Apds.org



Milestones 2.0HPBCompetencyLevel 1Level 2Level 3Level 4Level 5Patient Care:Ward CareThis resident can perform a focused, efficient, and accurate history and physical for a patient presenting with a core HPB surgery presentation such as choledochal cyst, benign biliary obstruction, hepatic neoplasms, pancreatic cysts/neoplasmsThis resident can manage common post-operative problems of the HPB surgery patient with direct supervision (senior residents or staff physically present).This resident can accurately diagnose some core HPB surgery conditions such as choledochal cyst, benign biliary obstruction, hepatic neoplasms, pancreatic cysts/neoplasmsThis resident can manage common post-operative problems of the HPB surgery patient via indirect supervision (consultation by phone).This resident can accurately diagnose most core HPB surgery conditions (such as those mentioned in Level 2), and some advanced HPB surgery conditions such as primary sclerosing cholangitis, portal hypertension, IPMN.This resident can independently manage complex post-operative problems and independently stabilize and transfer the HPB surgery patient to a higher level of care within the hospital. This resident can lead a team that cares for patients with complex past medical and surgical issues (e.g. a patient with multiple comorbidities requiring acute surgical care)This resident can provide supervision in the evaluation of complex post-operative problems, including supervising their stabilization and transfer within the hospital.This resident can recognize atypical presentations of HPB surgery patients and exhibits good judgment in when to proceed to the OR in complex presentations.Develops a clinical pathway for management of complex patient conditions. □ □ □ □ □ □ □ □ □ □ Not Yet Rotated □ Not yet completed Level 1Specific Comments:CompetencyLevel 1Level 2Level 3Level 4Level 5Patient Care:OperativeThis resident has basic surgical skills such as instrument handling, knot-tying, and simple suturing.The resident requires active direction to identify tissue plains and move the operation forward.Can perform common bedside procedures (central line, interrogation of biliary drain) with direct supervision.Can assist with core HPB procedures with direct coaching.Zwisch scale for core HPB procedures: show and tellRespect for tissue is not yet consistent.The resident can move independently through some portions of core operations such as cholecystectomy, liver biopsy, distal pancreatectomy, drainage of pancreatic pseudocyst.Still requires coaching to complete those core operations.Zwisch scale for core HPB procedures: Active HelpCan perform common bedside procedures (central line, interrogation of biliary drain) with indirect supervision.Teaches basic surgical skills (knot tying, suturing) to medical students and junior residents.This resident can demonstrate proficiency in the handling of all instruments.Able to navigate through core procedures fluidly while anticipating next steps in straightforward operations.Zwisch scale for core HPB procedures: Passive HelpStill requires coaching for advanced cases such as removal of gallbladder cancer or bile duct neoplasms, hepatic lobectomy, pancreaticoduodenectomy.Zwisch Scale for advanced HPB procedures: Active HelpTeaches bedside procedures to those more junior.This resident demonstrates proficiency in use of instruments and can visualize and dissect abnormal anatomic structures. Adapts technique to tissue type.Performs core operations fluidly with variant anatomy.Zwisch scale for core HPB procedures: Supervision OnlyAble to perform and anticipate next steps in advanced cases such as those listed in Level 3.Zwisch Scale for advanced HPB procedures: Passive HelpTeaches core operations to those more junior.The resident can perform advanced operations fluidly.Zwisch scale for advanced HPB procedures: Supervision OnlyIncorporates novel surgical techniques and technology into practice.Serves as teaching assistant on complex operations. □ □ □ □ □ □ □ □ □ □ Not Yet Rotated □ Not yet completed Level 1Specific Comments:CompetencyLevel 1Level 2Level 3Level 4Level 5Patient Care:Medical KnowledgeThis resident has understanding of The signs, symptoms, pahthophysiology and treatment of core conditions seen in HPB surgery such as cholecystitis, benign biliary obstruction, hepatic abscess, hepatic and pancreatic neoplasms.The steps of core operations in HPB surgery such as cholecystectomy, choledochoenteric anastomosis, CBD exploration, drainage of liver abscess, pancreatic debridement.The anatomy involved in core operations in HPB surgery.This resident has understanding of Signs, symptoms, pathophysiology and treatment of advanced HPB surgical conditions such as functional biliary disorders, cirrhosis, pancreas divisum.The most likely variations in anatomy for core operations in HPB surgery such as cholecystectomy, CBD exploration, liver biopsy, distal pancreatectomy.The impact of abnormal anatomy on the steps of core operations in HPB surgery. This resident has understanding ofThe impact of patient factors on pathophysiology and on the treatment of patients with core and advanced HPB surgical conditions.The steps of advanced operations in HPB surgery such as repair of bile duct injury, removal of gallbladder cancer, hepatic segmentectomy, total pancreatectomy.The anatomy involved in advanced operations in HPB surgery.This resident has comprehensive knowledge about Varying patterns of presentation and alternative and adjuvant treatments and can make the diagnosis and provide the initial treatment for complex patients in HPB surgery.The most likely variations in anatomy for advanced operations in HPB surgery.The impact of abnormal anatomy on the steps of advanced operations in HPB surgery.This resident contributes to peer-reviewed literature on presentation, workup and treatment of patients with HPB surgical diseases.This resident instructs others on the correct workup and treatment of patients with HPB surgical diseases through simulation.This resident instructs others on appropriate identification of anatomy relevant to surgical diseases. □ □ □ □ □ □ □ □ □ □ Not Yet Rotated □ Not yet completed Level 1Specific Comments:CompetencyLevel 1Level 2Level 3Level 4Level 5Systems-Based PracticeThis resident has a basic understanding of the team members coordinating care for the HPB patient.This resident can safely and effectively hand off care of uncomplicated patients.This resident is aware of the mechanism to report patient safety concerns.This resident has a basic understanding of payment systems.This resident has a basic understanding of how documentation relates to billing.This resident utilizes the resources available to coordinate care for uncomplicated patients. This resident can safely and effectively hand off care of complex patients.This resident is aware of system factors that impact patient safety and hospital initiatives to improve quality.This resident documents accurately to support appropriate billing.This resident can coordinate multidisciplinary care of complex patients.This resident teaches junior residents to safely and effectively hand off care of patients.This resident takes part in hospital quality improvement initiatives.This resident participates in root cause analyses.This resident has a basic understanding of the elements needed to transition to practice.This resident is able to navigate challenging situations in transitioning care (eg: discharges with multiple home needs, conflicts in handoff between teams).This resident helps lead quality improvement initiatives.This resident can tailor their care to patients based on the patients’ economic situation.This resident has identified resources and has an individual plan to transition to practice.This resident designs innovative ways to improve care coordination and/or transitions of care.This resident develops and implements quality improvement projects.This resident participates in advocacy activities for health policy at a regional or national level. □ □ □ □ □ □ □ □ □ □ Not Yet Rotated □ Not yet completed Level 1Specific Comments:CompetencyLevel 1Level 2Level 3Level 4Level 5Patient Care:Practice-Based Learning and ImprovementThis resident is able to access resources to answer clinical questions.This resident accepts constructive feedback.This resident develops goals for personal and professional development.This resident develops clinical questions based on patient presentation and utilizes resources to provide evidence-based care.This resident can identify opportunities for personal improvement and develop a learning plan.This resident integrates patient preferences with evidence-based practice to manage complex patients.This resident actively seeks feedback to improve performance.This resident integrates feedback and personal performance data to develop a plan for improvement.This resident critically appraises the literature in light of patient preferences to determine the best options for care and counsels patients regarding the pros and cons of each.This resident participates in 360 degree analysis of performance by seeking and delivering effective feedback.This resident uses personal performance data to revise their learning plan.This resident teaches others how to critically appraise literature and apply it to practice.This resident participates in the creation of guidelines for evidence-based care.This resident assists others in the creation and implementation of personal learning plans. □ □ □ □ □ □ □ □ □ □ Not Yet Rotated □ Not yet completed Level 1Specific Comments:CompetencyLevel 1Level 2Level 3Level 4Level 5Professionalism 1This resident understands the items to include when obtaining informed pletes patient care tasks (d/c summaries, notes, etc) in a timely pletes administrative tasks in a timely manner.This resident has appropriate time management skills. This resident utilizes ethical principles in straightforward situations.This resident pays attention to detail in performing patient care tasks in routine situations.This resident pays attention to detail in performing administrative tasks in routine situations.This resident takes responsibility for his/her/their own behavior.This resident seeks help in managing complex ethical situations.This resident pays attention to detail in performing patient care tasks in complex situations.This resident pays attention to detail in performing administrative tasks in complex situations.This resident demonstrates professional behavior during stressful situations.This resident can resolve complex ethical dilemmas utilizing resources at his/her/their disposal.This resident recognizes situations that may impact others’ ability complete patient care and/or administrative tasks in a timely manner.This resident appropriately reports lapses in professional behavior.This resident identifies and attempts to address system-level issues that contribute to ethical dilemmas.This resident develops systems to improve efficiency in patient care and/or administrative work. □ □ □ □ □ □ □ □ □ □ Not Yet Rotated □ Not yet completed Level 1Specific Comments:CompetencyLevel 1Level 2Level 3Level 4Level 5Professionalism 2(Awareness/Wellness)This resident recognizes the limits in his/her/their own knowledge and skills and seeks help.This resident demonstrates knowledge of principles of physician well-being and fatigue mitigation.This resident identifies institutional resources to assist with well-being.This resident recognizes the limits in the knowledge or skills of the team and seeks help.This resident self-monitors personal health and wellness and appropriately mitigates fatigues and/or stress.This resident demonstrates insight by owning his/her/their limitations and being truthful when unsure in a clinical setting. This resident contributes to the creation of an emotionally healthy environment.This resident models appropriate management of personal health issues, fatigue and stress.This resident demonstrates insight by recognizing his/her/their own personal stressors and utilizes tools to manage emotions.This resident helps others identify limitations in knowledge and skills.This resident recognizes and appropriately addresses signs of impaired well-being in team members.This resident intervenes when other members of the team demonstrate impaired well-being. This resident coaches others in developing and improving emotional intelligence.The resident models habits that assist with well-being, stress reduction, and fatigue mitigation. □ □ □ □ □ □ □ □ □ □ Not Yet Rotated □ Not yet completed Level 1Specific Comments:CompetencyLevel 1Level 2Level 3Level 4Level 5Interpersonal and communication skillsThis resident uses understandable language when communicating with patients and families.This resident provides timely updates to patients and families.Requests and receives consults respectfully.This resident values the contributions of all team members.This resident keeps the medical record accurate, complete and up to date.This resident recognizes barriers to communication and customizes their delivery appropriately.This resident actively listens to patients and families.This resident requests and receives consults clearly and concisely.This resident asks for feedback from other members of the team.This resident utilizes the medical record to efficiently communicate.This resident delivers difficult information to patients and families compassionately.This resident uses shared decision making to create an individualized care plan.This resident verifies understanding of recommendations when providing recs to other services.This resident adapts his/her/their communication style to suit the needs of the team.This resident provides timely, specific and actionable feedback to team members.This resident facilitates difficult conversations in family conferences.This resident manages and resolves conflict among patients, families and the healthcare team.This resident coordinates recommendations from multiples services to provide optimal patient care.This resident communicates effectively during crises.This resident communicates constructive feedback to superiors.This resident selects the appropriate form and urgency of communication based on context.This resident coaches others in the facilitation of crucial conversations.This resident coaches others in conflict resolution.This resident coaches others in flexible communication strategies that value input from all team members.This resident facilitates team feedback after complex or stressful situations.This resident guides departmental or institutional communication around policies and procedures. □ □ □ □ □ □ □ □ □ □ Not Yet Rotated □ Not yet completed Level 1Specific Comments: ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download