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Resident Education Program in Thoracic Surgery

Second Year Curriculum

GENERAL THORACIC SURGERY ROTATION YEAR 2

General Surgery Curriculum (PGY2)

PGY2 Thoracic Surgery:  A 28-day rotation

Description:  Residents will spend one month on this service, becoming proficient in the indications, workup, and postoperative care of common thoracic conditions. The resident will learn to manage the patients including placement of chest tubes, central lines, PA catheters, and airway management.  Residents will learn basic surgical and endoscopic skills, including wound closure, bronchoscopy/endoscopy, and handling of tissues. Finally, residents may have the opportunity to practice procedures and situations in the simulation laboratory.

Evaluation of the resident's understanding of the patient and disease process will be reviewed (in part) at the time of operation and through resident-faculty interaction. Feedback will be verbal and timely; residents are encouraged to establish a dialogue with the faculty to facilitate feedback.

Faculty will evaluate residents based upon the ACGME core competencies. Faculty will evaluate residents at the end of the rotation in writing. Residents will evaluate faculty teaching and education efforts as well as each rotation at its conclusion.

A final "end of rotation" review will be conducted with Dr. Putnam.   Questions or comments can be directed to Dr. Putnam, Program Director, or any of the thoracic surgery faculty.

Other Comments and Responsibilities

Daily rounds will include the General Care Wards and the Intensive Care Unit at the VA and the Vanderbilt University Hospital.

Surgery residents are expected to achieve at least 1 full clinic day each week

Surgery residents are invited to participate in the

  • Resident Teaching conference on either Friday or Tuesday mornings (7 am Oxford House 6th floor  Thoracic Surgery Conference Room) ,
  • Esophageal Conference on 1st and 3rd Thursday mornings (7 am PRB 8th floor), and
  • Thoracic Surgery QI Conference on Wednesday morning (7 am Oxford House 6th floor  Thoracic Surgery Conference Room) and
  • Surgery Grand Rounds on Friday mornings.
  • An invitation to attend Journal Club is extended while on the Thoracic Surgery rotation.

EVALUATION INSTRUMENTS

The evaluation instruments for the rotation include:

  • Faculty Evaluation of Resident, Resident Evaluation of Faculty, Resident Evaluation of Rotation
  • Daily verbal feedback from faculty to resident
  • Didactic lectures
  • Faculty assessment of the resident from interactions in various patient care settings (e.g. Operating room, Intensive care unit, General care wards, Outpatient clinics, Other)

ACGME Core Competencies to be developed during this rotation include:

Medical Knowledge

  1. Anatomy, embryology, physiology and pathology of the trachea, lungs, esophagus, pleura, and mediastinum.
  2. The pharmacology, indications, complications of drugs commonly used, including anti-arrhythmic therapy, diuretics, anticoagulants, bronchodilators, and pain medications.
  3. The general principles of preoperative assessment and postoperative management of thoracic surgical patients.
  4. The natural history of treated and untreated diseases, including lung and esophageal cancer, emphysema/COPD, interstitial lung diseases, esophageal dysmotility, and Barrett’s esophagitis, pleural effusions/empyema, emphysema, and pneumothorax.
  5. Principles of surgery, including hemostasis, wound healing, wound complications, electrolyte and fluid replacement, surgical nutrition, and oncology.
  6. Understand common postoperative care issues in the thoracic surgery patient, including pain management, exercise expectations/limitations, need for home oxygen, and indications for SNF/rehab facility.
  7. The technology, interpretation and complications of invasive and noninvasive diagnostic methods, including CT and MRI scanning, respiratory function tests, PET scan, and echocardiography, ABGs, ventilation-perfusion tests, MVO2 studies, and esophageal manometry studies.

Patient Care

      Expected:

  1. Perform an appropriate relevant history and physical exam in the ward, ambulatory and emergency department settings.
  2. Arrive at a management plan for the disease process, including differential diagnosis.
  3. Order appropriate laboratory, radiological, and other diagnostic procedures; demonstrate proper interpretation of the results
  4. Formulate a plan of management, demonstrating knowledge in the operative and non-operative management of the disease process.
  5. Manage the patient throughout the hospital stay, including management in an intensive care unit setting, demonstrating knowledge and ability to anticipate, recognize, and manage potential complications of the disease processes and operative procedures.
  6. Management of post-operative bleeding (medical and surgical).
  7. Assessment and treatment of post-operative arrhythmias.
  8. Identification of critically ill and major complications of patients on the ward with appropriate acute management.
  9. Demonstrate ability to perform daily resident work rounds efficiently, including dictation of operative cases, daily progress notes, and dictation of discharge summary, prescription writing.
  10. Provide a plan for patient follow-up.
  11. As the operating surgeon or first assistant, demonstrate an ability to anticipate surgical maneuvers, to take direction well, to make reasonable suggestions, and to contribute to a positive operating room atmosphere.
  12. Insertion of central lines, PA catheter, arterial lines, insertion/removal chest tubes, and thoracentesis in the operative and ICU setting.
  13. As the operating surgeon, perform flexible bronchoscopy, demonstrating knowledge of lobar segmental anatomy.
  14. Observe and assist with common thoracic surgical procedures, including lobectomy, esophagectomy, and VATS lung wedge resection/biopsy.
  15. Demonstrate ability to recognize errors in technique and possible consequences of specific technical mistakes.

      Recommended:

  1. As the operating surgeon, perform thoracotomy.
  2. As the operating surgeon, perform VATS lung wedge resection/biopsy.

Professionalism

  1. The ability to be honest, reliable, and respectful of the religious, racial and gender characteristics of patients, their families and other members of the health care team.
  2. The ability to give and receive advice in a manner that is consistent with the harmonious operation of a health care team.
  3. The ability to recognize when to seek assistance from more experienced colleagues.
  4. Deliver highest quality care with ethics, integrity, honesty, and compassion.
  5. Exhibit appropriate personal and interpersonal professional behaviors.
  6. Understand the professional, legal, and ethical codes to which physicians are bound.

Interpersonal and Communication Skills

  1. Listen effectively.
  2. Establish therapeutic relationship with patients and families.
  3. Obtain and synthesize relevant history from patients and family.
  4. Inform patients and families about their condition at an appropriate and understandable level.
  5. Write clear consultation notes, progress notes, discharge summaries, and clinic notes.
  6. Prepare and present ward rounds in an organized manner.
  7. Participate actively in scheduled rounds.
  8. Communicate effectively with allied health care professionals.

 

Systems-based Practice

  1. Utilize resources effectively to balance patient care and learning needs.
  2. Allocate finite health care resources wisely.
  3. Work effectively and efficiently in a health care organization.
  4. Understand the importance and mechanisms to safely utilize resources in a cost-effective manner to benefit all patients.
  5. Recommend practices to effectively utilize resources including undertaking studies to assess effectiveness of standard care procedures.

Practice-Based Learning and Improvement

  1. Develop effective self-directed learning strategies for continuing education and assessment of knowledge base.
  2. Critically appraise sources of medical information and be aware of resources available.
  3. Read around clinical cases.
  4. Prepare and present scheduled rounds.
  5. Participate actively in scheduled morbidity and mortality conferences.
  6. Actively participate in journal club.
  7. Participate effectively in facilitate learning of patients, teaching house staff/students and other health professionals.

Copyright 2014, Vanderbilt University Medical Center, Department of Thoracic Surgery

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