Family Medicine Residency Program Surgery I
Surgery I
Description of Rotation or Educational Experience
Surgical care may be defined as the body of knowledge, skills and attitudes necessary to evaluate and manage conditions and disorders requiring operative intervention.
The minimum duration of this portion of the curriculum shall be twenty (20) weeks with four (4) weeks of general surgery training in OGME-1. Emphasis will be placed on the ambulatory management of surgical problems in the specific subspecialty areas listed below. Procedures appropriate to osteopathic family practice shall be emphasized. Pre and post operative diagnosis and management will be stressed. This 1 month rotation is at Plaza Medical Center.
Goal
Family-oriented comprehensive care with demonstrated emphasis on continuity shall be an integral part of each curricular component. Residents must be taught to demonstrate and articulate osteopathic family practice concepts to patients and colleagues.
For AOA residents:
Recognizing the validity of the principles of osteopathic medicine, especially that of treating the whole person, each program will provide the opportunity for the resident to gain a thorough understanding of the role social, cultural, behavioral, spiritual, and biologic dimensions play in the health of the individual.
Competencies
§ Demonstrate competency in the understanding and application of OMT appropriate to the medical specialty.
§ Integrate osteopathic concepts and OMT into the medical care provided to patients as appropriate.
§ Understand and integrate osteopathic principles and philosophy into all clinical and patient care activities.
Objectives
Osteopathic Philosophy and Osteopathic Manipulative Medicine
· The resident will demonstrate competency in the understanding and application of OMT appropriate to the medical specialty.
· The resident will integrate Osteopathic Concepts and OMT into the medical care provided to patients as appropriate.
· The resident will understand and integrate Osteopathic Principles and Philosophy into all clinical and patient care activities.
Patient Care
Goal
Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Residents are expected to:
Competencies
§ Communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families
Recognition of the importance of family and home in the overall life and health of patients.
Sensitivity to the patient's and family's concerns and anxieties regarding the potential need for surgical intervention.
§ Take a supportive and compassionate approach to the care of the patient with surgical disease
§ Take an accurate and effective surgical history
§ Make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment
Awareness of the principles involved in differentiating the causative origin of clinical symptoms resulting in the need for medical versus surgical intervention.
§ Develop and carry out patient management plans (including management and recognition of the prevalent and treatable diseases under “Medical Knowledge”) taking into consideration the severity and need for immediate expert assistance and referral.
§ Counsel and educate patients and their families
§ Use information technology to support patient care decisions and patient education
§ Provide health care services aimed at preventing health problems or maintaining health
Work with health care professionals, including those from other disciplines, to provide patient-focused care
Recognition of the importance of family and home in the overall life and health of patients.
Recognition of the importance of family physician and surgeon collaborating as partners in the evaluation of and decision making for the care of surgical patients.
Perform competently all medical and invasive procedures considered essential for the area of practice.
Objectives
The resident will demonstrate competency in his/her ability to:
1. Diagnose and manage surgical disorders and surgical emergencies.
2. Refer patients with surgical problems, in a timely and appropriate fashion, to the appropriate surgical specialist.
3. Assist the surgeon in the operating room.
4. Perform those specific surgical procedures that family physicians may be called on to perform.
5. Manage, in conjunction with the surgeon, the surgical patient during the preoperative and postoperative period.
6. Understand basic surgical principles, of asepsis, handling of tissue, and assisting in the operating room.
Medical Knowledge
Goal
Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care. Residents are expected to:
Competencies
§ Demonstrate knowledge of basic principles of surgical diagnosis, including basic surgical anatomy and wound physiology, care and healing processes
§ Demonstrate understanding of basic principles of anesthesia including medications, routes of administration, and resuscitation methods
§ Describe various risk levels for surgical procedures and anesthesia , and accurately perform pre-operative risk assessments using the standard pre-op physical form
Objectives
At the completion of the surgery rotations, residents will be able to demonstrate medical knowledge of common surgical conditions and “best practice treatment plans” suitable for the family physician, to include:
Basic principles of surgical diagnosis
a Basic surgical anatomy
b Wound physiology, care and healing processes
c Clinical assessment, laboratory evaluation and differential diagnosis of key signs and symptoms of surgical conditions
d Invasive versus noninvasive diagnostic tests
e Anesthesia
i Premedication
ii Agents
iii Routes of administration
iv Toxicity
v Resuscitation methods
f Recognition of surgical emergencies
Preoperative assessment
a Surgical risk assessment
b Comorbid diseases
c Antibiotic prophylaxis
d Patient preparation (bowel, etc.)
Intraoperative care
a Basic principles of asepsis and sterile technique
b Patient monitoring
c Fluid management
d Blood requirements
e Temperature control
f Use of basic surgical instruments
Postoperative care
a Routine
i Wound care
ii Patient mobilization
iii Nutritional management
iv Pain management
v Suctions and drains
b Common complications
i Fever work-up and management
ii Wound dehiscence
iii Urinary retention
iv Hemorrhage
v Pneumonia
vi Atelectasis
vii Fluid overload
viii Transfusion reaction
ix Thrombophlebitis
x Pulmonary embolism
xi Oliguria
xii Respiratory insufficiency
xiii Ileus
xiv Infection
xv Shock
c Long-term follow-up
Outpatient surgery
a Patient selection
b Conscious sedation
c Postoperative observation principles
d Follow-up
Office care of common conditions
a Lumps and bumps
b Simple lacerations
c Superficial burns
Approach to the care of common surgical conditions
a Abscesses
b Aortic aneurysm
c Appendicitis
d Arterial insufficiency
e Benign neoplasia
f Bowel obstruction
g Breast masses
h Carpal tunnel syndrome
i Colon cancer
j Coronary artery disease (obstruction)
k Cysts and hematomas
l Diverticuli
m Gallbladder disease
n Ganglia
o Gastrointestinal hemorrhage
p Hemorrhoids
q Hernias
r Intervertebral disk herniation
s Lung cancer
Shared management of common general surgical conditions
a Anal fistula, fissure or perianal abscess
b Carcinoma
c Esophageal varices
d ascites
e Incarcerated hernia
f Intussusception
g Malabsorption
h Obstruction
i Pancreatic disease
j Polyposis
k Regional enteritis
l Ruptured viscous
m Ulcerative colitis
Organ donation and transplantation
Practice- Based Learning and Improvement
Goal
Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and lifelong learning. Residents are expected to develop skills and habits to be able to:
Competencies
§ analyze practice experience and perform practice-based improvement activities using a systematic methodology
§ Locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems
§ Obtain and use information about their own population of patients and the larger population from which their patients are drawn
§ Apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness
§ Use information technology to manage information, access on-line medical information; and support their education
§ Facilitate the learning of students and other health care professionals
Objectives
At the completion of the surgery rotation, and subsequently in the family medicine clinic and inpatient setting, when presented with the surgical patient, residents will be able to:
1. Critically evaluate evidence basis for diagnosis and treatment of surgical conditions such as the use of interventional radiology procedures, laparoscopic techniques, and pre-procedure imaging
2. Interpret and apply treatment guidelines for management of surgical conditions; see www.guideline.gov for a list of guidelines
3. Modify patient treatment plans on an ongoing basis based on patient response to therapy
4. Use information technology to support evidence based patient care decisions
5. Identify strengths, deficiencies and limits in one’s knowledge and expertise;
6. Set learning and improvement goals
7. Identify and perform appropriate learning activities
8. Systematically analyze practice, using quality improvement methods, and implement changes with the goal of practice improvement
9. Incorporate formative evaluation feedback into daily practice
10. Locate, appraise and assimilate evidence from scientific studies related to their patients’ health problems
11. Use information technology to optimize learning
12. Participate in the education of patients, families, students, residents and other health professionals, as documented by evaluations of a resident’s teaching abilities by faculty and/or learners
Systems Based Practice
Goal
Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Residents are expected to:
§ Understand how their patient care and other professional practices affect other health care professionals, the health care organization, and the larger society and how these elements of the system affect their own practice
§ Know how types of medical practice and delivery systems differ from one another, including methods of controlling health care costs and allocating resources
§ Practice cost-effective health care and resource allocation that does not compromise quality of care
§ Formulating a diagnostic and management plan and assessing the need for expert advice with an awareness of the risks, benefits and costs of this evaluation
§ Advocate for quality patient care and assist patients in dealing with system complexities
§ Know how to partner with health care managers and health care providers to assess, coordinate, and improve health care and know how these activities can affect system performance
Objectives
1. Work effectively in various health care delivery settings and systems relevant to their clinical specialty
2. Coordinate patient care within the health care system relevant to their clinical specialty
3. Incorporate considerations of cost awareness and risk-benefit analysis in patient care
4. Advocate for quality patient care and optimal patient care systems
5. Work in interprofessional teams to enhance patient safety and improve patient care quality
6. Participate in identifying systems errors and in implementing potential systems solutions
Professionalism
Goal
Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to demonstrate:
Competencies
§ Demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients and society that supersedes self-interest; accountability to patients, society, and the profession; and a commitments to excellence and on-going development
§ Demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, and business practices
§ Demonstrate sensitivity and responsiveness to patients’ culture, age, gender, and disabilities
Objectives
During the surgery rotations, residents will exhibit characteristics of a professional health care provider by:
1 Dressing appropriately based upon standards present for attending physicians in the clinic and/or inpatient setting associated with the surgery rotations.
2 Demonstrating sensitivity and responsiveness to surgical patients’ perception of illness, and including these perceptions and patient preferences in formulation of management plan.
3 Demonstrating understanding of ethical and legal considerations including informed consent, quality of life, and end-of-life issues.
Interpersonal and Communication Skills
Goal
Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates. Residents are expected to:
Competencies
· Create and sustain a therapeutic and ethically sound relationship with patients
· Use effective listening skills and elicit and provide information using effective nonverbal, explanatory, questioning, and writing skills
· Work effectively with others as a member or leader of a health care team or other professional group
· Communicate effectively with patients and families across a broad range of socioeconomic and cultural backgrounds
· Communicate effectively with physicians, other health professionals, and health related agencies
· Work effectively as a member of leader of a health care team or other professional group
· Act in a consultative role to other physicians and health professionals
· Maintain comprehensive, timely, and legible medical records
Objectives
1. Create and sustain a therapeutic and ethically sound relationship with patients
2. Use effective listening skills and elicit and provide information using effective nonverbal, explanatory, questioning, and writing skills.
3. Work effectively with others as a member or leader of a health care team or other professional group
Teaching Methods
In the Surgery Rotation, the resident will have the opportunity to accompany and participate with the Attending Surgeon in all aspects of ambulatory and operative surgical care. The resident participates as first assistant in scheduled surgeries, in evaluation of patients in the surgeon’s clinic and accompanies on rounds in the hospitals (consultation, post-op care). Case based teaching by the Attending Surgeon and hands on experience will be the format, with independent reading/study expected from the part of the resident. The resident is also introduced to the business management aspect of private surgical practices with emphasis on patient satisfaction, evaluation and management documentation, CPT and ICD-9 coding, risk management, Communication Skills. The resident will also be exposed to the trends that are shaping Surgical Practices and Surgical Education.