General Surgery / 1

GENERAL SURGERY

GOALS AND OBJECTIVES

ROTATION COORDINATOR Dan Sepdham, MD

Surgery Curriculum Leader

Dept. of Family Medicine

214-648-1397

ROTATION ATTENDINGS Walton Taylor, MD (cell 214-725-8377)

True Surgical Partners

Texas Health MedSynergies

8160 Walnut Hill Lane

Perot Bldg., Suite 306

Dallas, TX 75231

Contact Diane Smith 214-345-8060 at

Dr. Taylor’s office prior to your 1st day.

ROTATION CONTACT PERSON Diann Smith for Dr. Taylor

Office Manager

8160 Walnut Hill Lane

Perot Bldg., Suite 306

Dallas, TX 75231

214-345-8060 or 214-345-8008

ROTATION DAYS/HOURS 5 Days/week

Monday – Friday, times per attending.

CALL FREQUENCY No Call

VACATION 5 days vacation allowed in this month

FAMILY MEDICINE CLINIC 3-4 half-days per week

ROTATION DAYS – PGY 1

Week / MON / TUE / WED / THUR / FRI
AM / FMC / Dr Taylor / Dr. Taylor / Dr. Taylor / Procedure Clinic Parkland FMC
PM / FMC / FM
Conference / Dr. Taylor / Dr. Taylor / Dr. Taylor

Overall Goal

The scope of diseases encountered in general surgery involves many areas of overlap with the practice of family medicine. Family physicians and general surgeons will often work closely together managing both operative and non-operative problems. Residents must learn to diagnose many common non-emergent surgical problems. They must also learn to recognize emergency situations and the early management required to prepare a patient for surgery. Surgical problems are addressed in a block rotation and longitudinally almost on a daily basis in family medicine.

EDUCATIONAL GOALS

At the completion of the rotation the resident should be able to:

Patient Care

1. Discuss peri-operative management of simple surgical problems.

2. Perform an assessment of patients with common general surgery problems.

3. Intraoperative skills

a. Preparation and draping of operative field

b. First assist at major surgery

c. Basic use of surgical instruments

d. Incision and dissection

e. Exposure and retraction

f. Hemostasis

g. Estimation of blood loss

h. Fluid replacement

i. Wound closure

i. Technique selection (ligature, staples, adhesives)

ii. Suture selection

iii. Drains

iv. Dressings

4. Postoperative care

a. Suture removal

b. Dressing changes

c. Drain removal

5. Minor surgical techniques

a. Local anesthesia

b. Simple excision

c. Incision and drainage of cysts and abscesses

d. Aspiration

e. Foreign body removal

f. Minor burns

g. Vasectomy

h. Cauterization and electrodesiccation

i. Skin biopsy (punch, shave, excisional)

j. Wound debridement

k. Enucleation and excision of external thrombotic hemorrhoid

l. Nail surgery

m. Cryosurgery (liquid nitrogen)

Communication

  1. Discuss surgical issues with patient and family in a practical and caring manner.
  2. Share care of peri-operative patients with members of the surgery team.

Medical Knowledge

The resident should demonstrate knowledge of the following:

1. Basic principles of surgical diagnosis

a. Basic surgical anatomy

b. Wound physiology, care, and healing processes

c. Clinical assessment, including history, physical examination, laboratory evaluation, and differential diagnosis of key signs and symptoms of surgical conditions

d. Invasive versus noninvasive diagnostic tests

2. Anesthesia

a. Premedication

b. Agents and routes of administration

c. Resuscitation methods

3. Recognition of surgical emergencies

a. Respiratory

i. Airway obstruction

ii. Chest trauma

1) Flail chest

2) Hemothorax

3) Pneumothorax

b. Circulation

i. Hypovolemia

1) Gastrointestinal bleeding

2) Traumatic blood loss

c. Acute abdomen

i. Perforated viscus

ii. Intestinal obstruction

iii. Incarcerated hernia

iv. Mesenteric ischemia

v. Appendicitis

vi. Diverticulitis

d. Soft tissue

i. Necrotizing soft tissue infections

ii. Thermal injuries

e. Trauma

i. Advanced Trauma Life Support

4. Common surgical procedures

a. Appendectomy

b. Cholecystectomy

c. Herniorrhaphy

d. Colectomy

e. Hemorrhoidectomy – surgical or simple banding

f. Breast surgery – lumpectomy, mastectomy

g. Arterial bypass

h. Varicose vein procedures

i. Thyroidectomy and thyroid nodules

j. Parathyroidectomy

5. Ethical, legal, and socioeconomic considerations

a. Informed consent

b. Quality of life

c. Cultural sensitivity

d. End-of-life issues

6. Preoperative assessment

a. Recognition of appropriate surgical candidates

b. Surgical risk assessment

c. Comorbid diseases

d. Antibiotic prophylaxis

e. Patient preparation (bowel, medication, schedule, etc.)

7. 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

8. Postoperative care

a. Routine

i. Wound care

ii. Patient mobilization

iii. Nutrition management

iv. Pain management

v. Suctions and drains

b. Common complications

i. Fever workup 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

9. Outpatient surgery

a. Patient selection

b. Procedural sedation and analgesia

c. Postoperative observation principles

d. Follow-up care

10.Office care of common conditions

a. Lumps, bumps, and abscesses

b. Simple lacerations

c. Superficial burns

d. Common methods of anesthesia

11.Adjunctive and long-term care of organ donors and recipients

12.Adjunctive and long-term care of bariatric surgical patients

13.Recognition and care of surgical wounds

a. Penetrating wounds

b. Avulsion, crush, or shear injury wounds

c. Bite wounds

Practice-Based Learning

1.  Apply evidence-based principles to form and answer clinical questions that arise in general surgery problems.

2.  Interact effectively with all members of the surgical team including consulting pathologists, oncologists, nursing staff and technicians.

System-Based Practice

1.  Discuss guidelines that apply in assessing surgical outcomes for common surgical diseases.

2.  List the costs of the most common general surgery and office surgery procedures.

Professionalism

  1. Works together with staff and consultants to improve patient care, decrease cost, promote wellness, and provide patient education.
  2. Practice ethical, reasonable medical care for all.
  3. Follow all the policies of the program at Parkland Hospital and respect the policies of CMC and UTSW.

EDUCATIONAL ACTIVITIES for this rotation

To accomplish the above goals, the resident will:

  1. Rotate with Dr. Walton Taylor, General Surgeon including travel to satellite locations for endoscopy, day surgery, surgical consultation and routine OR experience.
  2. Request feedback on performance of surgical procedures and medical management of surgery patients.
  3. Look up or otherwise discover the cost of at least 5 therapeutic or diagnostic modalities used during the rotation.
  4. Use EBM resources to address surgical patient care problems for at least one new patient everyday.
  5. Read EBM resources evaluating various surgical techniques employed in the rotation.

Other Learning Activities Related to Surgery Curriculum

All residents will:

  1. Perform emergency assessments of Surgical Patients during ER rotation.
  2. Perform office procedures in the Family Medicine Center on own continuity patients when indicated.

EVALUATION PROCESS

The resident will be evaluated by Dr. Taylor using the standard evaluation form. Satisfactory completion of the rotation will be determined by the director of the family medicine residency program in consultation with the attending doctor. The resident will hand deliver evaluation form to Dr. Taylor with its return envelope. In addition, Dr. Shakil will make an overall assessment of documented procedural skills log in Med Hub over entire residency.

READING LIST

1. Schwartz et al: Principles of Surgery

2. Pories & Thomas: Office Surgery for Family Physicians

3. Vandersalm et al: Atlas of Bedside Procedures

June 18, 2013