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General Surgery Residency

General Surgery Residency On-Line Handbook

Trauma & Acute Care Surgery, PGY-1

Updated December 2021

TRAUMA & ACUTE CARE SURGERY – PGY1 Resident 

A. Medical Knowledge  
Goal: The resident will achieve a detailed knowledge of the pathophysiology of blunt and penetrating trauma and develop the skills necessary to treat the trauma patient. 
Objectives: The resident should be able to…
1. Describe the mechanisms of injury of blunt and penetrating trauma. 
2. Become familiar with the steps of the primary, secondary, and tertiary surveys. 
3. Discuss the diagnosis and treatment of thoracic injuries, including: 
a. Airway obstruction
b. Hemothorax
c. Pneumothorax
d. Rib fracture 
4. Discuss the diagnosis and treatment of abdominal injuries, including: 
a. Splenic injury
5. Discuss the diagnosis and treatment of central nervous system injury, including:
a. Brain injury 
6. Discuss the diagnosis and treatment of orthopedic injuries 
7. Study and memorize the steps in the diagnosis and treatment of hemorrhagic shock. 
8. Review the indications for and complications of blood product transfusions.

 

B. Patient Care Goals
Goal: The resident will provide patient care that is compassionate, appropriate, and effective care in the initial evaluation and management of the trauma patient. 
Objectives: The resident should be able to…
1. Perform primary, secondary, and tertiary surveys of the trauma patient. 
2. Prompt performance of designated role as instructed by senior resident during the initial evaluation of trauma patient. 
3. Perform a complete neurological evaluation of trauma patients. 
4. Memorize the components and scoring used in the Glasgow Coma Scale (GCS). 
5. Become ATLS certified. 
6. Manage ICU patients under the direct supervision of senior residents. 
7. Observe and assist in the emergency treatment of flail chest, cardiac tamponade, pneumothorax, and airway obstruction. 
8. Participate in, under direct supervision, the following procedures: 
a. Chest tube placement 
b. Diagnostic peritoneal lavage 
c. Focused Assessment with Sonography for Trauma (FAST) exam
9. Observe and participate, primarily as an assistant in emergent procedures, including: 
a. Pericardiocentesis 
b. Pericardial window  
10. Participate as a surgical assistant in the operative treatment of thoracic and abdominal trauma. 


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. Use reliable information resources to prepare for surgical cases and start to develop a knowledge base of the current practices in trauma. 
2. Work to develop a personalized and effective approach to the care of the 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 initial evaluation and management of trauma patients. 
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. 

 

D. Interpersonal and Communication Skills 
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 trauma. 
2. Work to develop a personalized and effective approach to the care of the 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 initial evaluation and management of trauma patients. 
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 that enables the resident to critically review current literature to identify both strengths and weaknesses in study design and methods. 


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 should be able to: 
1. Assist in the coordination of the rehabilitation of trauma 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 trauma 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 trauma patients within the health care system. 
7. Refer trauma patients to the appropriate practitioners and agencies. 

 

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 should be able to… 
1. Develop sensitivity and awareness of the unique stresses placed on the trauma 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 to develop and apply 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 the individual patient’s profession, life goals, and cultural background as they apply to traumatic injuries. 
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.