HO IV - Methodist Vascular

Specific Educational Goals and Education

Level: PGY-4

Service: Methodist Vascular

Supervision: PGY-4 → Attending

All management decisions will be discussed with the 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. Schwartz's Principles of Surgery
   2. SCORE curriculum modules
   3. Rutherford's Vascular Surgery
2. Conferences
   1. Wednesday Resident Educational Curriculum
   2. Monday, 7am Methodist M&M

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. Demonstrate the appropriate incisions and exposure of:
   1. Abdominal aorta and its major branches
   2. Peripheral arterial system
   3. Carotid arterial system
   4. Arteriovenous fistula
2. Obtain vascular control of major vessels
   1. Aorta
   2. Vena cava
3. Participate in endarterectomy and bypass graftin
4. Demonstrate ability to manage graft and suture materials.
5. Perform selected operative procedures or selected parts of the following operative procedures under supervision:
   1. Aortic aneurysm repair
   2. Carotid endarterectomy
   3. Aortoiliac occlusive disease
   4. Femoral popliteal occlusive disease
   5. Diagnostic angiography
   6. Angioplasty and stenting of arteries
6. Select and use proper advanced techniques in managing patients with a variety of vascular disorders such as:
   1. Ruptured aortic aneurysm
   2. Supra-renal aortic aneurysm
   3. Renovascular hypertension
   4. Femoral tibial bypasses
7. Perform alternative methods of revascularization as:
   1. Lysis of thrombus
   2. Angioplasty and stenting
   3. In situtechniques
   4. Extra anatomic bypass
8. Manage prosthetic graft infections to include:
   1. Diagnosis
   2. Selection of alternate routes for revascularization
   3. Selection of appropriate graft materials
   4. Timing
9. Manage complications of common major vascular procedures such as:
   1. Carotid endarterectomy
   2. Aortic reconstruction
   3. Lower extremity vascular reconstruction
10. 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. Identify and describe vascular anatomy and regional anatomy related to vascular disease.
2. Discuss the broad range of vascular illnesses, including congenital vascular disease and diseases of the venous and lymphatic systems.
3. Explain the physiologic and organic manifestations of vascular disease, such as renovascular hypertension, portal hypertension, and renal failure.
4. Differentiate between the different operative approaches to the vascular system to include:
   1. Incisions and exposure
   2. Handling of vascular tissues
   3. Principles of vascular bypass grafting
   4. Emergency vascular surgery
   5. Reoperative vascular surgery
   6. Principles of endarterectomy
   7. Endovascular techniques
5. Illustrate the operative exposure of the major vessels, including:
   1. Aortic arch
   2. Proximal subclavian
   3. Carotid artery
   4. Descending thoracic aorta
   5. Suprarenal aorta
   6. Infrarenal aorta
   7. Femoral artery
   8. Popliteal artery
6. Outline the indications for intervention for claudication, abdominal aortic aneurysm, carotid stenosis, and amputation.
7. Describe the indications for balloon angioplasty and vascular stent placement with its risks and complications.
8. Describe the pathogenesis and complications of aneurysmal disease.
9. Summarize the etiology, microbiology, and treatment of diabetic foot infection.
10. Categorize the prevention and management of operative and post-operative complications, including graft infections, ischemic bowel, graft thrombosis, and extremity ischemic.
11. Outline the clinical and vascular laboratory manifestation of failing peripheral vascular grafts, contrasting angioplasty with reconstruction and amputation.
12. Discuss the principles of reoperative vascular surgery.
13. Outline procedures for managing vascular surgical emergencies such as acute tissue ischemia or major hemorrhage (traumatic or ruptured aneurysm).
14. Summarize the characteristics of congenital arterial, venous, and lymphatic diseases.
15. Analyze the options for treatment of patients with chronic venous insufficiency and venous ulceration.
16. Demonstrate a basic knowledge of the various types of graft and suture material available.
17. Analyze alternative measures for the diagnosis and management of renovascular hypertension.
18. Summarize the surgical or interventional techniques available for managing the following vascular disorders:
    1. Abdominal aortic bypass or aneurysmectomy
    2. Carotid stenosis
    3. Femoral-popliteal occlusion
    4. Tibial artery occlusion
19. Review critical factors for decision making in vascular surgery:
    1. Risk: reward ratio
    2. Morbidity and mortality probability
    3. Pre-operative and post-operative assessment
    4. Vascular laboratory criteria for carotid, renal stenosis, DVT
    5. Role of advanced radiologic techniques: Angiography, CT angiography, MRI/MRA imaging
20. Apply the decision making process in analyzing complex vascular diseases, including the following:
    1. Cerebrovascular problems
    2. Mesenteric vascular disease
    3. Renovascular disease
    4. Aneurysmal disease
    5. Lower extremity arterial occlusion
    6. Venous disease
21. Outline the management of prosthetic graft infections, including:
    1. Diagnosis
    2. Use of alternate routes for revascularization
    3. Use of alternative graft materials
22. Summarize complications of common major vascular procedures such as:
    1. Carotid endarterectomy
    2. Aortic reconstruction
    3. Lower extremity vascular reconstruction
23. Demonstrate knowledge of pathophysiology of vascular disease in the elderly patient.
24. Discuss differences in management and outcome of elderly versus younger patients undergoing treatment of vascular diseases.

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-4 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 patient's 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 resident's 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.