GOALS AND OBJECTIVES
General Surgery
Goals of the Rotation
There are two primary focal points of the rotations on the General
Surgical Services. The first focal point is experience in preoperative,
operative and postoperative management of patients who present
to the General Surgical service. The second focal point is the
primary component of General Surgery. Specifically, it is the
goal that each resident have experience in operative and non-operative
lesions of the head and neck, skin soft tissue and breast, alimentary
tact and the abdomen, vascular diseases, endocrine diseases, and
surgical endoscopy. Beginning with the PGY-1 year resident extending
through the PGY-2 year, it is the goal of this service this service
to offer the resident exposure in the preoperative diagnosis and
medical management of patients with this category of diseases.
Residents will participate in the operative management fitting
within these categories, and finally, residents at each level
of training will be expected to play a role in the postoperative
management and follow-up of these patients. He/she will address
educational issues and present at Grand Rounds on areas represented
in the primary components of General Surgery. He/she will establish
treatment strategies in the preoperative and postoperative management
and care of patients in this area, and assist in the operative
training and education of subordinate residents and students.
Objectives Learned
The PGY-1 and PGY-2 year residents are expected to gain experience
and instruction in the foundations for preoperative evaluation
and the post operative management of patients who present to the
hospital with disorders in the primary components of General Surgery.
Although some operative experience is likely in the first two
years, the focus of these years is primarily in evaluation and
management of patients. Thus, the resident has exposure to the
appropriate laboratory and imaging techniques involved in defining
diseases within the primary components, for example interpretation
of CT scan of the abdomen or mammogram for breast diseases. The
skills required to perform history and physical exam will be emphasized.
Experiences overlap between hospitalized patients and clinic patients,
and much of the diagnostic experience is obtained during clinic
evaluation. After operation, the first-and second-year residents
review the ongoing medical management of patients in the postoperative
period, including laboratory and imaging information. Pathology
reports will be discussed in order to strengthen the ability of
interpreting carefully the implications of these findings. These
data form the basis for the appropriate follow-up of patients.
Finally, PGY-1 and PGY-2 residents gain exposure to the long-term
clinic follow-up of patients after operation and after discharge
from the hospital including such features as possible side effects
of operative intervention and recognizing anticipated outcomes
of specific operative procedures. Operative experience is progressive,
with less time assisting and more time operating as surgeon in
the PGY-2 years.
Surgical Intensive Care Unit
Goals of the Rotation
Rotation through the Surgical Intensive Care Unit (SICU) is intended
to introduce PGY-2 residents to the evaluation and care of critically
ill surgical patients. Through practical supervised experience
residents are expected to establish a baseline knowledge and competency
that will be utilized and further enhanced in the remainder of
the residency.
Objectives Learned
After completion of the two-month rotation, residents are expected
to have achieved the following educational goals: 1) The ability
to perform an initial evaluation and stabilization of new SICU
patients including proposing and implementing the means necessary;
2) ability to recognize and initiate appropriate treatment of
common acute problems in the SICU including, but not limited to,
respiratory distress; shock, whether hypovolemic, septic, neurogenic
or cardiogenic; renal failure; arrhythmias; nosocomial infections;
3) ability to assess nutritional need and formulate and institute
a rational plan to address them; 4) competence in troubleshooting
and interpreting commonly used monitoring equipment; 5) competence
in ventilator management including working knowledge of commonly
used modes of ventilator support; 6) demonstrated competence in
endotracheal intubation, insertion of central lines, insertion
of arterial lines and placement of pulmonary artery catheters;
and 7) competence in daily management of critically ill patients
including assessment, formulation of a management plan and its
implementation.
Pediatric Surgery
Goals of the Rotation
The goal of the rotation in Pediatric Surgery is to expose the
resident to the preoperative evaluation of pediatric patients
with surgical disorders. This will include expertise in evaluation
of laboratory and imaging information as well as history and physical
examination. Specific attention is given to fluid management and
acid base status of very young patients as well as working with
adjustments in hydration and in pharmaceutical management of pediatric
patients of varying sizes and metabolisms. Acquisition of operative
skills in simple and progressively complex pediatric surgical
procedures is also a goal and finally the postoperative management
and long-term follow-up of patients with specific pediatric surgical
diseases is achieved.
Objectives Learned
The PGY-1 resident receives guidance and instruction regarding
evaluation of common disorders such as appendicitis and somewhat
more complex disorders such as necrotizing enterocolitis or congenital
anomalies. The PGY-3/4 resident participates in the supervision
of the PGY-1 resident and interfaces directly with the assigned
faculty in Pediatric Surgery. The resident is offered an opportunity
to learn skills in the operative management of simple pediatric
surgical diseases and refines his/her skills in the postoperative
management of patients with these diseases. A complete understanding
of the diagnostic and therapeutic strategy for each of these patients
is achieved by exposure to the spectrum of pediatric surgical
diseases seen during his/her rotation. By virtue of our own pediatric
hospital within our complex, it is possible to anticipate that
the rotation in Pediatric Surgery will expose the resident to
the entire spectrum of pediatric surgical diseases An important
unique feature of this rotation includes development of skills
for interdisciplinary management of patients by sharing the clinical
decisions with representatives form General Pediatrics and specialty
divisions of Pediatrics, including Pediatric Intensive Care and
Neonatology. A broad program using extracorporal using extracorporal
membrane oxygenation offers the resident significant experience
in critical care management of neonatal patients. Cognitive information
is obtained by means of weekly pediatric surgical conferences
as well as periodic conferences in the Department of Pediatrics,
which require significant contributions by the representatives
from Pediatric Surgery. The resident supervises and participates
actively in the outpatient clinics for Pediatric Surgery.
Trauma Service
Goals of the Rotation
The Trauma Service is the primary setting for surgical trainees
to learn the continuum of principles involved in the care of injured
patients, and in addition, provides significant exposure to the
assessment and care f patients with non-traumatic emergent surgical
conditions. The resident assignments are designed to provide a
graduated increase in responsibility for each level trainee -
PGY-1, PGY-2, and PGY-4
Objectives Learned
The PGY-1 rotation is one month in duration and is designed to
teach the principles of routine patient care including the identification
of those at risk for iatrogenic complications and meticulous attention
to detail in their avoidance. The PGY-1 rotation provides the
trainee with the opportunity to learn the indications for and
technical aspects of basic procedure including: thorough physical
examination, phlebotomy, intravenous access, insertion of nasogastric
and urinary catheters, splinting of injured extremities, suturing
of lacerations, and thoracostomy tube insertion. PGY-1 trainees
routinely perform appendectomy and herniorrhaphy while on the
Trauma/Emergency Surgery rotation under the supervision of the
senior resident and the attending physician.
The PGY-2 rotation is designed to provide an increased level of
responsibility for initial assessment of acutely injured and ill
patients. The PGY-2 is responsible for performing the initial
assessment of trauma patients and is also responsible for the
non-trauma surgery emergency consultations. Through the intense
exposure to a large number of patients with a diverse spectrum
of illness, the PGY-2 develops increased clinical diagnostic skills
and is able to develop plans of action, including the decision
on the need for operative intervention in conjunction with the
senior resident and the surgical faculty. The PGY-2 rotation provides
for significant ICU exposure and responsibility in the management
of critically injured patients, with a daily ICU load of 2-8 patients/day.
The PGY-2 rotation provides the trainee with the opportunity to
learn the indications for an technical aspects of more advanced
techniques and procedures including: the use of mechanical ventilators,
the insertion and use of pulmonary artery catheters, diagnostic
peritoneal lavage, interpretation of abdominal CT scans and abdominal
ultrasound. PGY-2 trainees routinely perform emergency operations
under the supervision of the senior resident and the attending
faculty.
Transplant Service
Goals of the Rotation
Goals of the Transplant Service rotation are to develop a working
knowledge of transplantation including the actual transplant procedures
(living and cadaveric donor and transplant recipient procedures),
the immunosuppression used to maintain the organs, and the complications,
both procedural and medication induced, that may occur and how
to deal with these problems.
The following intellectual objectives are taught during resident
rotation of this service: what organs can be transplanted, rationale
for donor choice, rationale/workup for recipient eligibility,
immunosuppression (what drug are used, how do they work, side
effects), immunobiology of rejection and tolerance, complications
post-transplant, primary caretaker concerns for transplanted patients
(all-fever and neurologic complaints, kidney-abdominal/graft pain
and elevated creatinine, pancreas-elevated glucoses). Residents
are evaluated on their examination skills (renal, pancreas, liver,
and heart), radiologic interpretational skills (VCUG, renal scan,
ultrasound of the transplanted kidney and pancreas, donor arteriograms),
and procedural skills (central lines, paracentesis, first assisting
with transplant surgeries, creating vascular anastomosis). The
following exceptional objectives are also evaluated: ongoing research,
small bowel, new immunosuppressants and islet cells.
Vascular Surgery
Goals of the Rotation
The goal of the rotation on the Vascular Surgery service are to
accurately evaluate, correctly diagnose and adequately treat patients
with vascular disease. It is imperative for the resident ot understand
the risk factors for atherogenesis, the associated diseases which
occur in vascular patients the natural history of vascular disorders,
with and without treatment, and the treatment alternatives available.
Objectives Learned
There are three residents on the Vascular Surgery service at any
given time: one chief resident (PGY-5), one junior resident (PGY-2)
and one intern (PGY-1). The goals for the PGY-2 resident during
the rotation are to accurately evaluate, diagnose and treat vascular
patients with vascular diseases. Performing vascular consultations
on patients in the Emergency room and inpatient setting attains
these goals. The junior resident also evaluates out-patients in
the clinic setting and performs some vascular surgical procedures
including placement, thrombectomy and revision of dialysis access
grafts, construction of AV fistulas for dialysis, saphenous vein
harvesting, and portions of other major arterial Reconstructive
operations. The goals for the PGY-1 include performing an adequate
history and physical examination of the patient with vascular
disease, helping to manage the in-patient with vascular disease,
and evaluating clinic patients with vascular diseases, and performing
debridements and amputations in the vascular surgery patient.
Faculty members always perform these functions at each resident
level under direct supervision with training in vascular surgery.
Cardiothoracic Surgery
Goals of the Rotation
The Cardiothoracic Surgery rotation provides a primary setting
for the surgery resident to learn the principals and practice
of preoperative, intraoperative and postoperative care of general
thoracic surgical problems. The General Surgery resident in direct
collaboration with the Cardiothoracic surgery resident is expected
to evaluate a patient for a general thoracic problem by history,
physical exam, laboratory data and non-invasive tests to determine
the appropriateness of operative intervention or invasive radiology
care. The resident should be able to describe the appropriate
invasive approach and the information required. These goals are
achieved by daily discussion and review with the attending physician.
The Surgery resident is also responsible for all General Thoracic
Surgery consults and for participating in our weekly multiple
disciplinary lung cancer and thoracic surgery clinic in collaboration
with weekly multiple disciplinary lung cancer and thoracic surgery
clinic in collaboration with Pulmonary Medicine, Pathology, Radiation
Therapy and Interventional Radiology.
Objectives Learned
The educational objective of the Surgery resident is to evaluate
the problems concerning chest wall, lungs and pleura, trachea
and bronchia, mediastinum and pericardium, diaphragm and esophagus,
as well as understanding the basics of acquired heart disease
thoracic trauma. The residents are exposed to congenital heart
disease and cardiac transplantation as well as the mechanisms
of cardiopulmonary bypass. The minor procedures which a General
Surgery resident is expected to master include bronchoscopy, mediastinoscopy
and tube thoracostomy.
Burn Service
Goals of the Rotation
Goals include learning assessment and classification of burn wounds,
including estimation of burn size, depth and reduction of related
morbidity and mortality; gaining an appreciation stress response
to acute burn injury, including hemodynamic, metabolic, nutritional
and immunologic sequelae; learning initial management of the acute
burn patients, including fluid resuscitation, nutritional support,
wound care and ventilatory management; learning wound management
of burn patients, including an understanding of wound healing,
wound sepsis, topical antimicrobial agents, biological dressings
and skin substitutes, and skin grafts developing fundamental surgical
skills in treatment of burn patients, including wound debridement,
wound dressing and splinting, skin grafting, and scar contracture
release; gaining an appreciation for burn rehabilitation, including
physical/occupational therapy, psychosocial support and reconstructives
needs; improving communication and leadership through interactions
and coordinated discussions with patients and their families,
attending physicians, medical personnel, medical students and
fellow residents; learning principles of management of injuries
of a special nature, including inhalation injuries, chemical injuries,
electrical injuries and dermatologic conditions necessitating
the wound and surgical care that only a burn center can provide.
Goals of Rotation (PGY-3)
The resident will return to the Burn service for progressive experience
with the evaluation and treatment of acute burns. The resident
is expected to supervise the PGY-1 and PGY-2 residents and serve
as back up for them. The resident will help educate the students
and the more junior residents in the evaluation and treatment
of the acute burn including fluid management. The resident will
become more experienced with the operative debridement and resurfacing
for acute burn. The resident will become more adept in recognition
and treatment of burn complications, particularly infections.
The resident will be adept at running a fluid resuscitation and
evaluating the patient for smoke inhalation, compartment syndrome,
and related trauma.
Objectives Learned
Successful management of the acute burn patient requires prompt
aggressive fluid resuscitation, metabolic/nutritional support,
control of bacterial infection, anticipation and prevention of
complications, timely closure of the burn wound and early initiation
of rehabilitation therapy. Burn shock must be adequately treated.
Post-burn malnutrition must be prevented. In the post-burn stress
response, all major organ systems are affected. Closure of the
wound is essential for correction of the pathophysiologic post-burn
derangements. In essence, management of the burn patient is a
race against time, as rapidity of wound closure is inversely related
to complications and mortality. This race must be tempered with
thoughtful considerations of ultimate function, cosmesis and quality
of life.
Urology
Goals of the Rotation
The goal of this rotation is to provide the PGY-1 resident with
the ability to evaluate and be familiar with the treatment of
urologic problems.
Objectives Learned
The resident will attend the outpatient clinic and the emergency
room and become familiar with the evaluation and management of
common urologic problems such as benign prostatic hypertrophy,
renal or Uro-lithiasis, urologic trauma, and benign and malignant
neoplasms. The resident will learn the inpatient care of operative
and non-operative patients by participation in the service. The
resident will attends the operating room and is familiar with
the anatomy and physiology pertinent to urologic patients.
Neurosurgery
Goals of the Rotation
The goal of this rotation is to provide the PGY-1 resident with
the ability to evaluate and be familiar with the treatment of
neurosurgery problems.
Objectives Learned
The resident will attend the outpatient clinic and the emergency
room and become familiar with the evaluation and management of
common neurosurgery problems. The resident will learn the inpatient
care of operative and non-operative patients by participation
in the service. The resident will attend the operating room and
be familiar with the anatomy and physiology pertinent to neurosurgery
patients. The resident will learn the emergency room evaluation
and management of cranial and spinal head trauma. The resident
will learn outpatient evaluation of acquired neurosurgical problems
such as vascular malformations and other neoplasms, and participate
in the operative and post-operative care of these patients.
Anesthesiology
Goals of the Rotation
The resident will become familiar with the induction and monitoring
of patients who have general or regional anesthetics?
Objectives Learned
The resident will participate in the preoperative evaluation,
intraoperative management, and post operative evaluation of patients
who are undergoing general or regional anesthetics. The resident
will learn to evaluate the patient for their anesthetic risk and
properly monitor these patients. The resident will become familiar
with the pharmacology of a variety of anesthetic agents. The resident
will learn common anesthetic procedures both of monitoring and
induction of anesthetic, including intubation.
Otolaryngology
Goals of the Rotation
The goals of the rotation in Otolaryngology are to provide the
resident with experience in the care of patients with head and
neck oncology and pediatric otolaryngologic problems.
Objectives Learned
The resident will spend two separate rotations on this service.
The first will provide experience in head and neck oncology. The
resident will learn to evaluate and stage head and neck tumors,
will participate in the outpatient evaluation and care as well
as the inpatient management, including the surgical procedures.
The second component of the rotation will provide the resident
with experience in pediatric otolaryngology. Particular emphasis
will be placed on pediatric airway management and otologic problems
such as are part of the care of cleft palate children.
Orthopaedic Surgery
Goals of the Rotation
The goals of the PGY-2 rotation on Orthopaedic Surgery are to
familiarize the resident with the evaluation and treatment of
adult musculoskeletal trauma.
Objective Learned
The resident will participate in emergency room evaluation and
treatment of musculoskeletal adult fractures and dislocations
by taking call with the residents in Orthopaedics. The resident
will assist in the inpatient management and outpatient clinic
setting of evaluation and management of adult Orthopaedic problems.
The resident will participate in the combined cases with Plastic
Surgery to evaluate and treat patients requiring soft tissue coverage
after such trauma. The resident will participate in the surgical
care of these patients. The resident will become familiar with
possible Orthopaedic complications such as neurovascular compromise
and compartment syndrome.
Plastic Surgery
Goals of the Rotation (PGY-1)
The major goal and objective of a one month rotation on Plastic
Surgery during the PGY-1 is to provide experience with the subset
of patients that are treated by the specialty of Plastic and Reconstructive
Surgery. During that time, the PGY-1 will be able to obtain far
more the five cases in the area of plastic surgery that the Surgery
Residency Review committee requires.
Objectives Learned and Method of Teaching (PGY-1)
During the one month rotation the duties of the PGY-1 would include:
1) primary responsibility for a set of in patients on the Plastic
Surgery service with duty shared by the other Plastic Surgery
residents. This means that there will be histories and physicals,
patient orders, management and diagnostic plans, participation
as the assistant surgeon or the surgeon on that particular surgical
case for each patients, monitoring of the patient by being familiar
with pertinent laboratory studies and vital signs, and other duties
as assigned by the chief resident on that service; 2) primary
assessment and evaluation of the outpatient which is done in the
clinic or the emergency room. This will be monitored by a resident
and then faculty evaluation of the same patient with discussion
of the management plan and diagnosis; 3) call rotation will be
taken at the same frequency as the junior Plastic Surgery residents
and in accompaniment with the junior Plastic Surgery resident.
This will mean responsibilities for the in house patients, return
of patient calls an Emergency Room duty with care rendered either
in the Emergency Room or the operating room during the call; 4)
the PGY-1 will round with the surgical team members, attend clinic,
the operating room and all conferences with the service; 5) the
PGY-1 will be the surgeon of record for the following types of
cases: placement of tissue expanders, removal of tissue expanders
with advancement or rotation of the subsequent flap; harvesting
and placement of composite grafts, full thickness grafts, or split
thickness skin grafts; placement of allograft material; debridement
and closure of pressure sores; scar revision by direct excision,
or local flap rotation; repair of lacerations of the face, hand,
and other body parts; 6) during this rotation the resident will
obtain additional exposure, but not as surgeon, to the following
types of cases: cleft lip, palate, or nasal deformity repair;
transfer of skin, musculocutaneous, or free flaps.
PGY-2 Plastic Surgeon
Goals of the Rotation
This rotation will provide the resident with progressive experience
in plastic surgery. Emphasis is placed on the pediatric rotation.
Objectives Learned
The resident will take call in rotation with the second year residents.
This will allow progressive experience with patient evaluation
and management both in the emergency room and in the hospital
setting. The resident will be assigned to the Pediatric Plastic
service at UTMB (Galveston). There the resident will learn the
evaluation and treatment of congenital and traumatic pediatric
plastic surgical problems. The resident will participate in the
cleft Palate clinic every Wednesday and in the operative experience.
The resident will learn the evaluation and management of the cleft
lip and palate and the use of the entire Cleft Palate Team. The
resident will participate in the evaluation operative and postoperative
treatment of the children with craniofacial anomalies, myelomeningocele
and traumatic injuries.
Adult Plastic Surgery
Goals of the Rotation
The resident will develop progressive understanding and independence
in the evaluation and management of adult plastic surgery resident.
The PGY-3 resident will become independent in the Emergency room
evaluation of Plastic Surgical patients, with back up from the
faculty. The resident will participate in the outpatient evaluation
and treatment of Adult Plastic surgical problems, including reconstructive
surgery of the breast, trunk, upper and lower extremities, head
and neck.
Objective Learned
The resident will perform procedures more complexes than at the
PGY-1 or 2 levels. The resident will instruct the medical students.
The PGY-4 rotation will provide the resident with more autonomy
in the operating room. The resident is expected to be able to
develop an operative or non-operative treatment plans and be able
to execute the more simple procedures. The resident may be called
upon to assist a PGY-3 resident in a surgical procedure. The resident
will have greater responsibility for surgical procedures of the
breast and trunk.
The PGY-5 rotation provides the plastic surgery resident with senior responsibility. The resident will serve as second call (back up) for the junior residents. The resident is more autonomous in the operating room and is expected to be able to develop a treatment plan for even the most complex and unusual plastic surgical adult problems. The resident will serve as the chief Administrative Resident and as such is responsible for ensuring the smooth running of the patient service as well as administrative responsibilities for conferences and call.
Research Rotation
Goals of the Rotation
The two-month of research in the 5th year will provide the resident
with the opportunity for a clinical or basic science project.
The project must be cleared with Dr. Philips prior to beginning
this rotation.
Objectives Learned
The resident may pursue an area of inquiry within or without the
Division of Plastic Surgery, but located geographically at UTMB
(Galveston). The resident will learn to be critical of research
techniques and be able to criticize other research.
Pediatric Plastic
Goals of the Rotation
The PGY-3 rotation will provide the resident with greater autonomy
with pediatric plastic surgery patients.
Objectives Learned
More simple procedures will allow them to become surgeons. The
resident will become proficient in the outpatient evaluation and
treatment of pediatric surgical problems, including congenital
and traumatic injury. The resident will be expected to instruct
the medical students and assist the faculty or chief resident
on the service.
The PGY-5 rotation allows the resident senior responsibility.
The resident will organize the service obligations and the residents
on that service. The resident is expected to develop a treatment
plan for the patient in conjunction with the faculty and be able
to execute this plan, whether surgical or non-surgical. The resident
is expected to be able to correct cleft lips, cleft palates and
participate in the correction of myelomeningocele and craniofacial
deformities.
M.D. Anderson
Goals of the Rotation
This month long rotation provides the resident with concentrated
exposure to complex microsurgical reconstruction for oncologic
problems.
Objectives Learned
The PGY-4 resident is expected to participate in the care of these
patients and serve as surgeon or assistant surgeon in these free
tissue transfers. The resident has particular exposure to head
and neck reconstruction. The resident will become more adept at
microvascular surgical planning and techniques, postoperative
monitoring, and treatment of complications.
Miami Anesthetic
Goals of the Rotation
The PGY-4 resident travels off site to the private practice of
Drs. Baker, Stuzin and Baker.
Objectives Learned
There the resident will become facile with the preoperative evaluation
and post operative care of aesthetic patients, particularly those
desiring facial resurfacing or other rejuvenation techniques,
rhinoplasty, and body sculpturing. The resident will assist as
required on this rotation. The resident has exposure to the extensive
library of this faculty. In addition the resident will learn the
office management of a private practice.
Shriners Hospital
Goals of the Rotation
The PGY-4 resident will spend four months learning principles
and techniques of reconstructive surgery for burns.
Objectives Learned
The resident will learn to evaluate the defect, the available
donor sites, and constructs a surgical treatment plan. The resident
will participate in the out patient evaluation and treatment as
well as the in patient management and surgical procedures. The
resident will serve as surgeon for most procedures, assistant
surgeons on those that are more complex. The resident will also
participate in the care of the patients with congenital vascular
lesions and other pediatric plastic problems as accepted into
the Shriners Hospital system. The resident will learn to apply
techniques such as skin graft or flap releases, ear reconstruction,
tissue expansion for burn alopecia, laser treatment for vascular
lesions and use of osseointegrated implant. The resident will
help to instruct medical students on this service, coordinate
this service, and serve as the administrator for the clinical
care of these patients.
Texas Department of Corrections of
Criminal Justice (TDCJ)
Goals of the Rotation
The PGY-5 resident will serve in a semi autonomous position to
evaluate and treat the patients in the Texas Department of Criminal
Justice setting on campus at UTMB (Galveston).
Objectives Learned
The resident will evaluate and manage the patients in both the
in-patient and out-patient setting, the resident is expected to
be able to develop a surgical or non surgical treatment plan and
be able to execute this independently. This rotation allows the
resident to work with a PA student for whom the resident is responsible
to educate and coordinate the activities of the service. In addition,
the resident will serve to instruct medical students as appointed
to the service.
Hand Service
Goals of the Rotation
The rotation will allow the PGY-5, working with the new plastic
surgery hand faculty, to evaluate, and treat more complex hand
problems.
Objectives Learned
The resident will learn to evaluate acute and non-acute hand problems,
traumatic and otherwise acquired, as well as congenital. The resident
will treat long-term complications of flexor and extensor tendon
injuries, Dupuytren's contractures, arthritides, nerve compression
syndromes, bifid or syndactylized digits, and other congential
disease. Working with faculty, the resident will develop operative
and non-operative management plans and be able to execute these.