium
• Mixed gram-negative
Demonstrate knowledge of diagnostic criteria
• Define infections based on level of involvement
Understand treatment modalities
Differentiate from Staph Scalded Skin Syndrome and Purpura Fulminans
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Patient Care
G-Level Technical / Procedural Skills
PGY-1
Perform appropriate diagnostic workup
Perform radical excision of affected
tissue
Identify sepsis/severe sepsis
Perform definitive coverage of wounds
PGY-3
Perform appropriate diagnostic workup
Perform radical excision of affected
tissue
Identify sepsis/severe sepsis
Manage associated sepsis/severe sepsis
Determine timing of definitive coverage
Perform definitive coverage of wounds
Care Plans
Identify/evaluate by history and exam
Initiate treatment plan and management:
• Diagnostic workup
• Fluid resuscitation
Identify/evaluate by history and exam
Initiate treatment plan and management:
• Diagnostic workup
• Fluid resuscitation
• Severe sepsis
ROTATION GOALS AND OBJECTIVES FOR PROBLEM-BASED LEARNING AND IMPROVEMENT,
INTERPERSONAL SKILLS AND COMMUNICATION, PROFESSIONALISM, AND SYSTEMS BASED
PRACTICE
Problem-Based Learning and Improvement
G-Level Objectives
All
• Identify own learning needs or goals at the onset of the rotation.
• Following a surgical procedure, debrief what went well, and what could have
been improved.
• Identify differences in incidence, prognosis, and outcomes of cancer treatment
according to race and gender.
• Diagnose personal learning needs associated with any medical errors,
complications, or “near misses” that occurred during your watch.
• Use feedback gained from others, and the experience gained on this rotation,
to formulate future learning goals and steps.
Interpersonal Skills and Communication
G-Level Objectives
All
• Communicate patient information clearly to other health providers in written
notes and oral presentations.
• Apply appropriate communication skills with patients and families (i.e. effective
listening, awareness of nonverbal cues, and use of open-ended questions).
• Counsel and educate patients and families on their treatment options, their
surgical outcomes and prognosis, and home care needs.
• Explain to medical students / junior residents the fundamentals of your job, as
well as their jobs.
Professionalism
G-Level Objectives
All
• Adhere to patient privacy and informed consent policies at all times.
• Adhere to University behavior policies (e.g., sexual harassment, duty hours,
dress code) at all times.
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•
Demonstrate respect, compassion, integrity, and honesty in all interactions with
patients, families, and other health care providers.
Demonstrate personal responsibility for patient welfare.
Articulate ethical issues underlying clinical decisions made for at least once
complex case seen during this rotation.
Systems-Based Practice
G-Level Objectives
All
• Know when to call for help from attending physicians.
• Understand when, how, and why to request a consult from medical specialists,
and how to use the information gained as a result.
• Provide timely and pertinent consultation when asked by emergency medical,
medical or surgical colleagues.
• Use the talents and skills of other health providers in the OR and Burn Unit.
• Estimate the relative costs / benefits of different surgical and nonsurgical
management of the disease processes cared for in the Burn Unit.
• Consider patient characteristics (e.g., age, race and ethnicity, family support,
socio-economic status, type of insurance) in evaluating treatment options and
developing an appropriate care plan.
• Discuss the distinction between medically necessary care and over care, and
its implications for our patients.
Diagnose any “systems issues” associated with medical errors, complications,
and “near misses” that occurred during this rotation.
LEARNING RESOURCES FOR TRAINEES
Regions Burn Center:
• Burn Pearls available on the Burn Potpourri Internet
• The Burn Library
 Total Burn Care. Herndon Ed.
 Journal of Burn Care and Resuscitation
 Burns
 The Journal of Trauma
 More than 200 books covering aspects of burn and trauma care
• Burn resuscitation flash cards
SCORE Website Portal:
• Modules, chapters, videos, and radiographic images (STAT dx) pertinent to the core topics enumerated
above
• Evidence-Based Reviews in Surgery
• MD Content Course on Health Care (economics, operations, legal/financial, leadership)
REGIONS BURN Moodle Website
• See assignments and additional resources
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GENERAL/VASCULAR SURGERY
Minneapolis Veterans Affairs Medical Center
Patient Care
PGY-1&2
PGY-5
Manual Dexterity
Manual Dexterity
Understand wound care
Conduct all general surgery procedures
Opening of infected surgical wounds
with appropriate direction and
Wet to dry dressing
assistance, including complex,
Perform simple suture technique
multistep procedures.
Perform bedside procedures
Abdominoperineal resection
Central venous catheterization
Whipple
Fine-needle aspiration of superficial
Total thyroidectomy
lesions
Modified radical mastectomy
Develop operative skills:
Incision and drainage of subcutaneous and Care Plans
perirectal abscess
Identify and evaluate by history and
Excision of simple skin and subcutaneous
physical examination
lesions
Formulate differential diagnoses
Incisional biopsy
Initiate treatment plan and management
Surgical breast biopsy
Intraabdominal catastrophe
Surgical lymph node biopsy
Ischemic bowel
Open inguinal herniorrhaphy
Perforated diverticulitis
Simple hemorrhoid procedures
Perforated ulcer disease
Lower extremity amputation
Massive gastrointestinal bleeding
Varicose vein surgery
Postoperative complications
Necrotizing infection
Care Plans
Anastomotic leak
Understand Advanced Cardiac Life
Hemorrhage
Manual Dexterity & Care Plans
Support protocols
Identification and evaluation by history and Perform complex vascular surgical
physical examination
procedures
Formulation of differential diagnoses
Carotid endarterectomy
Initiation of treatment plan and
Repair of aortic aneurysm
management
Aortic reconstruction for occlusive
Acute abdomen
disease
Soft-tissue infections
Femoral distal bypass
Cellulitis
Extra-anatomic reconstruction
Necrotizing soft-tissue
Distal lower extremity bypass
infections
Wound infections
Acute leg pain
Acute respiratory distress
Acute chest pain
Extremity swelling
Manual Dexterity & Care Plans
Perform a focused history and physical for
the vascular system, including Doppler
&
ankle brachial index
Manage wounds-wet to dry dressings
Perform wound debridement
Place central venous lines
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Femoral
Jugular
Subclavian
Care for an ischemic limb
Apply an Unna boot
Amputate digits
Gen/Vasc SX (VAMC) cont.
Medical Knowledge
PGY-1&2
PGY-5
Understand principles of wound healing
Understand primary surgical literature
Understand normal acid-base balance, and
beyond that in textbooks and review
fluid, electrolyte, and nutritional
articles
parameters
Understand the natural history of
Provide treatment of fluid, electrolyte, and
medically treated or untreated
nutritional abnormalities
Vascular disease
Gastric outlet obstruction
Carotid artery stenosis
Acute renal failure
Abdominal aortic aneurysm
Acute and chronic diarrhea
Lower extremity arterial occlusive
Bowel obstruction
disease
Cancer cachexia
Summarize principles for preoperative
Identify and manage hematologic
assessment and postoperative care of
abnormalities
patients undergoing major vascular
Anemia
surgical procedures
Coagulopathy
Describe the indications for
Platelet disorders
Balloon angioplasty
Understand principles of microbiology and
Arterial stent placement
their clinical applications
Inferior cava filter placement
Describe arterial and venous anatomy
Describe the indications for operative
Understand risk factors of atherosclerosis
intervention
Understand risk factors, signs, and
Claudication
symptoms of chronic venous
Critical limb ischemia
insufficiency
Abdominal aortic aneurysm
Understand signs and symptoms of acute
Transient ischemic attack and stroke
and chronic arterial disease
Asymptomatic carotid stenosis
Make differential diagnosis of a swollen
Varicose veins
extremity
Venous stasis ulcer
Make differential diagnosis of foot ulcer
Renal and visceral artery stenosis
Understand signs and symptoms of
lymphedema
Gen/Vasc SX (VAMC) cont.
Interpersonal Communication Skills
PGY-1&2
PGY-5
Create ethical and appropriate patient
Create ethical and appropriate patient
relationships.
relationships.
Develop effective listening skills, including
Develop effective listening skills, including
observing nonverbal cues and using
observing nonverbal cues and using
explanatory questioning.
explanatory questioning.
Develop effective, complete, and legible
Develop effective, complete, and legible
note writing skills.
note writing skills.
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Learn to give effective medical
presentations to other providers, on
rounds, at institutional conferences,
and at local/national meetings.
Effective and thorough patient handoff/sign out.
Learn to give effective medical
presentations to other providers, on
rounds, at institutional conferences,
and at local/national meetings.
Effective and thorough patient handoff/sign out.
Professionalism
PGY-1&2
PGY-5
Demonstrate respect, compassion,
Demonstrate respect, compassion,
integrity and honesty.
integrity and honesty.
Demonstrate patient care that supersedes Demonstrate patient care that supersedes
personal self-interest.
personal self-interest.
Demonstrate personal responsibility for
Demonstrate personal responsibility for
patient problems.
patient problems.
Understand and utilize privacy policies,
Understand and utilize privacy policies,
informed consent, business and
informed consent, business and
medical ethics.
medical ethics.
Understand and follow institutional
Understand and follow institutional
behavior policies (i.e. Sexual
behavior policies (i.e. Sexual
harassment, duty hours, dress code,
harassment, duty hours, dress code,
etc.).
etc.).
System-Based Practice.
PGY-1&2
PGY-5
Understand how patient care affects other
Understand how patient care affects other
health care providers.
health care providers.
Understand the continuity between clinic
Learn role of consultant.
and hospital based care.
Understand the continuity between clinic
Understand the role of the Veterans Affairs
and hospital based care.
Medical Center in the healthcare
Understand the role of the Veterans
system.
Affairs Medical Center in the healthcare
Practice cost-effective and appropriate
system.
preoperative evaluation and
Practice cost-effective and appropriate
postoperative follow up.
preoperative evaluation and
Understand resource allocation issues.
postoperative follow up.
Understand resource allocation issues.
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SURGICAL CRITICAL CARE
Minneapolis Veterans Affairs Medical Center
Patient Care
PGY-1
Manual Dexterity
Perform bedside procedures
Central venous catheterization
Pulmonary artery catheterization
Arterial line placement
Endotracheal intubation
Observe bedside procedures:
Percutaneous gastrostomy,
tracheostomy, other minor procedures
Care Plans
Understand Advanced Cardiac Life
Support protocols.
Identification and evaluation by history and
physical examination.
Formulation of differential diagnoses for
common ICU problems.
Standard ventilator management and
weaning.
Initiation of treatment plan and
management for:
Sepsis
Hypoxemia
Hypotension
Shock
Cardiogenic
Distributive
Hypovolemic
Obstructive
Renal failure
Respiratory failure
Gastrointestinal bleeding
Understand appropriate utilization of:
Antibiotics
Sedatives
Blood component therapy
Therapy for treatment of disorders of
coagulation including aspirin,
heparins
PGY-2
Manual Dexterity
Supervise and instruct bedside
procedures:
Central venous catheterization
Pulmonary artery catheterization
Arterial line placement
Perform bedside procedures:
Endotracheal intubation
Percutaneous gastrostomy,
tracheostomy, other minor
procedures
Care Plans
Identify and evaluate by history and
physical examination.
Formulate differential diagnoses for ICU
problems.
Ventilator management in the patient with
acute lung injury.
Initiation of treatment plan and
management for:
Severe sepsis
Multisystem organ dysfunction
CNS dysfunction (e.g. intracranial
bleed)
Acute GI bleed
Hepatic failure
Myocardial ischemia
Understand appropriate utilization of:
Vasoactive agents
Antibiotics and other antimicrobials
Paralytics and sedatives
Therapy for treatment of disorders of
coagulation including nonheparin
anticoagulants, and fibrinolytic therapy.
Appropriately interpret and utilize invasive
hemodynamic data.
ICU (VAMC) cont.
Medical Knowledge
PGY-1
PGY-2
Demonstrate knowledge of:
Demonstrate knowledge of:
Pathophysiology of sepsis
Pathophysiology of organ failure
Principles of Antimicrobial therapy
(pulmonary, renal, GI, cardiac)
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Evaluation of fever in the
immunosuppressed patient
Introductory interpretation of
radiographs
Common surgical conditions leading to
ICU admission
Interpretation of common laboratory
tests (e.g. Arterial blood gasses,
electrolytes)
Basic principles of nutritional support
Principles of resuscitation from shock
states
Hormonal, biochemical, and metabolic
response to tissue injury.
Appropriate indications for radiographic
evaluation of critically-ill patients
Appropriate interpretation of advanced
diagnostics (e.g. CT scans)
Pathophysiology of nosocomial
infections in the critically-ill
Principles of nutritional support
including advanced nutritional
monitoring techniques (e.g.
respiratory quotient) and
specialized issues (refeeding
syndrome, Rx of hepatic and renal
failure) Common disorders of
coagulation in the ICU (e.g. deep
venous thrombosis,
thrombocytopenia)
Practice-Based Learning & Improvement
PGY-1
PGY-2
Demonstrate insight into contributing
Perform critical evaluation of
factors associated with ICU and
complications of ICU care by
surgical complications by participation
preparation and presentation of
in monthly morbidity and mortality
complications at monthly ICU morbidity
conference.
and mortality conference.
Demonstrate commitment to personal
Continue commitment to personal lifelong
lifelong learning by initiating directed
learning by initiating reading using
reading regarding patient issues in the
advanced sources (e.g. source
ICU.
literature) regarding patient issues in
the ICU.
Interpersonal Communication Skills
PGY-1
PGY-2
Understand proper interaction skills with
Develop supervisory skills by providing
regards to communication with other
oversight and supervision of junior
services in care of complex, critically ill
members of the Surgical ICU team
patients (in other words,
(e.g. anesthesia and surgery residents,
communication, communication,
medical students).
communication!) .
Demonstrate facility with family
communication skills, understanding
Develop tools for proper family
nuances of communication with
communication skills, understanding
patient’s families in the setting of
nuances of communication with
critical illness. Demonstrate proper
patient’s families in the setting of
techniques for communicating “bad
critical illness. Relate proper
news” to patient’s family in the ICU.
techniques for communicating “bad
Participate as appropriate in family care
news” to patient’s family in the ICU.
conferences.
Participate as an observer in family care
conferences.
Demonstrate knowledge of current uses
of medical documentation, including
Understand principles of effective
interactions with 3rd party payer
documentation as a tool for
communication.
system.
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ICU (VAMC) cont.
Professionalism
PGY-1
Demonstrate knowledge of principals of
informed consent.
Discuss the issues of patient rights in the
setting of critical illness.
Understand the process for implementation
of DO NOT RESUSCITATE orders in
the critically ill.
Demonstrate appropriate transfer of patient
care to primary services caring for the
critically-ill patient in transition to
hospital care.
PGY-2
Understand nuances of withholding or
withdrawing life support in the criticallyill patient.
Relate the role of advanced directives in
the critically-ill patient.
Experience the effects of critical illness on
families of different backgrounds (age,
culture, etc.).
Understand methods of coping with stress
of caring for critically ill (and dying)
patients.
System-Based Practice
PGY-1
PGY-2
Relate techniques for cost-effective,
Understand cost-effective health care
appropriate perioperative evaluation.
delivery in the ICU.
Demonstrate principles of infection control Appropriate ability to utilize triage and
(prevention of health care associated
bed-control to provide for critically ill
and blood borne infections).
patients.
Demonstrate ability to provide ongoing
Relate the role (and cost) of ICU care in
care of patients with chronic critical
the setting of the Veteran’s Affairs
illness (e.g. appropriate transfer of
Medical Center.
patients to chronic hospital, ventilator,
Demonstrate knowledge of current uses
and advanced nursing facilities).
of medical documentation, including
Understand the role of other services in
interactions with 3rd party payer
proper care of complex, critically ill
system.
patients.
Understand the role of other services in
proper care of complex, critically ill
patients.
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ROTATION PLAN FOR 2014-15
ROTATION NAME METHODIST HOSPITAL (Park Nicollet Medical
TRAINING LEVELS ON SERVICE: 3 PGY-4; 1 PGY-3; Medical Students
SERVICE DIRECTOR: M. Mark Melin, M.D.
TEACHING FACULTY:
George Belzer, M.D.
Mary Colbert, M.D.
Joel Friedman, M.D.
Brian Grubbs, M.D.
Keith Heaton, M.D.
Tom Jones, M.D.
Jeffrey Mendeloff, M.D.
Kevin Ose, M.D.
Michael Schueppert, M.D.
Charles Svendsen, M.D.
Paul Vietzan, M.D.
Robert Wetherille, M.D.
David Willis, M.D.
Center)
ROTATION’S WEEKLY EDUCATION SCHEDULE
Monday
7:00 – 8:00 am
Colorectal
Conference
(once a month)
Tuesday at
UMMC
6:30 G4+G5
7:00 M+M
7:45 Grand
Rounds
8:30 Core
Curriculum
9:45-noon Skills
Lab
Wednesday
6:30-7:00 am
Ethics / Journal
Club (once-twice
a month) with
G3, G4, med
students
Thursday
6:30-7:00 am
Vascular
Conference
(once a month)
Activity
Who is responsible?
Orientation to the Rotation
Bedside Teaching Rounds
Weekly Core Topic Teaching
Mid-Rotation Review
End-of-Rotation Oral Exam
End-of-Rotation Meeting w/
Resident
Mark Melin, MD
Monthly M+M Leader
All staff
All staff
M+M Leader
Mark Melin, MD
Friday
6:30-7:30 am
M+M Conference
Gen/Vascular
When does this
occur?
Start of rotation
1-2 Fridays per month
Weekly
Weekly
Every Friday after M+M
End of rotation
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ROTATION GOALS AND OBJECTIVES FOR MEDICAL KNOWLEDGE AND PATIENT CARE, BY CORE
TOPIC AND RESIDENT TRAINING LEVEL
The rotation at Methodist Hospital consists of three PGY-4 residents and one PGY-3 resident. The PGY-3 and
4 residents are treated equally during the course of their rotation at Methodist with respect to peri-operative
responsibilities and surgical case involvement.
Core Topic 1: Benign Gall Bladder
Medical Knowledge
G-Level Objectives
PGY-3
All residents should:
and
• Understand biliary colic and its management, how it differs from common duct
PGY-4
stones
• Know how to interpret labs
• Recognize and describe abnormal anatomy
• Know how to manage post-op complications
Patient Care
G-Level Technical / Procedural Skill
PGY-3
All residents should be able to:
and
1. Execute adequate preoperative
patient preparation.
PGY-4
2. Recognize and act on indications for
intra-operative common bile duct
study, laparoscopic versus open.
3. Understand abnormal biliary duct
anatomy and variations.
4. Recognize and act on indications for
conversion to open procedure.
Care Plans:
All residents should be able to:
1. Manage postoperative complications
such as retained common bile duct
stone, biliary leak, cholangitis.
Core Topic 2: C. Difficile Infection
Medical Knowledge
G-Level Objectives:
PGY-3
All residents should understand:
and
• The epidemiology of C. Diff infections
PGY-4
• Differential diagnosis
• “Benign” versus “malignant”
• Forms of C. Difficile infection and differentiation from toxic megacolon
• Indications for surgical management versus persistent medical management
Patient Care
G-Level Technical / Procedural Skills:
PGY-3
All residents should be able to recognize
and
and act on:
PGY-4
1. Indications for surgical management
of C-Difficile infection, toxic
megacolon.
2. Options for preoperative GI
preparation.
3. Assessment of nutritional status.
Care Plans:
All residents should be able to:
1. Manage postoperative complications
such as sepsis syndrome,
malnutrition.
2. Recognize and act on indications and
timing for reestablishment of
gastrointestinal continuity.
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4. Intra-operative technical aspects of
managing toxic megacolon.
5. Options for primary anastomosis
versus creation of colostomy, versus
diverting loop ileostomy.
Core Topic 3: Colitis
Medical Knowledge
G-Level Objectives:
PGY-3
All residents should know:
and
• Defining types of colitis
PGY-4
• Differential diagnosis
• Options for medical management.
Patient Care
G-Level Technical / Procedural Skills:
PGY-3
All residents should be able to:
and
1. Execute preoperative
PGY-4
gastrointestinal/colon preparation.
2. Understand and initiate rapid
recovery protocols.
3. Perform technique of colectomy and
options for pouch reconstruction.
4. Describe options for pouch
reconstruction and determine clinical
indications for each type of pouch
reconstruction option.
Care Plans:
All residents should be able to:
1. Manage postoperative complications
such as anastomotic leak, sepsis
syndrome,
2. Initiate and commence medical
management of colitis.
Core Topic 4: Crohn’s Disease
Medical Knowledge
G-Level Objectives:
PGY-3
All residents should know:
and
• Differentiation of Crohn’s disease versus ulcerative colitis
PGY-4
• Other colon pathology differential diagnosis
• Indications for medical therapy versus surgical management
Patient Care
G-Level Technical / Procedural Skills:
PGY-3
All residents should be able to:
and
1. Execute preoperative
PGY-4
gastrointestinal/colon preparation.
2. Understand, describe, assist, and
perform the technical skills and
anastomotic principles for small
intestine/colon resection, technique
and option for stricturoplasty.
Care Plans:
All residents should be able to:
1. Manage postoperative complications
such as anastomotic leak, sepsis
syndrome
2. Provide postoperative medical
management of Crohn’s disease.
Core Topic 5: Large Bowel Obstruction
Medical Knowledge
G-Level Objectives:
PGY-3
All residents should know:
and
• Differential diagnosis of causes of large bowel obstruction
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PGY-4
•
•
Options for medical management, including the role of colonic stents
Options for diagnostic evaluations.
Patient Care
G-Level Technical / Procedural Skills:
PGY-3
All residents should be able to:
and
1. Execute preoperative
gastrointestinal/colon preparations.
PGY-4
2. Describe and perform the
construction of a primary
anastomosis versus diversion
procedures.
3. Understand, describe and perform
the appropriate creation of stoma
placement.
4. Describe bowel preparation options.
Care Plans:
All residents should be able to:
1. Recognize and act on postoperative
anastomotic leaks.
2. Manage sepsis syndrome.
3. Manage persistent postoperative
ileus.
4. Manage nutritional needs.
Core Topic 6: Colorectal Cancer
Medical Knowledge
G-Level Objectives:
PGY-3
and
PGY-4
All residents should know:
• Preoperative evaluation
• Radiographic evaluation for performance of accurate colorectal cancer staging
• Indications for preoperative chemotherapy/radiation therapy
• Indications for non-operative management of colorectal cancer
Patient Care
G-Level Technical / Procedural Skill:
PGY-3
All residents should be able to:
and
1. Execute gastrointestinal/colon
PGY-4
preoperative preparations.
2. Understand, describe, and perform
management of colorectal cancer
procedural options, including
assisting in the performance of AP
resection.
3. Understand, describe and determine
the arterial anatomy and implications
for intra-operative resection.
Care Plans
All residents should be able to:
1. Recognize and act on post-operative
anastomotic leaks
2. Manage sepsis syndrome.
3. Recognize and act on indications for
restoration of colonic continuity.
Core Topic 7: Diverticulitis
Medical Knowledge
G-Level Objectives:
PGY-3
All residents should know:
and
• Medical assessment and management of diverticulitis
PGY-4
• Observation versus selective percutaneous drain placement, versus surgery
• Indications of medical failure
• Indications for surgical management of diverticulitis
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Patient Care
G-Level Technical / Procedural Skills:
PGY-3
and
PGY-4
All residents should be able to:
1. Execute preoperative
gastrointestinal/colon preparation.
2. Execute intra-operative techniques:
two-handed dissection, finding
appropriate retroperitoneal planes for
dissection.
3. Understand, describe and address
techniques that allow avoidance of
potential intra-operative
complications of ureteral trauma, and
vein trauma.
Care Plans:
All residents should be able to:
1. Recognize anastomotic leak, sepsis
syndrome.
2. Manage stomas.
3. Recognize and act on indications for
restoration of intestinal continuity.
Core Topic 8: Parathyroid
Medical Knowledge
G-Level Objectives:
PGY-3
and
PGY-4
All residents should:
• Understand accurate medical evaluation, diagnosis of parathyroid pathology
• Understand indicated preoperative laboratory evaluation
• Describe differential diagnosis for causes of hypercalcemia
• Describe localization studies
• Describe radiologic studies for preoperative evaluation
• Describe acute medical treatment of malignant hypercalcemia
Patient Care
G-Level Technical / Procedural Skills:
PGY-3
All residents should be able to:
and
1. Describe, demonstrate and initiate
the surgical approach of parathyroid
PGY-4
exploration versus focused surgical
resection.
2. Describe and demonstrate the
location of “missing” parathyroid
glands.
3. Describe and demonstrate
hyperplasia versus adenoma
management.
Care Plans
1. Describe and initiate management of
postoperative complications including
hypocalcemia, recurrent nerve injury,
and neck hematoma.
Core Topic 9: Acute Limb Ischemia
Medical Knowledge
G-Level Objectives:
PGY-3
and
PGY-4
All residents should be able to:
• Describe clinical presentation, risk factors for development of acute limb
ischemia.
• Know important aspects of clinical history, radiologic options for evaluation
versus immediate surgical management
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Patient Care
G-Level Technical / Procedural Skills
PGY-3
All residents should be able to:
and
1. Describe, demonstrate, and initiate
field preparation for performance of
PGY-4
technique of embolectomy.
2. Describe and demonstrate technique
of intraoperative angiography.
3. Describe indications for performance
of four compartment fasciotomy and
initiate performance of four
compartment fasciotomy.
Care Plans:
All residents should be able to:
1. Describe and initiate postoperative
limb ischemia management,
identification of potential
compartment syndrome if fasciotomy
not performed intraoperatively,
management of postoperative
wounds, indication for
anticoagulation.
2. Describe and initiate management of
cardiac complications and renal
complications.
Core Topic 10: Chronic Limb Ischemia
Medical Knowledge
G-Level Objectives:
PGY-3
All residents should be able to:
and
1. Define clinical presentation, associated clinical risk factors, and the important
aspects of medical history
PGY-4
2. Differentiate chronic limb ischemia from acute limb ischemia
3. Describe indications for radiographic evaluations.
Patient Care
G-Level Technical / Procedural Skills:
PGY-3
All residents should be able to:
and
1. Describe and initiate adequate field
preparation.
PGY-4
2. Describe options for surgical
reconstruction of chronic limb
ischemia and demonstrate
appropriate interpretation of
angiogram preoperatively.
3. Describe and demonstrate types of
vascular conduits utilized.
4. Describe and initiate appropriate
preoperative vein mapping.
Care Plans:
All residents should be able to:
1. Initiate and manage perioperative
cardiac and renal complications.
2. Initiate and manage postoperative
wound complications.
3. Identify and appropriately manage
and execute recognition of bypass
graft complications.
4. Evaluate and initiate short-term and
long-term follow-up plans for vascular
bypass grafts.
Core Topic 11: Venous Insufficiency
Medical Knowledge
G-Level Objectives:
PGY-3
All residents should be able to:
• Define clinical presentation, clinical risk factors for development of venous
insufficiency
• Explain medical versus surgical treatments options of venous insufficiency
• Define management of wounds in patients with venous insufficiency and identify
associated peripheral arterial disease
Patient Care
G-Level Technical / Procedural Skills:
PGY-3
All residents should be able to:
and
1. Define, outline and evaluate surgical
Care Plans:
All residents should be able to:
1. Describe, initiate and execute
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PGY-4
2.
3.
4.
5.
options for management of
superficial venous insufficiency.
Describe the technique of saphenous
vein stripping.
Describe ablation of the saphenous
vein using radiofrequency ablation or
laser therapy.
Describe and demonstrate technique
of varicose vein avulsion (ambulatory
phlebectomy).
Describe and initiate management of
perforating vein management in
patients with venous ulcerations.
postoperative care plans for varicose
vein surgical patients.
2. Describe and initiate management
and appropriate evaluation of
postoperative deep venous
thromboses and pulmonary emboli.
3. Initiate and manage patients with
venous hypertensive ulcerations.
Core Topic 12: Carotid
Medical Knowledge
G-Level Objectives:
PGY-3
and
PGY-4
All residents should be able to:
• Describe surgical indications for asymptomatic patients
• Describe surgical versus medical management for asymptomatic patients
• Describe surgical versus nonsurgical management options for symptomatic
patients
• Describe indications for carotid artery stent placement
• Describe options for radiographic evaluation of carotid artery stenosis
• Describe preoperative assessment of cardiac status
Patient Care
G-Level Technical / Procedural Skills:
PGY-3
and
PGY-4
All residents should be able to:
1. Describe and initiate field
preparation.
2. Describe and initiate surgical
technique and exposure for carotid
artery endarterectomy.
3. Describe and assist in options for
intraoperative cerebral protection
including EEG utilization, blood
pressure management, indications
for shunt utilization.
Care Plans:
All residents should be able to:
1. Describe, initiate and manage
postoperative complications of
carotid endarterectomy including
transient ischemic attack,
cerebrovascular accident, myocardial
infarction, neck hematoma,
compromised airway.
Core Topic 13: Thoracic Outlet
Medical Knowledge
G-Level Objectives:
PGY-3
• Define clinical presentation of neurogenic versus venous (Paget-Schroetter),
and
versus arterial
PGY-4
• Describe medical management
• Describe indications for surgical management
• Describe management of subclavian venous thrombosis associated with effort
thrombosis
• Describe preoperative evaluation of neurogenic thoracic outlet
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•
Describe options for radiographic evaluation of thoracic outlet syndrome.
Patient Care
G-Level Technical / Procedural Skills:
PGY-3
1. Describe and initiate field
and
preparation.
PGY-4
2. Describe and assist in surgical
options for management of thoracic
outlet syndrome, including
transaxillary first rib resection versus
anterior approach to first rib
resection.
3. Describe and determine the
indications for vein patch angioplasty
in patients with a history of venous
thoracic outlet syndrome.
Care Plans:
1. Describe and initiate management of
postoperative complications including
hematoma, neurogenic
complications, arteriocclusive
complications.
2. Describe, initiate and management of
postoperative physical therapy
ROTATION GOALS AND OBJECTIVES FOR PROBLEM-BASED LEARNING AND IMPROVEMENT,
INTERPERSONAL SKILLS AND COMMUNICATION, PROFESSIONALISM, AND SYSTEMS BASED
PRACTICE
Problem-Based Learning and Improvement
G-Level Objectives
PGY-3
• Identify own learning needs or goals at the onset of the rotation.
and
• Following a surgical procedure, debrief what went well, and what could have
PGY-4
been improved.
• Identify differences in incidence, prognosis, and outcomes of cancer treatment
according to race and gender.
• Diagnose personal learning needs associated with any medical errors,
complications, or “near misses” that occurred during your watch.
• Use feedback gained from others, and the experience gained on this rotation,
to formulate future learning goals and steps.
Interpersonal Skills and Communication
G-Level Objectives
PGY-3
• Communicate patient information clearly to other health providers in written
and
notes and oral presentations.
PGY-4
• Apply appropriate communication skills with patients and families (i.e. effective
listening, awareness of nonverbal cues, and use of open-ended questions).
• Counsel and educate patients and families on their treatment options, their
surgical outcomes and prognosis, and home care needs.
• Explain to medical students / junior residents the fundamentals of your job, as
well as their jobs.
Professionalism
G-Level Objectives
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PGY-3
and
PGY-4
•
•
•
•
Adhere to patient privacy and informed consent policies at all times.
Adhere to University behavior policies (e.g., sexual harassment, duty hours,
dress code) at all times.
Demonstrate respect, compassion, integrity, and honesty in all interactions with
patients, families, and other health care providers.
Demonstrate personal responsibility for patient welfare.
Articulate ethical issues underlying clinical decisions made for at least once
complex case seen during this rotation.
Systems-Based Practice
G-Level Objectives
PGY-3
• Know when to call for help from attending physicians.
and
• Understand when, how, and why to request a consult from medical oncology
PGY-4
and radiation oncology, and how to use the information gained as a result.
• Provide timely and pertinent consultation when asked by medical or surgical
colleagues.
• Use the talents and skills of other health providers in the OR and ward.
• Estimate the costs / benefits of cancer screening (mammography,
colonoscopy), staging (CT, PET, etc.), and treatment.
• Consider patient characteristics (e.g., age, race and ethnicity, family support,
socio-economic status, type of insurance) in evaluating treatment options and
developing an appropriate care plan.
• Discuss the distinction between medically necessary care and over care, and
its implications for our patients.
Diagnose any “systems issues” associated with medical errors, complications,
and “near misses” that occurred during this rotation.
LEARNING RESOURCES FOR TRAINEES
SCORE Website Portal:
•
•
•
Modules, chapters, videos, and radiographic images (STAT dx) pertinent to the core topics enumerated
above
Evidence-Based Reviews in Surgery
MD Content Course on Health Care (economics, operations, legal/financial, leadership)
METHODIST HOSPITAL Moodle Website
•
See assignments and additional resources
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ROTATION PLAN FOR 2014-15
ROTATION NAME NORTH MEMORIAL MEDICAL
TRAINING LEVELS ON SERVICE: PGY-1
SERVICE DIRECTOR: Alan Beal, M.D.
TEACHING FACULTY:
Mark Ahrendt, M.D.
Dana Carlson, M.D.
Sandra Engwall, M.D.
Isaac Felemovicius, M.D.
Eric Irwin, M.D.
ROTATION’S WEEKLY EDUCATION SCHEDULE
Monday
3:45 pm
Attending Walk
Rounds (On Call
trauma surgeon)
Tuesday at
UMMC
6:30 G4+G5
7:00 M+M
7:45 Grand
Rounds
8:30 Core
Curriculum
9:45-noon Skills
Lab
CENTER
Wednesday
Thursday
Friday
3:45 pm
Attending Walk
Rounds (On Call
trauma surgeon)
7:00 am: Trauma
M+M, Trauma
Journal Club;
Surgery Topics
conference
(Trauma
Attending Staff)
3:45 pm
Attending Walk
Rounds (On Call
trauma surgeon)
Activity
Who is responsible?
Orientation to the Rotation
Bedside Teaching Rounds
Weekly Core Topic Teaching
Susan Adler / Alan Beal, MD
Core Trauma Surgeons
Core Trauma Surgeons
Mid-Rotation Review
End-of-Rotation Oral Exam
Alan Beal, MD
Alan Beal, MD
End-of-Rotation Meeting w/
Resident
Alan Beal, MD
When does this
occur?
First day of rotation
See above schedule
Thursday am, or at
afternoon Walk Rounds
Variable
Last Thursday of
rotation
Last week of rotation
ROTATION GOALS AND OBJECTIVES FOR MEDICAL KNOWLEDGE AND PATIENT CARE, BY CORE
TOPIC AND RESIDENT TRAINING LEVEL
Core Topic 1: Appendicitis
Medical Knowledge
G-Level Objectives
PGY-1
Understand natural history, common presentation, current concepts of imaging, use
of open vs. laparoscopic techniques, and antibiotic choices for acute appendicitis in
both adults and children.
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Patient Care
G-Level Technical / Procedural Skills
PGY-1
Gradual increase in operative technical
responsibility with both open and
laparoscopic appendectomy.
Care Plans
Gain comfort and experience with postoperative plans and management of both
complicated and uncomplicated
appendicitis
Core Topic 2: Biliary Disease
Medical Knowledge
G-Level Objectives
PGY-1
Understand various presentations of symptomatic gallstone disease, its natural
history, surgical indications, and use of imaging techniques. Begin to appreciate the
variable biliary anatomy. Become familiar with both laparoscopic and open
cholecystectomy techniques, their indications, as well as various techniques to
remove choledocholithiasis. Discuss the presentation and basic management of bile
duct injuries. Characterize the presentation and management of acalculous
cholecystitis.
Patient Care
G-Level Technical / Procedural Skills
PGY-1
Gradual increase in operative technical
responsibility with laparoscopic
cholecystectomy and cholangiography.
Care Plans
Gain comfort and experience with
postoperative plans and management of
both complication and uncomplicated
biliary disease.
Core Topic 3: Bowel Obstruction
Medical Knowledge
G-Level Objectives
PGY-1
Understand the epidemiology, clinical manifestations, and diagnostic techniques for
bowel obstruction, as well as surgical indications.
Patient Care (Bowel Obstruction)
G-Level Technical / Procedural Skills
PGY-1
Assist in laparotomy and lysis of
adhesions for small bowel obstruction.
Care Plans
Gain comfort and experience in nonoperative and pre-operative
management of those with acute bowel
obstruction, as well as post-operative
management after laparotomy.
Core Topic 4: Abdominal Wall Hernias
Medical Knowledge
G-Level Objectives
PGY-1
Understand the natural history of inguinal and ventral/incisional hernias and be able
to discuss the surgical indications for each, including non-operative management.
Compare and discuss advantages and disadvantages of open vs. laparoscopic
techniques for both inguinal and incisional hernias.
Patient Care
G-Level Technical / Procedural Skills
PGY-1
Gradual increase in operative technical
responsibility for both open and
laparoscopic hernia repairs for both
Care Plans
Be knowledgeable of indications and
risks of open and laparoscopic
techniques for informative discussions
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inguinal and incisional hernias.
with patients pre-operatively and postoperatively.
Core Topic 5: Central Venous Catheters
Medical Knowledge
G-Level Objectives
PGY-1
Be familiar with different approaches to placement of central venous lines,
indications for such catheters, and a variety of complications, both acute and subacute. Acquire knowledge of the definition of catheter-related blood stream infection,
diagnostic criteria, basic treatment regimens, and preventative measures.
Patient Care
G-Level Technical / Procedural Skills
Care Plans
PGY-1
Acquire experience under attending staff Become familiar with the technique of full
guidance in placement of several types
barrier draping and ongoing local
of central venous catheters.
catheter care after insertion.
Core Topic 6: Sepsis
Medical Knowledge
G-Level Objectives
PGY-1
Know the definitions of sepsis, severe sepsis, and septic shock. Be familiar with the
Surviving Sepsis Campaign and international guidelines for management of severe
sepsis, as well as landmark studies of early goal-directed therapy. Be able to
choose appropriate first-line antibiotic choices for patients with sepsis.
Patient Care
G-Level Technical / Procedural Skills
PGY-1
NA
Care Plans
Be familiar with institutional order sets for
the treatment of severe sepsis.
Core Topic 7: Solid Organ Injury (Liver and Spleen)
Medical Knowledge
G-Level Objectives
PGY-1
Obtain knowledge in the diagnosis of blunt injuries to liver, spleen, kidney, and
pancreas in both adults and children. Be familiar with the American College of
Surgeons CT staging of blunt solid organ injury scales. Know the indications for
surgical intervention in these injuries. Become familiar with the indications for
angioembolization as a form of treatment in blunt solid organ injuries. Become more
comfortable in CT evaluation of blunt solid organ injuries.
Patient Care
G-Level Technical / Procedural Skills
PGY-1
Assist in a trauma exploratory
laparotomy.
Care Plans
Be familiar with institutional order sets for
the non-operative treatment of blunt
splenic and hepatic injuries.
Core Topic 8: Fluid Resuscitation and Massive Transfusion
Medical Knowledge
G-Level Objectives
PGY-1
Become familiar with the key areas of fluid resuscitation in the trauma patient in both
adults and children and discuss the endpoints/goals for fluid resuscitation. Discuss
the indications for blood transfusion in the surgical and/or trauma patient. Be familiar
with the term, “damage control resuscitation,” and “massive blood transfusion
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protocol,” and discuss the types of patients where these techniques might be used.
Is there a role for the use of Factor VII?
Patient Care
G-Level Technical / Procedural Skills
PGY-1
NA
Care Plans
Discuss the intricacies of developing an
institutional massive transfusion protocol.
ROTATION GOALS AND OBJECTIVES FOR PROBLEM-BASED LEARNING AND IMPROVEMENT,
INTERPERSONAL SKILLS AND COMMUNICATION, PROFESSIONALISM, AND SYSTEMS BASED
PRACTICE
Problem-Based Learning and Improvement
G-Level Objectives
PGY-1
• Identify own learning needs or goals at the onset of the rotation.
• Following a surgical procedure, debrief what went well, and what could have
been improved.
• Identify differences in incidence, prognosis, and outcomes of cancer treatment
according to race and gender.
• Diagnose personal learning needs associated with any medical errors,
complications, or “near misses” that occurred during your watch.
• Use feedback gained from others, and the experience gained on this rotation,
to formulate future learning goals and steps.
Interpersonal Skills and Communication
G-Level Objectives
PGY-1
• Communicate patient information clearly to other health providers in written
notes and oral presentations.
• Apply appropriate communication skills with patients and families (i.e. effective
listening, awareness of nonverbal cues, and use of open-ended questions).
• Counsel and educate patients and families on their treatment options, their
surgical outcomes and prognosis, and home care needs.
• Explain to medical students / junior residents the fundamentals of your job, as
well as their jobs.
Professionalism
G-Level Objectives
PGY-1
• Adhere to patient privacy and informed consent policies at all times.
• Adhere to University behavior policies (e.g., sexual harassment, duty hours,
dress code) at all times.
• Demonstrate respect, compassion, integrity, and honesty in all interactions with
patients, families, and other health care providers.
• Demonstrate personal responsibility for patient welfare.
Articulate ethical issues underlying clinical decisions made for at least once
complex case seen during this rotation.
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Systems-Based Practice
G-Level Objectives
PGY-1
• Know when to call for help from attending physicians.
• Understand when, how, and why to request a consult from medical oncology
and radiation oncology, and how to use the information gained as a result.
• Provide timely and pertinent consultation when asked by medical or surgical
colleagues.
• Use the talents and skills of other health providers in the OR and ward.
• Estimate the costs / benefits of cancer screening (mammography,
colonoscopy), staging (CT, PET, etc.), and treatment.
• Consider patient characteristics (e.g., age, race and ethnicity, family support,
socio-economic status, type of insurance) in evaluating treatment options and
developing an appropriate care plan.
• Discuss the distinction between medically necessary care and over care, and
its implications for our patients.
Diagnose any “systems issues” associated with medical errors, complications,
and “near misses” that occurred during this rotation.
LEARNING RESOURCES FOR TRAINEES
SCORE Website Portal:
•
•
•
Modules, chapters, videos, and radiographic images (STAT dx) pertinent to the core topics enumerated
above
Evidence-Based Reviews in Surgery
MD Content Course on Health Care (economics, operations, legal/financial, leadership)
NORTH MEMORIAL Moodle Website
•
See assignments and additional resources
Teaching Medical Students
Residents are an essential part of the teaching of medical students. It is critical that any resident who
supervises or teaches medical students must be familiar with the educational objectives of the course or
clerkship and be prepared for their roles in teaching and evaluation. Therefore, we’ve included in this manual
the clerkship objectives for Surgery as well as the overall Educational Program Objectives.
Surgery – SURG 7500
Goals and Objectives
This course provides the medical students an opportunity to learn various responsibilities of a PGY-1 Surgery
resident. At the completion of the rotation it is expected that the student will have achieved competence in the
following subject areas:
•
•
•
mastery of 12 assigned core topics in general surgery
initial history and physical examination of the patient
orderly, systematic diagnosis of surgical diseases
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•
•
•
•
•
•
suitable pre-operative preparation of the surgical patient
function of the O.R. and the surgeon's role
operative procedures used in treatment of surgical diseases
perioperative patient care
how to interpret surgical literature
interpersonal behavior with surgical patients
Educational Program Objectives
University of Minnesota Medical School
Graduates of the University of Minnesota Medical School should be able to:
OUTCOME MEASURES
OBJECTIVE
1.
Demonstrate mastery of key
concepts and principles in the basic
sciences and clinical disciplines that
are the basis of current and future
medical practice.
2.
Demonstrate mastery of key
concepts and principles of other
sciences and humanities that apply to
current and future medical practice,
including epidemiology, biostatistics,
healthcare delivery and finance,
ethics, human behavior, nutrition,
preventive medicine, and the cultural
contexts of medical care.
3.
Competently gather and present in
oral and written form relevant patient
information through the performance
of a complete history and physical
examination.
4.
Competently establish a doctor-
 USMLE Steps 1 and 2
 Year 1 and 2 course
performance, based on
standardized examinations
 Clinical rotation performance
 Feedback from residency
directors
 USMLE Steps 1 and 2
 Course performance (esp. in
Physician and Society,
Nutrition, and Human Behavior
at TC campus; Medical
Sociology, Medical
Epidemiology and biometrics,
Family Medicine I, Medical
Ethics, Human Behavioral
Development and Problems,
and Psycho-Social-Spiritual
Aspects of Life-Threatening
Illness at DU campus)
 Clinical rotation performance
 Feedback from residency
directors
 Yr. 2 OSCE
 Physician and Patient (PAP)
course performance at TC
campus, assessed by tutors
using global rating forms and
observed practical exams
 Course performance at DU
campus in Applied Anatomy,
Clinical Rounds & Clerkship
(CR & C), Clinical Pathology
Conference, and Integrated
Clinical Medicine
 Clinical rotation performance
 Yr. 2 OSCE and Primary Care
ACGME ESSENTIAL
COMPETENCY
Medical Knowledge
Medical Knowledge
Patient Care;
Interpersonal and
Communication Skills
Patient Care;
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patient relationship that facilitates
patients’ abilities to effectively
contribute to the decision making and
management of their own health
maintenance and disease treatment.
5.
Competently diagnose and
manage common medical problems in
patients.
6.
Assist in the diagnosis and
management of uncommon medical
problems; and, through knowing the
limits of her/his own knowledge,
adequately determine the need for
referral.
7.
Begin to individualize care through
integration of knowledge from the
basic sciences, clinical disciplines,
evidence-based medicine, and
population-based medicine with
specific information about the patient
and patient’s life situation.
8.
Demonstrate competence
practicing in ambulatory and hospital
settings, effectively working with other
health professionals in a team
approach toward
integrative care.
9.
Demonstrate basic understanding
of health systems and how physicians
can work effectively in health care
organizations, including:

Use of electronic communication
and database management for
patient care.

Quality assessment and
improvement.

Cost-effectiveness of health
interventions.

Assessment of patient
satisfaction.

Identification and alleviation of
medical errors.
Clerkship (PCC) OSCE
 PAP course performance at
TC campus, assessed by
tutors using global rating forms
and observed practical exams
 Preceptorship and CR & C
course performance at DU
campus
 Clinical rotation performance
 PCC OSCE
 Clinical rotation performance
Interpersonal and
Communication Skills
 Clinical rotation performance
 Documented achievement of
procedural skills in the
Competencies Required for
Graduation
Medical Knowledge;
Patient Care;
Practice-Based
Learning and
Improvement
 Clinical rotation performance
 Feedback from residency
directors
Patient Care; Medical
Knowledge;
Interpersonal and
Communication
Skills;
Professionalism
 Yr. 2 and PCC OSCE
 PAP course performance at
TC campus, assessed by
tutors using global rating forms
and observed practical exams
 Physician and Society (PAS)
course performance at TC
campus
 Preceptorship, CR & C, and
Introduction to Rural Primary
Care Medicine course
performance at DU campus
 Clinical rotation performance
 PAS course performance at
TC campus
 Medical Sociology and CR & C
course performance at DU
campus
 Clinical rotation performance,
especially the PCC
 Feedback from residency
directors
 Feedback from local health
plans
Practice-Based
Learning and
Improvement;
Systems-Based
Practice
Medical Knowledge;
Patient Care
Practice-Based
Learning and
Improvement;
Systems-Based
Practice
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10.
Competently evaluate and manage
medical information.
11.
Uphold and demonstrate in
action/practice basic precepts of the
medical profession: altruism, respect,
compassion, honesty, integrity and
confidentiality.
12.
Exhibit the beginning of a pattern of
continuous learning and self-care
through self-directed learning and
systematic reflection on their
experiences.
13. Demonstrate a basic understanding
of the healthcare needs of society and
a commitment to contribute to society
both in the medical field and in the
broader contexts of society needs.
 Critical reading exercises in
PAS and other courses at TC
campus
 Clinical Pathology Conference
performance and exercises in
Problem Based Learning
Cases at DU campus
 Year 2 Health disparities
project
 PCC EBM project
 PAS course performance at
TC campus
 Preceptorship and Cr & C
course performance at DU
campus
 Clinical rotation performance
 Participation in honor code and
student peer assessment
program
 Participation in anatomy
memorial
 Participation in volunteer
service activities
 PBL cases at DU campus
 Yr. 2 Health disparities project
 Clinical rotation performance
 Participation in research
Patient Care; Medical
Knowledge; PracticeBased Learning and
Improvement;
Systems-Based
Practice
 Course performance in all
years
 Introduction to Rural Primary
Care Medicine course project
at DU campus
 Involvement of students in
international study
 Enrollment in RPAP, RCAM,
and UCAM
 Yr. 2 Health disparities project
 Feedback from residency
directors
 Participation in volunteer
service activities
Patient Care; Medical
Knowledge; PracticeBased Learning and
Improvement;
Professionalism;
Systems-Based
Practice
Professionalism
Professionalism
These objectives are written to reflect the qualities and competencies expected of our graduates. Each
objective specifies the expected competency level to be attained by our students, the outcome measures used
to evaluate attainment of the objective, and the essential qualities and competencies of a physician (as defined
by the six ACGME Essential Competencies) addressed by the objective. The Accreditation Council for
Graduate Medical Education (ACGME) has formulated essential competencies felt to be necessary for
physicians practicing in the current health care climate. They are:

Patient Care that is compassionate, appropriate, and effective for the treatment of health
problems and the promotion of health
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




Medical 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
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 families, and other health professionals
Professionalism, as manifested through a 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 optimal patient care
Impaired Resident/Fellow and Procedure
POLICY STATEMENT
An impaired resident/fellow (trainee) is defined as any trainee who, by virtue of physical disability, mental
illness, psychological impairment, chemical substance abuse or misconduct, is unable to safely care for
patients, perform duties normally expected of a trainee physician or engage in peer interaction necessary for
patient care.
Documentation of perceived impairment must include written reports from at least two individuals (patients,
faculty, trainees, nursing staff or others) who have firsthand knowledge of an incident involving the trainee. The
final decision of what constitutes inability to perform duties shall rest with the program director.
The remedial measures in dealing with the impaired trainee require identification and immediate institution of
an appropriate treatment program. There must be available methods that identify stressors and factors within
the environment that could cause problems, and individual attributes that could put the trainee at risk.
Consultation with appropriate agencies/individuals including the Designated Institution Official (DIO),
Residency Assistance Program, the Director of Learner Development and/or the Office of General Counsel
may also be utilized.
The goal is to try to minimize the incidence of impairment. Resources have been developed to educate
trainees about physician impairment, including problems of substance abuse. Education includes
knowledge concerning signs and symptoms of impairment, emphasizing detection of abnormal behavior
associated with use of psychoactive drugs and alcohol abuse. Programs should include impairment
education in their regular didactic sessions.
PROCEDURE
Program Responsibility:
1. There should be regular documented monitoring of trainee performance by the program directors and the
faculty. When a suspicion of impairment is detected, an in-depth interview with the trainee by the program
director and one other faculty member shall be carried out. Mutually agreeable resources may be utilized to
establish the fact and severity of the impairment.
2. As soon as the program director has confirmed a trainee’s impairment there shall be:
a. An immediate referral to one or more of the following resources: Resident Assistance Program (RAP);
Health Professionals Services Program or Physicians Serving Physicians.
b. A restriction of privileges based on the impairment and privileges of the trainee.
c. A plan developed by the program director and the trainee for reduction, and/or elimination, of the
impairment. The plan should stipulate specific goals and objectives and methods of evaluation/monitoring. If
agreement is reached, both the program director and the trainee sign the plan. The original will be kept in the
trainee’s file, and copies sent to the trainee, the program director, and the department chair.
d. Reporting of a confirmed impaired physician shall be made to:
(1) the Minnesota Board of Medical Practice and carried out under the provisions of State of Minnesota
Statutes Chapter 147.111 Reporting Obligations.
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(2) the Designated Institution Official’s office. This includes periodic status reports.
e. If a leave of absence is involved in the plan, it must meet the criteria stated in the regulations of the
appropriate Specialty Board.
f. If the program director and the trainee cannot agree on either the fact of the impairment or plan for
remediation of the impairment, then the regular dismissal policies and procedures of the Medical School may
be utilized.
RESOURCES
 Resident/fellow Assistance Program: http://www.med.umn.edu/gme/residents/rap/home.html
 Health Professionals Services Program: http://mn.gov/health-licensing-boards/hpsp/
 Physicians Servicing Physicians: http://psp-mn.com/
 Minnesota Board of Medical Practice: http://mn.gov/health-licensing-boards/medical-practice/
 GME Well-Being Tools: http://www.med.umn.edu/gme/residents/wellness/home.html
American Board of Surgery-Requirements for Certification in Surgery
Please see the following URL for the complete resource on this topic:
http://home.absurgery.org/xfer/BookletofInfo-Surgery.pdf
ACGME Program Requirements for Residency Education in Surgery
Please see the following URL for the complete resource on this topic:
http://www.acgme.org/acWebsite/RRC_440/440_prIndex.asp
ACGME Surgical Operative Log Program
Tracking Your Operative Experience on the ACGME Surgical Operative Log Program
The Accreditation Council for Graduate Medical Education (ACGME), requires that the following groups of
residents use their system, the ACGME General Surgery, Resident Case Log System, for tracking your
operative experience:
Categorical General Surgery Residents
Urology Residents
Preliminary Residents
Per the ACGME “The resident experience log is an Internet based case log system utilizing CPT codes or ICD9-CM codes (ICD-9) to track resident experience. The Residency Review Committees have indexed these
codes into categories for evaluation. Any valid CPT or ICD-9 code can be entered in the application but only
those codes the RRC has selected will be evaluated for experience. This application was designed to allow
residents to enter procedures on a regular basis at their convenience. Entry can be done from any PC
connected to the Internet. The site is secured by encryption certificate obtained through the VeriSign
Corporation.”
Your operative log will be monitored by the Program Director, Dr. Chipman, and the Surgical Education Council
and it is reviewed with you at your biannual evaluation meetings.
Getting Started on the Resident Case Log System
Using your Internet-browser, go to the ACGME homepage at www.acgme.org. From the left column select-Data Collection Systems, Resident Case Log System, Login.
Your User ID and Password is your X500 for both, an example is:
User ID-johns756
Password-johns756
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If you would like to change your password click on the Change Password box on the log in page.
Please refer to the Data Entry Manual in the Help section for additional information. Please call Cathy Larson,
612-625-6483, or email Cathy at [email protected] and she can provide you with any additional information
or if you have any problems with this system.
Note some recent changes to operative log requirements:
Requirement for Endoscopy Numbers
Laparoscopy
Basic: 60 total cases
Cholecystectomy
Appendectomy
Advanced: 25 total cases
Lap, Gastrostomy and Feeding Jejunoscopy
Lap, Inguinal and Incisional Herniorrhaphy
Bariatric Laparoscopy
Lap, Anti-reflux Procedure
Lap, Enterolysis
Lap, Small and Large Bowel
Lap, Renal and Adrenal surgery
Lap, Donor Nephrectomy
Lap, Splenectomy
Endoscopy: 85 total
Upper endoscopy, including percutaneous endoscopic gastrostomy: 35 procedures
Colonoscopy: 50 procedures
Requirement to Pediatric Numbers
Pediatric Appendectomy 6
Pediatric Hernia 8
Total Pediatric cases 20
You must be familiar with the ACGME operative log requirements located at
http://www.acgme.org/acWebsite/RRC_440/440_info.asp
Credit roles for Surgery Residents
Only one resident may take credit as surgeon for each operation and only for one procedure in a multiprocedure operation. On same patient/same day/same operation a senior resident may take credit as surgeon
while another resident takes credit as a First Assistant, or a senior resident may take credit as a Teaching
Assistant while a more junior resident takes credit as a surgeon SC = Surgeon Chief Year (only cases credited
as surgeon during 12 months of Chief Year)
J = Surgeon Junior Years (all cases credited as surgeon prior to Chief Year) TA = Teaching Assistant (more
senior resident working with junior resident who takes credit as surgeon) FA = First Assistant (any instance in
which a resident assists at an operation with another surgeon---an attending or more senior resident--responsible for the operation)
Critical Care Cases
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Select the patients who best represent all the essential aspects of intensive care unit management. Each
resident is to develop a Critical Care Index Case (CCIC) log of at least 20 patients who best represent the full
breadth of critical care management. At least two out of the seven categories listed below should be
applicable to each chosen patient. The completed CCIC log should include experience, with at least one
patient, in all seven of the following essential categories.
You must enter such cases in the SOL system and on the log at both the SC & SJ level. Please make sure
you have entered cases for all areas, do not miss 99199-multible organ trauma no operation required.
Must report Critical Care experience for all areas as both SC and SJ, and 1 pt with all options
Multi Organ Trauma-No Operation Required
Must report both SJ & SC experience with Sentinel Lymph Node Biopsy SLN Breast code # 38525B
You must meet or exceed all Defined Category Numbers
Surgery Research Resident Manual
Please see the following URL for the complete resource on this topic:
http://www.surgery.umn.edu/prod/groups/med/@pub/@med/@surg/documents/asset/med_asset_241168.pdf
Residency Management Suite
To use Residency Management Suite:
You will need to use an IBM compatible computer.
1. To access RMS, open your Internet browser to access RMS.
Website: https://www.new-innov.com/Login/
Institution’s login: mmcgme
Username: user specific
2. Password: user specific
**If you do not remember your username and/or password, contact the Surgical Education Office,
Michelle Lunden directly at 612-626-2590 or the Surgical Administrative Center RMS coordinator, at 612626-4959.
3. It is highly recommended to bookmark this page. By doing that, you will not have to enter mmcgme
every time.
4. Once in the system, you will see a menu on the top of the screen for your options. Under Main choose
Duty Hours. Once to the Duty Hours main page there will be a bold header saying Logging Hours.
Click on the My Duty Hour link under that. On this screen you will see 4 Data Entry Views to choose
from. PLEASE NOTE: You can choose whatever method you want; however, it has been found that
the Graphical entry screen is the best for your specific specialty. Because of this, only directions on
Graphical and Vacation/Leave are outlined below.
A. Graphical
The screen that RMS defaults to is the graphical data entry screen. Pick the day to log hours
off the calendar then click the continue button. From this screen you will see the full week
around the day you picked. Choose the appropriate Assignment Definition from the drop
down box and fill in duty hours by color coding the daily hours. You can fill in multiple days
and multiple assignments all on one screen. Click on save when done. You can also edit in
bulk here if changes need to be made to past assignments. This will be used most often to
log hours after they have happened.
D. Vacation/Leave
This screen allows you to pick the correct Time Away designation to track vacation and leave.
Make sure you have the correct Assignment Definition chosen and then simply click on the first
day of vacation in the first calendar and the last day of vacation in the second calendar. There
are five different Vacation/Leave Assignment Definitions.
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1. Time Away-Does NOT Extend Training-Short
This Assignment Definition should be chosen if you will be gone for 14 days or
less.
2. Time Away-Does NOT Extend Training-Short-Education
This Assignment Definition should be chosen for approved Academic Leave time.
3. Time Away-Does NOT Extend Training-Short-Holiday
This Assignment Definition should be chosen for approved Holiday Leave time.
4.
Once hours have been logged on the system, it is important to make sure no
conflicts and that all hours are approved. To do this scroll over My Duty Hours
and click on Approve My Hours. You can also click on the blue Approve
Existing Hours link on the main Duty Hour page. After picking the appropriate
date range the only hour that will show up are hours either not approved or in
conflict (these will be marked with an asterisk). To clear up conflicts either edit
the entries or mark the incorrect one with Did Not Work. Make sure to approve
all hours worked with Approve Selected Entries.
5.
Make sure to logout of the system until you are ready to log more hours.
Resident Duty Hours in the Learning and Working Environment
Duty Hour Policy, GME: http://www.med.umn.edu/gme/instpolicyman/genpolprocdutyhrpol/home.html
Residency Management Suite (RMS) Updating and Approving Assignments and Hours in Duty Hour Module of
RMS, GME
http://www.med.umn.edu/gme/instpolicyman/genpolprocrms/home.html
Principles
The program must be committed to and be responsible for promoting patient safety and resident well-being
and to providing a supportive educational environment.
The learning objectives of the program must not be compromised by excessive reliance on residents to fulfill
service obligations.
Didactic and clinical education must have priority in the allotment of residents’ time and energy.
Duty hour assignments must recognize that faculty and residents collectively have responsibility for the safety
and welfare of patients.
Fatigue
Cab vouchers available for any trainee who feels or is deemed by another that they are too impaired to drive
safely home.
Faculty and residents must be educated to recognize the signs of fatigue and sleep deprivation and must adopt
and apply policies to prevent and counteract its potential negative effects on patient care and learning.
Duty Hours (the terms in this section are defined in the ACGME Glossary)
Duty hours are defined as all clinical and academic activities related to the program; i.e., patient care (both
inpatient and outpatient), administrative duties relative to patient care, the provision for transfer of patient care,
time spent in-house during call activities, and scheduled activities, such as conferences. Duty hours do not
include reading and preparation time spent away from the duty site.
Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house
call activities.
Residents must be provided with one day in seven free from all educational and clinical responsibilities,
averaged over a four-week period, inclusive of call.
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Adequate time for rest and personal activities must be provided. This should consist of a 10-hour time period
provided between all daily duty periods and after in-house call.
Reporting Duty Hour Violations, GME
In accordance with the Institution Duty Hour Monitoring Policy trainees concerned about continuous duty hour
violations by their program can contact the Designated Institution Official or send a confidential email to
[email protected]
Supervision of Residents
Supervision Policy, GME GME Institution Manual or
http://med.umn.edu/gme/InstitutionPolicyManual2013/index.htm
University of Minnesota Department of Surgery
Resident Supervision Policies and Procedures
Effective July 1, 2014
Policy Overview
This document summarizes the University of Minnesota Department of Surgery (DOS) policies and procedures
regarding resident supervision. These policies are designed to be 100% compliant with the 2014 ACGME
Program Requirements. It is mandatory that all residents and faculty understand and uphold these policies at
all times.
Levels of Supervision
• Direct Supervision: supervising physician is physically present during the procedure/encounter.
• Indirect Supervision: supervising physician is available by phone, text, or pager to be able to provide
Direct Supervision
• Oversight: supervising physician reviews the procedure/encounter at a later time and provides
feedback after care is delivered.
Principles of Supervision of All Residents (PGY-1 to PGY-5)
All residents are supervised by an identifiable, credentialed, and privileged attending surgeon faculty who is
ultimately responsible for that patient's care. This information is readily available to residents, faculty
members, and other health care professionals at each hospital. Additionally, every patient is apprised of who
this attending is upon admission to the hospital. Typically, this information is available to the patient with
complete information about the care team at the facility (resident, fellow, faculty, nurse, etc.) This also clarifies
the roles of each member of the care team for the patient. Attending call schedules are available through the
hospital operators. Additionally, most sites have attending call schedules available on line. Direct Supervision
is provided in the operating room for all residents when performing cases at our training institutions.
Guidelines for Specific Circumstances and Events
The University of Minnesota Physicians faculty practice has established guidelines for when attending
physicians are to be notified about patient care issues. While not all-inclusive, residents are also expected to
contact attending staff for other issues as needed. Each resident is provided a card listing the guidelines to
attach to his/her identification badge as a reminder. Additionally, the UMMC SICU rotation has a similar card
as noted below. Residents are required to notify attending staff specifically for the following indications.
University of Minnesota Physicians Surgery Attending Physician Notification Guidelines
• Admission to the hospital
• Transfer to ICU or higher level of care
• Unanticipated intubation or ventilator support
• Development of new significant neurological changes (e.g. CVA, seizure, new onset of paralysis, acute
decline in level of consciousness)
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•
•
•
•
•
•
•
Development of new significant cardiac changes (e.g. CODE, serious arrhythmia, PE, hemodynamic
instability)
Development of major wound complications (e.g. dehiscence or evisceration)
Medication or treatment errors requiring clinical intervention (e.g. invasive procedures, increased
monitoring, new medications except Narcan)
Unanticipated blood transfusion without prior attending knowledge or instruction (before or after
operation)
Development of any clinical problem requiring an invasive procedure or operation
Patient, family, or clinical staff request for attending notification
Death
UMMC SICU Rotation “When to Call the Attending” Card
• Any new admission
• Pulmonary Issues
• Hypoxia
o No response to FIO2 > 60%
o Any new intubation
• High airway pressures
• Respiratory arrest
• Cardiovascular arrest
• New symptoms or evidence of myocardial ischemia or worsening of chronic angina
• Evidence of left ventricular failure or fluid overload not responsive to a first attempt at diuresis
• Hypotension
o Refractory to fluid administration (how much is your judgment)
o Need to start a pressor
• Need to place a pulmonary artery catheter for volume (preload) or cardiac pump (contractility) status
• Dysrhythmias
o Sinus tachycardia unresponsive to fluids
o Bradycardia
o Tachydysrhythmias (atrial fibrillation, flutter, etc.)
• Escalation of antihypertensive therapy (i.e. starting a drip)
• Significant decline in renal function including oliguria unresponsive to fluid resuscitation, or rise in
BUN or creatinine
• Significant change in neurological status or new seizure activity
• Any death (unless planned comfort care)
• Other Issues
• Inability to resuscitate
• Any time you are uncertain or need help
• Major change in course
• Remember Airway, Breathing, Circulation (i.e. stabilize the patient)
• Formulate a plan before you call
• Use other resources (residents/interns) in the hospital if needed
• Additional thoughts
o It is better to be aware of a problem than discover it during rounds
o More minds working a problem consider more solutions
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•
Attending staff are with you and want to help
We recognize that starting this academic year, particular levels of residents require more strict attention and
accountability for activities within our hospital systems, especially as this pertains to procedural skills. We are
keenly aware of this and in fact, in a proactive way, have been functionally utilizing our SimPORTAL curriculum
with this exact paradigm in mind for several years. This year, we have formally introduced a supervision policy
as it relates to the new requirements in this area.
PGY-1: Indirect Supervision
PGY-1 residents may be indirectly supervised for the following. Supervision will be by senior members of the
resident teams, fellows, or attending faculty. Direct supervision may be appropriate depending on the
resident's level of proficiency. The basic competencies that are addressed below are introduced in a
structured way as part of our PGY-1 bootcamp experience. Taken together, supervision occurs during daily
rounds and other reporting structures currently in place:
1. Patient Management Competencies
a. evaluation and management of a patient admitted to hospital, including initial history and
physical examination, formulation of a plan of therapy, and necessary orders for therapy and
tests
b. pre-operative evaluation and management, including history and physical examination,
formulation of a plan of therapy, and specification of necessary tests
c. evaluation and management of post-operative patients, including the conduct of monitoring, and
orders for medications, testing, and other treatments
d. transfer of patients between hospital units or hospitals
e. discharge of patients from the hospital
f. interpretation of laboratory results
2. Procedural Competencies
a. performance of basic venous access procedures, including establishing intravenous access
b. placement and removal of nasogastric tubes and Foley catheters
c. arterial puncture for blood gases
PGY-1: Direct Supervision
Until competency is demonstrated, PGY-1 residents require direct supervision for the following. In each
situation below, PGY- 1 residents know to alert more senior residents (or attendings) who are expected to
supervise patient care and who’s role on the care teams is to provide care in these situation. For example,
patients with hypotension, oliguria, cardiac arrhythmias, etc. are cared for in the intensive care units. The ICU
teams are led by PGY-2 residents or above.
1. Patient Management Competencies
a. initial evaluation and management of patients in the urgent or emergent situation, including
urgent consultations, trauma, and emergency department consultations (ATLS required)
b. evaluation and management of post-operative complications, including hypotension,
hypertension, oliguria, anuria, cardiac arrhythmias, hypoxemia, change in respiratory rate,
change in neurologic status, and compartment syndromes
c. evaluation and management of critcially-ill patients, either immediately post- operatively or in the
intensive care unit, including the conduct of monitoring, and orders for medications, testing, and
other treatments
d. management of patients in cardiac or respiratory arrest (ACLS required)
2. Procedural Competencies
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a. carry-out of advanced vascular access procedures, including central venous catheterization,
temporary dialysis access, and arterial cannulation
b. repair of surgical incisions of the skin and soft tissues
c. repair of skin and soft tissue lacerations
d. excision of lesions of the skin and subcutaneous tissues
e. tube thoracostomy
f. paracentesis
g. endotracheal intubation
h. bedside debridement
Methods for Determining Progression from Direct to Indirect Supervision
• PGY-1 Orientation Bootcamp and Simulation Skills Pre-Test
• PGY-1 Simulation Skills Post-Test
• PGY-1 Onsite Faculty Evaluation
• Competency Passport: Residents will carry a booklet (Passport) that contains the competencies where
documentation is required prior to being able to perform the procedure with indirect supervision.
On-Call Schedules
On-call schedules are located on AMION at http://amion.com - The pass code is surgerymn.
If you are on-call the night before you begin a new rotation you must inform the education office that will be
creating your call schedule, so that you are not placed on call back to back.
Resident days off, during which they are free of all responsibilities, should be built into the specific call
schedules for each site. Thus, each resident will know specifically which days they are to have off, without
exception. This allows us to formalize days off for each resident and it also permits us to track compliance with
this RRC requirement.
Clearly some flexibility is required because of the demanding and variable nature of the surgical services. The
RRC recognizes this and that is why it is stated that residents have 1 day out of 7 free, on average. Therefore,
this policy should not be construed as a mandatory weekly day off, but one that provides on average, 1 day out
of 7 free.
Moonlighting Policy, GME GME Institution Manual or
http://med.umn.edu/gme/InstitutionPolicyManual2013/index.htm
General Surgery Resident Rotation Dates for 2014-2015
PGY-1
June 16, 2014 through June 15, 2015
6/16/14-7/13/14
4wks
7/14/14-8/10/14
4wks
8/11/14-9/7/14
4wks
9/8/14-10/5/14
4wks
10/6/14-11/9/14
5wks
11/10/14-12/14/14
5wks
12/15/14-1/11/15
4wks
1/12/15-2/15/15
5wks
2/16/15-3/22/15
5wks
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3/23/15-4/19/15
4wks
4/20/15-5/17/15
4wks
5/18/15-6/15/15
4wks
VA Orthopaedic Rotation Dates on Surgery Rotations
6/16/14-6/20/14
5 weeks
7/21/14-8/17/14
4 weeks
8/18/14-9/14/14
4 weeks
9/15/14-10/12/14
4 weeks
10/13/14-11/9/14
4 weeks
11/10/14-12/14/14
5 weeks
12/15/15-1/11/15
4 weeks
1/12/15-2/15/15
5 weeks
2/16/15-3/22/15
5 weeks
3/23/15-4/19/15
4 weeks
4/20/15-5/17/15
4 weeks
5/18/15-6/14/15
4 weeks
PGY-2
July 1, 2014 through June 30, 2015
7/01/14-8/10/14
5wks
8/11/14 - 9/14/14
5wks
9/15/14-10/26/14
6wks
10/27/14-12/7/14
6wks
12/8/14 - 1/19/15
6wks
1/20/15- 3/1/15
6wks
3/2/15-4/12/15
6wks
4/13/15-5/17/15
5wks
5/18/15-6/30/15
6wks
PGY-3
July 1, 2014 through June 30, 2015
7/01/14-8/24/14
7 weeks
8/25/14-10/26/14
9 weeks
10/27/14-1/1/15
9 weeks
6 days
3 days
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1/2/15-3/1/15
8 weeks
3/2/15-5/3/15
9 weeks
5/4/15-6/30/15
8 weeks
4 days
2 days
PGY- 4
June 13, 2014 through June 11, 2015
Long
Short
6/13/14-12/14/14
6/13/14-8/17/14
9 weeks
26 weeks
8/18/14-10/19/14
9 weeks
12/15/14-6/11/15
10/20/14-12/14/14
8 weeks
26 weeks
12/15/14-2/15/15
9 weeks
2/16/15-4/19/15
9 weeks
4/20/15-6/11/15
8 weeks
3 days
3 days
PGY- 5
June 13, 2014 through June 12, 2015
6/13/14-8/17/14
9 weeks
8/18/14-10/19/14
9 weeks
10/20/14-12/14/14
8 weeks
12/15/14-2/15/15
9 weeks
2/16/15-4/19/15
9 weeks
4/20/15-6/12/15
8 weeks
3 days
Revised 5/13/14
ABSITE Performance Standards Department of Surgery Policy
Starting in 2008-09 and the 2009 ABSITE, the Department created a new policy regarding performance. This
policy is as follows:

Scoring below the 30th percentile (Total Test Score) on the ABSITE for the first time places a resident at
risk for academic probation. The at-risk status is removed if the resident’s subsequent year’s
performance exceeds the 30th percentile.
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
Scoring two times in a row below the 30th percentile results in automatic academic probation. The
probationary status is removed from the resident’s file if the subsequent year’s performance exceeds
the 30th percentile.

Scoring below the 30th percentile for a second time in three or more years, after one or more years of
improved performance, places the resident back in the at-risk status for academic probation.

Scoring three times below the 30th percentile (either sequentially or intermittently), despite attempts at
remediation, and in combination with poor performance in other areas, places a resident at risk for
dismissal from the program. The ABSITE score will never constitute the sole criterion for promotion
decisions or dismissal, however it has been shown to be a valid predictor of performance on the written
ABS board exam, and as such will be taken very seriously in determining satisfactory progress towards
graduation.

Residents at-risk for academic probation, and those on probation due to their performance on the
ABSITE, are required to participate in remediation as directed by the Department.

Residents who are at risk or on academic probation during any year they are scheduled for the
research lab will have their moonlighting privileges significantly reduced or removed. Privileges will be
regained if performance on the subsequent year’s ABSITE exceeds the 30th percentile.
Communication Policy
1.
All general announcements and information will be disseminated via email.
2.
Residents/Fellows are required to maintain an active email address and access it at least weekly.
3.
Resident/Fellows may use a personal email address in lieu of their University X.500 address but must
forward their University address to their personal address.
Grand Rounds Compliance
1. Attendance at Grand Rounds is monitored and each resident must attend Grand Rounds and Core
Curriculum.
2. Promotion to the next year of training is predicated upon documented attendance at ≥ 70 percent of Grand
Rounds sessions during the academic year.
3. Attendance at Grand Rounds is mandatory for all General Surgery Residents at all training sites, including
those participating in research endeavors, as it is critical for their training. The only exceptions are those
residents who are on call the evening prior at non-UMMC sites, any trainees involved in emergent patient care,
and residents on vacation.
Dress Code Policy
All Department of Surgery Residents and Fellows will comply with the University of Minnesota, Medical School,
Graduate Medical Education Committee Dress Code Policy listed below.
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In addition, all Department of Surgery Residents and Fellows will dress appropriately such that while attending
conferences and when participating in all training activities shirts/ties and business attire are worn. Post call
residents must be neatly groomed and clean.
Please see the following URL for the complete resource on this topic: GME Institution Manual or
http://med.umn.edu/gme/InstitutionPolicyManual2013/index.htm
UMMC On Call Rooms
University of Minnesota Medical Center has 18 on-call rooms located on the 4th floor of the Mayo building. All
rooms have punch code security access which is changed daily and contain a desk, TV, clock radio, and air
conditioning, with a security monitor on duty from 2:00 pm-8:00 am.
On-call Residents, on-call Medical
Students, on-call fellows, on-call attending physicians and certain on-call hospital staff are eligible to check-in
to a call room. Check-in can only occur during the designated check-in hours of 2:30 pm until 7:00 am. To
check-in, go to the check-in desk located in the Resident Lounge (Mayo C-496). The check-in desk is staffed
by a security monitor during set hours 7 days/week and will require you to present your hospital ID badge. The
security monitor will assign you a room and give you the access code along with the locker room and lounge
access codes. All individuals must be out of their rooms by 8:00 am. Housekeeping will come to begin
cleaning by 7:00 am. If you wish to sleep until 8:00 am, make sure your DO NOT DISTURB sign is indicated
on your door. No room is checked out to the same service two days in a row. Belongings left in room past
noon will be removed and kept in a security locker. Belongings can be picked up any time after 2:30 pm from
the security monitor.
UMMC General Surgery Resident/Fellow Workroom
The Department of Surgery Resident Workroom is located in 11-145C PWB. The room contains two
computers and two local printers. The room also has a built in desk and refrigerator.
UMMC Resident Lounge
The Resident Lounge at the University of Minnesota Medical Center is located in Room 6-501 in Unit J and is
available 24 hours per day for residents from all specialties. The room is accessible by punch code access,
which is changed weekly, or by open door when security monitor is on duty. TV/VCR, computers, and phones
with access to the main hospital are available. There is also a partially stocked kitchen with refrigerator,
coffee/tea makers, microwave, and toaster.
Support Services
Please refer to the Institution Manual for different services that are offered to Residents and Fellows, GME
Institution Manual or
http://med.umn.edu/gme/InstitutionPolicyManual2013/index.htm
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Visa Sponsorship Policy
The J-1 alien physician visa sponsored by ECFMG is the preferred visa status for foreign national trainees in
all UMN graduate medical education programs; therefore, the Department of Surgery sponsors only J-1 visas.
We do not sponsor H-1B visas. More information on the J-1 visa can be found on the UMN-GME webpage.
GME Institution Manual or
http://med.umn.edu/gme/InstitutionPolicyManual2013/index.htm
Laboratory/Pathology/Radiology Services
Laboratory, pathology, and radiology services are readily available through University of Minnesota Medical
Center. Below is the contact information and location of each of these medical services:
UMMC Diagnostic Laboratories
Mayo Medical Building, Room D-293
420 Delaware Street SE, MMC 198
Minneapolis, MN 55455
Tel: 612-273-7838
Fax: 612-273-0183
Pathology
Pathology Department (also, Pathology Surgical, Mayo Room 422, MMC 76)
Mayo Medical Building, Room C-477
420 Delaware Street SE, MMC 609
Minneapolis, MN 55455
Tel: 612-273-5920
Fax: 612-273-1142
Radiology
Radiology Department (also, Reading Rooms, Registration)
Harvard at East River Road (UH), Room 2-300 (all divisions: MMC 292)
Minneapolis, MN 55455
Tel: 612-273-5690
Fax: 612-273-8954
Interventional CV Radiology, UH-2-300
Tel: 612-273-4220
Fax: 612-273-7500
Radiology Engineering, UH 2-493
Tel: 612-273-6801
Fax: 612-273-6887
Radiology Film Desk Hospital, UH 2-403
Tel: 612-273-5777
Fax: 612-273-7515
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Medical Records
Patient records can be accessed either via the UMP Electronic Medical Records (EMR) system as far back as
January 1, 2002, or by calling University of Minnesota Medical Center’s (UMMC) Health Information
Management (HIM) offices at 612-626-3535.
For official medical record retrieval, patients are to contact the UMMC’s HIM offices at:
University of Minnesota Medical Center
ATTN: Release of Information
420 Delaware Street SE, MMC 601
Minneapolis, MN 55455
Tel: 612-626-3535
Fax: 612-273-2345
Security/Safety University of Minnesota Medical Center
The Security Monitor Program (SMP) is a branch of the University of Minnesota Police Department. SMP
offers a walking/biking escort service to and from campus locations and nearby adjacent neighborhoods. This
service is available completely free to students, staff, faculty, and visitors to the University of Minnesota – Twin
Cities campus. To request an escort from a trained student security monitor, please call 624-WALK shortly
before your desired departure time and walk safe.
Fairview University Medical Center also employes security officers who are on duty 24 hours a day to respond
to emergencies and to escort persons to and from the parking facilities. A security officer is available after 2:20
PM Monday- Friday, you may calltheur offuce at 612-273-4544. If you wish to take the shuttle it runs 7 00 AM2:20 PM, Monday Friday every 20 minutes.
Monitoring of Resident Well-Being
Available to all residents is the Resident Assistance Program (RAP). In order to monitor resident stress,
including mental or emotional conditions inhibiting performance or learning, and drug or alcohol related
dysfunction, the University of Minnesota Medical School has contracted with an agency called Sand Creek to
provide services for you or anyone in your family.
Sand Creek’s counselors have particular expertise in dealing with the unique needs of individuals in their
residency training programs. In contacting them, you will receive help in determining the problem, what should
be done, and how to go about it.
Your privacy is a primary concern. That is why an outside firm provides your RAP services. Your counselor
will keep everything strictly confidential. Nothing is disclosed to your faculty or to others without your written
consent.
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The RAP services cost you nothing for the initial assessment. Depending on your needs, you may be referred
to outside sources of help. If so, you will receive assistance in finding an appropriate, affordable resource.
Your health insurance does provide portions of coverage for personal counseling, psychiatric care, chemical
dependency and drug treatment.
Whether you have an emergency on your hands or you simply need someone to help you sort things out, there
is help. A counselor will quickly respond to your call. When the Sand Creek’s office is closed, an answering
service will take your call and relay your message. In an emergency, a counselor will contact you immediately.
You may discuss your concerns with a counselor at the Sand Creek Office or a counselor will meet you at your
hospital. The RAP is designed to be flexible and to accommodate your busy schedule.
Sand Creek
www.sandcreekeap.com
610 North Main Street, Suite 200, Stillwater, MN 55082
Tel: 651-430-3383 or 1-888-243-5744
Section 6 Department of Surgery Contacts
Surgical Education Office
Fax: 612-625-4411
Location: 11-145 A-F PWB
Jeffrey G. Chipman, MD
612-625-7129
[email protected]
Surgery Program Director
Melissa Brunsvold, MD
612-626-2867
[email protected]
Surgery Associate Program Director
Robert D. Acton, MD
612-626-4214
[email protected]
Surgery Associate Program Director &
Medical Student Director
Connie Schmitz, Ph.D.
612-624-1722
[email protected]
Director of Educational Research &
Development
Gina Deveney
612-625-3141
[email protected]
GME Associate Administrator
Niea Johnson
612-626-2590
[email protected]
Medical Student Coordinator
Cathy Larson
612-625-6483
[email protected]
General Surgery Residency Coordinator
Michelle Lunden
612-626-2590
[email protected]
Resident Education Assistant
Surgery Chairman’s Office
Fax: 612-626-0654
Location: 11-132 PWB
David Rothenberger MD
612-626-1999
[email protected]
Jay Phillips Professor and Chairman
Ann Lavallee
612-626-1999
[email protected]
Executive Administrator
Surgery-Admin Center Contact
Fax: 612-626-0654
Location: 11-132 PWB
Sherri Novitsky
612-625-1174
[email protected]
Surgery Dept. Administrator
Surgery Research
Lisa Rogers
612-626-3843
Location: 11-135 PWB
[email protected]
Research Coordinator
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