Residency Training in General Surgery
GENERAL SURGERY: Goals and Objectives
@ Winthrop–University Hospital
GOAL
To prepare physicians to function as well-qualified, independent specialist in surgery.
OBJECTIVES
At the completion of training, the resident is expected to demonstrate competence in the areas of Medical Knowledge, Patient Care, Interpersonal and Communication Skills, Professionalism, Practice based learning and Systems-Based Practice as described by ACGME. Specifically,
1. Manage surgical disorders based on a thorough knowledge of basic and clinical science.
2. Demonstrate appropriate skill in those surgical techniques required of a qualified surgeon.
3. Demonstrate the use of critical thinking when making decisions affecting the life of a patient and/or the patient's family.
4. Make sound ethical and legal judgments appropriate for a qualified surgeon.
5. Collaborate effectively with colleagues and other health professionals.
6. Ability to use various effective methodologies especially verbal communication skills in interpersonal communication between peers, other health care professionals and patients.
7. Teach and share knowledge with colleagues, residents, students and other health care providers.
8. Demonstrate professionalism, empathy and compassion by showing respect to patients' privacy and self-esteem at all times.
9. Respect the religious needs of patients and their families and provide surgical care in accordance with those needs.
10. Teach patients and their families about the patient's health needs.
11. Demonstrate acceptance of the value of life-long learning as a necessary prerequisite to maintaining surgical knowledge and skill.
12. Demonstrate a commitment to scholarly pursuits through the conduct and evaluation of research.
13. Demonstrate leadership in the management of complex programs and organizations.
14. Demonstrate ability to recognize urgent clinical conditions and respond to these in a very timely and appropriate fashion, including seeking assistance from senior residents or faculty as needed.
15. Provide cost-effective care to surgical patients and families within the community.
16. Carry out timely, accurate and legible completion of medical records and orders to deliver appropriate care for patients.
The General Surgery Residency Program is designed to provide progressive responsibility in pre and post operative care and non operative management of surgical patients, as well as to foster the development of operative skills, culminating in the capability to assume independent responsibility for clinical decision making in surgery.
(Residents will be expected to fulfill the requirement of the core competencies identified by ACGME according to the steps described by SUNY-Stony Brook Surgery Program)
*Adapted from the format of Jay C. Smout, PhD. and Walter J. Pories, MD. With additional expectations specific for the program.
PGY-1
1. Exhibit dedication to the principles of professional preparation in surgery that emphasizes the primacy of the patient as the focus for surgical intervention.
2. Demonstrate continued progress in attaining competency in basic and clinical sciences and all the elements of core competency as described by ACGME/ABS (Medical knowledge, Patient Care, Interpersonal and communication Skills, Professionalism, Practice based learning and System based practice).
3. Explain basic ethical principles inherent in surgical practices.
4. Share data obtained from a comprehensive physical diagnostic and therapeutic procedures.
5. Carry out detailed and comprehensive history and physical exam
6. Demonstrate competence in performing selected invasive diagnostic and therapeutic procedures
7. Demonstrate the proper use of sterile techniques when performing or assisting with operative procedures
8. Demonstrate the ability to teach patients and their families about disease processes and their health
9. Recognize responsibility for and develop skill in teaching residents, students and other health care providers
10. Develop and implement plans for study, reading, and research that promote personal and professional growth
11. Use available resources to survey current surgical research
12. Demonstrate the leadership principles that relate to management of patient care
13. Demonstrate understanding of the socioeconomic, cultural and managerial factors inherent in providing cost-effective health care
14. Develop and present a scholarly paper on a surgical topic
15. Demonstrate the ability formulate differential diagnosis and and carry out diagnostic and treatment plans and to understand expected outcome of the following clinical conditions: Acute Abdomen, soft tissue infection, leg pain, chest pain, shortness of breath, oliguria, electrolyte derangement, and nutrtional shortcomings.
16. Demonstrate technical skills in carrying out the following: Simple suturing, insertion of central venous access, tube thoracostomy, first assistant skills, Incision and drainage, FNA, Incisional and excisional biopsy, hemorrhoidectomy, hernia repairs, amputations, varicose veins, tracheostomy, attaining an airway and appendectomy.
PGY-2
All objectives for PGY-1, plus the following:
1. Demonstrate continued progress in the acquisition of knowledge and skill in the practice of surgery
2. Use available date from basic and social sciences when planning pre-intra-post-operative care for newly admitted patients
3. Relate scientific knowledge and research findings to care of patients
4. Play a leading role in care of the critically ill patient showing competence in ventilatory management, fluid resuscitation, appropriate use of cardiovascular drugs and recognizing abnormal responses.
5. Teach medical and other health professional students and junior residents about the management of surgical patients
6. Demonstrate progress toward achievement of goals for personal and professional growth and development
7. Evaluate current research and its relationship to surgical practice
8. Function in a leadership role by using the problem solving approach in planning care for patients and families
9. Demonstrate the development of cost conscientiousness in the use of diagnostic and therapeutic technology when caring for the surgical patient.
10. Demonstrate the technical skill required of a first assistant to the operating surgeon.
11. Demonstrate the ability to formulate differential diagnosis and carry out diagnostic and treatment plans and to understand expected outcome of the following clinical conditions along with a senior resident: management of trauma and burn patients, cerebrovascular event, advanced ischemic extremity, portal hypertension, shock, cardiac failure and arrest, pneumothorax, spinal injury, deep venous thrombosis and PE, and GI bleeding.
12. Demonstrate skills in carrying out the following: Cholecystectomy, hernia repair, basic laparoscopy, endoscopy, pacemaker insertion, Arterio-venous fistula/ grafts, diagnostic peritoneal lavage, ventral hernia repairs and small bowel resection
PGY-3
All objectives for PGY-2, plus the following:
1. Manage patients having complicated surgical conditions.
2. Act as first assistant in more complicated surgical interventions.
3. Use critical thinking in making decisions about management of care.
4. Incorporate ethical concepts in the planning of pre-intra- and post-operative care of patients and families.
5. Collaborate with patients and family when planning operative procedures and postoperative care.
6. Continue to demonstrate appropriate skill in teaching other residents and other health care professionals.
7. Analyze resources available for providing continued learning experiences.
8. Develop research proposals to promote improvements in medical and surgical care.
9. Use leadership strategies in the implementation of health care to patients and families.
10. Demonstrate the ability TO formulate differential diagnosis and carry out diagnostic and treatment plans and to understand expected outcome of the following clinical conditions: melanoma, GI cancers, breast cancer, complications of the ICU patient, endocrine tumors and emergencies.
11. Demonstrate technical skills in carrying out the following: mastectomy, right colon resection, hemodialysis access, thyroid and parathyroid surgery, master basic laparoscopic surgery, all colon surgery, lymph node dissection / sentinel nodes, splenectomy, femoral-popliteal reconstruction, common bile duct surgery and peptic ulcer surgery
PGY-4
All objectives for PGY-3, plus the following:
1. Lead and Assist junior residents in assuming, planning and managing pre and post-operative care for patients with common surgical disorders.
2. Perform more complex surgery under appropriate supervision.
3. Provide complete follow-up care until the patient is fully recovered.
4. Independently formulate patient care plans and guide junior residents in making decisions about findings of physical examination and management of pre- and post-operative care.
5. Incorporate appropriate ethical principles when presenting patients care studies.
6. Collaborate with residents, faculty and other health professionals to provide comprehensive health care for patients.
7. Evaluate standards for surgical practice.
8. Evaluate achievement of identified goals for personal and professional growth.
9. Demonstrate the ability to conduct experimental research studies in the laboratory and in clinical settings.
10. Implement leadership role in planning changes for improving and managing care of patients in a variety of settings.
11. Demonstrate ability use TNM classification model for Cancer staging and prognosis.
12. Familiarity with chemotherapeutic and other adjuvent treatment agents.
13. Demonstrate understanding of the impact of health legislation and the third-party payment system to cost of health care.
14. Demonstrate the ability formulate differential diagnosis and carry out diagnostic and treatment plans and to understand expected outcome of the following clinical conditions: Sarcoma, gastric cancer, carotid artery stenosis, abdominal aortic aneurysm, advanced traumatic injuries, common bile duct and liver pathologies, pancreatitis and malignancies.
15. Demonstrate technical skills to adequately perform: carotid endarterectomy, aortic aneurysm repair, tibio-peroneal arterial reconstruction, lung resection, esophageal resection, fundoplication, rectal resection, anal pouch creation, liver resections, pancreatic surgery, gastric resection, adrenalectomy, bariatric surgery and advanced laparoscopic surgery
PGY-5
All objectives of PG- 4, plus the following:
1. Supervise and provide leadership to junior residents in caring for patients with complex.
2. Knowledge and skill during operative procedures.
3. Demonstrate effective and independent decision making in the management of care for all types of surgical patients and their families.
4. Discuss with junior residents and medical students the ethical issues related to surgical practice.
5. Demonstrate to junior residents the collaborative role of the surgeon in the practice of surgery in the community.
6. Evaluate the teaching skills of junior residents and provide guidance for improving these skills.
7. Evaluate knowledge gained from continuing education and its relationship to professional development.
8. Conduct independent research and assist junior residents in planning clinical research proposals.
9. Provide leadership to medical students and junior residents in the management of complex programs for providing health care.
10. Evaluate the cost-effectiveness of present and future surgical care of patients and families.
11. Master the knowledge base of a PGY-4 and be prepared for independent decision-making and treatment of all general surgical patients as well as prepare for successful completion of American Board of surgery examination..
12. Master the technical skills attained at PGY-4 level
