General Surgery Red PGY 2

Length of Goals: 6 weeks

Goals

Riverside County Regional Medical Center will provide a learning environment for the PGY-2 resident to develop cognitive and technical skills in dealing with with acute abdomen, biliary disease, hemorrhoids as well as critical care and trauma patient management. 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

  • Complete assigned SCORE topics:
    • Invasive ductal carcinoma
    • Invasive lobular carcinoma
    • Ductal carcinoma in-situ
    • Lobular carcinoma in-situ
    • Intraductal papilloma
  • Describe the clinical presentation of a patient with biliary disease
  • Draw the anatomy of the gallbladder, triangle of Calot, and hepatic artery .
  • Describe the physiology bile production and excretion
  • Describe in detail anatomical variation of biliary ducts
  • Describe the blood supply of the colon and rectum.
  • Describe pathophysiology of hemorrhoids and fissures
  • Describe non-operative treatment options for management of hemorrhoids
  • Describe relationship of diet, constipation with anorectal benign disease
  • Diagram the anatomy of the abdomen including its viscera and anatomic spaces.
  • Describe the embryological development of the peritoneal cavity and the position of the abdominal viscera.
  • Describe the anatomy of the omentum and its role in responding to inflammatory processes.
  • Describe clinical presentation and pathophysiology of acute abdomen.
  • List at least seven etiologies for acute abdomen and bowel obstruction.
  • Differentiate between complete vs. partial bowel obstruction.
  • Describe the alternatives of treatment for the patient with an acute abdomen according to the specific etiology.
  • Demonstrate familiarity with various modes of mechanical ventilation.
  • Describe oxygen carrying capacity curve and factors that influence it.
  • Demonstrate knowledge of bacterial versus fungal infections and sepsis.
  • List differential diagnosis for hypotension, hypertension, and hypoxia.
  • Be familiar with actions as well as side effects of ionotropic medications.
  • Outline the basic techniques of evaluation and resuscitation of trauma patients using the
  • Describe the basic principles and types of shock
  • Review the anatomy, physiology, and pathology applicable to the management of trauma patients, including: central nervous system, musculoskeletal system, and cardiac system, and major vascular structure, intra-abdominal contents including the stomach, small bowel, colon, spleen, pancreas, hepato-biliary system and diaphragm.
  • Refined ability to interpret radiographic findings, EKGs, laboratory data, and intravascular and intra-cranial monitoring systems.

Assessment

  • Written basic science tests.
  • During the formative evaluation at the end of the rotation.
  • Annually at the in-training examination

Patient Care

  • Perform complete trauma exam including primary and secondary surveys
  • Demonstrate proficiency in examining patients with acute abdomen and correctly identify those patients who require surgical interventions.
  • Proficiently Interpret: X-Rays, ultrasounds, CT scans of trauma patients.
  • Demonstrate proficiency in insertion of central line, arterial line and chest tubes.
  • Assist in the performance of general surgical and laparoscopic procedures.
  • Demonstrate knowledge of steps to be taken to have a patient ready for laparotomy including pre-op workup and medical clearance.
  • Demonstrate skill in basic surgical techniques, including:
    • Hemorrhoidectomy
    • Appendectomy
    • Cholecystectomy (Laparoscopic and open)
    • Total Mastectomy
    • Sentinel lymph node biopsy (SCORE)
    • Lumpectomy (SCORE)

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

  • The resident should be receptive to feedback on performance, attentive to ethical issues
  • Resident should demonstrate ability to discuss end-of-life discussions and decisions with patients and their families
  • Assist with families of critically injured/ill patients and guidance of families towards or through difficult decisions.
  • Complete the Professional in Surgery curriculum for the current month (See Attached Schedule)
  • Complete professionalism assignment as outlined in the professionalism curriculum.

Systems-Based Practice

  • Understand, review, and contribute to the refinement of clinical pathways
  • Partner with health care management to facilitate efficient resource utilization.
  • Describe in general terms the benefits of clinical pathway implementation
  • 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
  • Complete the Systems Based Practice curriculum for the current month

Practice-Based Learning & Improvement

  • Present complications of his/her cases in morbidity and mortality conference
  • 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 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 on line educational tools.
  • Complete the Personal Learning Project for the current month as outlined in the Practice Based Learning and Improvement Curriculum

Assessment

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

Interpersonal & Communication Skills

  • 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
  • Effectively communicates the transfer of trauma patients care to the ICU resident
  • Demonstrate sensitivity and thoughtfulness to patients concerns, and anxieties.
  • The resident will demonstrate the ability to effectively communicate with consultation services.

Assessment

  • Formative evaluation will be completed by the attending faculty at the end of the rotation

Conference Attendance: Conference attendance is mandatory at the hospital in which you are rotating. The Basic Science Lecture is required for all PGY 1 & 2 residents and is held at RCRMC, if you are at another hospital, you are released from your duties to attend this lecture series. All residents attend Wednesday Educational Day conferences at RCRMC.