General Surgery Residency

Goal: The resident will supervise and manage the evaluation and management of burn patients.  

Objectives: The resident should be able to… 

1. Fulfill all the objectives of a PGY1 level resident:

a) Discuss the resuscitation techniques used to treat major acute burn patients.

b) Discuss the different types of burn injury based on depth: 

i. Superficial (first degree) burn

ii. Superficial partial thickness (second degree) burn

iii. Deep partial thickness (second degree) burn

iv. Full thickness (third degree) burn 

c) Discuss the three zones of a burn wound:

i. Zone of Coagulation 

ii. Zone of Stasis

iii. Zone of Hyperemia 

d) Discuss the properties of split thickness vs. full thickness skin grafts

e) Discuss the airway management and treatment of inhalational injuries.

f) Describe the resuscitation and management of electrical burn injuries.

2. Gain comfort with the care of critically ill patients. Describe the indications and how to perform fasciotomies and escharotomies. 

3. Discuss the use of pressure garments and silicone therapy in the prevention of abnormal burn scars. 

4. Outline the principles of burn shock, immunologic alteration, biological dressings, allografts, and xenografts in the treatment of burn patients. 

5. List the details regarding the use of skin substitutes, biological dressings, allografts, and xenografts in the treatment of burn patients. 

6. Discuss reconstruction for burn contractures. 

7. Describe the pathophysiology and management of thermal, chemical, and electrical injury and their relationship to morbidity, mortality, and patient recovery. 

8. Discuss the epidemiology, prevention, socioeconomic, and psychological impact of burns. 

9. Recite the physiologic response to thermal, chemical, and electrical burn injuries, including the micro- and macro- disruption of normal skin anatomy and physiology. 

Goal: The resident will provide care that is compassionate, appropriate, and effective for the burn patient. 

Objectives: The resident should be able to…

1. Perform burn wound debridement and preparation for skin grafting.

2. Perform split thickness skin grafts. 

3. Perform full thickness skin grafts. 

4. Utilize skin substitutes, biological dressings, allografts, and xenografts in the treatment of burn wounds.  

5. Evaluate the appearance of the burn

6. Perform central line placement and intubations

7. Evaluate and develop treatment plans for the various types of shock

Goal: The resident will investigate and evaluate his or her own patient care practices, appraise and assimilate scientific evidence, and improve patient care practices.

Objectives: The resident should be able to… 

1. Routinely analyzes the effectiveness of own practices and accepts feedback on performance from senior residents and faculty. 

2. Improves patient care practices via the integration of appropriately gathered data and feedback. 

3. Develop organizational and teaching skills required in basic management of a surgical service

4. Educate junior residents, medical students, and other healthcare professionals in the early management, resuscitation, and the complications/risks associated with burn injury. 

5. Educate medical students and other healthcare professionals on the significance of infectious precautions in the burn unit and teach techniques used in infection control.

6. Reviews patient clinical status including laboratory and radiologic studies with junior residents and medical students for teaching purposes.

7. Understand principles of clinical research and application of biostatistics.

8. Exhibits an interest in and actively seeks scientific literature/data to support current practices in trauma surgery.

9. Presents patient complications and deaths at weekly morbidity and mortality conferences. 

Goal:  The resident will demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their families, and professional associates. 

Objectives: The resident should be able to… 

1. Continues to develop and refine communication and interpersonal skills for the effective exchange of information with burn patients and their families. 

2. Exhibits confidence and ability in the education of patients and families in the basic management, rehabilitation, and possible complications associated with acute burn injuries. 

3. Attune to patient circumstances or characteristics that may require customized communication to ensure understanding of the patient’s condition, prognosis, and future care needs. 

4. Assist critical care fellows and faculty in developing a plan of care for the burn patient and accurately relays the plan to patients and families.

5. Develop skills in the management of surgical services. Manage service administrative duties as assigned by critical care fellow and/or faculty. 

6. Continue to develop personal values and interpersonal skills to integrate with the burn team and consulting services. 

7. Effectively communicates significant information regarding patient status to critical care fellow and/or faculty in an appropriate and timely manner. 

8. Develop the ability to sensitively ad effectively deliver bad news to patients and their families.     

Goal: The resident will demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. 

Objectives: The resident should be able to: 

1. Educate junior residents on and assist in all aspects of care of the transplant patient, including the initial evaluation, acute management, and long-term rehabilitation.

2. Demonstrate understanding of complex health care systems and effectively call upon appropriate resources as needed to optimize patient outcomes. 

3. Collaborate with infection control practitioners to familiarize with infectious organisms common to the burn unit, antibiotic resistance patterns, and routes of transmission.  

4. Direct the rehabilitation plan and timely discharge/placement of the burn patient through partnerships with other health care professionals, including: 

a. Social workers

b. Nurse practitioners

c. Physician assistants

d. Dieticians/Nutritionists

e. Physical therapists

f. Occupational therapists. 

5. Demonstrate knowledge of cost-effective care practices and avoid unnecessary expenses when ordering laboratory and radiologic studies. 

6. Advocates cost-effective care. Limited use of unnecessary diagnostic tests/studies and avoids duplication to minimize health care costs. 

7. Communicate with consulting services and discuss their recommendations with other members of the transplant team. 

8. Manifests proficiency in the rational use of surgical literature and evidence-based medicine in the management of transplant patients. 

Goal: The resident will demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to diverse patient population. 

Objectives: The resident will be able to: 

1. Possesses a sensitivity and awareness of the unique stresses placed on burn patients and their families. 

2. Exhibit unselfish regard for the welfare of patients. Is respectful of patients and their families especially during times of stress.

3. Demonstrate firm adherence to a code of moral and ethical values. Maintains composure in accordance with ethical principles even in stressful situations.

4. Recognizes the limits of his or her knowledge and asks for help when needed.  

5. Demonstrates commitment to professional responsibilities and continuity of patient care.  

6. Responds to pages and consultation requests promptly. 

7. Demonstrate sensitivity to individual patient’s profession, life goals, and cultural background as they apply to burn surgery. 

8. Understand the concepts of autonomy, beneficence, non-maleficence, justice and respect for life. 

9. Maintain patient confidentiality.