General Surgery PGYII

Description of Rotation or Educational Experience

The purpose of the surgery rotation is to prepare the resident for recognition of the importance of family physician and surgeons collaborating as partners in evaluation and decision making for the care of surgical patients.  In this six-week rotation, the PGYIl resident will develop an awareness of the principles involved in differentiating the causative origin of clinical symptoms resulting in the need for medical versus surgical interventions.  The resident will learn to show sensitivity to the concerns of the patients and families regarding the potential need for surgical intervention and post-op follow-up.

Goal I: The resident will be able to recognize, diagnose, manage and refer for consultation the surgery problems that may present in his/her practice.

Goal II: To provide in-patient and out-patient learning opportunities in the area of surgery through a two-month block rotation and continuous longitudinal experience throughout the residency.

The Resident is expected to:

• Make hospital rounds with the surgeon and provide inpatient and outpatient surgical assistance.
• Follow the surgeon in his office to gain experience in outpatient pre-op and post-op management.
• Participate in the Outpatient Surgery Clinic held at the Northwest Family Medical Center on every other Wednesday afternoon with Dr. Wayne Hudec, Board Certified Surgeon.
• Participate in the Outpatient Surgery Clinic held at the Family Medical Center every other Thursday afternoon with Dr. Wayne Hudec, Board Certified Surgeon.
• Attend two ½ day continuity clinics per week in the FMC.

Patient Care

Goal

Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.  Residents are expected to:

Competencies

The resident will:

·         Learn how to work with and consult with general surgeons.

·         Be able to work in the surgical arena (OR, OP Surgery, ER).

·         Understand basic surgical techniques, surgical scrub and OR protocols.

Objectives

·         Residents will be oriented to the surgical arena and will be instructed about hospital protocols and procedures that will help facilitate a safe surgical outcome.

·         Residents will be involved in the “team approach” to patient care and will learn to interact with surgical nurses and staff, faculty, and attending physicians.

·         Make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up to date scientific evidence and clinical judgment.

Medical Knowledge

Goal

Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care.  Residents are expected to become familiar with:

Objectives

The resident will:

• Become familiar with surgical technique.

• Learn and understand surgical anatomy.
• Gain experience in the diagnosis and management of the following problems/conditions:
  • Pancreatitis
  • Peptic ulcer disease
  • Bowel obstruction
  • Diverticulitis
  • Ischemic bowel problems
  • Diabetic and venous stasis foot ulcers
  • GI bleeding

Practice- Based Learning and Improvement

Goal

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life long learning.  Residents are expected to develop skills and habits to be able to:

Competencies

• Identify strengths, deficiencies and limits in one’s knowledge and expertise;

Objectives

• Surgical care and trauma require an understanding of the limitation of the family physician’s ability to provide appropriate care and the need for consultation.
• Locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems
• Obtain and use information about their own population of patients and the larger population from which their patients are drawn.
• Use information technology to manage information, access on-line medical information, and support their own education

Systems Based Practice

Goal

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.  Residents are expected to:

Competencies

• Advocate for quality patient care and optional patient care systems.
• Know how types of medical practice and delivery systems differ from one another including methods of controlling health care costs and allocating resources
• Practice cost-effective health care and resource utilization that does not compromise quality of care

Objectives

The resident will:

• Demonstrate an understanding of options available for surgical treatments.
• Demonstrate an understanding of the indications, contraindications and risk of common surgical procedures.
• Demonstrate competence in the informed consent process.

Professionalism

Goal

Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.  Residents are expected to demonstrate:

Competencies

• Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation

Objectives

• Surgery occurs in all areas of family medicine and the resident will learn that cost and availability limit access to some patients.  The resident will take action on behalf of patient regardless of ability to pay in a varied population. 

Interpersonal and Communication Skills

Goal

Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates.  Residents are expected to:

Competencies

• Communicate effectively with physicians, other health professionals, and health related agencies.

Objectives

• Communication with surgeons requires precise description of patient history, physical findings, lab, x-ray reports, and possible diagnosis.  The resident will increasingly become able to perform in this area.
• Communication with patients and families must be tailored to their knowledge and ability to understand benefits and negative outcomes of surgery.  The residents will learn this skill.

Teaching Methods

In and outpatient discussion, evaluation of x-rays and lab reports, preceptor rounds.

Assessment Method

At the conclusion of each resident rotation, the residency coordinator sends a formative-type, rotation-specific performance evaluation form to the rotations’ supervising physician.  When the completed evaluation is returned, the resident physician and the resident’s faculty advisor review the evaluation and attest to reviewing it by signing/initialing the form.  Next, the program director reviews and attests to the document.  Once all three have reviewed and attested the evaluation, it is included in the resident’s permanent file. 

Each resident is asked to evaluate the rotation and supervising physician(s) at the end of the rotation.  The resident’s faculty advisor and program director review the evaluation and attest to reviewing it by signing/initialing the form. These evaluations are filed together by resident year.

Educational Resources

References available at the AHEC Library:

Pfenninger JL, Fowler GC. Procedures for primary care physicians. St. Louis, Mo.: Mosby,

Sabiston DC Jr., Lyerly HK. Textbook of surgery: the biological basis of surgical practice. 16^th ed. Philadelphia: Saunders

Schwartz SI. Principles of surgery. 7^th ed. McGraw-Hill

Doherty GM. Washington manual of surgery. Little, Brown and Company

Lynge DC, Weiss BD. Surgical Problems and procedures in primary care (20 common problems). 1^st ed. McGraw-Hill

Brown, JS. Minor surgery, a text and atlas. 4^th ed. London, Arnold Publishers

Whelland RG. Cutaneous surgery. Philadelphia. W.B. Saunders

On Line Resources:

UpToDate and DynaMed