CURRICULUM

Year Two:  WOUND CARE (2 weeks)

Wound Care PGY II

 

Description of Rotation or Educational Experience

 

The purpose of the Wound Care rotation is to familiarize family medicine residents with all aspects involved in the diagnosis, treatment, and management of wound care patients.  Residents will gain confidence and improved skills in treating patients with both acute as well as chronic wounds in an outpatient clinic, the Washington Regional Medical Center Wound Care Clinic, with the support of a multidisciplinary team including surgeons and certified wound care nurses.  This second year required rotation will be two weeks in length. Supervision is provided by the staff physicians at the Wound Care Clinic. 

 

Goal I: To gain the knowledge and skills to manage patients with acute and chronic wounds.

 

Goal II: Recognize the need for proper referral and consultation to a wound care specialist for those problems that are beyond his/her capabilities.

 

 

Patient Care

 

Goal

 

Residents will provide patient care under the supervision of the Wound Care Clinic staff physicians that is effective and appropriate. Residents are expected to:

 

Competencies

  • Learn basic wound care management.

 

Objectives

 

The resident will

  • Make informed decisions about diagnostic and therapeutic interventions based on patient preference, evidence based medicine and clinical judgment. 
  • Carry out incision and drainage as well as wound packing and dressing.

 

 

Medical Knowledge

Goal

 

Residents will demonstrate established and evolving biomedical, clinical, epidemiological, and socio behavioral sciences as well as the application of this knowledge to patient care.  Residents are expected to:

 

Competencies

 

The resident will gain cognitive knowledge and experience in the diagnosis and management of the following:

 

1.       Peripheral artery disease

2.       Venous insufficiency

3.       Lymphedema

4.       Pressure ulcers

5.       Diabetic ulcers

6.       Non-healing surgical wounds

7.       Burns

8.       MRSA abscesses

9.       Skin cancers

 

 

 

 

 

Objectives

 

1.       Performance of history and problem-focused physical examination

2.        Wound Assessment including:

a.  Measurements including length, width, depth, undermining, tracks and tunnels

b.       Evaluation of wound base

c.  Evaluation of periwound tissue

d.  Bedside vascular assessment

3.       Interpretation of radiographs, nuclear medicine exams, TCPO2 exams, and vascular studies

4.        Interpretation of laboratory tests

 

 

5.        Performance of procedures under supervision:

a.       Sharp debridement

b.       Apligraf application

c.       Biopsy

d.       Application of compression wraps

e.       Chemical cauterization

f.         Incision and drainage

g.       Removal of various foreign bodies

h.       Nail and callous care

6.       Efficient interaction with other physicians and hospital support staff

7.       Familiarity with community resources and utilization of appropriate services

8.       Patient education and preventative health care

9.       Timely and proficient medical records documentation

10.    Compassionate patient and family counseling

11.    Cost effective case management as patient advocate

12.    Selection of appropriate topical dressings and treatment modalities

13.    Awareness that informed consent applies not only to invasive surgical procedures, but also to every clinical decision.  If the patient lacks decision-making capacity, the physician should seek consent from the appropriate substitute decision maker

14.    Awareness of the importance of identifying goals of treatment with the patient.  Is the goal curative or palliative?

15.     Awareness of the benefits and limitations of advance directives, living wills, and durable powers of attorney

16.     The importance of assessing pain levels with these patients with each visit and making modifications in pain management as needed or referral to specialist in pain management

17.     Basic understanding of the role of hyperbaric oxygen, its benefits and limitations in wound healing

 

 

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

  • The resident will understand the limitations of the family physician’s ability to provide appropriate care and the need for consultation.
  • The resident will locate, appraise, and assimilate evidence from scientific studies related to their patients’ problems.
  • The resident will use information technology to support their education such as UpToDate and DynaMed.

 

 

 

 

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 optimal patient care systems.
  • Practice cost effective health care and resource utilization that does not compromise quality of care.

 

Objectives

 

The resident will be able to:

 

1.       Understand available options for treatment.

2.       Understand the indications and risks of certain procedures.

3.       Understand informed consent.

 

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

  • The resident will learn to advocate for the patient regardless of their diversity or socioeconomic status.

 

 

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 communicate effectively with other physicians, staff, patients and families.

 

Competencies

  • The resident will communicate effectively with physicians, other health professionals, health related agencies, patients and their families.

 

Objectives

  • The resident will learn to communicate with patients and families tailored to the knowledge and ability to understand the need for specific treatments.

 

 

Teaching Methods

 

Direct preceptor/resident interaction in the treatment of wound care patients with the support of a multidisciplinary team. 

 

 

 

 

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 Regional Wound Care Clinic:

 

Barbul, A, Pines, E, Caldwell, M, Hunt, T, Growth Factors and Other Aspects of Wound Healing: Biological and Clinical Implications. New York, Liss, Inc, .

 

Davis, JC, Hunt, TK, Problem Wounds: The Role of Oxygen. New York, Elsevier Science Publishing.

 

Kindwall, EP, Hyperbaric Medicine Practice, Flagstaff, AZ, Best Publishing.

 

Kozac, Hoar, Rowbotham, Wheelock, Gibbons, Campbell, Management of Diabetic Foot Problems, Philadelphia, WB Saunders

 

Levin, ME, O’Neal, LW, The Diabetic Foot, 4th Ed. Washington, DC, CV Mosby Company.

 

Mulder, GD, Jeter, KF, Fairchild, PA, Clinicians Pocket Guide to Chronic Wound Repair. Spartanburg, SC, Wound Healing Publications.

 

Reeves J, Maibach, H. Clinical Dermatology Illustrated, A Regional Approach. 2nd Edition. Philadelphia, FA Davis,

 

Wu, K, Foot Orthoses: Principles and Clinical Applications, Williams and Wilkin.

 

 

 

On Line resources:

 

UpToDate and DynaMed