Residency Training in General Surgery

EMERGENCY SURGERY/TRAUMA: Goals and Objectives

See our Trauma Handbook [Restricted Area] Adobe Acrobat Reader required.

The Emergency Surgery/Trauma Service covers 3 years of training: PGY-1, - and -4. The service consists of four residents at night and two during the day. The PGY 4 runs the entire service and rounds morning and night with the entire team. The daytime PGY-2 runs the team of a PGY-1 and one or two physician assistants in conjunction with the Trauma Attending during the day. The PGY-2 at night is responsible for consults among other duties. The PGY-1's at night are responsible for inpatients and ED patients requiring surgical consult.

PGY-1

Patient Care: Understand the basics of the ABC's of trauma evaluation and
management, diagnose and treat complications of the postoperative patient and gain initial experience in the operating room as well as in the performance of basic procedures, i.e., placement of nasogastric tubes, Foley catheters, central venous lines and chest tubes.
Medical Knowledge: Understand the pathophysiology of postoperative complications and understand the pathophysiology, diagnosis and treatment of injury and surgical emergencies through the weekly resident lecture and Trauma Conference series.
Practice-Based Learning and Improvement: Understand, through monthly case discussions, how to evaluate the effectiveness of their patient care and learn to critically evaluate literature and apply it to practice through our monthly Journal Club meetings.
Interpersonal and Communication Skills: Understand the importance of communication in patient care through daily interactions with healthcare staff, patients and families as well as the Trauma Conference series.
Professionalism: Understand principles of professionalism and ethics by example and through the Trauma Conference series.
Systems-Based Practice: Be introduced to the concepts of Trauma Scoring systems, triage and regionalization of care as well as billing, coding and compliance issues through day-to-day activities as well as Trauma Conference, resident lecture and web-based modules.

PGY-2

Patient Care: Begin to assess patients in need of emergency surgery or trauma consults, develop a differential diagnosis and a reasonable, efficient workup for each patient and independently perform basic procedures as well as be introduced to more advanced emergency procedures, i.e., diagnostic peritoneal lavage and cricothryotomy.
Medical Knowledge: Further develop their understanding of the pathophysiology, diagnosis and treatment of injury and surgical emergencies with special attention to the more complex problems of the multiply injured patient and emergency surgery patients with multiple comorbidities.
Practice-Based Learning and Improvement: Apply principles learned in the first year regarding effectiveness of workups and the relation to surgical literature.
Interpersonal and Communication Skills: Develop skills in communicating with consultants, patients and families with guidance from Attending staff as appropriate as well as through the Trauma Conference series. Topics would include delivering bad news, family meetings and DNR discussions.
Professionalism: Begin to develop leadership skills in the daily running of the day trauma team, with increasing levels of responsibilities on both the day and night team and learn basic ethical principles and cultural issues through Trauma Conference and resident lecture.
Systems-Based Practice: Through performance of consults, weekly multidisciplinary conference and leadership of the day trauma team, interact with members of the healthcare team to include nursing, social work, physical and occupational therapy, respiratory therapy, nutrition and other consultants to provide the best and most efficient care possible for our patients.

PGY-4

Patient Care: Supervise and lead the Emergency Surgery/Trauma Team in the delivery of patient care, teaching the junior residents how to do so with compassion and effectiveness. Lead trauma resuscitations, making critical diagnostic and therapeutic decisions under the supervision and guidance of an Attending and exhibiting proficiency at such.
Medical Knowledge: Further develop the knowledge base to the point of teaching the care of the injured and seriously ill surgical patient.
Practice-Based Learning and Improvement: Become proficient at evaluating< patient care and surgical literature by participation in the Morbidity and Mortality Conference and Quality Assurance Processes.
Interpersonal and Communication Skills: Lead patient and family discussions regarding injured patients or those requiring emergency surgery with appropriate skill and compassion and exhibit maturity and respect in interactions with healthcare staff.
Professionalism: Exhibit appropriate use of ethical principles and the consideration of cultural and spiritual issues in medical decision-making and family and patient interactions.
Systems-Based Practice: Teach junior residents the multidisciplinary approach to patient care, identify and utilize resources to the patient's benefit and effectively coordinate services for the patient. Knowledge of social work and long-term care issues, special needs of the geriatric and pregnant patients and those with disability is especially important.