Residency Level:



Residency Level: PGY 1; PGY 5

Surgical Rotation: Acute Care Surgery/General Surgery

Length of Rotation: PGY1 - 32 Weeks - (Eight 4-Week Rotations)

PGY5 – 1 four month rotation

Goals and Objectives

Patient care:

• Evaluation and preparation of the pre-operative general surgical patient in the acute setting

• Management skills required to independently evaluate the acute surgical patient, develop your own plan for the patient and communication of the plan to the appropriate level of supervision

• PGY 1s - take ownership in care of the patient. PGY 5s – take ownership of the service

• Post-operative care of the surgical patient

• Mechanisms and criteria for minimally invasive surgery of the abdomen

• Fluid and electrolyte management including indications for parenteral and enteral nutrition

• Understanding and utilization of diagnostic techniques including routine films, contrast studies, ultrasound, CT scan, MRI and endoscopic procedures

• Clear and timely documentation of daily progress notes

• Develop a strong work ethic

• Develop appropriate safe hand offs

• Develop the ability to care for surgical emergencies in the role as the surgical resident on call

Technical skill:

• Become proficient in correct basic surgical technique such that incision, suturing, knot-tying and dissection

• Evaluation of the acute abdomen

• Assist at major abdominal and minimally invasive surgical procedures

• After a period of learning and appropriate supervision, perform procedures for venous access, chest tube placement, etc.

• After a period of learning and appropriate supervision, learn to perform minor surgical procedures (i.e. excisional biopsies, lipoma removal), hernia repair, appendectomy, cholecystectomy and bowel resections

Medical knowledge:

• Demonstrate evidence of continued increase in general surgery core knowledge from basic surgical texts, additional readings and the SCORE curriculum as noted below

• Obtain a broad knowledge base of general surgery and other surgical specialties

• Study and prepare for the ABSITE

• Anatomy and physiology of the GI tract, liver, biliary tract and pancreas

• Fluid and electrolyte management including management of parenteral and enteral nutrition

Practice-based learning and improvement:

• Participate actively in M and M conferences, daily chief conferences and journal clubs

• Understand and when possible participate in SCOAP projects

• Learn to critically read the literature

• Master the IT resources available to you to develop a commitment to lifelong learning and education

• You are encouraged to pursue a clinical research project in an area that interests you

Interpersonal and communication skills:

• Develop the appropriate skills to provide efficient, concise, patient presentations

• Master text paging, emailing, etc.

• Develop strong doctor patient relationships using counseling and education of patients and their families

• Learn to master EPIC to provide proper documentation in the electronic medical record

• Learn to properly consult other specialty services in a professional manner

Professionalism:

• Respect every patient regardless of social or other circumstances

• Log cases appropriately

• Log your duty hours using My Evaluations appropriately and in a timely fashion

• Complete all required clinical and residency documents in a timely fashion

• Demonstrate sensitivity to age, gender and culture of patients and other members of the health care delivery team

• Learn to be punctual

• Always exemplify professional attire, appropriate grooming and hygiene

• Demonstrate honesty, integrity and leadership skills

Systems-based practice:

• Demonstrate effective communication with referring physicians throughout the Swedish health care system

• Keep patients’ safety foremost while discharging patients in a timely fashion

• Demonstrate time management and organizational skills while adhering to work hour regulations

• Gain an understanding of the importance of discharge planning and the writing of timely discharge orders to the overall throughput of patients in our system

|CATEGORY 1: ABDOMEN − GENERAL |

|Diseases/Conditions |Operations/Procedures |

|BROAD |ESSENTIAL − COMMON |

|• Acute abdominal pain |• Insertion peritoneal dialysis catheter |

|• Intra-abdominal abscess |• Laparoscopic exploratory laparotomy |

|• Rectus sheath hematoma |• Open exploratory laparotomy |

| | |

|FOCUSED |ESSENTIAL − UNCOMMON |

|• Chronic abdominal pain |• Open drainage abdominal abscess |

|• Carcinomatosis | |

|• Pseudomyxoma peritoneii | |

|• Spontaneous bacterial peritonitis | |

|• Desmoid tumors | |

|• Chylous ascites | |

|• Retroperitoneal fibrosis | |

|SCORE CURRICULUM - CATEGORY 2: ABDOMEN − HERNIA |

|Diseases/Conditions |Operations/Procedures |

|BROAD |ESSENTIAL − COMMON |

|• Inguinal hernia |• Open repair of inguinal and femoral hernia |

|• Femoral hernia |• Laparoscopic repair of inguinal and femoral hernia |

|•Ventral hernia |• Open repair of ventral hernia |

|• Miscellaneous hernias |• Laparoscopic repair of ventral hernia |

| | |

| |ESSENTIAL − UNCOMMON |

| |• Repair miscellaneous hernias |

|SCORE CURRICULUM - CATEGORY 3: ABDOMEN − BILIARY |

|Diseases/Conditions |Operations/Procedures |

|BROAD |ESSENTIAL − COMMON |

|• Jaundice |• Open cholecystectomy with or without cholangiography |

|• Cholangitis |• Laparoscopic cholecystectomy with or with |

|• Acute cholecystitis |out cholangiography |

|• Chronic cholecystitis | |

|• Choledocholithiasis |ESSENTIAL − UNCOMMON |

|• Biliary pancreatitis |• Cholecystostomy |

|• Acalculous cholecystitis and biliary dyskinesia | |

|FOCUSED | |

|• Gallbladder cancer | |

|• Cancer of the bile ducts | |

|• Choledochal cyst | |

|SCORE CURRICULUM - CATEGORY 4: ABDOMEN − LIVER |

|Diseases/Conditions |Operations/Procedures |

|BROAD |ESSENTIAL − COMMON |

|• Liver mass − evaluation |• Open liver biopsy |

|• Hepatic abscess |• Laparoscopic liver biopsy |

| | |

|FOCUSED |ESSENTIAL − UNCOMMON |

|• Hepatic adenoma |• Drainage liver abscess |

|• Focal nodular hyperplasia | |

|• Hemangioma | |

|• Hepatocellular carcinoma | |

|• Cholangiocarcinoma | |

|• Metastatic tumors | |

|• Miscellaneous hepatic neoplasms | |

|SCORE CURRICULUM - CATEGORY 5: ABDOMEN − PANCREAS |

|Diseases/Conditions | |

|BROAD | |

|• Pancreatic abscess and infected necrosis | |

|• Pancreatic pseudocyst | |

| | |

|FOCUSED | |

|• Autoimmune pancreatitis | |

|• Chronic pancreatitis, including hereditary | |

|pancreatitis | |

|• Pancreatic insufficiency | |

|• Ductal adenocarcinoma | |

|• Acinar cell carcinoma | |

|• Cystic neoplasms | |

|• Intraductal papillary mucinous neoplasms | |

|SCORE CURRICULUM - CATEGORY 6: ABDOMEN − SPLEEN |

|Diseases/Conditions | |

|BROAD | |

|• Postsplenectomy sepsis | |

| | |

|FOCUSED | |

|• Hemolytic anemias | |

|• Idiopathic thrombocytopenic purpura | |

|• Secondary hypersplenism and splenomegaly | |

|• Neoplasms of spleen | |

|• Splenic cysts | |

|SCORE CURRICULUM - CATEGORY 7: ALIMENTARY TRACT −ESOPHAGUS |

|Diseases/Conditions |Operations/Procedures |

|BROAD |ESSENTIAL − COMMON |

|• Gastroesophageal reflux and Barrett’s esophagus |• Laparoscopic antireflux procedure |

|• Hiatal hernia | |

|• Dysphagia | |

|FOCUSED | |

|• Achalasia | |

|• Zenker’s diverticulum | |

|• Epiphrenic diverticulum | |

|• Foreign bodies | |

|SCORE CURRICULUM - CATEGORY 8: ALIMENTARY TRACT − STOMACH |

|Diseases/Conditions |Operations/Procedures |

|BROAD |ESSENTIAL − COMMON |

|• Upper gastrointestinal bleeding |• Percutaneous endoscopic gastrostomy |

|• Gastric carcinoma |• Open gastrostomy |

|• Duodenal ulcer | |

|• Gastric ulcer | |

|• Peptic ulcer disease with bleeding | |

|• Peptic ulcer disease with perforation | |

|• Peptic ulcer disease with obstruction | |

|SCORE CURRICULUM - CATEGORY 9: ALIMENTARY TRACT − SMALL INTESTINE |

|Diseases/Conditions |Operations/Procedures |

|BROAD |ESSENTIAL − COMMON |

|• Small bowel obstruction and ileus |• Open small bowel resection |

|• Emergent management of Crohn’s disease of |• Open adhesiolysis |

|small intestine |• Laparoscopic adhesiolysis |

|• Acute mesenteric ischemia: arterial, venous, |• Ileostomy |

|and nonocclusive |• Ileostomy closure |

|• Meckel’s diverticulum |• Open feeding jejunostomy |

|• Radiation enteritis |• Laparoscopic feeding jejunostomy |

|SCORE CURRICULUM - CATEGORY 10: ALIMENTARY TRACT − LARGE INTESTINE |

|Diseases/Conditions |Operations/Procedures |

|BROAD |ESSENTIAL − COMMON |

|• Lower gastrointestinal bleeding |• Open appendectomy |

|• Large bowel obstruction |• Laparoscopic appendectomy |

|• Acute appendicitis |• Open partial colectomy |

|• Diverticulitis |• Laparoscopic partial colectomy |

|• Diverticular bleeding |• Colostomy |

|• Diverticular fistulae |• Colostomy closure |

|• Colonic polyps | |

|• Colonic cancer | |

|•Volvulus | |

|• Ischemic colitis | |

|• Antibiotic-induced colitis | |

|SCORE CURRICULUM - CATEGORY 11: ALIMENTARY TRACT − ANORECTAL |

|Diseases/Conditions |Operations/Procedures |

|BROAD |ESSENTIAL − COMMON |

|• Hemorrhoids |• Banding for internal hemorrhoids |

|• Anal fissure |• Hemorrhoidectomy |

|• Anorectal abscess and fistulae |• Subcutaneous lateral internal sphincterotomy |

|• Rectal cancer |• Drainage anorectal abscess |

|• Anal cancer |• Anal fistulotomy/seton placement |

| | |

|FOCUSED | |

|• Pelvic floor dysfunction | |

|• Rectal prolapse | |

|SCORE CURRICULUM - CATEGORY 15: SKIN AND SOFT TISSUE |

|Diseases/Conditions |Operations/Procedures |

|BROAD |ESSENTIAL − COMMON |

|• Pilonidal cyst and sinus |• Excisional and incisional biopsy of skin/soft |

|• Nevi |tissue lesions |

|• Melanoma |• Incision, drainage, debridement for soft tissue infections |

|• Squamous cell carcinoma |• Pilonidal cystectomy |

|• Basal cell carcinoma | |

|• Evaluation of soft tissue masses |ESSENTIAL − UNCOMMON |

|• Epidermal cyst |•Wide local excision melanoma |

|• Apocrine tumor |• Sentinel lymph node biopsy for melanoma |

|• Eccrine tumor | |

|• Sebaceous tumor | |

|• Merkel cell tumor | |

|• Dermatofibrosarcoma | |

|• Hidradenitis | |

|• Cellulitis | |

|• Necrotizing fasciitis | |

|• Paronychia | |

|• Felon | |

|•Wound infection | |

| | |

|FOCUSED | |

|• Decubitus ulcer | |

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