Program Goals and Objectives

Competency Based Program Goals

The overall goal of the five-year surgery residency program is to provide the resident with an in-depth and enriched training experience that will impart the essential “fund of knowledge” needed to function as a general surgeon. This educational experience will be accomplished by completing all rotations successfully and by participating in a robust, structured series of didactic conferences. All rotations and conferences are aligned with the ACGME General Competencies and have been tailored to the resident’s level of training (PGY 1 - 5). Upon graduation, the resident should be able to provide the highest quality medical and surgical patient care in a competent, safe and professional manner.

The goals as stated in this document are overall goals, which encompass the entirety of the residency. They are a general guide for each of the rotations, but are not intended to detail each rotation’s specific content. They are organized by the six competencies as defined by the ACGME Outcome Project.

Patient Care and Procedural Skills

Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.

The resident will become proficient at all peri-operative care including: pre-operative evaluation, work-up, risk assessment, intra-operative management, post-operative follow-up, including outpatient visits.

The resident will acquire operative skills appropriate for training level and acquire technical proficiency consistent with safe practice upon graduation.

The resident will become proficient with critical care of the surgical patient as is consistent with the intentions of the American Board of Surgery (ABS):

• Alimentary Tract (including Bariatric Surgery)
• Abdomen and its Contents
• Breast, Skin and Soft Tissue
• Endocrine System
• Solid Organ Transplantation
• Pediatric Surgery
• Surgical Critical Care
• Surgical Oncology (including Head and Neck Surgery)
• Trauma/Burns and Emergency Surgery
• Vascular Surgery

The resident will acquire proficiency in caring for patients in essential content areas of surgery as defined by the ACGME (Primary: abdomen, alimentary tract, breast, skin and soft tissue, trauma and nonoperative trauma, endocrine surgery, head and neck surgery, pediatric surgery, surgical oncology, surgical critical care and vascular system).

Surgery residents will:

• Gather and document accurate and essential patient information during all rotations and outpatient clinics
• Competently perform all invasive procedures, including bedside procedures, and log them in the ACGME Resident Case Log System by level of training
• Formulate diagnostic and therapeutic interventions that are based upon clinical findings, lab re-ports and current best scientific practices
• Residents must be able to competently perform all medical, diagnostic, and surgical procedures in the above areas, plus knowledge, familiarity and in some cases technical proficiency with more uncommon and complex operations in each of the above areas.
• Develop their clinical problem solving skills through daily patient care interactions
• Understand the patient safety and quality factors associated with patient care
• Residents must demonstrate competence in manual dexterity appropriate for their level; and, must develop competence in and execute patient care plans appropriate for the resident’s level, including management of pain.

Medical Knowledge

Surgery residents will acquire an understanding of the basic science and clinical factors leading to accurate diagnosis and treatment of surgical patients. The residents will also acquire proficiency and a broad knowledge base as it pertains to the essential content of the ABS and the ACGME.

Objectives

Surgery residents will:

• Develop a fundamental knowledge base of surgery through self-directed reading program that will be enhanced by participation in departmental conferences and mentored research endeavors
• Develop skill and gain experience in the following areas: clinical evaluation and management, or stabilization and referral, of patients with surgical diseases; management of preoperative, operative and postoperative care; management of comorbidities and complications; and knowledge of appropriate use and interpretation of radiologic and other diagnostic imaging.
• Demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social-behavioral sciences, as well as the application of this knowledge to patient care.
• Develop competence in the critical evaluation and demonstration of knowledge of pertinent scientific information and demonstrate knowledge of the fundamentals of basic science as applied to clinical surgery.
• Learn applied surgical anatomy and surgical pathology; the elements of wound healing; homeostasis, shock and circulatory physiology; hematologic disorders; immunobiology and transplantation; oncology; surgical endocrinology; surgical nutrition, fluid and electrolyte balance; and the metabolic response to injury, including burns.
• Gain knowledge of the principles of immunology, immunosuppression, and the management of general surgical conditions arising in transplant patients.

Practice Based Learning and Improvement

Residents are expected to demonstrate graduated participation during the weekly Departmental Morbidity and Mortality Conference. Residents will determine the best scientific evidence to support patient care practices and develop an understanding of rotation specific practice- based learning as performed on the various services (quality projects, outcome projects, registries, series tracking and etc.).

Objectives

Surgery residents will:

• Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning.
• Residents are expected to develop skills and habits to be able to meet the following goals:
• Identify strengths, deficiencies, and limits in one’s knowledge and expertise, set learning and improvement goals and identify and perform appropriate learning activities.
• Systematically analyze practice using quality improvement methods, and implement changes with the goal of practice improvement.
• Incorporate formative evaluation feedback into daily practice.
• Locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems and use information technology to optimize learning.
• Participate in the education of patients, families, students, residents and other health professionals.
• Participate in mortality and morbidity conferences that evaluate and analyze patient care outcomes and utilize an evidence-based approach to patient care.
• Understand workings of registries for trauma, vascular, transplant, cancer and their role in clinical quality and patient outcomes.
• Understand hospital, system, and division level quality process and current initiatives.
• Be an active listener and participant in the weekly M&M using EBM skills.

Interpersonal and Communication Skills

Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information, ability to obtain informed consent and collaboration with patients, their families, and health professionals.

Residents are expected to:

• Communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds. They must communicate in a caring and respectful fashion and demonstrate the ability to establish goals of care and code status.
• Communicate effectively with physicians, other health professionals, and health related agencies.
• Work effectively as a member or leader of a health care team or other professional group and act in a consultative role to other physicians and health professionals.
• Maintain comprehensive, timely, and legible medical records.
• Counsel and educate patients and families; and effectively document practice activities.
• Partner with other health care team members to provide patient-centered health care.
• Develop excellent presentation skills during M&M and during annual research presentation during Grand Rounds during senior years.
• Develop teaching skills for medical students and more junior residents.

Professionalism

The resident will demonstrate professionalism by completing all assigned clinical and professional responsibilities, maintaining cultural sensitivity and ethical standards.

Residents are expected to:

• Demonstrate compassion, integrity, respect, honesty, high ethical standards and cultural sensitivity toward all patients and their families.
• Complete assigned administrative and clinical tasks in a prompt, timely and efficient manner, i.e. documentation, sign-out, patient care responsibilities and team functions
• Adhere to Duty Hour Guidelines, as dictated by the FIRST Trial and ACGME.
• Attend all regularly scheduled educational sessions (≥ 80%)
• Complete hand-offs that are accurate, clear and succinct.
• Present oneself in a professional manner at the highest level and fiber and personal ethics that emphasizes ideal patient care.
• Engage in active teaching of the medical students and more junior residents as a way to develop and solidify educational goals and be attentive to their needs.
• Responsiveness to patient needs that supersedes self-interest.
• Respect for patient privacy and autonomy and accountability to patients, society and the profession.
• Demonstrate cultural and emotional sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation.
• High standards of ethical behavior; and a commitment to continuity of patient care.

Systems Based Practice

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide quality and optimal health care.

Surgery residents will:

• Be able to differentiate between the different types of health systems e.g. HMO, PPO, Medicaid, Medicare, fee-for-service, and their effect on patients access to care.
• Identify health care sources for the uninsured and underinsured.
• Understand and acquire proficiency in obtaining necessary disposition and equipment for patients including: nursing home, skilled nursing facility, rehab, slow paced rehab, TBI unit, burn unit/rehab and vent facility.
• Work effectively in various health care delivery settings and systems relevant to their clinical specialty.
• Coordinate patient care within the health care system relevant to their clinical specialty.
• Incorporate considerations of cost awareness and risk-benefit analysis in patient and/or population-based care as appropriate.
• Advocate for quality patient care and optimal patient care systems.
• Work in inter-professional teams to enhance patient safety and improve patient care quality and participate in identifying system errors and implementing potential systems solutions.
• Understand system of care as they affect individual surgical domains: trauma systems, organ procurement systems and emergency medical systems
• Practice high quality, cost effective patient care.
• Demonstrate knowledge of risk-benefit analysis; and an understanding of the role of different specialists and other health care professionals in overall patient management.