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Gen Surg Objectives

Rotation-Specific Objectives for Neurosurgical Residents on General Surgery Services: PGY1 Rotation

As PGY1s, residents complete a 3 block rotation on General Surgery.

MEDICAL EXPERT

Knowledge

By the end of the rotation the resident will be able to:

  • Describe the principles of resuscitation of the general surgery patient
  • Demonstrate proficiency in the primary, secondary and tertiary survey for the injured patient
  • Recognize and provide initial management of the acutely unwell patient and inform senior colleagues.
  • Demonstrate proficiency in the management of patients with intra-abdominal infections.

Technical Skills

By the end of the rotation the resident will be able to:

  • Understand the conduct of a standard laparotomy
  • Demonstrate the ability to open and close a laparotomy incision and safely place laparoscopic ports
  • Complete surgical checklists with the peri‐operative team
  • Demonstrate proficiency in open and closing the abdomen in a relatively stable patient without previous intra-abdominal  surgery

COMMUNICATOR

By the end of the rotation the resident will be able to:

  • Communicate effectively with consultant services
  • Provide timely, accurate, compassionate and patient‐centered information exchange with patients and their families, at the point of care.
  • Obtain informed consent for routine emergency and elective surgery, including appendectomy, cholecystectomy, repair incarcerated hernia.
  • Demonstrate proficiency in completion accurate discharge summaries and operative dictations for appendectomy, cholecystectomy, inguinal hernia repair, breast lumpectomy

COLLABORATOR

By the end of the rotation the resident will be able to:

  • Collaborate effectively with consulting services and allied professionals to ensure best care delivery.
  • Consult relevant services and incorporating relevant therapeutic plans into the overall plan of care for the patient.

LEADER

By the end of the rotation the resident will be able to:

  • Demonstrate proficiency in the pre and post- operative care of patients undergoing elective and/or emergency surgery.
  • Ensure timely discharge of patients including timely completion of discharge summaries
  • Manage multiple tasks on time (i.e. follow up on reports, prioritize tasks appropriately)
  • Utilize health care resources safely, effectively
  • Utilize an electronic medical record effectively

HEALTH ADVOCATE

By the end of the rotation the resident will be able to:

  • Ensure diagnostic tests are completed in a timely fashion.
  • Organize resources to enable that patients can be safely discharged from hospital in a timely fashion.
  • Demonstrate familiarity with important determinants of health affecting patients undergoing anesthesia (e.g. smoking, obesity, drug or alcohol dependence, cervical disc problems, family history anesthetic problems) and address preventative measures with patients

SCHOLAR

By the end of the rotation the resident will be able to:

  • Recognize gaps in knowledge and develop strategies to correct these
  • Develop a strategy for self-directed learning and demonstrate the spirit of continuous improvement

PROFESSIONAL

During the rotation the resident will:

  • Demonstrate proficiency in handover with the team on call and senior resident patients with active issues prior to leaving the hospital (pending investigations, requires clinical reassessment, pending surgical intervention, recent transfer to the ICU).
  • Provide patient care in a compassionate and ethical manner, reflecting an understanding of issues related to age, gender, culture and ethnicity.
  • Recognize limitations and seek advice and consultation when needed
  • Discuss appropriate boundaries in work and learning situations

 

General Surgery Rotation Specific Objectives

GENERAL OBJECTIVES:

Neurosurgery residents at the University of Toronto are required to spend 3 months on a general surgery service as part of their PGY1 training. They will rotate to one of the teaching hospitals within the University, most often Sunnybrook Health Sciences Centre, Toronto Western Hospital/Toronto General Hospital, and St Michael's Hospital. The following is a description of the rotation-specific objectives for neurosurgery residents undertaking their general surgery rotation: 

GOAL 
To develop the clinical skills, professional attitudes, and knowledge base for the practice of General Surgery through exposure to adult general surgical disorders. Appreciate the medical management and basic foundations underlying the care of surgical patients. 

DESCRIPTION 
The trainee will function as a junior consulting member of the inpatient General Surgery service. Senior residents and attending staff will supervise the trainee and evaluate their progress. 
 

SPECIFIC OBJECTIVES:

MEDICAL EXPERT/CLINICAL DECISION MAKER

CLINICAL SKILLS

  • Understand the conduct of a standard and trauma laparatomy
  • Demonstrate early skill in basic laparoscopic and psychomotor technique
  • Demonstrate proficiency in surgical asepsis and infection control techniques

KNOWLEDGE

  • Describe the principles of resuscitation of the major trauma patient
  • Demonstrate proficiency in the primary, secondary and tertiary survey for the injured patient
  • Describe role of the trauma centre in secondary prevention
  • Demonstrate early skills in reviewing trauma imaging (CXR, pelvic Xray, CT chest, abdomen, pelvis)
  • Demonstrate proficiency in the management of acute appendicitis, intestinal obstruction, gall stone disease
  • Describe the principles of source control for surgical infections
     

COMMUNICATOR:

General Requirements

  • Obtain and synthesize relevant history from patients/families/communities.
  • Listen effectively.
  • Discuss appropriate information with patients/families and the health care team.

Specific Requirements

  • Communicate effectively and regularly (daily) with patients, parents, and families to review medical status and establish therapeutic relationships.
  • Discuss appropriate information with patients/families.
  • Be considerate and compassionate in communicating with patients and families; willingly provide accurate information appropriate to the clinical situation, with a reasonable attempt at prognosis.
  • Communicate effectively with the health care providers including general surgery staff, nurses, ward nurses, consulting physicians, residents, medical students and discuss appropriate information.
  • Communicate appropriately with service providers when ordering investigative procedures.
  • The trainee must ensure there has been adequate communication about the patient with the person who will actually be doing and/or reporting the diagnostic study.

COLLABORATOR:

General Requirements

  • Consult effectively with other physicians and health care professionals.
  • Lead and contribute effectively to interdisciplinary team activities.
  • Be an effective teacher of medical students, residents, allied health professionals, and patients.

Specific Requirements

  • Be informed of the management plans proposed by the referring physician or other consultants for every inpatient to effectively coordinate the patients care.
  • Contribute effectively to discharge planning for every inpatient (e.g. long-term care facility, homecare, parent education).
  • Discharge planning must be discussed with the referring physician(s) and other consultants.
  • Be an effective teacher of medical students, residents, and patients

MANAGER:

General Requirements

  • Utilize resources effectively to balance patient care, learning needs, and outside activities.
  • Allocate finite health care resources wisely.
  • Work effectively and efficiently in a health care organization.
  • Demonstrate appropriate judgement in triaging patients for access to resources which are limited.
  • Utilize information technology to optimize patient care, life-long learning and other activities.

Specific Requirements

  • Demonstrate the following professional skills in time management: 
    • Demonstrate proficiency in the basic pre and post operative care of patients undergoing elective and/or emergency surgery
    • Demonstrate ability in obtaining informed consent for emergency and elective surgery
    • Ensure timely discharge of patients
    • Demonstrate ability in the management of postoperative complication after major laparotomy
  • Maintain complete and accurate medical records:
    • Record and maintain a complete and accurate medical record for patients seen
    • Clinic letter for outpatient consultations should be dictated the day of clinic to ensure their completeness and accuracy.
    • Effectively coordinate the work of the health care team.

HEALTH ADVOCATE:

General Requirements

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

Specific Requirements

  • Demonstrate proficiency in ensuring diagnostic tests are completed in a timely
  • Demonstrate proficiency in effectively organizing resources to enable that patients can be safely discharged from hospital in a timely fashion (PGY1-5).
  • Demonstrate proficiency in effectively allocating health care resources within a finite health care environment

SCHOLAR:

General Requirements

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

Specific Requirements

  • Development and implementation of a personal continuing education strategy is expected of the trainee. This will be monitored by the attending staff and evaluated by the knowledge level and "evidence of reading" demonstrated by the trainee with respect to the patients on the inpatient service
  • Present teaching rounds on a topic for the purpose of educating oneself and peers.
  • Be able to critically assess the literature as it relates to patient diagnosis, investigation and treatment

PROFESSIONAL:

General Requirements

  • Deliver highest quality care with integrity, honesty and compassion.
  • Exhibit appropriate personal and interpersonal professional behaviors.
  • Practice medicine ethically consistent with obligations of a physician.

Specific Requirements

  • Demonstrate personal and professional attitudes consistent with a consulting physician role:
    • Include the patient in discussions concerning appropriate diagnostic and management procedures.
    • Show appropriate respect for the opinions of fellow consultants and referring physicians in the management of patient problems and be willing to provide means whereby differences of opinion can be discussed and resolved.
  • Be willing and able to appraise accurately his/her own professional performances and show that he/she recognizes his/her own limitations with regard to skill and knowledge by appropriately consulting other physicians and paramedical personnel when caring for the patient.
  • Be willing and able to keep his/her practice current through reading and other modes of continuing medical education and develop a habit of maintaining current his/her clinical skill and knowledge base through continuing medical education.