Goals and Objectives

Overall Competency Goals: PGY-3

The overall aim of the program is to train you to become a knowledgeable, safe and competent surgeon. These goals - what you are expected to achieve - and objectives - how you are expected to achieve them - are guidelines designed to reflect a series of supervised patient care experiences in a system of graduated responsibility. Each year in the program is designed to present you with a unique set of challenges to help develop your surgical skills in a graduated fashion. Therefore,all sevencompetency levels in each year must be mastered prior to advancement to the next year of training. This year you will build on the competency skills obtained as a PGY-2 resident. There should be evidence of a clear progression in skill and knowledge developed in the PGY-3 year, that allow you to exercise greater responsibility in the management of surgical patients, as well as in the type of surgical cases you can act as primary surgeon, as judged by the chief resident and staff. This should be used in concert with theGlobal G&Oand theFaculty Evaluation toolas a guide for this year of your training. These level-specific competency objectives were prepared by the faculty to give you more concrete examples of the performance standards we expect during the R3 year.

We expect that you will demonstrate...in Patient Care

  • Clear and timely documentation of daily progress notes, any procedures, and major changes daily on all patients.
  • Management skills required to lead a surgical team. You should focus on organizational and administrative skills required to manage a surgical service as acting senior resident on the burns-plastics service at Harborview, the general surgery service at the VA and as the senior resident on the trauma service at HMC. This includes directing the junior residents on your team.
  • Skills for organization and prioritization for your patients that includeyour own management planthat is effectively communicated with the next level of supervision
  • Assure the implementation of this plan.
  • Sound clinical judgment and logical, linear, analytic thinking.
  • Consistently gather detail-oriented information and appropriately synthesize, organize and interpret findings. The mark of a good surgeon is being detail-oriented.
  • A strong work ethic and appropriate initiative.
  • Conscientious and reliable patient care so that the team can consistently count on you to "get the job done". To do this, you will continue to need to "bird dog" things and take personal responsibility (i.e. making sure the job gets done no matter what) - though often in a more delegatory role.
  • Patient ownership in your patient care and act as if you were your patient’s only doctor – while at the same time functioning as a member of the team with appropriate communication to your senior residents/attending.
  • Leadership in ensuring that your interns have an accurate patient list and patient card system. If using UWCores, be familiar withMinimum Expectations for Using UWCores.
  • When admitting a patient (as consult resident, ICU resident, ER resident) it is your responsibility to put the patient onto the team’s UWCores list. The intern can populate the fields.
  • An understanding of criteria for admission, and management of patients in the in-patient and out-patient environment.
  • Proficiency in the assessment and management of critically ill patients including preoperative stabilization and ICU care.
  • Leadership in ensuring your interns are pre-rounding daily and checking items on ORCA such as micro results and other things not printed out on the UWCores sheet.
  • An assertive and proactive attitude toward patient care that includes always considering the worst case scenario and looking for the "snake under every rock". This is the hallmark of the surgical mentality that helps you to expand your differential diagnoses and allows you to anticipate problems and potentially minimize treatment delays of your patients, which is directly related to their morbidity and mortality.
  • Rounding on all patients at least twice a day to ensure continuity of patient care.
  • The ability to evaluate and care for surgical emergencies in the role as the surgical resident on-call.
  • Safe and effective transfer of patient care, ensuring continuity of care with appropriate face-to-face sign-outs. Any transfer of patient care requires a voice to voice communication (ICU to floor, floor to ICU, ER to floor/ICU, OR to ICU, OR to floor, etc... ).
  • Evidence that you have readResidency Tips: Marks of a Well-Trained Surgeon

We expect that you will demonstrate...in Technical Skills

  • Proficiency with correct open and laparoscopic basic surgical techniques, such as incision, suturing, knot tying, and dissection with a new focus on teaching correct techniques to junior residents in these areas.
  • Proficiency with minor procedures and operations appropriate for the R1 and R2 levels. Should now be capable of independently completing indexed R1&2 procedures.
  • Proficiency with open and laparoscopic procedures such as major colon and gastric resections, thyroid resections, vascular access grafts.
  • Developing skills as a first assistant/ teaching assistant in the operating room by proctoring junior residents on minor procedures such as wound closure and excisions.
  • Preparation for the OR by knowing: positioning, anatomy, steps of the procedure and possible pitfalls. Implementation of the contents of theOR Checklist.
  • A completed EVATS and ISIS technical skills portfolio for this year.

We expect that you will demonstrate...in Medical Knowledge

  • Evidence of continual and progressive increase in general surgery core knowledge.
  • Completely read and study one of the major surgical texts (e.g. Cameron'sCurrent Surgical Therapy)
  • A broad base of knowledge in general surgery and other surgical specialties.
  • An ABSITE score above the 50th percentile.
  • Passing the UW Mock Oral Exam
  • Proficiency in accessing and applying information technology and the surgical literature to research a given topic, instead of only textbook information.

Practice Based Learning & Improvement

  • Evidence that you are actively applying the knowledge learned in conferences (M&M,Grand Rounds, Surg Science Series) to your patients in an ongoing fashion.
  • An understanding of NSQIP and SCOAP projects and how the data can be used to improve patient care.
  • Ongoing ability to critically appraise the literature using principles learned in Journal Club.
  • Ongoing evidence of your use of PubMed and other IT resources for daily patient care activities consistent with a commitment to lifelong learning and an active pursuit of education.
  • Ongoing work on your research project, with the minimum goal of one academic project done with a UW faculty mentor (publication in a peer-reviewed journal or presentation at a regional or national meeting) prior to graduation.
  • Evidence that you are an active, not a passive learner.
  • Proficiency in the teaching of medical students and junior residents

We expect that you will demonstrate...in Interpersonal Skills & Communication

  • Patient ICU presentation skills that utilize a standardized ICU format with complete data and plans
  • Mastery of patient presentation skills for consult patients that utilize a standardized format with complete data and plans. (SeePresenting a Surgical Consult Patient)
  • An appropriate level of keeping team members well informed of patient status. A continual stream of patient updates is the name of the game! Your role will often be to interface between the junior residents and the chief.
  • Foster the liberal use of communication (text paging, calling, emailing, going down to the OR) by your junior residents.
  • A common misperception is: "No news is good news" or "My chief needs to be able to focus on the OR and just wants me to take care of everything and not hear about it until rounds".
  • Proficiency in the management of a service, utilizing the cooperative skills of medical students, nurses and ancillary personnel.
  • Skill and sensitivity for appropriately counseling and educating patients and their families in a variety of clinical situations.
  • Effective documentation of practice activities with proper operative/procedure note dictations, clinic visit dictations, discharge summary dictations, daily progress notes and event notes
  • How to properly consult a specialty service (radiology, GI, PT, etc.) by correctly formulating the specific question to be answered.
  • Presentation of all patient and conference material in a concise, organized, logical and knowledgeable manner.
  • A kind, thoughtful, understanding and helpful attitude to all consulting services.
  • Leadership by assuring the attendance of team members at all rounds and conferences and getting your R1's and R2's into at least 2 large cases/week to position/open/close.

We expect that you will demonstrate...in Professionalism

  • Respect to every patient, regardless of social or other circumstances giving the same degree of respect you would afford to your own family members.
  • A personal commitment to continuity of patient care.
  • Be proactive with verbal communication foralltransfers of patient care (if someone doesn’t call you - then call them)
  • Finishing every operative case you begin.
  • Daily/weekly updates of yourSurgical Operative Logon the ACGME web.
  • Daily/weekly updates of your duty hours.
  • An understanding that duty hours are a shared responsibility in our department (you, your service chief, the program) and that you must know what the work hour expectations are for each service. You must abide by them and when you can’t, notify the Chief resident with enough time to avoid a violation. Also we want you to notify the Program Director or Asst Program Directors about any system problems with duty hours, so that problems can be fixed expeditiously
  • Accountability with timely completion of all required clinical and residency documents and emails.
  • Compassionate, helpful, kind, altruistic and ethically sound behavior with patients and all members of the health care team.
  • Dependability and attendance. It is your personal responsibility to document attendance by signing-in.
  • Administrative skill in preparation of the weekly M&M reports and presentation at conferences. The faculty expect you to contact the attending in advance to review their case, discuss presentation angles and relevant literature.
  • Punctuality for all required functions (OR, clinic, conferences) by you and your junior residents and answering pages in a timely fashion.
  • Professional attire, appropriate grooming and hygiene.
  • A professional attitude including initiative, honesty and integrity.
  • Leadership. Whether you know it or not, you are an example to others.
  • If you bring a problem – bring a solution with it.

We expect that you will demonstrate...in Systems Based Practice

  • Effective communication with referring physicians throughout the WWAMI region. This includes appropriate cc's on all dictated documents.
  • Safe patient care that focuses on the "big picture" and getting the patient discharged with minimal delays.
  • Effective personal time management and adherence to work hours regulations including taking a leadership role in watching your junior residents’ hours on your team.
  • An understanding of the larger system of hospital care by ensuring that your junior residents participate in weekly multidisciplinary rounds at HMC and UWMC.

Evaluation Forms

  • See how the program will evaluate your performance:Evaluations

Service Specific Goals & Objectives

  • See what the faculty expect you to learn on each rotation:Service Info