General Surgery Residency

Goal: The resident will achieve a detailed knowledge of the evaluation and treatment of a variety of disease processes in transplant surgery. The resident will be exposed to both medical and surgical emergencies and become comfortable in the initial evaluation and stabilization of such patients. 

Objectives: The resident should be able to… 

1. Discuss the basic pathophysiology of end-stage liver disease (ESLD) and end-stage renal disease (ESRD). 

2. Discuss alterations in physiology in ESLD and ESRD. 

3. Describe the general medical care of the immunosuppressed transplant patient. 

4. Understand the basic processes involved in organ donation.

5. Discuss the etiologies of failure of the following organ systems: 

a) kidney

b) liver

c) pancreas

d) cardiac

e) lung

f) small bowel 

6. Discuss the mechanism of action of immunosuppressive agents in transplant surgery, including:

a) Steroids

b) Purine analogs and inhibitors (azathioprine, mycophenolate) 

c) Anti-lymphocyte preparations (OKT3, thymoglobulin) 

d) Anti-T helper cell drugs (cyclosporine, tacrolimus) 

7. Familiarize to issues in transplant immunobiology for the post-transplant patient, including: 

a) Wound healing

b) Basic immune responses, including:

i. Antibody recognition of foreign antigens

ii. Cellular responses to foreign tissue or material 

iii. The role of lymphocytes, macrophages, and T-cells

c) Graft rejection 

i. Hyperacute

ii. Acute cellular 

iii. Chronic 

d) Infections

i. Bacterial 

ii. Fungal

iii. Viral

e) Tumors 

i. Skin

ii. PTLD

iii. Others 

8. Study the diagnosis and treatment of acute and chronic rejection in transplant patients, including: 

a) Differential diagnosis 

b) Method of evaluation and diagnosis

c) Treatment rationales

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

Objectives: The resident should be able to…

1. Interpret laboratory and diagnostic studies. 

2. Participate in the general medical care of the immunocompromised transplant patient. 

3. Pre-operatively evaluate and manage patients with end-stage liver or kidney disease. 

4. Participate in the pre-operative assessment, preparation for surgery, postoperative inpatient and outpatient care of transplant patient. 

5. Observe and act as surgical assistant in procedures for the placement of vascular access: 

a. Vascular shunts

b. Peritoneal dialysis catheters

c. Cimino fistulas

d. Vascular access procedures 

6. Observe and act as a surgical assistant in transplant surgery procedures, including:

a. Kidney transplantation 

b. Living related donor organ donation 

c. Pancreas transplantation

d. Small bowel transplantation 

e. Hepatobiliary procedures

f. Portosystemic shunts

g. Liver resections 

7. Participate and assist in the diagnosis and care of patients with postoperative complications in transplant surgery, including:

a. Delayed graft function

b. Infectious complications

c. Transplant dysfunction and rejection

d. Immunosuppressive drug toxicity

8. Participate and assist in the treatment of liver failure complications, including: 

a. Acute variceal hemorrhage

b. Hepatic encephalopathy

c. Refractory ascites

d. Hepatorenal syndrome

e. Spontaneous bacterial peritonitis 

f. Alterations in drug metabolism/excretion 

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. Use reliable information resources to prepare for surgical cases and start to develop a knowledge base of the current practices in transplant surgery. 

2. Work to develop a personalized and effective approach to the care of the transplant surgery patient.   

3. Be receptive to feedback from both senior residents and faculty. 

4. Be proactive and integrate recommended changes to improve performance.

5. Educate medical students in the mechanism of action of the different immunosuppressant medications and the management of the immuno-compromised patient. 

6. Know the different types of study designs (e.g. RCT, case-control, cohort) and their appropriate application in clinical research. 

7. Possess a basic understanding of biostatistics.  

8. Develop a knowledge base to enable resident to critically review current literature to identify both strengths and weaknesses in study design and methods. 

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. Develops communication and interpersonal skills for the effective exchange of information with transplant surgery patients and their families. 

2. Begin to exhibit confidence and ability in the education of patients and families in the basic management and rehabilitation of transplant patients. 

3. Provide appropriate and accurate information regarding the plan of care to patients and families as discussed with senior residents and/or faculty. 

4. Demonstrate compassion for transplant surgery patients and their families. 

5. Develop personal values and interpersonal skills to integrate with other members of the transplant team. 

6. Effectively communicates significant information regarding patient status to senior resident or faculty in an appropriate and timely manner. 

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. Assist in the coordination of the rehabilitation of transplant patients. 

2. Develop a basic understanding of the resources available for the coordination of patient care, including social workers, nurses, dieticians, and physical and occupational therapists. 

3. Establish relationships and create partnerships with other healthcare professionals to develop a rehabilitation plan and facilitate the timely discharge of the transplant patient. 

4. Recognize the significance of cost-effective medicine and avoid unnecessary expenses when ordering laboratory and radiologic studies. 

5. Request consultations from appropriate services when appropriate and follow up on the recommendations of consulting services and communicate this information to senior residents. 

6. Advocate for transplant patients within the health care system. 

7. Refer transplant patients to the appropriate practitioners and agencies. 

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 should be able to… 

1. Develop sensitivity and awareness of the unique stresses placed on the transplant patients and their families. 

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

3. Begin developing and applying a code of moral and ethical values to daily medical practice.

4. Promptly complete clinical responsibilities and tasks as instructed by senior residents and faculty.   

5. Demonstrate sensitivity to individual patient’s profession, life goals, and cultural background as they apply to transplant recipients. 

6. Be reliable, punctual, and honest with team members in regard to patient care. 

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

8. Maintain patient confidentiality.