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HMCR4Goals and ObjectivesWe expect that you will demonstrate...?in?Patient Care, Procedural Skills, and Medical KnowledgeGoalsResidents will demonstrate the knowledge, judgment, and technical proficiency in providing surgical care for common and complex surgical problems, especially trauma and critically ill surgical patients in a public hospital, inner-city, Level I Trauma Center.ObjectivesPerform a large number of general surgery cases with attending surgeons to learn the judgment involved in patient selection and technical skills. Operate on technically challenging procedures such as advanced videoendoscopic, pancreatic, esophageal, hepatic, gastric, vascular and biliary operations. Demonstrate the understanding of diagnostic approach, procedures and functional evaluation of patients with emergency surgical conditions including trauma and other general surgical and vascular emergencies. Oversee the clinical care of all in-patients on the service, those evaluated in the ER and consults, and be present to receive all unstable patients and all pediatric trauma patients. Oversee the R3s in their management of the service and meet with them at least twice a?shift ?to review the patients and their management. Round with the trauma attending on service every morning at?Sign?Out Conference?to provide updates and prn as problems arise. Recognize patients that require serial operative procedures and arrange the add-on operative schedule as necessary. Serve as the senior surgical staff member at night, paying particular attention to ICU bed space, OR case load, ER volume and delays. Communicate with the attending on call regarding any potential problems. Provide supervision and guidance to consulting services in the management of complex multisystem trauma patients. Demonstrate ability to evaluate and care for female patient with abdominal pain and gynecologic pathology. Demonstrate the ability to take junior residents through simple operative cases such as incision and drainage of abscesses, inguinal herniorrhaphy, and appendectomy. Be mindful of the work hours restrictions for all members of the team and adjust schedules as necessary. Act as teaching assistant for junior residents for appropriate cases.?Provide supervision and guidance to NF R1 with any patients requiring Rapid Response Team activation, and prn.R4Overall Competency Goals: PGY-4 The overall aim of the program is to train you to become a knowledgeable, safe and competent surgeon. These goals - what you are expected to achieve - and objectives - how you are expected to achieve them - are guidelines designed to reflect a series of supervised patient care experiences in a system of graduated responsibility. Each year in the program is designed to present you with a unique set of challenges to help develop your surgical skills in a graduated fashion. Therefore,?all seven?competency levels in each year must be mastered prior to advancement to the next year of training. This year you will build on the competency skills obtained as a PGY-3 resident. There should be evidence of a clear progression in skill and knowledge developed in the PGY-4 year, that allow you to exercise greater responsibility in the management of surgical patients, as well as in the type of surgical cases you can act as primary surgeon, as judged by the Chief Resident and staff. This should be used in concert with the?Global G&O?and the?Faculty Evaluation tool?as a guide for this year of your training. These level-specific competency objectives were prepared by the faculty to give you more concrete examples of the performance standards we expect during the R4 year.We expect that you will demonstrate...?in Patient CareClear and timely documentation of daily progress notes, any procedures, and major changes daily on all patients.Leadership, organizational and administrative skills required to manage a surgical service as acting chief resident. Assure that all residents are prepared and on time for all OR's, conferences and clinics by completing morning rounds in a timely fashion. Make resident assignments for the next day’s OR cases and post the names on the OR board.Assist juniors in preparation for weekly M&M conference.Provide copies of relevant literature to the junior residents.Meet at least weekly with the students and provide a didactic session on common surgery management topics.Be available to junior residents to assist in evaluation of consults and ER patients.Oversee the clinical care of all in-patients on the service and all surgical consultsSkills for organization and prioritization for your patients that include your own management plan that is effectively communicated with the next level of supervision.Sound clinical judgment and logical, linear, analytic thinking.Consistently gather detail-oriented information and appropriately synthesize, organize and interpret findings. The mark of a good surgeon is being detail-oriented.A strong work ethic and appropriate initiative.Conscientious and reliable patient care so that the team can consistently count on you to "get the job done" in a delegatory role.Patient ownership in your patient care and act as if you were your patient’s only doctor - while at the same time functioning as a member of the team with appropriate communication to your senior residents/attending.Leadership in ensuring that your interns have an accurate patient list and patient card system. If using UWCores, be familiar with?Minimum Expectations for Using UWCores. When admitting a patient (as consult resident, ICU resident, ER resident) it is your responsibility to put the patient onto the team’s UWCores list. The intern can populate the fields.An understanding of criteria for admission, and management of patients in the in-patient and out-patient environment.Proficiency in the assessment, management and triage of critically ill patients including preoperative stabilization and ICU care.Leadership in ensuring your interns are pre-rounding daily and checking items on ORCA such as micro results and other things not printed out on the UWCores sheet.An assertive and proactive attitude toward patient care that includes always considering the worst case scenario and looking for the "snake under every rock". This is the hallmark of the surgical mentality that helps you to expand your differential diagnoses and allows you to?anticipate problems and potentially minimize treatment delays of your patients which is directly related to their morbidity and mortality.Rounding on all patients at least twice a day to ensure continuity of patient care. This should be followed by early communicate with attendings daily (by 8am at the latest) and at any time regarding problems or sudden changes in status of patients. Routine afternoon communication with attendings is expected and should occur with updates in patient status and f/u of tests.The ability to evaluate and care for surgical emergencies in the role as the senior surgical resident on-call.Safe and effective transfer of patient care as a role model to junior residents by ensuring continuity of care with appropriate face-to-face sign-outs. Any transfer of patient care requires a voice to voice communication (ICU to floor, floor to ICU, ER to floor/ICU, OR to ICU, OR to floor, etc... ).Evidence that you have read?Residency Tips: Marks of a Well-Trained SurgeonWe expect that you will demonstrate...?in Technical SkillsProficiency with correct open and laparoscopic basic surgical techniques, such as incision, suturing, knot tying, and dissection with a focus on teaching correct techniques to junior residents in these areas.Should now be capable of independently completing indexed R1-3 procedures.Proficiency with most open and laparoscopic procedures.Proficiency with skills as a first assistant/ teaching assistant in the operating room by proctoring junior residents in the OR.Preparation for the OR by knowing: positioning, anatomy, steps of the procedure and possible pitfalls. Implementation of the contents of the?OR Checklist.A completed EVATS and ISIS technical skills portfolio for this year.We expect that you will demonstrate...?in Medical KnowledgeEvidence of continual and progressive increase in general surgery core knowledge. Completely read and study one of the major surgical texts (e.g. Cameron's?Current Surgical Therapy)Use the surgical literature heavily in your day-to-day practice (eg.?Selected Readings in General Surgery)A broad base of knowledge in general surgery and other surgical specialties. At the R4 level you should have a very strong and broad base of textbook general surgery knowledge. You will now be expected to be able to discuss pertinent literature as it relates to particular clinical problem for your patients.An ABSITE score above the 50th percentile.Ongoing use and development of an electronic or hard binder of the surgical curriculum based on the SCORE topicsPassing the UW Mock Oral ExamFLS certification (skills and didactic testing)Proficiency in accessing and applying information technology and the surgical literature to research a given topic, instead of only textbook information.We expect that you will demonstrate...?in Practice Based Learning & ImprovementEvidence that you are actively applying the knowledge learned in conferences (M&M,Grand Rounds, Surg Science Series) to your patients in an ongoing fashion.An understanding of NSQIP and SCOAP projects and how the data can be used to improve patient care.Ongoing ability to critically appraise the literature using principles learned in Journal Club.Ongoing evidence of your use of PubMed and other IT resources for daily patient care activities consistent with a commitment to lifelong learning and an active pursuit of education.Near-completion of your academic project required for graduation.Evidence that you are an active, not a passive learner.Proficiency in the teaching of medical students and junior residents.We expect that you will demonstrate...?in Interpersonal Skills & CommunicationPatient presentation skills that utilize a standardized format with complete data and plans.Leadership with your junior residents for their patient presentation skills for consult patients that utilize a standardized format with complete data and plans. (See?Presenting a Surgical Consult Patient)Leadership with your junior residents to foster the liberal use of communication (text paging, calling, emailing, going down to the OR) by your junior residents – and then passing on appropriate information to the Chief/attendings.Proficiency in the management of a service, utilizing the cooperative skills of medical students, nurses and ancillary personnel. You are expected to be able to independently manage a general surgery service, to include administrative, clinical and academic responsibilities.Skill and sensitivity for appropriately counseling and educating patients and their families in a variety of clinical situations.Effective documentation of practice activities with proper operative/procedure note dictations, clinic visit dictations, discharge summary dictations, daily progress notes and event notesHow to properly consult a specialty service (radiology, GI, PT, etc.) by correctly formulating the?specific question?to be answered.Presentation of all patient and conference material in a concise, organized, logical and knowledgeable manner.A kind, thoughtful, understanding and helpful attitude to all consulting services.Leadership by assuring the attendance of team members at all rounds and conferences and getting your R1’s and R2’s into at least 2 large cases/week to position/open/close.We expect that you will demonstrate...?in ProfessionalismRespect to every patient, regardless of social or other circumstances giving the same degree of respect you would afford to your own family members.A personal commitment to continuity of patient care. Be a role model by initiating verbal communication for all transfers of patient care to your junior residents.Finishing every operative case you begin.Daily/weekly updates of your?Surgical Operative Log?on the ACGME web.Daily/weekly updates of your duty hours.An understanding that duty hours are a shared responsibility in our department and you must know what the work hour expectations are for each service. You must abide by them and ensure that your team members do as well. You are expected to notify the Program Director or Asst Program Directors about any system problems with duty hours so that problems can be fixed expeditiously.Accountability with timely completion of all required clinical and residency documents and passionate, helpful, kind, altruistic and ethically sound behavior with patients and all members of the health care team.Dependability and attendance. It is your personal responsibility to document attendance by signing-in.Administrative skill in preparation of the weekly M&M reports and presentation at conferences. The faculty?expect?you to contact the attending in advance to review their case, discuss presentation angles and relevant literature (it’s not "cheating").Punctuality for all required functions (OR, clinic, conferences) by you and your junior residents and answering pages in a timely fashion.Administrative skill in preparation of the weekly M&M reports, presentation at conferences, and assignment of cases to students and junior residents on services where you are the "acting" Chief Resident.Equanimity and judgment in your role as a senior resident.Professional attire, appropriate grooming and hygiene.A professional attitude including initiative, honesty and integrity.Leadership. Whether you know it or not, you are an example to others. If you bring a problem – bring a solution with it.We expect that you will demonstrate...?in Systems Based PracticeEffective communication with referring physicians throughout the WWAMI region. This includes appropriate cc's on all dictated documents.Safe patient care that focuses on the ‘big picture’ and getting the patient discharged with minimal delays.Effective personal time management and adherence to work hours regulations. And taking a leadership role in watching your junior residents' hours on your team.An understanding of the larger system of hospital care by ensuring that your junior residents participate in weekly multidisciplinary rounds at HMC and UWMC. ................
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