Residency Level:PGY 1

Surgical Rotation:SICU

Length of Rotation:1 Weeks - (One 4-Week Rotations)

Goals and Objectives

Patient care:

  • Evaluation and preparation of the pre-operative general surgical patient
  • Management skills required to independently evaluate the surgical patient, develop your own plan for the patient and communication of the plan to the appropriate level of supervision
  • Take ownership in care of the patient
  • Post-operative care of the surgical patient
  • Mechanisms and criteria for minimally invasive surgery of the abdomen
  • Fluid and electrolyte management including indications for parenteral and enteral nutrition
  • Understanding and utilization of diagnostic techniques including routine films, contrast studies, ultrasound, CT scan, MRI and endoscopic procedures
  • Clear and timely documentation of daily progress notes
  • Develop a strong work ethic
  • Develop appropriate safe hand offs
  • Develop the ability to care for surgical emergencies in the role as the surgical resident on call

Technical skill:

  • Become proficient incorrect basic surgical technique such that incision, suturing, knot-tying and dissection
  • Evaluation of the acute abdomen
  • Assist at major abdominal and minimally invasive surgical procedures
  • After a period of learning and appropriate supervision, perform procedures for venous access, chest tube placement, etc.
  • After a period of learning and appropriate supervision, learn to perform minor surgical procedures (i.e. excisional biopsies, lipoma removal), hernia repair, appendectomy, cholecystectomy and bowel resections

Medical knowledge:

  • Demonstrate evidence of continued increase in general surgery core knowledge from basic surgical texts, additional readings and the SCORE curriculum as noted below
  • Obtain a broad knowledge base of general surgery and other surgical specialties
  • Study and prepare for the ABSITE
  • Anatomy and physiology of the GI tract, liver, biliary tract and pancreas
  • Fluid and electrolyte management including management of parenteral and enteral nutrition

Practice-based learning and improvement:

  • Participate actively in M and M conferences, daily chief conferences and journal clubs
  • Understand and when possible participate in SCOAP projects
  • Learn to critically read the literature
  • Master the IT resources available to you to develop a commitment to lifelong learning and education
  • You are encouraged to pursue a clinical research project in an area that interests you

Interpersonal and communication skills:

  • Develop the appropriate skills to provide efficient, concise, patient presentations
  • Master text paging, emailing, etc.
  • Develop strong doctor patient relationships using counseling and education of patients and their families
  • Learn to master EPIC to provide proper documentation in the electronic medical record
  • Learn to properly consult other specialty services in a professional manner

Professionalism:

  • Respect every patient regardless of social or other circumstances
  • Log cases appropriately
  • Log your duty hours using My Evaluations appropriately and in a timely fashion
  • Complete all required clinical and residency documents in a timely fashion
  • Demonstrate sensitivity to age, gender and culture of patients and other members of the health care delivery team
  • Learn to be punctual
  • Always exemplify professional attire, appropriate grooming and hygiene
  • Demonstrate honesty, integrity and leadership skills

Systems-based practice:

  • Demonstrate effective communication with referring physicians throughout the Swedish health care system
  • Keep patients’ safety foremost while discharging patients in a timely fashion
  • Demonstrate time management and organizational skills while adhering to work hour regulations
  • Gain an understanding of the importance of discharge planning and the writing of timely discharge orders to the overall throughput of patients in our system

CATEGORY 1: ABDOMEN − GENERAL
Diseases/Conditions
BROAD
• Acute abdominal pain
• Intra-abdominal abscess
• Rectus sheath hematoma
FOCUSED
• Chronic abdominal pain
• Carcinomatosis
• Pseudomyxoma peritoneii
• Spontaneous bacterial peritonitis
• Desmoid tumors
• Chylous ascites
• Retroperitoneal fibrosis / Operations/Procedures
ESSENTIAL − COMMON
• Insertion peritoneal dialysis catheter
• Laparoscopic exploratory laparotomy
• Open exploratory laparotomy
ESSENTIAL − UNCOMMON
• Open drainage abdominal abscess
SCORE CURRICULUM - CATEGORY 2: ABDOMEN − HERNIA
Diseases/Conditions
BROAD
• Inguinal hernia
• Femoral hernia
•Ventral hernia
• Miscellaneous hernias / Operations/Procedures
ESSENTIAL − COMMON
• Open repair of inguinal and femoral hernia
• Laparoscopic repair of inguinal and femoralhernia
• Open repair of ventral hernia
• Laparoscopic repair of ventral hernia
ESSENTIAL − UNCOMMON
• Repair miscellaneous hernias
SCORE CURRICULUM - CATEGORY 3: ABDOMEN − BILIARY
Diseases/Conditions
BROAD
• Jaundice
• Cholangitis
• Acute cholecystitis
• Chronic cholecystitis
• Choledocholithiasis
• Biliary pancreatitis
• Acalculous cholecystitis and biliary dyskinesia
FOCUSED
• Gallbladder cancer
• Cancer of the bile ducts
• Choledochal cyst / Operations/Procedures
ESSENTIAL − COMMON
• Open cholecystectomy with or withoutcholangiography
• Laparoscopic cholecystectomy with or with
out cholangiography
ESSENTIAL − UNCOMMON
• Cholecystostomy
SCORE CURRICULUM - CATEGORY 4: ABDOMEN − LIVER
Diseases/Conditions
BROAD
• Liver mass − evaluation
• Hepatic abscess
FOCUSED
• Hepatic adenoma
• Focal nodular hyperplasia
• Hemangioma
• Hepatocellular carcinoma
• Cholangiocarcinoma
• Metastatic tumors
• Miscellaneous hepatic neoplasms / Operations/Procedures
ESSENTIAL − COMMON
• Open liver biopsy
• Laparoscopic liver biopsy
ESSENTIAL − UNCOMMON
• Drainage liver abscess
SCORE CURRICULUM - CATEGORY 5: ABDOMEN − PANCREAS
Diseases/Conditions
BROAD
• Pancreatic abscess and infected necrosis
• Pancreatic pseudocyst
FOCUSED
• Autoimmune pancreatitis
• Chronic pancreatitis, including hereditary
pancreatitis
• Pancreatic insufficiency
• Ductal adenocarcinoma
• Acinar cell carcinoma
• Cystic neoplasms
• Intraductal papillary mucinous neoplasms
SCORE CURRICULUM - CATEGORY 6: ABDOMEN − SPLEEN
Diseases/Conditions
BROAD
• Postsplenectomy sepsis
FOCUSED
• Hemolytic anemias
• Idiopathic thrombocytopenic purpura
• Secondary hypersplenism and splenomegaly
• Neoplasms of spleen
• Splenic cysts
SCORE CURRICULUM - CATEGORY 7: ALIMENTARY TRACT −ESOPHAGUS
Diseases/Conditions
BROAD
• Gastroesophageal reflux and Barrett’s esophagus
• Hiatal hernia
• Dysphagia
FOCUSED
• Achalasia
• Zenker’s diverticulum
• Epiphrenic diverticulum
• Foreign bodies / Operations/Procedures
ESSENTIAL − COMMON
• Laparoscopic antireflux procedure
SCORE CURRICULUM - CATEGORY 8: ALIMENTARY TRACT −STOMACH
Diseases/Conditions
BROAD
• Upper gastrointestinal bleeding
• Gastric carcinoma
• Duodenal ulcer
• Gastric ulcer
• Peptic ulcer disease with bleeding
• Peptic ulcer disease with perforation
• Peptic ulcer disease with obstruction / Operations/Procedures
ESSENTIAL − COMMON
• Percutaneous endoscopic gastrostomy
• Open gastrostomy
SCORE CURRICULUM - CATEGORY 9: ALIMENTARY TRACT −SMALL INTESTINE
Diseases/Conditions
BROAD
• Small bowel obstruction and ileus
• Emergent management of Crohn’s disease of
small intestine
• Acute mesenteric ischemia: arterial, venous,
and nonocclusive
• Meckel’s diverticulum
• Radiation enteritis / Operations/Procedures
ESSENTIAL − COMMON
• Open small bowel resection
• Open adhesiolysis
• Laparoscopic adhesiolysis
• Ileostomy
• Ileostomy closure
• Open feeding jejunostomy
• Laparoscopic feeding jejunostomy
SCORE CURRICULUM - CATEGORY 10: ALIMENTARY TRACT −LARGE INTESTINE
Diseases/Conditions
BROAD
• Lower gastrointestinal bleeding
• Large bowel obstruction
• Acute appendicitis
• Diverticulitis
• Diverticular bleeding
• Diverticular fistulae
• Colonic polyps
• Colonic cancer
•Volvulus
• Ischemic colitis
• Antibiotic-induced colitis / Operations/Procedures
ESSENTIAL − COMMON
• Open appendectomy
• Laparoscopic appendectomy
• Open partial colectomy
• Laparoscopic partial colectomy
• Colostomy
• Colostomy closure
SCORE CURRICULUM - CATEGORY 11: ALIMENTARY TRACT −ANORECTAL
Diseases/Conditions
BROAD
• Hemorrhoids
• Anal fissure
• Anorectal abscess and fistulae
• Rectal cancer
• Anal cancer
FOCUSED
• Pelvic floor dysfunction
• Rectal prolapse / Operations/Procedures
ESSENTIAL − COMMON
• Banding for internal hemorrhoids
• Hemorrhoidectomy
• Subcutaneous lateral internal sphincterotomy
• Drainage anorectal abscess
• Anal fistulotomy/seton placement
SCORE CURRICULUM - CATEGORY 15: SKIN AND SOFT TISSUE
Diseases/Conditions
BROAD
• Pilonidal cyst and sinus
• Nevi
• Melanoma
• Squamous cell carcinoma
• Basal cell carcinoma
• Evaluation of soft tissue masses
• Epidermal cyst
• Apocrine tumor
• Eccrine tumor
• Sebaceous tumor
• Merkel cell tumor
• Dermatofibrosarcoma
• Hidradenitis
• Cellulitis
• Necrotizing fasciitis
• Paronychia
• Felon
•Wound infection
FOCUSED
• Decubitus ulcer / Operations/Procedures
ESSENTIAL − COMMON
• Excisional and incisional biopsy of skin/soft
tissue lesions
• Incision, drainage, debridement for soft tissueinfections
• Pilonidal cystectomy
ESSENTIAL − UNCOMMON
•Wide local excision melanoma
• Sentinel lymph node biopsy for melanoma