AM Acute Care Surgery PGY 2

Length of Rotation: 2 months
Rotation Supervisor: Drs. Agapian and Depew

Goals

Riverside County Regional Medical Center (RCRMC) will provide a learning environment for the care and management of the emergency surgery and trauma patient.  Surgical basic science will be emphasized, including pathophysiology and patterns of injury.  Clinically, residents will assess the patients emergently presenting to the emergency department for acute surgical problems and injuries, develop clinical judgment on managing these issues, and learn operative skills to address the problem.  Careful postoperative care and follow up also will be emphasized.  Residents will develop cognitive and technical skills in dealing with complex, acutely ill patients.

Objectives

Medical Knowledge

  • Outline the basic techniques of evaluation and resuscitation of trauma patients using the Advanced Trauma Life Support (ATLS) protocol.
  • Develop an understanding of the principles of pre- and post-surgical operative care for trauma and general surgical patients.
  • Know the indications for thoracotomy in the setting of hemothorax and of pneumothorax.
  • Describe chest tube management in the setting of hypoxia and of air leak.
  • Make and close a variety of incisions and describe exposure maneuvers for trauma.
  • Describe the basic principles of and indications for trauma laparotomy and damage control laparotomy.
  • Describe the basic management of intra-abdominal solid organ injury, including:
    • Nonoperative management of spleen and liver injuries
    • Splenectomy, splenorrhaphy, and hepatorrhaphy
    • Role of angiography with embolization
  • Describe the basic management of intra-abdominal hollow organ injury, including:
    • Bowel repair and resection
    • Role of stomas
  • Describe the basic management of genitourinary injury.
  • Describe the role of nonoperative management of penetrating abdominal injuries.
  • Describe injury patterns in pregnant women and the elderly.
  • Know indications for Caesarean section in trauma.

Patient Care

  • Establish proficiency in directing pre-operative and post-operative care, including initial resuscitation and discharge planning.
  • Demonstrate an increasing level of skill in the physical examination of the general surgery patient with a special emphasis in recognition of the surgical abdomen.
  • Develop a proficiency in evaluation and interpretation of the different diagnostic modalities including: X-Rays, ultrasounds, CT scans, contrast studies and MRIs, as well as when they are not needed for work-up.
  • Discuss treatment options, risks and potential complications of patients with general surgical issues.
  • Demonstrate proficiency in clearing spines from injury.
  • Work on gaining competency in:
    • Central line placement
    • Arterial line placement
    • Dialysis catheter placement
    • Tube thoracostomy
  • Demonstrate skill in basic surgical techniques, including:
    • Exposure
    • Knowledge of instrumentation
    • Incisions
    • Closure of incisions
    • Handling of graft material including mesh
    • Establishing pneumoperitoneum
    • Handling of laparoscopic instruments
    • Handling of the laparoscopic camera

Professionalism

  • The resident should be receptive to feedback on performance, attentive to ethical issues and be involved in end-of-life discussions and decisions.
  • Understand the importance of honesty in the doctor-patient relationship and other medical interactions.
  • Treat each patient, regardless of social or other circumstances, with the same degree of respect you would afford to your own family members.
  • Learn how to participate in discussions and become an effective part of rounds, attending staff conference, etc.
  • Complete all assigned patient care tasks for which you are responsible or provide complete sign out to the on-call resident.
  • Maintain a presentable appearance that sets the standard for the hospital this includes but is not limited to adequate hygiene and appropriate dress.
  • Assist with families of critically injured/ill patients and guidance of families towards or through difficult decisions.
  • Demonstrate mentoring and positive role-modelling skills.
  • Finish hospital documentation in a timely manner, including discharge paperwork and signing telephone orders.

Systems-Based Practice

  • Understand, review, and contribute to the refinement of clinical pathways.
  • Understand the cost implications of medical decision-making.
  • Partner with health care management to facilitate resource efficient utilization of the hospital resources.
  • Describe in general terms the benefits of clinical pathway implementation.
  • Develop a cost-effective attitude toward patient management.
  • Develop an appreciation for the benefits of a multi-disciplinary approach to management of critically ill surgical patients.
  • Comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations regarding patient privacy and confidentiality.

Practice Based Learning & Improvement

  • Demonstrate the ability to:
    • Evaluate published literature in critically acclaimed journals and texts.
    • Apply clinical trials data to patient management.
    • Participate in academic and clinical discussions.
  • Accept responsibility for all dimensions of routine patient management on the wards.
  • Apply knowledge of scientific data and best practices to the care of the surgical patient.
  • Facilitate learning of medical students and physician assistant students on the team.
  • Use the RCRMC library and databases on on-line resources to obtain up-to-date information and review recent advances in the care of the surgical patient.
  • Demonstrate a consistent pattern of responsible patient care and application of new knowledge to patient management.
  • Demonstrate a command and facility with online educational tools.
  • Complete the PBLI assignment and submit it to the program coordinator at the end of the rotation.

Interpersonal & Communication Skills

  • Work as an effective senior resident.
  • Cultivate a culture of mutual respect with members of nursing and support staff.
  • Develop patterns of frequent and accurate communication with team members and attending staff.
  • Gain an appreciation for both verbal and non-verbal communication from patients and staff.
  • Demonstrate consistent respectful interactions with members of nursing and support staff.
  • Demonstrate consistent, accurate and timely communication with members of the surgical team.
  • Demonstrate sensitivity and thoughtfulness to patients concerns, and anxieties.
  • Demonstrate the ability to provide and request appropriate consultation from other medical specialists.

Assessments

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