Specific Educational Goals and Education

Level: PGY-1

Service: UH2

Supervision: PGY-1 → PGY-4 → Attending

All management decisions will be discussed with the senior resident and faculty.

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. Schwartzs Principles of Surgery
    2. SCORE curriculum modules 
  2. Conferences
    1. Wednesday Resident Educational Curriculum

Competency Based Performance Objectives:

Patient Care:

Goal: Demonstrate the ability to surgically manage the pre-operative, operative, and post-operative care of patients with arterial, venous, and lymphatic disease.

Objective: The resident will be able to:

  1. Evaluate patients for vascular disease.
  2. Demonstrate skill in basic surgical techniques, including:
    1. Knot tying
    2. Exposure and retraction
    3. Knowledge of instrumentation
    4. Incisions
    5. Closure of incisions
    6. Handling of graft material
  3. Participate in surgery for varicose vein disease, including:
    1. Endovenous Laser Therapy
    2. Ultrasound venous access
    3. Ligation and stripping
    4. Management of venous stasis ulcers
    5. Management of venous thrombosis
  4. Participate in amputations with specific attention to:
    1. Demarcation levels
    2. Control of toxicity
  5. Demonstrate proficiency in venous access procedures.
    1. Use of ultrasound to guide access
  6. Demonstrate the ability to perform arterial access or arterio-venous access, including:
    1. Incisions
    2. Closure of incision
  7. Obtain vascular control of diseased or traumatically occluded blood vessels using:
    1. Vascular clamp
    2. Vessel loop
    3. Balloon occlusion
  8. Participate in thromboendarterectomy and thrombectomy.
  9. Demonstrate appropriate vascular suture techniques.
  10. Evaluate and manage sympathectomy procedures.
  11. Perform the pre-operative assessment and post-operative care of patients undergoing major vascular surgical procedures especially cardiac and renal workups.
  12. Demonstrate ability to manage vascular disease in elderly patients.

Competency Based Knowledge Objectives:

Medical Knowledge:

Goal: Demonstrate knowledge of the anatomy, physiology, and pathophysiology of the vascular system, including congenital and acquired diseases.

Objectives: The resident will be able to:

  1. Describe human arterial and venous anatomy.
  2. Describe basic arterial and venous hemodynamics.
  3. Discuss the anatomy, pathology, and pathophysiology of the arterial wall.
  4. Review and describe the basic clinical manifestations of the following vascular disorders:
    1. Obstructive arterial disease
    2. Aneurysmal arterial disease
    3. Thromboembolic disease - arterial and venous
    4. Chronic venous insufficiency and lymphatic obstruction
    5. Portal hypertension
    6. Congenital vascular disease
  5. Assess patients' vascular systems using appropriate skills in history-taking and clinical examination.
  6. Describe the relationship of the following disorders/practices to atherosclerotic vascular disease:
    1. Diabetes mellitus
    2. Hypertension
    3. Renal failure
    4. Congestive heart failure
    5. Hyperlipidemia
    6. Smoking
  7. Describe life-threatening signs of vascular disease and indicate when immediate intervention is required.
  8. Differentiate between the following diagnostic tools available for assessing vascular disease and explain the relative contribution of each:
    1. Angiography
    2. Computed axial tomographic (CAT) scanning
    3. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA)
    4. Duplex scanning (ultrasonography)
  9. Analyze and be prepared to explain the following concept: vascular disease, and specifically arterial disease may be diffuse and clinically silent, but it still represents a major threat to the patient.
  10. Summarize the etiology and therapeutic options of specific categories of vascular disease:
    1. Venous disease
      1. Varicose vein disease
      2. Postphlebitic syndrome
      3. Thromboembolic disease
      4. Pulmonary embolism
      5. Portal hypertension
    2. Lymphatic disease
      1. Anatomy of lymphatic system and lymphatic return
      2. Congenital lymphatic anomalies
      3. Acquired lymphatic disease
      4. Operative procedures for correction of lymphatic disease
    3. Arterial disease
      1. Atherosclerosis and its related disorders
      2. Aortic and other vascular aneurysms
      3. Inflammatory vascular disease
      4. Atherosclerotic vascular disease
      5. Arterial embolic disease
      6. Arteriovenous fistulas or malformations
      7. Extracranial cerebrovascular disease
      8. Neurovascular compression syndromes (thoracic outlet syndrome
      9. Visceral ischemic syndromes
      10. Renovascular hypertension
      11. Degenerative arterial disease
      12. Trauma
      13. Interactions of cardiovascular and pulmonary systems
    4. Pathophysiology of peripheral vascular disease
      1. Arterial stenosis
      2. Aneurysmal disease
      3. Arteriovenous fistulas (local and cardiac hemodynamic effects
      4. Venous thrombosis
    5. Interaction of cardiovascular and pulmonary systems
    6. Miscellaneous
      1. Tumors
      2. Sympathetic nervous system
      3. Congenital vascular syndromes
  11. Outline the principles of non-invasive laboratory diagnosis; include a description of the role and limitations of the vascular laboratory.
  12. Discuss basic principles of Doppler ultrasound in preparation for performing bedside arterial and venous Doppler testing.
  13. Outline the principles of care for ischemic limbs.
  14. Describe the natural history of medically treated vascular disease in the following categories:
    1. Carotid arterial stenosis
    2. Abdominal aortic aneurysm
    3. Chronic femoral artery occlusion
  15. Summarize principles for the pre-operative assessment and post-operative care of patients undergoing major vascular surgical procedures.
  16. Outline the fundamental elements of nonoperative care of the vascular patient, including the role of risk assessment and preventive measures.
  17. Indicate the role of anticoagulant agents, including antiplatelet agents, in the management of patients with vascular disease.
  18. Analyze the role of the endothelium in atherosclerosis, thrombosis, and thrombolysis.
  19. Describe the hemodynamics and pathophysiology of:
    1. Claudication
    2. Transient ischemic attack (TIA)
    3. Stroke
    4. Mesenteric angina
    5. Angina pectoris
    6. Renovascular hypertension
    7. Arteriovenous (AV) fistula
  20. Explain the concept of critical arterial stenosis.
  21. Differentiate between acute arterial and acute deep venous occlusion.
  22. Discuss the principles of angiography to include the following considerations:
    1. Indications and complications (including contrast-induced renal failure)
    2. Principles and techniques of intraoperative angiography
    3. Principles and techniques of emergency room angiography
  23. Discuss the principles of and contraindications for anticoagulation and thrombolytic therapy.
  24. Describe the surgically correctable causes of hypertension and their diagnostic modalities.
  25. Explain the risk:reward ratios of surgical care for patients with vascular disease.
  26. Discuss the mechanics of action and the therapeutic role of the following pharmacologic types of agents:
    1. Vasopressors
    2. Vasodilators
    3. Adrenergic blocking agents
    4. Anticoagulants
    5. Antiplatelet agents
    6. Thrombolytics
  27. Illustrate the general principles of vascular surgical technique including:
    1. Vascular control and suturing
    2. Endarterectomy
    3. Angioplasty
    4. Bypass grafting
  28. Determine a plan for assessment of operative risk in these categories:
    1. Cardiac
    2. Pulmonary
    3. Renal
    4. Metabolic
    5. Levels of anesthetic risk
  29. Discuss clotting factors and how they interact (coagulation cascade).
  30. Discuss the role of the following factors in maintaining homeostasis in the coagulation pathways:
    1. Protein S
    2. Protein C
    3. Platelets
    4. Platelet granules
    5. Endothelial cell
    6. Antithrombin III
  31. Describe the use of adjunctive measures in the management of patients with vascular disease such as:
    1. Antibiotics
    2. Anticoagulants
    3. Thrombolytic agents
    4. Antiplatelet agents
  32. Review the costs associated with providing surgical care to patients with vascular disorders.
  33. Demonstrate knowledge of the pathophysiology of vascular disease in the elderly patient.
  34. Discuss differences in management and outcomes of elderly versus younger patients undergoing treatment of vascular disease.

Interpersonal and Communication Skills:

Goal: Counsel patients and obtain informed consent for cardiothoracic procedures

Objectives: The resident will demonstrate the ability to obtain informed consent, outlining the risks and benefits

Goal: Communicate effectively to discharge patients after surgery.

Objectives: The resident will demonstrate the ability to instruct patients regarding monitoring for vascular complications:

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

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 traditional and online sources to support their educational experience

Goal: Use medical evidence to evaluate vascular practices

Objective: The resident will demonstrate the ability to:

  1. Discuss studies regarding vascular surgery

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

Duties/Responsibilities:

  1. Serve as PGY-1 on the vascular service
  2. Appropriate, professional supervision of student teaching in light of educational goals
  3. Attend clinic as assigned
  4. Manage OR patients with supervision
  5. Assist with consultations to the vascular service as assigned by the Attending
  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. 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 vascular 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.

;