Rotation-Specific Objectives

Rotation-Specific Educational Objectives for Core Surgical Residents in PGY1 and PGY2 Years

The following objectives have been prepared to aid neurosurgical residents and their supervisors as they rotate on the following non-neurosurgical rotations as PGY1 and PGY2 Year residents in the Surgical Foundations Program at The University of Toronto: Orthopedic Surgery, Plastic Surgery, Urology, Emergency Department, Anesthesia, Thoracic Surgery, and Vascular Surgery. These objectives have now been prepared in the format of the CanMEDS competencies.

Medical Expert/Clinical Decision-Maker

General Aims

1. To investigate and manage surgical patients with acute and chronic illness. 
2. To improve depth of knowledge, technical skills and decision-making capacity with respect to the surgical patient. 
3. To gain knowledge and management skills in the principles of surgery.


General Educational Objectives

A) Clinical Skills Applicable to all Surgical Rotations

Given a surgical patient with a given problem, the core surgery resident will be able to carry out the following to the satisfaction of his/her supervisors: 

1. Take a focused history. 
2. Perform a physical exam concentrating on the relevant areas. 
3. Arrive at an appropriate differential diagnosis. 
4. Order appropriate laboratory, radiologic and other diagnostic procedures demonstrating knowledge in the interpretation of these investigations. 
5. Arrive at an acceptable plan of management, demonstrating knowledge in operative and non-operative management of the disease process. 
6. Manage patients in the ambulatory setting, demonstrating a knowledge of common office techniques and procedures. 
7. Manage the patient throughout the entire in-hospital course, demonstrating knowledge of and being able to treat potential complications of disease processes and operative procedures and their treatment. 
8. Provide a plan for patient follow up.

B) Cognitive Knowledge and Technical Skills

Given a patient with a surgical problem, the core surgical resident must be able to perform the clinical skills listed in section (A), and be able to demonstrate to the satisfaction of his/her supervisor(s), a fundamental knowledge and understanding of the general and specific areas listed for each subspecialty below. The core surgical resident’s knowledge must be adequate to allow appropriate assessment, investigation, diagnosis, and treatment. 

At the end of a rotation on the surgical services listed below, the core surgical resident must be able to show technical competence in the following procedures to the satisfaction of his/her supervisor: 
 

Rotation Specific Objectives

Orthopaedic Surgery

The following are Rotation-Specific Objectives for knowledge base and technical skills to be acquired by a PGY-1 or PGY-2 resident completing a rotation in Orthopedic Surgery. 

a) General Areas 
1. Anatomy and physiology of the locomotor system. 
2. Pharmacology as related to diseases of bones and joints. 
3. Resuscitation and care of the multiple injured patient in the critical care setting. 
4. Principles of treatment of fractures, including open fractures. 
5. Principles of treatment of soft tissue injuries. 
6. Principles of treatment of spinal fractures. 

b) Specific Disease Entities 
1. Upper and lower extremity fractures (classification, treatment, complications & results). 
2. Spinal fractures (diagnosis, treatment, complications and prognosis). 
3. Ligamentous and tendinous injuries. 
4. Vascular and nervous complications. 
5. Compartment syndrome. 
6. Principles of reconstruction of arthritic joints. 
7. Principles of treatment of degenerative spinal disease. 

c) Clinical and Technical Skills 
At the end of rotation on an orthopedic surgery service, the core surgical resident must be able to show technical competence in the following procedures to the satisfaction of his/her supervisor(s). 

1. Assisting (both first and second) in the operating room, developing a facility for 
anticipation of surgical maneuvers, gentle traction on tissues, an ability to take direction well, to make reasonable suggestions and inquiry, and to contribute to a positive operating room atmosphere. 
2. Surgical approaches to upper and lower extremeties and spine. 
3. Closed reduction of fractures and application techniques. 
4. Open reduction of fractures and application of internal fixation devices including plate and IM nails. 
5. Repair of ligamentous injuries of the knee. 
6. Surgical repair of tendon injuries. 
7. Measurement of compartment pressures. 
 

Plastic Surgery

The following are Rotation-Specific Objectives for knowledge base and technical skills to be acquired by a PGY-1 or PGY-2 resident completing a rotation in Plastic Surgery 

a) General Areas 
1. Pathophysiology of trauma, general and specific to the plastic surgery service. 
2. Pathophysiology of burns. 
3. Wound healing in aseptic and septic conditions. 
4. Options for wound closure. 
5. Reconstructive surgery options for head and neck, hand and trunk. 
6. Aesthetic surgery options. 

b) Specific Disease Entities 
1. Trauma-polytraumatized patient, head and neck trauma, facial fractures, facial soft tissue injury. 
- hand trauma including skin loss, tendon injury, closed and open hand fractures. 
- burn patient (including frostbite and hypothermia) 
2. Wound healing problems- especially in difficult circumstances such as diabetes, immunosuppressed patients, paraplegic patients. 
3. Hand lesions- malformations, deficiencies, other diseases. 
4. Neoplastic skin lesions- benign and malignant tumours of the skin, head and neck, and the hand. 
5. Soft tissue infections- spontaneous, post-traumatic and post-operative 
- principles of tetanus prophylaxis, antibiotic usage. 
6. Principles of techniques of skin surgery 
- skin grafting, Z-plasty, rotation flaps, myocutaneous flaps, microvascular techniques. 
7. Skin ulcers- principles of management of vascular and diabetic and decubitus ulcers. 

c) Technical Skills 
At the end of a rotation on a plastic surgery service, the core surgical resident must be able to show technical competence in the following procedures to the satisfaction of his/her supervisor(s). 

1. Assisting (both first and second) in the operating room, developing a facility for anticipation of surgical maneuvers, gentle traction on tissues, an ability to take direction well, to make reasonable suggestions and enquiry, and to contribute to a positive operating room atmosphere. 
2. Excision of skin tumours. 
3. Vermilionectomy and wedge excision of the lip. 
4. Proper topical care and preparation for wound closure. 
5. Variety of wound closures (including design of incision, Z-plasty, flaps). 
6. Split-thickness skin graft. 
7. Minor maneuvers in facial fractures (e.g. zygoma elevation, jaw wiring). 
8. Tendon repair. 
9. Stabilization of hand and finger fractures (closed and open techniques). 
10. Debridement of wounds; handling the infected wound and the soft tissue infection requiring debridement as part of treatment. 
11. Local treatment and dressing of minor burns. 
12. Technical aspects of management of major burns- scar removal, dressings 

 

Emergency Medicine

The following are Rotation-Specific Objectives for knowledge base and technical skills to be acquired by a PGY-1 or PGY-2 resident completing a rotation in the emergency room. 

(a & b) General Areas and Specific Disease Entities 
1. Cardiac arrest. 
2. Cardiac crises – e.g. arrhythmias, diminished organ perfusion, pulmonary edema, mycardial infarction and severe hypertension. 
3. Shock. 
4. Respiratory failure. 
5. Coma, staus epilepticus, and acute neuromuscular diseases. 
6. Sepsis. 
7. Acid-base disorders. 
8. Fluid and electrolyte disorders. 
9. Renal Preservation and support. 
10. The acute abdomen, gastrointestinal hemorrhage, hollow viscus dysfunction, and hepatoniliary disease. 
11. Vascular crises. 
12. Endocrine disturbances in the critically-ill related to water and/or glucose metabolism and adrenal, parathyroid, thyroid and pituitary dysfunction. 
13. Coagulation disturbances and blood replacement therapy. 
14. Nutrition – enteral and parenteral. 
15. Drugs – general pharmacology of commonly-used drugs in the emergency department. 
16. Hypo- and hyperthermia syndromes. 
17. Trauma. 
18. Burns. 
19. Perioperative high-risk conditions. 
20. Pain, anxiety, and sleep. 
21. Intoxications. 
22. Pre-hospital care including paramedics, ambulance, first-aid providers, poison control, disaster planning. 
23. X-ray interpretation. 

c) Clinical and Technical Skills 
At the end of a rotation in an emergency department, the resident must be able to show technical competence in the following procedures to the satisfaction of his/her supervisor(s). 

1. Establishment and maintenance of the airway, including orotracheal and nasotracheal intubation, bag valve mask ventilation, bronchoscopy. 
2. Techniques used in advanced cardiac and trauma life support, including defibrillation and cardioversion, and EKG interpretation. 
3. Techniques of arterial and venous access, including arterial lines, CVP lines, venous cut-downs, and blood gas sampling. 
4. Thoracentesis, paracentesis, pericardiocentesis. 
5. Tube Thoracostomy. 
6. Lumbar puncture. 
7. Physiologic monitoring techniques, including O2 saturation, cardiac outputs. 
8. Foley catheter insertion, Nasogastric tube insertion, gastric lavage. 
9. Peritoneal lavage. 
10. Wound management, including cleaning, use of local anesthetics and techniques of wound closure. 
11. Fracture care, including splinting and casting. 
12. Slit lamp examination. 
13. Use of Schiotz tonometer. 
14. Use of externa; pacemakers. 
15. Epistaxis care, cauterization and nasal packing. 
 

Thoracic Surgery

The following are Rotation-Specific Objectives for knowledge base and technical skills to be acquired by a PGY-1 or PGY-2 resident completing a rotation in Thoracic Surgery. 

a) General Areas 
1. Anatomy and physiology of the heart, lungs, chest wall and mediastinum. 
2. Pharmacology as related to diseases of the heart and lungs. 
3. Resuscitation and care of the thoracic surgery patient in the critical care setting. 
4. Principles of gas exchange and the measurements thereof. 
5. Pulmonary reserve and the measurements thereof. 
6. Principles of esophageal manometry and pH testing. 
7. Principles of esophagoscopy. 

b) Specific Disease Entities 
1. Carcinoma of the lung, including staging, pathology and managements. 
2. Chronic obstructive pulmonary disease. 
3. Pneumothorax. 
4. Hemothorax. 
5. Chest trauma, blunt and penetrating, including rib fractures, broncho-tracheal disruption. 
6. Mediastinal tumours. 
7. Esophageal carcinoma. 
8. Esophageal motility disorders including achalasia, esophageal spasm. 
9. Gastroesophageal reflux. 

c) Clincal and Technical Skills 
At the end of a rotation on a thoracic surgery service, the core surgical resident must be able to show technical competence in the following procedures to the satisfaction of his/her supervisor(s). 

1. Assisting (both first and second) in the operating room, developing a facility for anticipation of surgical maneuvers, gentle traction on tissues, an ability to take direction well, to make reasonable suggestions and enquiry, and to contribute to a positive operating room atmosphere. 
2. To insert and remove chest tubes with minimal physical and emotional discomfort for the patient. 
3. Emergency treatment of tension pneuromthorax. 
4. Opening and closing of a thoracotomy incision. 
5. Intercostal nerve block. 
6. Arterial blood stab. 
7. Bronchoscopy and esophagogastoscopy. 
8. Mediastinoscopy. 
9. Pulmonary biopsy, wedge resection. 
10. Minor chest wall procedures. 
 

Vascular Surgery

The following are Rotation-Specific Objectives for knowledge base and technical skills to be acquired by a PGY-1 or PGY-2 resident completing a rotation in Vascular Surgery 

a) General Areas 
1. Anatomy and physiology of the arterial, venous and lymphatic systems, with emphasis on the arteries to the leg, the arterial and venous relationships at inguinal region, the carotid bifurcation, the subclavian artery and vein, and the abdominalvaorta and vena cava. 
2. Non-invasive and radiologic assessment of the arterial, venous and lymphatic systems. 
3. Pharmacology as related to diseases of arteries and veins, especially chronic and acute arterial disease, deep venous thrombosis and pulmonary embolism. 
4. Natural history of arterial disease processes and outcome of a variety of vascular procedures. 

b) Specific Disease Entities 
1. Arterial insufficiency of the legs, acute and chronic. 
2. Abdominal aortic aneurysm-asymptomatic and leaking. 
3. Peripheral aneurysms. 
4. Extracranial vascular disease (carotid). 
5. Renal hypertension. 
6. Associated diseases e.g. diabetes. 
7. Varicose veins. 
8. Deep venous thrombosis. 
9. Compartment syndromes. 

c) Clinical and Technical Skills 
At the end of a three-month rotation on a vascular service, the core surgical resident must be able to show technical competence in the following procedures to the satisfaction of his/her supervisor(s). 

1. Assisting (both first and second) in the operating room, developing a facility for anticipation of surgical maneuvers, gentle traction on tissues, an ability to take direction well, to make reasonable suggestions and enquiry, and to contribute to a positive operating room atmosphere. 
2. Control of hemorrhage in emergency situations. 
3. Femoral arterial embolectomy. 
4. Exposure of arterial pathology at various sites without injury to artery or surrounding structures. 
5. Repair of a traumatized artery. 
6. Patch of a diseased artery. 
7. Vascular anatomosis of a large vessel. 
8. Fasciotomy.

 

Communicator

General Requirements

During their specific core surgical rotations, PGY1 and 2 residents will be able to: 

1. Establish therapeutic relationships with patients/families. 
2. Obtain and synthesize relevant history from patients/families/communities. 
3. Listen effectively. 
4. Discuss appropriate information with patients/families and the health care team.

Specific Requirements

During their specific core surgical rotations, PGY1 and 2 residents will be learn to: 

1. Document appropriate histories, physical examinations, and progress notes. 
2. Establish communication with the patient and family that supports a trusting and open relationship. 
3. Provide information to the patient and family that supports the patient's participation in decision-making. 
4. Respond appropriately to patients, families, and colleagues, who express anger, hostility, or a complaint. 
5. Share information with other healthcare providers that supports teamwork and effective care planning and provision in an expeditious manner. 
6. Be sensitive to the needs of patients and their families as they are affected by gender, cultural and ethnic perspectives. 
7. Be able to communicate in a clear, concise and collegial manner with referring physicians. 
8. Be able to present data to a group of peers or allied health personnel in a clear and understandable way. 
9. Learn the avenues of communication with institutional managers and administrators to be able to clearly express the needs of his/her service. 
10. Prepare written documentation regarding patient consultations in a timely and accurate fashion.

 

Collaborator

General Requirements

During their specific core surgical rotations, PGY1 and 2 residents will be able to: 

1. Consult effectively with other physicians and health care professionals. 
2. Contribute effectively to other interdisciplinary team activities.

Specific Requirements

During their specific core surgical rotations, PGY1 and 2 residents will: 

1. Learn to communicate with other physicians and health care professionals to contribute effectively to interdisciplinary team activities to improve patient care in the management of surgical disorders that benefit from such approaches. 
2. Be able to collaborate with allied health care personnel in developing public education tools. 
3. Be able to work with healthcare governance at all levels. 
4. Contribute administrative skills to the physician team, including direction. 
5. Be able to delegate responsibilities where and when appropriate. 
6. Listen to concerns expressed by others providing care and assist in resolving these concerns if appropriate.

 

Manager

General Requirements

During their specific core surgical rotations, PGY1 and 2 residents will: 

1. Utilize resources effectively to balance patient care, learning needs, and outside activities.
2. Allocate finite health care resources wisely. 
3. Work effectively and efficiently in a health care organization. 
4. Utilize information technology (eg. searching medical databases) to optimize patient care, life-long learning and other activities.

Specific Requirements

During their specific core surgical rotations, PGY1 and 2 residents will: 

1. Learn time management for clinical activity, learning needs and family and recreational activities. 
2. Learn to function efficiently and effectively within a health care organization so as to optimize the application of existing resources. 
3. Learn to interact with the larger community to preserve and secure adequate resources for the provision of excellent care. 
4. Utilize current information technology for optimal patient care and for personal life-long learning.

 

Health Advocate

General Requirements

During their specific core surgical rotations, PGY1 and 2 residents will: 

1. Identify the important determinants of health affecting patients. 
2. Contribute effectively to improved health of patients and communities. 
3. Recognize and respond to those issues where advocacy is appropriate.

Specific Requirements

During their specific core surgical rotations, PGY1 and 2 residents will: 

1. Identify the important determinants of health that affect their patients. 
2. Contribute effectively to injury prevention, health maintenance and health enhancement programs in the community. 
3. Be effective advocates of practices that enhance health and well-being.

 

Scholar

General Requirements

During their specific core surgical rotations, PGY1 and 2 residents will: 

1. Develop, implement and monitor a personal continuing education strategy. 
2. Critically appraise sources of medical information. 
3.Facilitate learning of patients, house staff/students and other health professionals.

Specific Requirements

During their specific core surgical rotations, PGY1 and 2 residents will: 

1. Acquire current techniques to appraise sources of medical information and develop, implement and monitor a personal education strategy so as to become life-long learners. 
2. Acquire a sufficient awareness of the scientific method, including the principles of epidemiology, in order to critically analyse the literature for continuing medical education and investigation. 
3. Learn to facilitate the learning of patients, medical colleagues, both junior and senior, and other health care professionals.

 

Professional

General Requirements

During their specific core surgical rotations, PGY1 and 2 residents will: 

1. Deliver the highest quality care with integrity, honesty and compassion. 
2. Exhibit appropriate personal and interpersonal professional behaviours. 
3. Practice medicine ethically consistent with obligations of a physician.

General Requirements

During their specific core surgical rotations, PGY1 and 2 residents will: 

1. Have a thorough appreciation of the necessity for methods of quality assurance in the delivery of health care. 
2. Learn to deliver the highest quality care with integrity, honesty and compassion, and understand the importance of bio-ethical issues in the delivery of health care. 
3. Have the deportment of a professional including the demonstration of a sincere, caring attitude in dealing with patients. 
4. Fulfill medical, legal, and professional obligations of the specialist. 
5. Meet deadlines, be punctual, monitor patients, and provide follow-up. 
6. Understand the principles of ethics and apply these in clinical situations. 
7. Demonstrate self-assessment, seek and accept advice when necessary.

Back to Top