Plastic Surgery PGY 2

Goals

Riverside County Regional Medical Center, Division of Plastic Surgery will provide a learning environment for the care of plastic and reconstructive surgery patients. Surgical basic science, including management of fluids and electrolytes, wound healing and nutrition, will be emphasized. Residents will assess surgical pathology pre-operatively, develop clinical judgment for managing these issues, and will learn operative skills to address surgical problems. Careful postoperative care and follow up will be emphasized.

Objectives

Medical Knowledge

  • Outline the components of a comprehensive focused history and physical examination pertinent to the evaluation and correction of congenital or acquired defects under with in the area of plastic and reconstructive surgery.
  • Discuss and compare skin and connective tissue.
  • Explain the basic techniques for surgical repair of superficial incisions and lacerations of the head, neck, trunk, and extremities to include the following considerations: 
    • Skin
    • Subcutaneous tissue
    • Superficial muscle and fascia
    • Dressings
    • Suturing and knot tying
  • Describe the physiology of various techniques of skin and composite tissue transplantation with particular regard to component tissue circulation: 
    • Skin grafts (split- vs. full- thickness)
    • Bone (cartilage grafts)
    • Composite grafts
    • Skin flaps
    • Myocutaneous flaps
    • Osteocutaneous flaps and Myo- osseous
    • Neurocutaneous flaps
  • Discuss the use of reconstructive techniques from simple to more complex in the definitive management of traumatic or excised wounds
  • Explain the assessment of facial skeletal trauma according to the following systems: 
    • 1,2, and 3 classification of maxillary / mid face fractures
    • Nasoethmoidal disruption /classification
    • Zygomatic, orbit, fractures
    • Mandible fractures with classification
  • Discuss epidemiology, risk factors, treatment, and prevention of cutaneous malignancies in the geriatric patient, including: 
    • Etiology and epidemiology of BCC/ SCC
    • Usual modes of treatment for BCC/ SCC including Mohs histosurgery technique, radiation and chemotherapy as well as surgical treatment.
    • Epidemiology, recognition, appropriate biopsy technique and staging of melanoma and an algorithmic approach to the management of invasive melanoma including surgical treatment
  • Explain the methods for performing incisional and excisional biopsies of skin and oral cavity lesions.
  • Demonstrate the systematic examination of the hand to assess motor and sensory function, including: 
    • Intrinsic tendon and muscle function
    • Extensive tendon and muscle function
    • peripheral nerves
    • Distal circulation
    • Bones
  • Outline appropriate diagnostic/imaging studies needed to supplement the physical examination when developing a treatment plan for: 
    • Surgery of the hand
    • Facial fractures
  • Summarize the evaluation of patients with head and neck cancer, and develop a treatment plan according to clinical staging criteria.
  • Discuss the use of the reconstructive ladder (including skin grafts, local flaps, and regional and free microvascular flaps) in the definitive management of traumatic or excised wounds.
  • Discuss the surgical treatment of: 
    • Surgical repair of facial trauma, soft tissue, and bony defects
    • Resection and reconstruction of the simple, soft tissue defects after a removal of neoplasms of the head and neck
    • Resection of skin and soft tissue neoplasms requiring complex reconstruction
  • Summarize currently accepted surgical techniques for treating the following: 
    • Craniofacial anomalies, including cleft lip and palate
    • Breast reconstruction after mastectomy
    • Reconstruction and ablative head and neck surgery

Patient Care

  • Establish basic proficiency in providing pre-operative and post-operative care (writes appropriate pre-op and post-op orders for floor patients, handles nursing calls appropriately, and manages most routine post-operative care with no intervention senior house staff or attending physician.
  • Take an appropriate history to evaluate patients with plastic/reconstructive surgical issues or diagnosis
  • Develop a proficiency in evaluation and interpretation of the different diagnostic modalities including: X-rays, ultrasounds CT scans, Contrast studies and MRIs.
  • Discuss treatment options, risks and potential complications of patients with plastic surgery issues.
  • Demonstrate skill in basic surgical techniques, including: 
    • Knot tying
    • Exposure and retraction
    • Knowledge of instrumentation
    • Incisions
    • Closure of incisions including abdominal closure
    • Competency and handling allograft or alloplastic material including Mesh and reconstructive implants.
    • Handling and use of biologic skin matrix substitute such as Integra.
    • Demonstrate use of the dermatome; harvest, preparation, and application of skin grafts.
    • Resident can capably assist in performance of complex plastic and reconstructive surgery and procedures.

Professionalism

  • The resident should be receptive to feedback on performance
  • The resident will understand the importance of honesty and truthfulness in the doctor-patient relationship and other medical interactions.
  • The resident will understand and remain attentive to ethical principles such as patient autonomy, surrogacy, and risk benefit analysis.
  • Regardless of social circumstance; gender, ethnicity, or culture background, the resident will treat each patient with the same respect they would accord their own family members.
  • The resident will communicate effectively in rounds with attending staff and in conference
  • Reliably complete all assigned patient care tasks and provide complete sign out (handoff) to the on-call resident or attendings.
  • Maintain a presentable appearance that sets the standard for the hospital that includes but is not limited to adequate hygiene and appropriate dress (including OR attire).
  • Assist with families of critically injured/ill patients through difficult decisions; and guide them to engage appropriate support resources available in our hospital such as, Patient & Family Services or Chaplaincy.
  • Provide an appropriate orientation and guidance to any assigned medical students as to their roles and responsibilities during the rotation and assist them in learning basic skills appropriate for their level of training.
  • Assist in the orientation of other house staff coming on service.

Systems-Based Practice

  • Understand the cost implications of medical decision making; partner with hospital case management to facilitate resource efficient utilization of resources.
  • Describe in general terms the benefits of the implementation of clinical pathways and the elaboration and application of best practices to patient care.
  • Develop an appreciation for the benefits of a multi-disciplinary approach to management of the neonate or child with complex congenital anomalies.
  • Comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations regarding patient privacy and confidentiality.
  • Demonstrate proficiency in the use of the hospital electronic medical record and resources in inpatient care.
  • Demonstrate knowledge of and conduct appropriate "timeout" and related patient safety procedures before major surgery.
  • Have clear indications for the performance of any anticipated surgical procedure.

Practice-Based Learning & Improvement

  • Demonstrate the ability to: 
    • Evaluate published literature in critically acclaimed journals and texts
    • Apply clinical trials data to patient management
  • Accept responsibility for all dimensions of routine patient management on the plastc surgery service.
  • Apply knowledge of scientific data and best practices to the care of the surgical patient
  • Facilitate learning of medical students and physician assistant students assigned to the patient care 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.
  • Complete the Personal Learning Project in the Practice Based Learning and Improvement Curriculum for the month

Interpersonal & Communication Skills

  • Develop patterns of frequent and accurate communication with team members and attending 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 the ability to provide consultation for or to request appropriate consultation from other medical specialist in a timely manner.
  • Demonstrate sensitivity and thoughtfulness to patients concerns, and anxieties. The resident will demonstrate a willingness to communicate with patients and families in a manner, which facilitates or enhances their understanding of and their participation in their own surgical care.

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.