Residency Level:
Residency Level: PGY 4
Surgical Rotation: Vascular Surgery
Length of Rotation: Two Months
Goals and Objectives
Patient care:
• Master the evaluation and preoperative assessment, postoperative care and nonoperative care of the vascular surgery patient
• Master the management skills required to independently evaluate the vascular surgery patient, develop your own plan for the patient and communication of the plan to the appropriate level of supervision
• Diagnosis and management of the complex vascular patient with multi-level inflow obstruction
• Diagnosis and management of extra-anatomic bypass procedures and distal fem-tibial bypass procedures
• Diagnosis and management of post-procedure complications, i.e. graft infection, graft thrombosis
• Operative management of extra-cranial carotid occlusive disease
• Take ownership in care of the patient
• Master mechanisms and criteria for endovascular surgical interventions
• Diagnostic evaluation of arterial disease, including the role of duplex scanning, angiography, CT Scanning and MRI
• Care of the patient with venous disease and venous stasis disease
• Clear and timely documentation of daily progress notes
• Develop a strong work ethic
• Develop appropriate safe hand offs
• Master the ability to care for vascular surgery emergencies in the role as the senior surgical resident on call
Technical skill:
• After obtaining skill set and with appropriate supervision perform major vascular procedures, intra-abdominal and peripheral for occlusive and aneurysmal disease, including endo-vascular techniques
• Peri operative management of the complex and/or complicated vascular patient
• With appropriate supervision perform major vascular reconstructive procedures
• With appropriate supervision perform vascular access procedures, procedures for venous disease
• With appropriate supervision perform vascular anastomoses.
• Learn to master Doppler evaluation for arterial and venous disease
Medical knowledge:
• Pathophysiology of arterial occlusive and aneurysm disease and venous insufficiency
• Demonstrate evidence of continued increase in vascular surgery core knowledge from basic surgical texts, additional readings and the SCORE curriculum as noted below
• Anatomy, physiology, hemodynamics of the arterial and venous systems
• Obtain a broad knowledge base of vascular surgery and other surgical specialties
• Study and prepare for the ABSITE
• Anatomy and physiology of the arterial and venous systems
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
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 the 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
|SCORE CURRICULUM CATEGORY 18: VASCULAR − ARTERIAL DISEASE |
|Diseases/Conditions |Operations/Procedures |
|BROAD |ESSENTIAL − UNCOMMON |
|• Acute limb ischemia |• Embolectomy/thrombectomy artery |
|• Peripheral arterial emboli |• Above knee amputation |
|• Acute arterial thrombosis |• Below knee amputation |
|• Compartment syndromes |• Toe amputation |
|• Diabetic foot infections |CATEGORY 18: VASCULAR − ARTERIAL |
| |DISEASE |
|FOCUSED | |
|• Cerebrovascular occlusive disease |COMPLEX |
|• Aortoiliac occlusive disease |• Aorto-iliac/femoral bypass |
|• Chronic visceral occlusive disease |• Ilio-iliac/femoral bypass |
|• Renal artery occlusive disease |• Femoral-popliteal bypass |
|• Femoropopliteal occlusive disease |• Profunda endarterectomy |
|• Infrapopliteal occlusive disease |• Infrapopliteal bypass |
|• Upper extremity occlusive disease |• Other endarterectomy |
|• Buerger disease |• Composite leg bypass graft |
|• Fibromuscular dysplasia |• Revise/re-do lower extremity bypass |
|• Cystic medial necrosis |• Arm bypass, endarterectomy, repair |
|• Behcet disease |• Celiac/SMA endarterectomy/bypass |
|• Aortic aneurysms |• Renal endarterectomy/bypass |
|•Visceral arterial aneurysms |• Femoral-femoral bypass |
|• Peripheral arterial aneurysms |• Axillo-femoral bypass |
|• Aortic dissection |• Axillo-popliteal-tibial bypass |
|• Claudication |• Transmetatarsal amputation |
|• Hypercoagulable syndromes |• Upper extremity amputation |
|• Carotid body tumors |• Disarticulation |
|•Vascular graft infections |• Elective repair infrarenal aortoiliac aneurysm |
|• Aortic thrombosis |• Repair femoral aneurysm |
|• Thoracic outlet syndrome |• Repair popliteal aneurysm |
| |• Repair suprarenal abdominal aortic aneurysm |
| |• Repair thoracoabdominal aortic aneurysm |
| |• Repair thoracic aorticaneurysm |
| |• Carotid endarterectomy |
| |• Reoperative carotid surgery |
| |• Excise carotid body tumor |
| |• Direct repair aortic arch branches for CNS symptoms |
| |•Vertebral artery operation |
| |•Vascular ultrasound |
| |• Angioscopy |
| |• Balloon angioplasty |
| |• Transcatheter stent |
| |• Other endovascular graft |
| |• Endovascular repair aortic aneurysm |
| |• Endovascular repair other aneurysm |
| |• Endovascular thrombolysis |
| |• Pseudoaneurysm repair/injection |
| |• Explore post-op bleed, thrombosis, infection |
| |• Graft thrombectomy/revision |
| |• Excise infected vascular graft |
| |• Repair graft-enteric fistula |
| |• Sympathectomy |
| |• Harvest arm vein |
| |• Thoracic outlet decompression |
| |• Repair ruptured aortic aneurysm |
|SCORE CURRICULUM CATEGORY 19: VASCULAR − VENOUS |
|Diseases/Conditions |Operations/Procedures |
|BROAD |ESSENTIAL − COMMON |
|•Venous thrombosis/embolism |•Venous insufficiency and operation for varicose veins |
|• Thrombophlebitis, including suppurative |• Sclerotherapy, peripheral vein |
|•Venous stasis and chronic venous insufficiency |• Insertion vena caval filter |
|•Varicose veins |COMPLEX |
| |•Venous embolectomy/thrombectomy |
| |•Venous reconstruction |
| |• Non-reconstructive venous ulcer operation |
| |• Repair arteriovenous malformation |
|SCORE CURRICULUM CATEGORY 20: VASCULAR − ACCESS |
|Diseases/Conditions |Operations/Procedures |
|BROAD |ESSENTIAL − COMMON |
|• Percutaneous vascular access for dialysis |• Percutaneous vascular access |
| |• Arteriovenous graft/fistula |
| |• Revision arteriovenous access |
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