Updated June 2019
TRANSPLANT/HEPATOBILIARY SURGERY – PGY2 & 3 Resident
A. Medical Knowledge
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 disease in all systems that can be transplanted, including:
a) kidney
b) liver
c) pancreas
d) cardiac
e) lung
f) small bowel
2. Discuss the indications and contraindications for transplant surgery.
3. Recite the details of management of wound care in the immunocompromised patient.
4. Discuss the diagnosis and treatment of acute rejection and chronic rejection in transplant recipients.
5. Recite the details of the process of organ donation.
6. Discuss the effect of immunosuppression on tumor development and skin tumor presentation.
7. Understand the effect of immunosuppression on wound healing.
8. Discuss issues in transplant immunobiology, including:
a) Major histocompatibility complex (MHC)
b) Human leukocyte antigens (HLA)
c) Panel reactive antibody (PRA)
d) Donor specific crossmatch
e) Types of graft rejection (hyperacute, acute, chronic)
f) Differential diagnosis for rejection
9. Discuss the details of pharmacology (generic/brand names of drugs, side effects, and contraindications) of the immunosuppressive agents:
a) Steroids
b) Purine analogs and inhibitors
c) Anti-thymocyte preparations
d) Anti-T helper cell drugs (calcineurin inhibitors)
e) IL2 inhibitors
f) Target of rapamycin inhibitors
10. Discuss the details of the specific uses and dosing of immunosuppressive therapy in transplant surgery.
B. Patient Care Goals
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. Participate in the general medical care of the immunocompromised transplant patient
2. Participate in the pre-operative assessment, preparation for surgery, postoperative inpatient and outpatient care of transplant patient.
3. Participate in the following vascular access procedures:
a. Vascular shunts
b. Peritoneal dialysis catheters
c. Cimino fistulas
d. Vascular access procedures
4. Participate with graduated surgical independence 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
5. Care for patients with post-operative hemodynamic instability.
6. Participate in the diagnosis and care of patients with post-operative complications in transplant surgery, including:
a. Delayed graft function
b. Infectious complications
c. Transplant dysfunction and rejection
d. Immunosuppressive drug toxicity
7. Participate 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
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 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 practices of transplant surgery.
5. Reviews patient clinical status including laboratory and radiologic studies with junior residents and medical students for teaching purposes.
6. Understand principles of clinical research and application of biostatistics.
7. Exhibits an interest in and actively seeks scientific literature/data to support current practices in trauma surgery.
8. Presents patient complications and deaths at weekly morbidity and mortality conferences.
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 should be able to…
1. Continue to develop and refine communication and interpersonal skills for the effective exchange of information with transplant surgery patients and their families.
2. Exhibit confidence and ability in the education of patients and families in the basic management and rehabilitation following transplant surgery.
3. Develop awareness of patient circumstances or characteristics that may require customized communication to ensure understanding of the patient’s condition, prognosis, and future care needs.
4. Assist senior resident and faculty in the development of a plan of care for the transplant patient and accurately relays the care plan to patients and families.
5. Develop skills in the management of surgical services. Manage service administrative duties as assigned by chief resident or faculty.
6. Continue to develop personal values and interpersonal skills to integrate with the transplant team and consulting services.
7. Effectively communicate significant information regarding patient status to senior resident 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. Direct the rehabilitation plan and timely discharge/placement of the transplant 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.
4. Demonstrate knowledge of cost-effective care practices and avoid unnecessary expenses when ordering laboratory and radiologic studies.
5. Advocates cost-effective care. Limited use of unnecessary diagnostic tests/studies and avoids duplication to minimize health care costs.
6. Communicate with consulting services and discuss their recommendations with other members of the transplant team.
7. 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 a diverse patient population.
Objectives: The resident will be able to:
1. Possesses a sensitivity and awareness of the unique stresses placed on transplant 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 vascular surgery.
8. Understand the concepts of autonomy, beneficence, non-maleficence, justice, and respect for life.
9. Maintain patient confidentiality.