General Surgery Red PGY 3

Length of Goals: 3 Months

Goals

Riverside County Regional Medical Center will provide a learning environment for the PGY-3 resident to develop cognitive and technical skills in dealing with surgical diseases of foregut, midgut and hindgut. Clinically, residents will assess surgical pathology pre-operatively, develop clinical judgment on managing these issues, and learn operative skills to address the problem.  Careful postoperative care and follow up will be emphasized.

Objectives

Medical Knowledge

• Describe the blood supply and anatomy of stomach and duodenum
• Describe clinical presentation and management of gastrointestinal bleeding
• Describe pathophysiology of ulcer disease
• Explain different options for placement of gastrostomy and jejunostomy tubes
• Explain post-vagotomy syndromes and their diagnosis as well as their management
• Describe pathophysiology, management and natural history of pancreatitis and pseudocysts
• Describe avoiding biliary injury
• Describe pathophysiology of common bile duct, sphincter of oddi, as well and feedback mechanisms of endocrine and paracrine pathways of liver, stomach, duodenum and pancreas
• Describe the blood supply of the small and large bowel
• Demonstrate understanding of the physiology of small and large bowel
• Explain the screening guidelines for colon cancer
• Be able to describe genetic syndromes and their relationship to development of gastrointestinal cancers
• Describe different types of polyps and their managements
• Describe differences between different types of colon resection
• Show good understanding of inflammatory bowel disease, including their diagnostic work up and acute vs chronic management
• Demonstrate knowledge and management of enterocutanous fistulae
• Explain relationship of inflammatory bowel disease to development of colonic malignancy
• Explain pathophysiology of metastatic spread in gastrointestinal cancers
• Explain the role of chemotherapy and radiation therapy in the management of gastrointestinal malignancies

Assessment

• Oral exam at the clinical case conference.
• During the formative evaluation at the end of the rotation.
• Annually at the in-training examination

Patient Care

• Demonstrate proficiency with upper and lower endoscopies
• Be able to perform percutanous endoscopic gastrostomies
• Perform intestinal anastamoses
• Manage perforated viscus
• Show competence in managing patients with acute and chronic pancreatitis including both surgical and medical managements
• Perform common bile duct exploration with or without use of T-tube
• Demonstrate skills in performing;
  • Gastric resection
  • Pseudocyst drainage
  • Small bowel resection
  • Mobilization of splenic flexure
  • Colon resection
  • Modified radical mastectomy
  • Axillary lymph node dissection
  • Ventral hernia repair
  • Component separation – open and laparoscopic
• Is capable of managing enterocutanous fistulae
• Is familiar with and able to use effectively the endo-GIA staplers, harmonic scalpel and ligature devices
• Is proficient in diagnosing and managing abdominal wound dehiscence
• Demonstrates skills in managing open abdominal wounds, complex ostomies, and the use of wound VAC

Assessment

• Patient care and technical skills will be assessed by the attending surgeon in a daily basis.
• Technical skills will be assessed at the skills laboratory.
• During the formative evaluation at the end of the rotation

Professionalism

• Never leaves the operating room with old masks and shoe covers
• Is always on time to the clinic and appears appropriately dressed
• Becomes a great role model for the students and junior residents
• Handles difficult and stressful situation with a professional demeanor
• Accepts criticism well appears to be motivated to learn from them,
• Complete professionalism curriculum for the month "Professionalism in Surgery: Challenges and Choices"

Assessment

• Residents will complete a one page discussion of the vignette including lessons learned. This document will be added to the resident's portfolio
• Residents will participate in one of two grand rounds on professionalism schedule for the second week of December and June. During these grand rounds residents will make a presentation of a case in which they applied lessons learned on professionalism in surgery. The presentation and its content will be assessed by the faculty present

Systems-Based Practice

• Shows familiarity with the hospital drug formulary
• Effectively anticipates patients discharge needs in advance arranges for home health care and rehab or SNF placement
• Is able to understand availability of hospital resources and accordingly arranges and obtains laboratory and diagnostic imaging studies
• Attends and effectively participates in multidisciplinary conferences
• Complete the Systems Based Practice Curriculum for the current month

Assessment

• Will present the reports in one of the two annual Grand Rounds on Systems-Based Practice in November or May where the presentation will be assessed by the faculty present.

Practice-Based Learning & Improvement

• Demonstrate the ability to obtain most up-to-date practice guidelines and apply it to the patient's care
• Effectively discusses complications and deaths in the morbidity and mortality conference
• Is able to incorporate operative personal experience with literature to learn from his/her mistakes
• Performs root cause analysis of undesired outcomes or events and is able to implement changes to prevent them from happening again.
• Participates in tumor board and discussed management of cancer patients with other providers using the latest information from clinical trials and peer review journals
• Complete the Personal Learning Project in the Practice Based Learning and Improvement curriculum for the month

Assessment

• The completed PLP will be added to the resident's electronic portfolio and presented semi-annual evaluation

Interpersonal & Communication Skills

• Completes operative reports effectively and on time
• Is capable of communicating effectively with other providers
• Conducts family meetings where he/she is capable of providing informative and compassionate updates to the patient and their families
• Understands, respects and follows HIPA guidelines in communicating with others
• Is able to effectively discuss end of life issues with the patients and their families
• Effectively hands of patient's care in the evenings and weekends
• Resident must complete the assignment established for the months of rotation from the ACS DVD "Disclosing Surgical Error" and "The interactive learning resource for healthcare communication" from Drexel University and American Academy on Communication in Healthcare:

 Assessment

• Residents are required to write a one page summary of their conclusion and lessons learned from each of the ACS vignettes.
• The two summaries will be turned into the residency office before the first semi -annual interview. Residents will be prepared to discuss the vignettes with the program director.
• For the topics "giving bad news" and "discussing medical errors" Residents will be required to complete the on-line questions for each presentation and print the certificate that they passed the test.

Conference Attendance: Conference attendance is mandatory at the hospital in which you are rotating. The Clinical Case Conference is required for all PGY 3 residents and is held at RCRMC, if you are at Kaiser, you are released from your duties to attend this lecture series. All residents attend Wednesday Educational Day conferences at RCRMC.