Level: PGY Junior

Supervision: PGY Junior-Chief Resident ---- Attending 

All management decisions will be discussed with Senior Resident and Faculty 

Duty Hours: 

Hours are to be logged into New Innovations on a weekly basis and will be reviewed weekly by the Program Director for ACGME violations and reviewed weekly for delinquencies by the Program Coordinator. Over a four week period; you will not average more than 80 hours a work week, you will have one day in seven free of clinical duty, in-house call will be no more frequent than one in three nights, you should receive 10 hours free between all duty periods and after in-house call and you will not be on duty for more than 24 consecutive hours with an additional four hours for transitional activities only. If you are assigned more hours than mentioned heretofore or have patient care duties that are extending you beyond these limits, it is your responsibility to notify your supervising resident or faculty so arrangements can be made to relieve you. 

The aim of the night float rotation is to expose the first year surgical resident to the various principles and practice of General Surgery. The resident will be exposed to all aspects of Surgery under supervision after establishing competency through an elaborate curriculum.   This will allow our residents to develop knowledge and skills in assessment of the surgical patients that includes preoperative care, postoperative care, and critical care. The resident will be covering patients in the fields of General Surgery, Surgical Oncology, Endocrine Surgery, Thoracic Surgery and Vascular Surgery. 

Educational activities: 

  1. Recommended Reading           
    • Schwartz’s Principles of Surgery
    • Current Surgical Therapy – Cameron
    • Score Curriculum modules
  2. Conferences
    • Wednesday Resident Educational Curriculum 

Competency Based Objectives:  

A. MEDICAL KNOWLEDGE:

Goal:  The intern will achieve a detailed knowledge of the evaluation and treatment of a variety of disease processes.  The intern will be exposed to patients with both medical and surgical emergencies and will become comfortable with the initial evaluation and stabilization of patients.

Objectives:

  1. Discuss the diagnosis and treatment of patients with common surgical complaints including but not limited to:
    • Acute abdomen
    • Abdominal mass
    • Jaundice
    • Intestinal obstruction
    • GI Hemorrhage
    • Morbid obesity
    • Diverticulitis
    • Inflammatory bowel disease
    • Appendicitis
    • Abscess/infection
    • Hernia in various locations
    • Gall bladder disorders
    • management of various tubes and drains
    • ischemic extremity and other vaso-occlusive disorders
    • gangrene
    • venous disorders
    • aneurysmal disease
    • lung mass/medistinal mass
    • pneumothorax, hemothorax
    • management of chest tubes and other pleural catheters
    • airway disorders and management
  2.  Know the relevant anatomy of the peritoneal cavity,and its contents, thoracic cavity and its content and vascular anatomy
    • organs and other viscera
    • Arterial supply (celiac, SMA, IMA).
    • Venous anatomy (IVC, SMV, IMV, portal veins, hepatic veins).
    • lungs, pleura and mediastinum
    • major vasculature in the thoracic cavity
    • vascular anatomy- arterial and venous
  3.  Learn relevant basic GI tract physiology, pulmonary physiology, vascular physiology.
    • Bowel motility
    • Contraction alkalosis
    • Metabolism of the surgical patient
    • Fluids and electrolytes
    • air way exchange and mechanisms involved
    • abnormalities in ventilation, perfusion
    • blood flow principles and abnormalities
    • mechanisms of hemostasis
  4. Understand the workup and differential diagnosis of conditions such as but not limited to:
    • Acute abdomen
    • Abdominal mass
    • Jaundice
    • Intestinal obstruction
    • GI Hemorrhage
    • Diverticulitis
    • Inflammatory bowel disease
    • Appendicitis
    • Abscess/infection
    • Hernia in various locations
    • Gall bladder disorders
    • ischemic extremity and other vaso-occlusive disorders
    • gangrene
    • venous disorders
    • aneurysmal disease
    • lung mass
    • pneumothorax, hemothorax
  5.  Management of the postoperative patient.
    • Assessment of intra-/postoperative fluid status
    • Postoperative check
    • Pain control              
  6. Learn to appropriately recognize the signs and symptoms of common post-operative complications:
    • Chest Pain
    • Sinus Tachycardia
    • Atrial Fibrillation
    • Other arrhythmias
    • Low urine output
    • Acute abdomen (peritonitis)
    • Transfusion Reaction
    • Hypoxia/shortness of breath
    • Pulmonary Embolism
    • Alcohol Withdrawal
    • Pneumothorax
    • Wound infection
    • Ischemia
    • Confusion/agitation
    • Sepsis
    • Altered mental status
    • Stroke/TIA
  7. Learn basics of ventalitory management
    • Modes of ventilation
    • Oxygenation techniques
    • Ventilation techniques
    • Weaning strategies
    • Physiology of oxygen delivery
    • Types of ventilators
  8. Learn to interpret Swan Ganz catheter values
    • Indications for placement  
    • Cardiac output/index
    • Pulmonary artery wedge pressure
    • Systemic vascular resistance
  9.  Understand the basics of ionotropic support in surgical patients
  10. Understanding of the work up of cancer patients with knowledge of the staging for the most common malignancies such as:
    • Breast
    • Thyroid
    • Colon
    • Stomach
    • Pancreas
    • Liver
    • Lung

B.  Patient Care 

Goal:  The intern will provide patient care that is compassionate, appropriate, and effective for the treatment of general surgical problems.

Objectives

  1. Perform complete history and physical exams, consultations, and postoperative checks.
  2. Management of the postoperative patient
    • Evaluation of postoperative issues
    • Postoperative check
    • Management of fluids, electrolytes, nutrition
    • Assess for postoperative complications
    • Pain control
  3. Procedures:
    • Arterial catheter
    • Central venous access (SCV, IJ and Femoral line)
    • Changing lines over wire (Seldinger technique)
    • Nasogastric tube
    • Foley catheter
    • Chest thoracostomy tube.
    • Intubation/Cricothyroidotomy/Tracheostomy
    • Wound management/debridement
  4.  Learn the basics of a preoperative workup.
    • Informed consent.
    • Cardiovascular risk stratification.
    • Laboratory analysis.
    • Prophylactic antibiotic use and anticoagulants.
  5.  Learn to follow-up interventions in order to determine the effectiveness of the treatment.

C.  Practice Based Learning and Improvement 

Goal:  The intern will investigate and evaluate his or her own patient care practices, appraise and assimilate scientific evidence, and improve patient care practices. 

Objectives

  1. Utilize information technology to evaluate and treat patients.                                                                                                                         
  2. Improve the efficiency of care by appropriate and timely triage of patient-related problems. 
  3. Organize patient data/health information to facilitate timely care and reduce errors. 
  4. Teach medical students and other healthcare professionals about the practices of general surgery. 
  5. Achieve functional independence with graduated advancement and responsibilities. 
  6. Learn how and where to acquire relevant patient-care related information (electronic searches, textbooks, library resources). 
  7. Collect and appraise the evidence to provide care based on the most current evidence based guidelines.                                                                                                                         

D.  Interpersonal and Communication Skills 

Goal:  The intern will demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their families, and professional associates. 

Objectives

  1. Become an effective listener to the patients and their families.
  2. Demonstrates compassion for patients and families undergoing surgery.
  3. Educate patients and their families about postoperative recovery and disposition.
  4. Communicate patient-related issues in a timely manner to supervising resident or attending physician.  Discuss assessments and plans to all consultant services in a professional manner.
  5. Clearly and legibly document progress notes, procedure notes, event notes, and consult forms in the medical record.
  6. Ensure proper communication of patient-related issues and plans to the nursing staff and other healthcare workers. 
  7. Participate in efficient and comprehensive daily sign-in/sign-outs with the relevant services.
  8. Communicate effectively with all the team members involved in the care of patient to a model of team-based delivery of health care 

E.  System Based Practice 

Goal:  The intern will demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value.

Objectives 

  1. Coordinate the pre- and postoperative care and rehabilitation of general surgery patients.
  2. Use cost-effective and efficient diagnostic testing for patient work-ups. 
  3. Become advocates for your surgical patients within the health care system. 
  4. Refer general surgical patients to the appropriate practitioners and agencies. 
  5. Facilitate the timely discharge and/or placement of general surgery patients.          
  6. Learn to coordinate the admission of patients and communicate with primary care physicians, inpatient house staff, and consultants. 
  7. Review and complete the required medical documentation for all admitted/pre-admitted patients on the morning of their operation.  
  8. Review the relevant standards for quality and safety on the UCMC website

F.  Professionalism 

Goal:  The intern will demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. 

Objectives

  1. Safeguard the welfare of all patients. 
  2. Abide by established ethical and moral principles. 
  3. Respect all patients, their families, all healthcare personnel, and support services. 
  4. Provide timely and efficient care to all patients and requesting services. 
  5. Demonstrate an unbiased sensitivity to our patient’s cultural, spiritual, and personal beliefs. 
  6. Become accountable for your personal actions and conduct within the medical center. 
  7. Understands the concepts of autonomy, beneficence, nonmaleficence, justice, and respect for life. 
  8. Dress in a professional manner while caring for patients. 
  9. Maintain patient confidentiality at all times.

Duties/Responsibilities: 

  1. Serve as PGY Junior on night float to cover the services as described
  2. Appropriate, professional supervision of student teaching in light of educational goals
  3. Provide care with supervision
  4. Manage pre op and post op patients  
  5. Assist with consultations to the general surgical service as assigned by the Chief Resident
  6. Round on post surgical service patients as instructed.
  7. Attend educational conferences
  8. Complete surgical case logs
  9. Dictate in a timely fashion
  10. Obtain and provide comprehensive sign outs from/to the day time  residents

Evaluation:

  1. Performance feedback will be given to the resident as appropriate for educational events and mid-term progress will be discussed.
  2. Global evaluation will be performed by the general surgery attending physicians at the completion of each rotation. Surgical case logs will be evaluated for the appropriate number and breadth of procedures and will be present in the residents portfolio to be reviewed at the Program Evaluation meeting held twice yearly.
  3. At the completion of this rotation, the resident is required to complete a rotation evaluation form assessing the quality of the rotation. The resident should also address the teaching undertaken by the attending physicians on the rotation at the conclusion of this rotation.

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