Specific Educational Goals and Education
Service: Thoracic Surgery
Supervision: PGY-1 → PGY-4 → Attending
All management decisions will be discussed with the faculty.
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 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.
- Recommended Reading
- Schwartz’s Principles of Surgery
- SCORE curriculum modules www.surgicalcore.org
- Wednesday Resident Educational Curriculum
Competency Based Performance Objectives:
Goal: The resident will be able to use effectively apply their understanding of Thoracic medicine and procedures to the diagnosis, evaluation, and treatment of patients with thoracic problems who are to be managed by general surgery.
Objective: The resident will be able to:
- Perform and/or supervise all thoracic diagnostic and therapeutic endoscopic procedures.
- Resect ribs, treat empyema cavities, perform pleural and lung biopsies.
- Manage thoracic trauma
- Manage thoracic aortic aneurysms and dissections
- Direct complex ventilator-dependent patient management
- Perform lung resections, rib resections, mediastinoscopies, and mediastinotomies.
- Provide surgical management of neoplasms of the thorax and its contents.
- Provide medical and surgical management of infectious processes in the thorax
- Manage cardiac arrhythmias
- Manage all pharmacotherapeutics associated with thoracic surgery.
Competency Based Knowledge Objectives:
Goal: Demonstrate an understanding of the anatomy, physiology, and pathophysiology of thoracic conditions pertinent to general surgery, exhibiting knowledge of how these change with age and how those changes alter one’s considerations.
Objectives: The resident will be able to:
- Discuss the general diagnostic and operative approaches to treating blunt and penetrating trauma to the thorax and its contents.
- Describe specific surgical management of trauma to the thorax and its contents:
- Bony thorax
- Integrate the pathophysiology and surgical management of the following:
- Aortic aneurysms
- Aortic dissections
- Trauma to heart and great vessels
- Occlusive disease
- Evaluate infiltrates, infectious processes, and neoplastic processes in the thorax, and recommend appropriate management.
- Discuss and list thoracic tumor types, staging for each, including descriptions of nodal drainage sites and levels.
- Summarize the causes and appropriate management of cardiac arrhythmias, including:
- Describe the diagnosis and discuss therapy of such surgical complications as:
- Fistulas: bronchopleural, pleurocutaneous, tracheoesophageal (TE), arteriovenous (AV) and thoracic duct
- Esophageal leak/stenosis/obstruction
- Loculated hemothorax
- Post-operative bleeding
- Air leaks
- Bronchial obstructions
- Endstage COPD/pulmonary fibrosis
- Identify indications for and be prepared to interpret results of the following diagnostic modalities:
- Plain and positional chest x-rays
- Gastrointestinal contrast studies
- CAT, MRI, and PET scans
- Pulmonary function studies
- Ventilation-perfusion studies
- Nuclear medicine studies
- Split pulmonary functions
- Specify and justify the diagnostic or therapeutic indications for the use of the following modalities:
- Rigid and flexible bronchoscopy
- Esophagoscopy (rigid and flexible)
- Mediastinoscopy (cervical and parasternal)
- Lung transplant
- Assess and recommend the surgical procedures involved in :
- Tracheal, bronchial, and esophageal obstructing lesions
- Esophageal resection/reconstruction
- Anti-reflux procedures
- Sleeve resection of the trachea/bronchus for tumor
- Chest wall reconstruction using myocutaneous flaps and/or synthetic materials
- Select and specify diagnostic and therapeutic maneuvers to manage problem areas following thoracic surgery:
- Cardiovascular and pulmonary medical complications
- Renal failure
- Liver failure
- Diabetes mellitus
- Metabolic dysfunction
- Immune system suppression
Interpersonal and Communication Skills:
Goal: Counsel patients and obtain informed consent for thoracic 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 thoracic complications:
Goal: Communicate effectively as a member of the healthcare team.
Objectives: The resident will demonstrate the ability to communicate effectively by:
- Providing appropriate check out when handing patients to another team member
- Requesting consults from other services with appropriate information
- Dictating operative reports in a timely fashion
Goal: Maintain patient confidentiality
Objectives: The resident will demonstrate
- The ability to protect health-related patient information per HIPAA compliance
- 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:
- Medical students
- Nursing and support staff
- Supervising faculty
- Consulting residents
- Physician peers
- Patients and their families
Practice-Based Learning and Improvement
Goal: Identify personal and practice improvement strategies
Objective: The resident will demonstrate:
- Receptiveness to faculty instruction and feedback
- 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 thoracic practices
Objective: The resident will demonstrate the ability to:
- Discuss studies regarding thoracic surgery
Goal: Provide safe patient care
Objective: The resident will:
- Attend Crew Resource Management courses as required by the hospital
- Follow recommended protocols in the OR for patient safety
- Demonstrate compliance with Medical Center policy for surgical site identification
- Demonstrate compliance with Medical Center policy for patient identification
- Serve as PGY-5 on the thoracic service
- Appropriate, professional supervision of student teaching in light of educational goals
- Attend thoracic clinic as assigned
- Manage OR patients with supervision
- Assist with consultations to the thoracic service as assigned by the attending
- Round on post surgical service patient’s as instructed.
- Attend educational conferences
- Complete surgical case logs
- Dictate in a timely fashion
- Take night call as assigned
- Performance feedback will be given to the resident as appropriate for educational events and mid-term progress will be discussed.
- Global evaluation will be performed by the thoracic 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.
- 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.