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General Surgery Residency

General Surgery Residency On-Line Handbook

Thompson Service, PGY-4 & 5

Updated December 2021

General Surgery Rotation

Thompson/MIS – (PGY-4 & 5) Resident 

A. Medical Knowledge

I. Abdominal Surgery 
Goal: The resident will achieve a detailed knowledge of the evaluation and management of the general surgical patient with abdominal complaints.
Objectives: The resident will be able to…
1. Discuss the Pathophysiology, evaluation, and diagnosis of the following disorders of the esophagus. You should be able to explain the technical details of surgical management as well as the diagnosis and management of common complications of surgical treatment.
a. Zenker’s diverticulum
b. Esophageal motility disorders including achalasia 
c. Gastroesophageal reflux disease
d. Hiatal hernias
e. Barrett’s esophagus 
2. Discuss the Pathophysiology, evaluation, and diagnosis of the following disorders of the stomach and duodenum. You should be able to explain the technical details of surgical management as well as the diagnosis and management of common complications of surgical treatment.
a. Gastric volvulus
b. Peptic ulcer disease
c. Gastric cancer 
d. Gastrointestinal stomal tumors (GIST)
e. Morbid obesity
3. Discuss the Pathophysiology, evaluation, and diagnosis of the following disorders of the small intestines. You should be able to explain the technical details of surgical management as well as the diagnosis and management of common complications of surgical treatment.
a. Enterocutaneous fistulas
b. Small bowel obstruction
c. Short gut syndrome
d. Carcinoid tumors 
e. Small bowel tumors 
4. Discuss the Pathophysiology, evaluation, and diagnosis of the following disorders of the biliary system and pancreas. You should be able to explain the technical details of surgical management as well as the diagnosis and management of common complications of surgical treatment.
a. Cholelithiasis
b. Cholecystitis 
c. Choledocholithiasis 
d. Common bile duct injuries 
e. Cholangiocarcinoma 
f. Acute and chronic pancreatitis 
g. Pancreatic pseudocyst
h. Pancreatic adenocarcinoma
i. Functional and non-functional pancreatic tumors
5. Discuss the Pathophysiology, evaluation, and diagnosis of the following disorders of the spleen. You should be able to explain the technical details of surgical management as well as the diagnosis and management of common complications of surgical treatment.
a. Idiopathic thrombocytopenic purpura and thrombotic thrombocytopenic purpura
b. Hemolytic anemias
c. Splenic cysts and tumors 
d. Adrenal gland with speen
6. Discuss the Pathophysiology, evaluation, and diagnosis of the following disorders of the abdominal wall. You should be able to explain the technical details of surgical management as well as the diagnosis and management of common complications of surgical treatment.
a. Ventral and incisional hernias
b. Inguinal and femoral hernias
c. Lumbar hernias 
d. Diastasis recti


II. Minimal Access Surgery (including robotic surgery)
Goal:  The resident will achieve a detailed knowledge and understanding of minimal access surgery.
Objectives:   The resident will be able to…
1. Discuss the advantages and disadvantages of minimally invasive surgery.
2. Discuss the suitability of minimally invasive surgery for various disease processes.
3. Recite the physiologic effects of pneumoperitoneum, including:
a. acidosis 
b. cardiovascular changes 
c. urine output 
d. pulmonary 
e. air embolism 
f. deep venous thrombosis
4. Identify and know the use of basic equipment necessary for a laparoscopic and robotic platform.
5. Discuss and be able to use different methods to access the abdominal cavity for minimally-invasive cases. 

6. Identify the potential intraoperative and postoperative complications of minimally invasive surgery, including the pathophysiology of pneumoperitoneum.
7. Discuss the management of potential intraoperative and postoperative complications of minimally invasive surgery.


B.  Patient Care

Goal:  The resident will provide patient care that is compassionate, appropriate, and effective for the treatment of cardiothoracic problems. 
Objectives:   The resident will be able to…
1. Recite the steps of the preoperative evaluation of the fitness of a patient for surgery including cardiac screening, nutritional status, bowel preps, antibiotic prophylaxis, DVT prophylaxis, pre-operative fluid therapy, etc.
2. Lead the preparation and positioning of patients for open and minimally invasive surgical procedures.
3. Perform, with graduated independence, bedside procedures, to include:
a. Wound care
b. Drain care
c. Feeding tube placement and care
d. Placement and care of central lines
e. Placement and care of pleural catheters
f. Placement and care of nasogastric tubes
g. Placement and care of foley catheters
h. Airway management and running codes
i. ICU management
4. Demonstrate in the OR the techniques in minimally invasive surgery, including:
a. Maneuvering an angled laparoscope
b. Robotic surgery docking and bedside assistance
c. Intracorporeal knot-tying
d. Closing port sites
e. Endoscopic stapling
f. Harmonic scalpel use
g. Placement of endoscopic loop
h. Bimanual dexterity
5. Demonstrate in the lab first, and then in the OR, the basic open operative skills, including:
a. Incision of tissues
b. Suturing techniques
c. Knot tying
d. Gentle handling of tissues
e. Wound closure
f. Dressings
6. Participate, with graduated independence, in the following basic general surgery procedures:
a. Drainage of abscesses
b. Excisions of skin lesions at all depths
c. G- and J-tube insertions
d. Inguinal and femoral hernias (open, laparoscopic and robotic)
e. Ventral hernias (open, laparoscopic and robotic)
f. Diastasis recti (open, laparoscopic and robotic)
g. Lumbar hernias (open, laparoscopic and robotic)
7. Be able to perform, with adequate supervision, general surgery procedures, including:
a. Bowel resections 
b. Lysis of adhesion
c. Formation of stomas
d. Cholecystectomies
e. Esophagogastroduodenoscopy 
8. Participate, primarily as a surgical assistant, in general surgery procedures (laparoscopic and/or open) including:
a. Splenectomy
b. Gastric resections
c. Pancreatic resections
d. Liver resections and biliary reconstructions
e. Adrenalectomy
9. Perform, with graduated independence, postoperative management and care for surgical patients
a. Sleeve gastrectomy
b. Gastric bypass
c. Revisional bariatric surgery
d. Hiatal hernia repair
e. Heller myotomy
10. Perform, with graduated independence, the management of intraoperative and postoperative complications of open and minimally invasive surgery.
11. Perform, with graduated independence, interpretation of laboratory and diagnostic tests.
12. Perform, with graduated independence, interpretation of radiologic diagnostic test/examinations
13. Perform, with graduated independence, postoperative management and care for surgical patients
a. Timing of advancing diets
b. Drain management
c. Early ambulation
d. VTE prophylaxis


 

C. Practice Based Learning and Improvement

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 will be able to…
1. Routinely analyzes the effectiveness of own practices in caring for surgery patients.
2. Improve own practices in the care of patients by integrating appropriately gathered data and feedback.
3. Educate medical students and other healthcare professionals in the practices of general surgery.
4. Function independently with graduated advancement and appropriate faculty supervision.
5. Utilize library sources to perform research and perform literature searches.
6. Use information technology to prepare for cases, using in the OR the knowledge of current modalities of care and the scientific evidence for that care.
7. Understand the principles of clinical research and the application of biostatistics.
 

D.  Interpersonal and Communication Skills

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 will be able to…
1. Provide and instruct medical students and residents in the art of counseling and obtaining informed consent to patients.
2. Demonstrate compassion for all surgical patients and families.
3. Recognize and counsel the patients and family that need help dealing with the surgical experience; especially those that are dealing with bad news.
4. Listen to patients and their families.
5. Assimilate data and information provided by other members of the general surgery health care team.
6. Chart and record accurate information.
7. Educate patients and families in follow-up strategies and rehabilitation for general surgery patients.


E.   System Based Practice

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 will be able to…
1. Coordinates all aspects of the preoperative and postoperative care and rehabilitation surgical patients
2. Create a cost-effective, focused work-up of diagnostic testing
3. Advocate for surgical patients within the health care system
4. Facilitate the timely discharge and/or placement of surgery patients
5. Refer surgical patients to the appropriate practitioners and  agencies
6. Coordinate the admission of patients and communicate with primary care physicians, inpatient house staff, and consultants
7. Discuss the scientific basis and regulations governing clinical trials and their importance in defining appropriate therapy
8. Coordinate the total care of the surgical patient by partnering with other members of the medical team, such as:
a. Medical oncologist 
b. Radiation oncologists
c. Clinical Researchers
d. Pathologist
e. Radiologists
f. Geriatricians
g. PCP’s
h. Hospitalists
i. Critical Care Medicine
j. Nurse coordinators
k. NPs and PAs
l. Social workers
m. Pastoral care
n. Hospice
o. Dieticians
9. Participate in conferences and committees.
a. Grand rounds
b. Morbidity and mortality conference
c. Geriatric education for specialty residents conference
d. Journal club
e. Case conference
f. Tumor boards and surgical oncology


F.   Professionalism

Goal: The resident will demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.
Objectives: The resident will be able to…
1. Develop a sensitivity of the unique stresses placed on families under care for general surgery 
2. Exhibits unselfish regard for the welfare of general surgery patients
3. Demonstrates firm adherence to a code of moral and ethical values
4. Is respectful to patients and their families especially in times of stress to the family unit
5. Respects and appropriately integrates other members of the general surgery health care team
6. Demonstrates sensitivity to the individual patient’s profession, life goals, and cultural background as they apply to surgery
7. Is reliable, punctual, and accountable for own actions in the OR and clinic
8.   Understands the concepts of autonomy, beneficence, nonmaleficence, justice, and respect for life
9.   Maintains patient confidentiality


General Surgery Reference:

PRIMARY TEXT:
Townsend, Courtney, Beauchamp, Daniel, and Evers, B. Mark. Sabiston Textbook of Surgery. 21th ed. Philadelphia: Saunders, 2021

Zollinger, Robert M. Jr., Zollinger, Robert M. Sr. Zollinger’s Atlas of Surgical Operations. 10th ed. New York: McGraw- Hill Companies, Inc. 2016

Cameron, John L. Current Surgical Therapy. 13th ed. Philadephia: Elsevier, 2020