General Surgery Green PGY 5

Goals

Riverside County Regional Medical Center will provide a learning environment for the PGY-5 resident to develop cognitive and technical skills in management of complex surgical diseases of esophagus and advanced laparoscopic approach of spleen and adrenal gland pathology. Clinically, residents will assess surgical pathology pre-operatively, develop clinical judgment on managing these issues, and learn related appropriate operative skills to address these problems.  Careful postoperative care and follow up will be emphasized.

Objectives

Medical Knowledge

• Describe the anatomy of esophagus.
• Describe the physiology of esophageal motility and mortality diagnostic modalities.
• Explain path physiology of reflux disease and types of paraesophageal hernias along with their managements.
• Explain types of esophageal benign and malignant lesions along with their management.
• Explain role of chemotherapy and radiation therapy in management of esophageal malignancies.
• Explain types of esophageal perforations and how to manage them.
• Explain the advantages and disadvantages of laparoscopic colectomy.
• Explain the advantages and disadvantages of laparoscopic splenectomy.
• Explain indications of laparoscopic splenectomy as compared to open approach.
• Explain the role of laparoscopy in the treatment of adrenal glad pathology and be able to describe the indication for use of the minimally invasive approach in the treatment of adrenal gland pathologies.

Patient Care

• Demonstrate proficiency in mobilization of stomach and spleen.
• Demonstrate how a Pringle maneuver is performed.
• Be able to perform gastric resection with assistance of attending surgeon
• Be able to read and correctly identify pathology on esophagogram, CT scan and manometry studies.
• Be able to perform either an open or laparoscopic Nissen or other types of gastric wraps.
• Be able to perform upper and lower endoscopy
• Be able to perform advanced laparoscopic instrument handling and knot tying.
• Be able to perform laparoscopic splenectomy
• Be able to perform laparoscopic hemi-colectomies
• Be familiar with laparoscopic adrenelectomy

Professionalism

• Take the leading role in directing the weekly educational conferences. This includes choosing appropriate peer-reviewed articles and texts and arranging for films and presentations to be ready.
• Supervise junior residents in completing discharge summaries and complete pending medical record requirements.
• Professionally assume the role of an educator and teach medical students and junior residents to perform wound and skin closures, place chest tubes, insert central lines and arterial lines.
• Take a role in teaching during rounds illustrating learning points with clinical exam findings, laboratory data and radiographic studies
• Resident must obtain a copy of the ACS DVD "Professionalism in Surgery: Challenges and Choices" and review the curriculum on professionalism established for the months of rotation:

Systems-Based Practice

• Attend the multi-disciplinary trauma conference and organize the care and discharge planning of trauma patients
• Demonstrate an understanding of cost, availability and clinical significance of different tests
• Obtain from the residency office the ACS CD-ROM on "The Practice Management Course for Residents and Young Surgeons".

• Volume 1 is designed to educate and equip residents with the knowledge to manage their personal surgical future with a focus on issues such as: how to select a career in private practices I and II and Coding for Surgical Residents I and II
• Volume 2 is designed to educate and equip residents with the knowledge to manage their personal surgical future with a focus on issues such as: surgical financial management reports I and II, organizing a surgical practice, and understanding insurance processing
• Volume 3 is designed to educate and equip residents with the knowledge to manage their personal surgical future with a focus on issues such as: accumulation planning, goal planning and risk management, negotiation, and changing the liability equation

Practice-Based Learning & Improvement

• Is able to incorporate relevant literature into case presentations during the morbidity and mortality conference.
• Participates in the discussion of complicated cases and is able to formulate a management plan for the patient that is based on scientific facts.
• Can provide alternative options to prevent occurrence of similar undesired event
• Complete the Personal Learning Project as outlined in the Practice Based Learning and Improvement curriculum.

Interpersonal & Communication Skills

• Effectively communicates with the patients and guide the patients towards or through difficult decisions.
• Obtains informed consents of complex operative and elective surgical procedures.
• Is able to effectively communicate with the operating room staff to schedule cases and arrange to have equipments available for specific cases.
• Complete the Interpersonal and Communications Skills curriculum for the quarter.

Assessments

• Annually at the in-training examination
• 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.

Conference Attendance: Conference attendance is mandatory at the hospital in which you are rotating. The Clinical Case Conference is required for all PGY 3 - 5 residents and is held at RCRMC, if you are at another hospital, you are released from your duties to attend this lecture series.