Specific Educational Goals and Education

Level: PGY-1

Service: Plastic and Reconstructive Surgery

Supervision: PGY-1 → Plastic Surgery Resident → Attending

All management decisions will be discussed with the chief resident and faculty. An attending physician will round daily with the residents and students. Attending coverage for the ER is assigned daily.

Duty Hours:

Hours are to be logged into GMEOne 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 30 consecutive hours. 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.

Educational Activities:

  1. Recommended Reading
    1. Schwartz's Principles of Surgery
    2. SCORE curriculum modules 
    3. Grabb and Smith's Plastic Surgery; by Charles H Thorne (Editor), Scott P Bartlett (Editor), Robert W Beasley (Editor), Sherrell J Aston (Editor), Geoffrey C Gurtner (Editor)
  2. Conferences
    1. General Surgery Resident Educational Curriculum; Wednesdays, 8am Noon
    2. Plastic Surgery Core Curriculum; Wednesdays, 7am 9am

Competency Based Performance Objectives:

Patient Care:

Goal: The resident will be able to use acquired skills and knowledge to manage the treatment of acute, chronic, and neoplastic defects not requiring complex reconstruction.

Objective: The resident will be able to:

  1. Participate in the perioperative evaluation and management of congenital or acquired defects (traumatic and surgical)
  2. Participate in the evaluation and formulation of treatment plans for
    1. Hand injuries
    2. Facial fractures
    3. Head and neck cancer
    4. Congenital anomalies
    5. Breast deformities
    6. Burn patients
  3. Provide definitive treatment plans for superficial incised and lacerated wounds of the neck, trunk, and extremities.
  4. Evaluate and treat simple and intermediate abrasions and burns of the face, trunk, and extremities.
  5. Perform simple incisional biopsies and excise small lesions on the skin and subcutaneous tissue of the trunk or extremities.
  6. Apply and remove dressings of the head, neck, hand, trunk, and extremities, including:
    1. Occlusive
    2. Non-occlusive
    3. Wet to dry
    4. Casts
    5. Alginate
    6. Colloidal
  7. Harvest and apply split-thickness and full-thickness skin grafts
  8. Perform simple, localized skin flaps for wound coverage
  9. Act as first assistant and attending-supervised surgeon for major resectional and reconstructive surgery of the head, neck, breast, trunk and extremities
  10. Assess and act as first assistant or attending-supervised surgeon for the following
    1. Complex soft tissue injury
    2. Fractures requiring operative and non-operative reduction
    3. Nerve, tendon, and bone surgery of the hand
    4. Surgical repair of facial trauma
    5. Resection of neoplasms of the head and neck
    6. Resection of major skin and soft tissue neoplasms requiring complex reconstruction
    7. Surgical repair of craniomaxillofacial congenital defects
    8. h. Reconstruction of the breast
    9. i. Complex wound reconstruction using flap both local, regional, and free microvascular

Competency Based Knowledge Objectives:

Medical Knowledge:

Goal: Demonstrate an understanding of the nature and principles of correction and reconstruction of congenital and acquired defects of the head, neck, trunk, and extremities.

Objectives: The resident will be able to:

  1. Outline the components of a comprehensive focused history and physical examination pertinent to the evaluation and correction of congenital or acquired defects under the realm of plastic and reconstructive surgery
  2. Discuss and compare skin and connective tissue according to
    1. Anatomy
    2. Normal physiology and biochemistry
    3. Pathophysiology of benign and malignant skin disorders
    4. Unique pathophysiology of connective tissue disorders
  3. Explain the basic techniques for surgical repair of superficial incisions and lacerations of the head, neck, trunk, and extremities to include the following considerations
    1. Skin
    2. Subcutaneous tissue
    3. Superficial muscle and fascia
    4. Dressings
    5. Splints
    6. Suturing and knot tying
  4. Describe the physiology of various techniques of skin and composite tissue transplantation with particular regard to component tissue circulation
    1. Skin grafts (split vs full-thickness)
    2. Bone (cartilage grafts)
    3. Composite grafts
    4. Skin flaps
    5. Muscle flaps
    6. Myocutaneous flaps
    7. Bone flaps
    8. h. Osteocutaneous flaps
    9. i. Myo-osseous flaps
    10. j. Vascularized versus nonvascularized flaps
    11. k. Neurocutaneous flaps
  5. Outline the components of a comprehensive examination of the naso-oro, and hyo-pharynx to include
    1. Normal anatomy
    2. Common congenital anomalies
    3. Evolution of neoplastic disease
  6. Explain the assessment of facial skeletal trauma according to the following systems
    1. LeFort I, II, and III classification of maxillary fractures
    2. Nasoethmoidal disruption classification
    3. Zygomatic, orbit, and mandibular fractures
    4. Disruption classification
  7. Define the tumor, node, and metastases (TNM) classification system as used for neoplasms of skin, soft tissue, and head and neck
  8. Discuss epidemiology, risk factors, treatment, and prevention of cutaneous malignancies in the geriatric patient
  9. Explain the methods for performing incisional and excisional biopsies of skin and oral cavity
  10. Demonstrate the systematic examination of the hand to assess motor and sensory function, including
    1. Intrinsic tendon and muscle function
    2. Extensive tendon and muscle function
    3. Median nerve
    4. Ulnar nerve
    5. Radial nerve
    6. Circulation
    7. Bones
  11. 1Summarize the evaluation of patients with head and neck cancer and develop a treatment plan according to the following criteria
    1. Location of the lesion
    2. Size of primary lesion
    3. Presence of metastatic disease
  12. Discuss the use of the reconstructive ladder (including skin grafts, local flaps, and regional and free microvascular flaps) in the definitive management of traumatic or excised wounds.
  13. Demonstrate a working knowledge of the safe use of nasopharyngoscopy, laryngoscopy, esophagoscopy, and other endoscopic procedures utilized in the evaluation of patients with head and neck cancer

Interpersonal and Communication Skills:

Goal: Counsel patients and obtain informed consent for plastic procedures

Objectives: The resident will demonstrate the ability to obtain informed consent, outlining the risks and benefits of common plastic surgical procedures.

Goal: Communicate effectively to discharge patients after surgery.

Objectives: The resident will demonstrate the ability to instruct patients regarding:

  1. Discharge instructions
  2. Coordination of post surgical care

Goal: Communicate effectively as a member of the healthcare team.

Objectives: The resident will demonstrate the ability to communicate effectively by:

  1. Providing appropriate check out when handing patients to another team member
  2. Requesting consults from other services with appropriate information
  3. Dictating operative reports in a timely fashion
  4. Dictating discharge summaries in a timely fashion

Professionalism:

Goal: Maintain patient confidentiality

Objectives: The resident will demonstrate

  1. The ability to protect health-related patient information per HIPAA compliance
  2. List and be aware of sites in the hospital and clinic where loss of privacy for the patient may occur

Goal: Maintain appropriate professional relationships

Objectives: The resident will demonstrate professional interactions with:

  1. Medical students
  2. Nursing and support staff
  3. Supervising faculty
  4. Consulting residents
  5. Physician peers
  6. Patients and their families

Practice-Based Learning and Improvement

Goal: Identify personal and practice improvement strategies

Objective: The resident will demonstrate:

  1. Receptiveness to faculty instruction and feedback
  2. Ability to use medical information with the ability to access information through tradition and online sources to support their educational experience

Goal: Use medical evidence to evaluate Plastics practices

Objective: The resident will demonstrate the ability to:

  1. Discuss studies regarding operative procedures
  2. Discuss studies regarding non-operative care
  3. Evaluate literature associated with the natural history of soft tissue diseases

Systems-Based Practice

Goal: Provide safe patient care

Objective: The resident will:

  1. Attend Crew Resource Management courses as required by the hospital
  2. Follow recommended protocols in the OR for patient safety
  3. Demonstrate compliance with Medical Center policy for surgical site identification
  4. Demonstrate compliance with Medical Center policy for patient identification

Goal: Discharge patients with appropriate follow-up

Objective: The resident will demonstrate the ability to:

  1. Refer patients appropriately to home health services
  2. Refer patients appropriately to psychiatric and social services

Duties/Responsibilities:

  1. Serve as PGY-1 on the Plastic and Reconstructive service
  2. Appropriate, professional supervision of student teaching in light of educational goals
  3. Attend Plastics clinic as assigned
  4. Attend rounds on the Plastics service daily
  5. Perform initial evaluation of patients presenting to the ER and present these patients to the Chief Resident or attending physician, including completing the history and physical sheet
  6. Manage ER patients with supervision
  7. Assist with consultations to the Plastics service as assigned by the Chief Resident
  8. Round on post surgical service patient's daily, present patients to the Chief Resident and attending at morning rounds
  9. Attend educational conferences
  10. Attend other conferences as listed
  11. Complete surgical case logs
  12. Dictate in a timely fashion
  13. Take night call as assigned

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 Plastics attending physicians at the completion of each rotation and yearly by the nursing and support staff
  3. Surgical case logs will be evaluated for the appropriate number and breadth of procedures and will be present in the resident's portfolio to be reviewed at the Program Evaluation meeting held twice yearly.
  4. 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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