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General Surgery Residency

Patient Care - full statement

 
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.

Residents:

-will demonstrate manual dexterity appropriate for their level

-will develop and execute patient care plans appropriate for the resident’s level, including management of pain

-will participate in a program that must document a clinical curriculum that is sequential, comprehensive, and organized from basic to complex. The clinical assignments should be carefully structured to ensure that graded levels of responsibility, continuity in patient care, a balance between education and service, and progressive clinical experiences are achieved for each resident

The 60-month clinical program should be organized as follows:
1) At least 54 months of the 60-month program must be spent on clinical assignments in surgery, with documented experience in emergency care and surgical critical care in order to enable residents to manage patients with severe and complex illnesses and with major injuries.

2) 42 months of these 54 months must be spent on clinical assignments in the essential content areas of surgery. The essential content areas are: the abdomen and its contents; the alimentary tract; skin, soft tissues, and breast; endocrine surgery; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and non-operative trauma (burn experience that includes patient management may be counted toward non-operative trauma) and the vascular system.

3) A formal rotation in burn care, gynecology, neurosurgery, orthopaedic surgery, cardiac surgery, and urology is not required. Clearly documented goals and objectives must be presented if these components are included as rotations.
(a) Knowledge of burn physiology and initial burn management is required.

4) A formal transplant rotation is required. It must include patient management and cover knowledge of the principles of immunology, immunosuppression, and the management of general surgical conditions arising in transplant patients. Clearly documented goals and objectives must be presented for this experience.

5) No more than six months total may be allocated to research or to non- surgical disciplines such as anesthesiology, internal medicine, pediatrics, or surgical pathology. (Gastroenterology is exempt from this limit if this rotation provides endoscopic experiences.)
No more than 12 months may be devoted to surgical discipline other than the principal components of surgery.

6) The Chief Year 

(a) Clinical assignments at the chief resident level should be scheduled in the final (5th) year of the program.
(b) To take advantage of a unique educational opportunity in a program, up to 6 months of the chief year may be served in the next to the last year (4th). This experience must not occur any earlier than the 4th clinical year. Any special Program of this type must be approved in advance by the Review Committee. Operative cases counted as the chief cases must be performed during the 12 months designated as the chief year.
(c) The clinical assignments during the chief year must be scheduled at the primary clinical site or at participating integrated site(s).
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d) Clinical assignments during the chief year must be in the essential content areas of general surgery. No more than four months of the chief year may be devoted exclusively to any one essential content area.
(e) Noncardiac thoracic surgery and transplantation rotations may be considered an acceptable chief resident assignment as long as the chief resident performs an appropriate number of complex cases with documented participation in pre and post-operative care (program director may use the flexibility outlined in IV.A.5.a.3.d.ii.).

7) Operative Experience
(a) The program must document that residents are performing a sufficient breadth of complex procedures to graduate qualified surgeons.
(b) All residents (categorical, designated preliminary, and nondesignated preliminary residents in ACGME-accredited positions) must enter their operative experience concurrently during each year of the residency in the ACGME case log system.
(c) A resident may be considered the surgeon only when he or she can document a significant role in the following aspects of management: determination or confirmation of the diagnosis, provision of preoperative care, selection, and accomplishment of the appropriate operative procedure, and direction of the postoperative care.
(d) When justified by experience, a PG 5 (chief) resident may act as a teaching assistant (TA) to a more junior resident with appropriate faculty supervision. Up to 50 cases listed by the chief resident as TA will be credited for the total requirement of 750 cases. TA cases may not count towards the 150 minimum cases needed to fulfill the operative requirements for the chief resident year. The junior resident performing the case will also be credited as surgeon for these cases.
(e) Each program is required to provide residents with an outpatient experience to evaluate patients both pre-operatively, including initial evaluation, and post-operatively. At least 75% of the assignments in the essential content areas must include an outpatient experience of 1/2 day per week. (An outpatient experience is not required for assignments in the secondary components of surgery or surgical critical care).

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