EDUCATIONAL GOALS FOR SPECIFIC ROTATIONS

1. Knowledge: Resident should learn the initial assessment and management of the patient with a
musculosketetal injury (fracture or dislocation). The resident will learn the role of the orthopaedist in the team
approach to the polytraumatized patient. In addition, the resident will learn the basics of radiographic
interpretation of musculoskeletal injuries and the post-operative management of orthopaedic trauma patients.
2. Skills:

History, Physical, and Initial management of the Patient with an isolated Musculoskeletal Injury
(e.g., ankle fracture / sprain)
Orthopaedic Trauma Exam of the Polytraumatized Patient,
Splint Application for the Lower Extremity and Upper Extremity,
Basic Radiographic Interpretation of Orthopaedic Injuries,
Pre-operative and Post-operative Order Writing for Orthopaedic Trauma Patients,
Ability to communicate with other services, therapy staff, and nursing staff in the day-to-day
management of Orthopaedic Trauma Patients.

3. Other Attributes of Resident: Work ethic, Interdisciplinary Communication skills, Teamwork,
Attention to Detail, Problem Solving, Ability to work independently (yet judgment to know when help is needed).

Orthopedics 1	Score
Ability to assess and document the history and physical exam of a orthopaedic or orthopaedic trauma patient	Green	Yellow	Red
Interpretation of upper extremity, lower extremity, and pelvic radiographs	Green	Yellow	Red
Ability to place posterior splint on ankle, and sugar tong splint on upper extremity	Green	Yellow	Red
Ability to write pre-operative and post-operative orders on Orthopaedic Trauma patients	Green	Yellow	Red
Ability to order post-operative physical therapy and to communicate needs for such to therapist and patient	Green	Yellow	Red
Ability to assess the post-operative orthopaedic patient	Green	Yellow	Red

ROTATION: Plastic Surgery LOCATION: VUMC LEVEL: PGY I

1.         Knowledge: Assessment and initial management of patients with a variety of clinical problems including
facial trauma, hand injuries, lower extremity trauma, congenital anomalies, surgical defects requiring
reconstructive procedures and the management of other complex wounds.
2.         Skills: Participates in both inpatient and outpatient surgical procedures with emphasis on techniques
of wound closure and wound management are stressed. The individual performs variety of superficial, less
complex surgical procedures under the supervision of senior house staff and faculty.
3.         Other Attributes of Resident: Participates in all teaching conferences, rounds, journal clubs and
works as a member of the plastic surgery team with plastic surgery residents and faculty. He is expected
to help teach medical students as well.

Plastic Surgery 1	Score
Understand management of traumatic and complex wounds of face, trunk and extremities	Green	Yellow	Red
Understand different wound closure techniques	Green	Yellow	Red
Appreciate algorithm of the “’Reconstructive Ladder:	Green	Yellow	Red
Perform basic wound closure	Green	Yellow	Red
Perform wound debridement and Wound- Vac placement	Green	Yellow	Red
Understand initial assessment of maxillofacial and hand injuries	Green	Yellow	Red

ROTATION: Burn Unit LOCATION: VUMC LEVEL: PGY I

Podcast site: http://burndoc.libsyn.com/

Web homepage: www.burndoc.com

1. Knowledge: Develop skills in initial assessment and management of acute burns injury. This
includes thermal burns, electrical burns and chemical burns. It will encompass the initial fluid resuscitation
and treatment of burn shock; ventilatory management of acute inhalation injuries, as well as, chronic pulmonary
complications following major burn injury; the assessment of wounds for initial treatment including the need for
escharotomy or fasciotomy and local wound care with topical antimicrobials and hydrotherapy; nutrition, infection
and management of associated complications and problems.

2. Skills: Participate in the management of the burned patient including placement of central and invasive
lines; performance of escharotomies and fasciotomies, performance of tracheostomy, debridement of wounds,
harvesting and placement of skin grafts and selective reconstructive procedures.

3. Other Attributes of Resident: Works and provides leadership role to other interdisciplinary members
of the burn team including nurses, physical therapists, occupational therapists, dietitians and social services.
Also provides instruction to medical students rotating through the Plastic Surgery Service. Participants in all
teaching conferences, rounds, journal clubs of the Department of Plastic Surgery.

Burn --PGY 1	Score
Understands how to initiate fluid resuscitation in a burn patient	Green	Yellow	Red
Understands spectrum of topical antibiotics and their side effects	Green	Yellow	Red
Can independently harvest a STSG and graft a burn wound	Green	Yellow	Red
Able to insert a cordis	Green	Yellow	Red
Understands basic vent management	Green	Yellow	Red
Ability to titrate drips	Green	Yellow	Red

ROTATION: Neurosurgery LOCATION: VUMC LEVEL: PGY I

1.            Knowledge: Goal: Develop a basic understanding of common neurosurgical disease processes,
appropriate initial management, and need for neurosurgical consultation.
A.            Demonstrate knowledge of and skills in taking an adequate history and performing a fundamental
neurological exam. This should result in logical conclusions regarding the presence of, nature, and location
of neuropathology. A minimum level of understanding should include:
1.                  Diagnosing changes in level of consciousness, performance of voluntary motor function, and
speech.
2.            Recognizing the significance of cranial nerve changes and their reflection on brain stem function.
3.            Identifying complaints differentiating spinal cord from spinal nerve injuries.

B.            Demonstrate a basic understanding of neuroanatomy directed towards localizing lesions seen in
the central and peripheral nervous system.
1.                  Sensory, motor and language regions of the brain.
2.                  General divisions of the cranial nerves; e.g. ocular, facial, pharyngeal, and visceral.
3.                 Spinal cord and spinal nerve levels and their association with the spine.
4.                 Peripheral nerve; e.g. brachial plexus, sciatic nerve.

C.         Apply knowledge of neuroanatomy and neuropathology to decide on appropriate radiographic tests to
order. This includes judicious use of:
1.            Plain X-rays of the skull and spine.
2.            CT scan of the head and spine.
3.            Myelography.
4.            Cerebral Angiography.
5.                  Magnetic Resonance Imaging of the head and spine

D.            Demonstrated knowledge of the initial work-up and basic principles in the management of neurological
emergencies, such as:
1.            Closed and open head injuries.
2.            Intracranial hypertension.
3.            Acute hydrocephalus.
4.            Subarachnoid hemorrhage.
5.            Spine injury.

E.            Demonstrate a basic understanding of the work-up and management of elective neurosurgical cases,
such as:
1.            Supra-and infra tentorial brain tumors.
2.            Pituitary tumors.
3.            Cerebral aneurysms
4.            Temporal lobe epilepsy.
5.            Herniated spinal disks.

2. Clinical Skills: Goal: Develop basic techniques in the evaluation and management of neurosurgical
disease.

A.            Demonstrate the ability to perform a basic neurological exam so as to differentiate brain, brain stem,
spinal cord, or peripheral nerve pathology.
B.            Demonstrate the ability to perform basic emergency procedures, such as:
1.            Immobilization of an unstable spine injury.
2.            Institution of hyperventilation, osmotic diuresis, and head elevation as initial management concerns in
head injury.
3.            Placement of a burr hole.

C.            Demonstrate the ability to perform basic elective procedures, such as:
1.            Lumbar spinal tap and/or placement of lumbar drain.

D.            Demonstrated fundamental operative skills in the exposure and closure of neurosurgical wounds,
such as:
1.            Tissue handling during opening of a cranial or spinal wound.
2.            Suturing techniques in closure of a cranial or spinal wound.
3.            Exploration of open cranial wounds to determine violation of the galea and/or presence of skull
fractures and defects.
E.            Assist, if appropriate, in common neurosurgical procedures, such as:
1.            Excision of a herniated spinal disk.
2.            Evacuation of an intracranial hematoma.
3.            Decompression of an entrapped peripheral nerve.

Neurosurgery 1	Score
Basic neurologic exam	Green	Yellow	Red
Pre-op/Post-op spine/craniotomy neurological exam	Green	Yellow	Red
Acute management of seizure	Green	Yellow	Red
Management of post-op drains (i.e. JP drain)	Green	Yellow	Red
Indications/management of LP/lumbar drain	Green	Yellow	Red
Initial workup of diabetes insipitus	Green	Yellow	Red

Neuro Intensive Care Unit Rotation VUMC PGY 1

I. Goals and Primary Area of Knowledge Assessed

II. Cognitive Objectives

The junior resident should be able to:

     A. Describe basic differential diagnoses, physiology, and management for common problems of the following organ systems or disease states.
          1. respiratory
          2. cardiac
          3. renal
          4. gastrointestinal and hepatic
          5. neurological
          6. metabolic
          7. shock

     B. Describe the basic pharmacology and use of the following classes of drugs:
          1. antiarrhythmics
          2. antihypertensives
          3. inotropes
          4. vasoactive pressors
          5. antimicrobials
          6. antithrobotics/anticoagulants
          7. sedatives, anesthetics, and neuromuscular blocking drugs

     C. Describe the basic indications, contraindications, and/or interpretation of the following:
          1. tracheal intubation
          2. mechanical ventilation, including basic ventilator modes and weaning techniques.
          3. pulmonary artery catheter placement
          4. radiographic tests
          5. renal replacement therapy, including techniques for dialysis
          6. blood gases, electrolytes
          7. hemodynamic profiles
          8. bedside central pressure monitoring
          9. noninvasive techniques for assessing oxygenation and gas exchange
          10. enteral and parenteral nutrition
          11. techniques for pain management and sedation

III. Skill Objectives

The Junior resident should be able to:
A. Complete histories and physicals on critically ill patients

B. Coordinate the care of patients including admission, evaluation, and management of all patients for whom he is responsible.

     C. Perform the following procedures:
          1. Arterial line placement (radial, brachial, femoral)
          2. Insertion of a pulmonary artery catheter
          3. endotracheal intubation
          4. insertion of subclavian or jugular venous catheters

D. Develop basic communication skills with patients and family members, colleagues, nursing staff, respiratory therapists, administrative staff, and other support personnel.

IV. Conference and Literature Assignments

A. The Intensive Care Unit Manual (Lanken) 2001.

B. Journal club articles, conferences, and assignments.

This “junior” rotation provides surgical interns with the basic hands-on skills and intellectual background in the care of critically ill patients. The educational program, administered by full-time intensivists, broadly covers the clinical and cognitive components essential to the multidisciplinary practice of Critical Care Medicine. The surgical interns provide primary care for assigned ICU patients, attend didactic conferences, and participate in case-discussions and journal cubs.

A broad perspective of Critical Care Medicine will be provided so that a surgical intern may achieve a basic understanding of:

A. The assessment and management of critically ill patients, including postoperative and severely injured patients.

B. The use of life support equipment.

C. The use of vasoactive drugs.

D. The role of teamwork in the critical care setting.

E. The socioeconomic, ethical, and legal issues related to critical care.

ROTATION: Urology LOCATION: VUMC LEVEL: PGY I

1. Knowledge:

The goal of this rotation is to develop in the resident a knowledge of the pathophysiology of various conditions
of the genitourinary system and the ability to manage problems in an inpatient, outpatient, and emergency room
setting. Examples of conditions for which the resident should be familiar with diagnostic workup and treatment
are genitourinary trauma, hematuria, urinary stone disease, evaluation of acute scrotal pain, genitourinary
malignancies, voiding dysfunction, incontinence, impotence, and hematuria. The resident should become
familiar with the role of various diagnostic studies in managing these problems including cystoscopy, bladder
catheterizations, radiographic studies such as intravenous pyelogram and cystogram, computerized tomography
canning, and transrectal ultrasound. The resident should develop an understanding of the indications for elective
GU surgical procedures and for management of acute urologic emergencies including obstruction, bleeding, or
infections. There should be
an understanding of the indications for urologic consultation. The resident should be able to discuss the
advantages and disadvantages of various surgical approaches to the kidney, ureter, bladder and retroperitoneum.

2. Performance Objective:

The resident should be able to complete a history and physical examination, which focuses on the genitourinary
system or related findings in other body systems. He should understand the indications for passage of a
urethral catheter as well as the anatomic variance which may require special equipment or be an indication
or cystoscopy. He should also be able to place a punch suprapubic cystostomy tube. The resident should
gain rudimentary skills in endoscopic evaluation of the genitourinary system and in minor open urologic surgical
procedures including scrotal surgery. The resident should learn post-operative management of patients
undergoing major urologic procedures including fluid and electrolyte management as well as management
of postoperative drains after genitourinary surgery including nephrostomy tubes, stents, and catheters.

Urology 1	Score
Become familiar with the role of various diagnostic studies in managing urologic problems including cystoscopy, bladder catheterizations, radiographic studies such as intravenous pyelogram and cystogram, computerized tomography scanning, and transrectal ultrasound.	Green	Yellow		Red
Develop an understanding of the indications for elective GU surgical procedures and for management of acute urologic emergencies including obstruction, bleeding, or infections.	Green	Yellow	Red
Should be able to discuss the advantages and disadvantages of various surgical approaches to the kidney, ureter, bladder and retroperitoneum.	Green	Yellow	Red
Learn post-operative management of patients undergoing major urologic procedures including fluid and electrolyte management as well as management