RGS Service Overview
The Reconstructive General Surgery (RGS) service is comprised of faculty in the Division of Trauma and Surgical Critical Care, nurse practitioners, and residents at the PGY-4 and PGY-1 level. The RGS service was established to facilitate the care of patients requiring elective operation for reconstruction. The patient population includes former EGS and trauma patients, as well as new patients referred from other physicians. Operations frequently performed on the RGS service include reversal of ileostomy/colostomy, ventral hernia repair/abdominal wall reconstruction, and resection of enterocutaneous fistulae.
Core competencies as defined by the ACGME form the basis of resident evaluations.
1) Patient Care
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.
For PGY-1 residents on the RGS service, this will largely take place in the context of operative cases, and perioperative care with support and mentoring from faculty. At present, the RGS patients are cohorted with the trauma service (i.e. T3, trauma patients not located on 10N) for the purpose of attending and nurse practitioner coverage. The PGY-1 is not expected to round on the trauma patients.
2) Medical Knowledge
Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social-behavioral sciences, as well as the application of this knowledge to patient care.
The Surgical Council on Resident Education (SCORE) has defined an excellent curriculum for the traditional 5 year General Surgery training program. This has been further grouped to aid in sequencing the material by PGY year. For the PGY-1 year grouping, diseases and conditions which could be encountered on the RGS rotation include:
•Pilonidal Cyst and Sinus
•Management of Acute Pain
•Derangements of Electrolytes and Acid Base
•Pneumonia - Hospital Acquired
•Pleural Effusion - Empyema
One of the most effective ways to retain knowledge while at the same time improving the care of your surgical patients is to read about the diseases and conditions faced by patients as you encounter them.
3) Practice-based Learning and Improvement
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.
A good technique to achieve this objective is to review evidence-based guidelines (e.g. Cochrane Reviews: http://www2.cochrane.org/reviews/), as well as critical reading of relevant articles in the surgical literature. Self-evaluation as it relates to patient care is best performed in real-time by seeking feedback and discussion from faculty. (i.e. What could we have done differently?)
4) Interpersonal and Communication Skills
Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals.
Residents are expected to conduct themselves in a courteous and professional manner when interacting with patients, families and nursing staff. Good communication is critical to patient care, particularly in the emergency setting. Examples of specific elements which are of value throughout surgical training and practice include:
•Discussion of risk/benefit/nature of the operation with patients and families in the setting of informed consent.
•Communication with the surgical team. While a “Time-out” is performed before every invasive procedure or operation, the communication ideally begins much sooner (i.e. with anesthesia re: anticipated need for antibiotics, blood products, etc, with scrub/circulating nurses regarding nature of the operation, needed equipment/suture etc).
•Transition of patient care, i.e. “sign out”
•Communication with consultants and nursing staff
Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to demonstrate:
(a) compassion, integrity, and respect for others
(b) responsiveness to patient needs that supersedes self-interest
(c) respect for patient privacy and autonomy;
(d) accountability to patients, society and the profession; and,
(e) sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation.
(f) high standards of ethical behavior, and
(g) a commitment to continuity of patient care
6) 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 optimal health care.
7) Technical Skills
PGY-1 residents will learn essential clinical skills in the evaluation and treatment of RGS patients. Time spent in the operating room in a critical part of training, regardless of whether or not one is “doing” the operation. Knot tying, suturing, and learning to function as an effective first or 2nd assistant are other goals of the rotation. Other skills will include management of complex wounds with a variety of dressing change techniques including negative-pressure wound therapy.