ROTATION:   Trauma              LOCATION:    VUMC      LEVEL:             PGY II

1.            Knowledge:

a.         Emergency Department.  The PGY II will carry out the initial assessment and initiate
management of injured patients, under the supervision of the PGY IV.  Leadership, prioritization,
and decision-making skills are fostered.

b.         Operating Room.  The PGY II will, under the supervision of the attending surgeon, assist and
participate to an appropriate degree in the surgical management of trauma patients.  Conceptual
issues are emphasized in the operating room; e.g. the strategy of a celiotomy for blunt trauma
and the general stepwise plan of the operation.  Fundamental technical skills are acquired and
refined.

c.         Intensive care unit.  Under the supervision of the PGY IV and the attending surgeon, the PGY II
will actively participate in the assessment and resuscitation of critically ill trauma patients in the
intensive care unit.  Critical analysis skills are emphasized.

d.         Stepdown/Regular floor.  The PGY II will assess floor patients and propose management plans to
the PGY IV and attending surgeon, to facilitate the graded development of clinical judgment.

e.         Post discharge.  The PGY II will develop understanding of post injury recovery and return to
community life by participating (clinical load permitting) with the attending surgeons in twice
weekly clinics.

2.         Skills:

The PGY II on the Trauma rotation performs a large number of procedures, ranging from complex wound
closure to central line placement, and airway management.

3.         Other Attributes of Resident:  

The PGY II will critique and refine assessment and management skills by participating in daily teaching
rounds and the multidisciplinary video review conference. To provide continuity of care, assess outcomes,
and gain experience in pt management, all R2s on trauma when assigned to the day shift will attend
out-patient clinic two half-days per week

Trauma 2	Score
Demonstrates knowledge of w/u and management of peripheral vascular injury	Green	Yellow	Red
Demonstrates knowledge of managing penetrating and blunt neck injury	Green	Yellow	Red
Independent insertion of chest tubes, central lines, swans, a-lines	Green	Yellow	Red
Independent completion of perc trachs and bronchoscopies	Green	Yellow	Red
Demonstration of basic ventilator management	Green	Yellow	Red
Resident Trauma Clinics: Resident Trauma Clinic will start a 1pm, the Satellite Trauma Attending will staff the clinic. Only Trauma Follow-ups will be seen in clinic. It is a mandatory clinic for all trauma surgery residents to attend. The only indication not to attend will be emergent or urgent patient care. Six clinic rooms will be available to see patients & Trauma NP with Clinic staff will help with patient flow. The mechanism for patient follow up will be as follows:

ROTATION:  General Surgery   (GI - Laparoscopy)    LOCATION:  VUMC  LEVEL:          PGY II

1.         Knowledge:

Development of a base of knowledge in  pathophysiology and treatment options for general surgical diseases with an emphasis on gastrointestinal disorders.  Development of basic skills in interpreting history, physical examination and diagnostic testing of these diseases.  Competence of interpretation of radiologic studies such as abdominal films and CAT scans.  Interpretation of foregut diagnostic studies including but not limited to esophageal motility, pH studies and Gastric emptying studies.

2.         Skills:

Mastery of basic instrumentation and suturing skills.  Introduction to basic laparoscopic procedures such as cholecystectomy and diagnostic laparoscopy.  Advanced laparoscopic skills including but not limited to suturing, hemostatic techniques, and dissection with such procedures as fundoplication, solid organ and bariatrics. 

3.         Other Attributes of Resident:

Improved efficiency in pre and postoperative care and evaluation of patients.  Improving interpersonal skills and basic development of teaching skills for students.  Introduction to importance and accuracy of documentation with regards to clinic, inpatient and operative notes.  Development of collaborative team environment with hospital staff and administration.  Development of sense of responsibility for patients, hospital and medical community.

4.         Objective Measurements:

            Be able to perform a inguinal and ventral/incisional herniorrhaphy.

Be able to diagnose symptomatic cholecystitis, GERD, and morbid obesity and discuss the operative indications, alternatives, and controversies.

            Be able to set up the equipment and initiate a laparoscopic procedure.

VU GI LAP 2 Score Performs 2-handed square knot with both hands Green Yellow Red Adept at performing Laparoscopic knots in Lap lab Green Yellow Red 3 hrs/week in Lap lab Green Yellow Red Able to perform Lap Chole from L side of table Green Yellow Red Understands GERD and achalasia physiology, w/u of reflux, and anatomy of esophagus and stomach  Green Yellow Red Describes essential Laparoscopic components; able to troubleshoot CO2 insufflation problems Green Yellow Red Able to perform intraoperative upper endoscopy  during gastric bypass, Nissen fundoplication and heller myotomy Green Yellow Red

 

ROTATION:  Vascular Surgery           LOCATION:  VAMC     LEVEL:           PGY II
Readings for Vascular Surgery (Requires VUNET ID log-in)

Please see the "Educational Goals" and "Supervision of Trainees" sections in the Introduction.

1.         Knowledge:

Obtain an understanding of vascular disease and appropriate workup of the outpatient.  Preoperative
preparation and postoperative care.  Understanding of instructions for operation of vascular patients.  Understanding possible complications from treatment.

2.         Skills:

Acquire an introduction to the technical aspects of vascular surgical procedures.

3.         Other Attributes of Resident:

Interaction with vascular team and full participation with clinical activity of vascular service.

VA Vascular 2 Score Basic understanding of noninvasive vascular testing Green Yellow Red Basic interpretation skills CTA/MRA/angiograms/venograms Green Yellow Red Understands pathophysiology of atherosclerotic occlusive disease, aneurysm, thrombosis, venous insufficiency, renovascular hypertension, diabetes Green Yellow Red Able to evaluate acute/chronic mesenteric ischemia Green Yellow Red Able to evaluate renovascular hypertension Green Yellow Red Able to evaluate vertebral basilar insufficiency and subclavian occlusive disease Green Yellow Red Able to evaluate aortic dissection Green Yellow Red Able to evaluate TAAA Green Yellow Red Able to evaluate peripheral aneurysms Green Yellow Red Able to evaluate upper extremity vascular problems Green Yellow Red Able to evaluate venous insufficiency Green Yellow Red Able to perform BKA/AKA with minimal assistance Green Yellow Red Able to perform dialysis access with minimal assistance Green Yellow Red Able to perform vein stripping/phlebectomy with minimal assistance Green Yellow Red Responsible for milestones of PGY 1 Green Yellow Red

ROTATION:  Gold           LOCATION:  VUMC and NVAMC     LEVEL:          PGY II

KPT Resident Manual

1.         Knowledge:

The goal is to gain knowledge and experience in the evaluation and management of kidney, pancreas, and liver transplant patients and dialysis access for patients with chronic kidney disease including selection and pre-operative evaluation, the surgical procedure, post-operative care and surgical complications.  The resident will also acquire knowledge relative to histocompatibility testing, immunologic monitoring, immunosuppressive medication, and learn to recognize, diagnose and treat rejection, opportunistic infection, and immunosuppression-related complications. 

2.         Skills:

The resident will acquire operative skills necessary to establish access for peritoneal dialysis and hemodialysis and be exposed to living donor nephrectomy and kidney transplantation.

3.         Clinic Experience:

The residents are required to spend a minimum of two half-days in clinic, one of which will be the VA transplant clinic Monday mornings.  In this clinic they see all the pre-operative patients, both transplant and dialysis access, and evaluate them for their operation. It also gives the residents long-term follow-up of renal transplant and dialysis access patients.  In addition, the residents are also required to participate in a least one other half-day outpatient clinic in TVC for pre-operative evaluation and post-operative follow-up of transplant and/or dialysis access patients, the specific clinic assignment to be determined by the chief (PGY5) resident of the Gold service. 

4.         Other Attributes of Resident:

The resident in this position will function as a junior assistant resident and have responsibilities on the transplant service for preoperative evaluation and postoperative management of kidney, pancreas and liver transplant recipients.  In this role he will interact with the PGY3 and PGY5 surgical residents on the Gold (transplant) serviceas well as transplant nephrology, general nephrology or medical residents consulting on transplant recipients.  The resident will make daily rounds with the attending transplant surgeon on the service.

Gold 2 Score Understands renal transplant physiology Green Yellow Red Understands immunosuppressive regimen for kidney transplants Green Yellow Red Understands different types of rejection Green Yellow Red Ties 2-handed square knot with either hand Green Yellow Red Understands importance of using autogenous vein for AV access procedures Green Yellow Red Understands different types, indications for, and surgical creation of different dialysis access procedures Green Yellow Red

ROTATION:      General/Vascular Surgery     LOCATION:         St. Thomas       LEVEL:            PGY II

1.         Knowledge:    

a.                     Demonstrate acquisition of the knowledge necessary to determine whether or not surgical intervention is appropriate.

b.         Demonstrate, particularly for assessment of preoperative diagnostic factors and preoperative preparation, increasing knowledge about surgical disease processes.

c.                     Demonstrate how understanding of the concepts of continuity of care distinguishes surgical practice from care provided by technical adequacy alone.

d.       Demonstrate the capacity to discuss the impact of ethical, legal, economic, and/or social issues upon an individual patient's care.

            e. Demonstrate acquisition of the knowledge necessary to determine whether or not surgical intervention is appropriate with emphasis upon differentiating urgent, acute, and chronic states from one another, manifestations of limb, cerebra, and/or renal ischemia.

f.          Demonstrate, particularly for assessment of preoperative diagnostic factors and preoperative preparation, increasing knowledge about vascular surgical disease processes by distinguishing claudication, rest pain, or tissue loss one from another and understanding of the etiology and microbiology of diabetic foot conditions.

g.         Demonstrate basic knowledge about standard types of vascular grafts.

h.         Demonstrate understanding of the principles involved with specialized testing such as Doppler studies and duplex scans.

2.         Skills:

a.         Demonstrate the capacity to analyze data derived from history, physical examination, and all components of laboratory evaluation.

b.         Demonstrate the skills necessary to effectively use collaborative interaction with other residents, surgical faculty, and members of other health care professions.

c.          Demonstrate the capacity to perform less-complex operative procedures, including laparoscopic cholecystectomy, vascular access procedures, exposure of the carotid bifurcation and femoral artery.

d.             Demonstrate an understanding of the principles involved in the management of surgical wounds and drains.  

e.                      Demonstrate an understanding of the principles involved in care of patients with extremity amputations.  

d.         Demonstrate an understanding of the principles involved in the management of vascular wounds, graft failure and graft infection.

e.         Demonstrate the skills involved in the implementation of surgical care interventions of the more complex nature such as central lines, PA catheters, jugular and subclavian vein access catheters, et cetera.

f.          Demonstrate an understanding of the principles involved in care of patients with extremity amputations.  

g.         Demonstrate an understanding of the principles involved in the management of vascular wounds, graft failure and graft infection.

3.         Other Attributes of Resident:

a.         Demonstrate appropriate interactions and collaboration with the entire surgical team.

b.         Demonstrate efficient and effective use of resources during evolution of the care plan for a surgical patient.

c.         Teach the principles involved in surgical intervention to more junior house staff and other health care providers.     

ST General Surgery 2	Score
2-handed square knots with both hands	Green	Yellow	Red
Performs wire-guided breast mass excision independently	Green	Yellow	Red
Able to expose carotid bifurcation and femoral artery	Green	Yellow	Red
Able to direct the completion of a sentinel lymph node biopsy	Green	Yellow	Red
Completes wound debridements independently	Green	Yellow	Red