ROTATION:  Pediatric Surgery               LOCATION:  VCH     LEVEL:            PGY IV

1.         Knowledge:

Management of critically ill children including neonates.  Pathophysiology of complex surgical illnesses in children and neonates including airway obstruction, necrotizing enterocolitis, congenital anomalies of the abdominal wall, GI tract, chest and diaphragm, solid tumors, etc.

2.         Skills:

Airway management in neonates.  Venous access in neonates.  Organization of trauma care.  Organization of assessment protocols for patients with abdominal pain, abdominal mass, respiratory distress, gastrointestinal bleeding, etc.

Surgery for complex problems in infancy and childhood.

3.                  Continuity of Care:

Assurance of continuity of care including active participation in preoperative assessment and diagnostic workup and postoperative care and long term follow-up through participation in outpatient clinics and emergency room evaluation of more severe and urgent surgical problems.  Preoperative evaluation of all patients is expected including inpatients and outpatients.

4.                  Other Attributes of Resident:

Organization and leadership of the surgical team including care in the Emergency Room, Pediatric Care Unit, Neonatal Intensive Care Unit and Operating Room.  

Pediatric Surgery 4	Score
Understands classification and anatomic variations of anal atresia	Green	Yellow	Red
Understands anatomic variations of malrotation	Green	Yellow	Red
Understands presentation and treatment for intussusception.	Green	Yellow	Red
Demonstrates logical management of gastrostomy tubes and advancement of feeds	Green	Yellow	Red
Knowledge of pediatric trauma resuscitation and its differences from adult trauma resuscitation	Green	Yellow	Red

ROTATION:  Trauma                LOCATION:  VUMC       LEVEL:          PGY IV

1.         Knowledge:

a.         Emergency Department.  The  PGY IV will be able to conduct and coordinate a multidisciplinary resuscitative effort.  The PGY IV is principally responsible for orchestrating and guiding resuscitation & evaluation, rather than for procedures.  Leadership and decision making skills are emphasized.

b.         Operating Room.  The PGY IV will, under the supervision of the attending surgeon, participate actively in the surgical management of trauma patients.  While technical skills are taught and refined, the major focus is on intraoperative analysis and management plan formation.  Independent thinking, data processing and decision making skills are emphasized.  Advanced technical skills are acquired - and refined.

c.         Intensive care unit.  Under the supervision of the attending surgeon, the PGY IV will guide and oversee the resuscitation of critically ill trauma patients in the intensive care unit.

d.         Stepdown/Regular floor.  The PGY IV will formulate management plans with the attending surgeon to facilitate the convalescence of injured patients.

e.         Post discharge.  The PGY IV will reinforce the understanding of post injury recovery and return to community life by attending (clinical load permitting) twice weekly clinics, with the patient's attending trauma surgeon.

2.         Skills:

The major focus for the PGY IV on the Trauma rotation is on leadership and decision making skills rather than technical exercises.  However, the PGY IV has ample opportunity to reinforce operative skills while on the rotation.

3.         Other Attributes of Resident:

The PGY IV will participate with the attending surgeon in family conferences and interdisciplinary educational conferences.   To provide continuity of care, assess outcomes, and gain experience in pt management, all R4s on trauma when assigned to the day shift will attend out-patient clinic two half-days per week.

Trauma 4	Score
Management of trauma resuscitations	Green	Yellow	Red
Management of multisystem injured patients	Green	Yellow	Red
Demonstration of trauma laparotomy	Green	Yellow	Red
Demonstration of open abdomen technique	Green	Yellow	Red
Independently performs splenectomy	Green	Yellow	Red
Understands management of rectal injuries	Green	Yellow	Red
Demonstrates knowledge of indications for thoracotomy	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/ Vascular Surgery     LOCATION:        St. Thomas     LEVEL:  PGY IV

1.         Knowledge:

a.         Increasingly incorporate acquired knowledge and assessment of data provided by collaborative interactions with appropriate consultants into all processes contributing to the total care for surgical patients.

b.         Implement into surgical patient care knowledge the national standards of care as these features apply to both diagnostic and therapeutic approaches.

c.   Demonstrate postoperative and follow-up care knowledge as a mechanism to understand the consequence of surgical therapy, be they positive or negative on the natural history of surgical disease processes.

d.         Demonstrate an understanding of the significance of the principles of continuity of care as they relate both to acute episodes requiring hospital therapy and to surgical care occurring in ambulatory settings.

e.         Demonstrate a capacity for a self-evaluation of your use of knowledge and skills as the basis for documentation of adequate performance and surgical competence.

f.    Uphold the use of ethical, legal, economic, and/or societal issues as these principles are incorporated into the surgical patient's hospital and follow-up care.

2.         Skills:

a.         Demonstrate competence to interpret and prioritize patient data into an effective and efficient total surgical care plan.

b.         Demonstrate the capacity to perform increasingly complex operative procedures.

c.         Demonstrate commitment to continuity of care by participation, as assigned, in the office practice of the Saint Thomas surgical faculty.

d.   Demonstrate the capacity to participate in the surgical care of patients with significant vascular, urologic, gynecologic, or thoracic surgical problems.

e.   Participate in the teaching of all aspects of surgical care to junior residents and other health providers as well as patients and their families.

f.    Demonstrate commitment to continuity of care by participation, as assigned, in the office practice of the Saint Thomas surgical faculty.

3.         Other Attributes of Resident:

a.         Demonstrate significant leadership via successful implementation of care plans.

b.         Demonstrate a clear understanding of the significance of collaborative interaction with the radiologist, pathologist, internist, ethicist, and other health professionals by integrating information derived from these sources into efficient and effective care plans.

c.         Demonstrate supervisory capacity by well-recognized guidance of PGY-I and PGY-II's contribution to surgical care.

d.         Discuss and interpret the understanding of the concept of continuity of care with PGY-I and PGY-II residents and with other health professionals.

e.         Manage all aspects of preparation for M & M presentation conference.

f.          Evaluate the performance and competency of the PGY-I and PGY-II residents.                                                                                                       

ST General Surgery 4	Score
Able to perform a right, left, or total abdominal colectomy	Green	Yellow	Red
Able to interpret a pancreas protocol dedicated CT	Green	Yellow	Red
Able to perform a lap chole & IOC with a minimum of assistance	Green	Yellow	Red
Demonstrates independent clinical decision making for management of AAA, carotid occlusive disease, acute/chronic limb ischemia, acute/chronic mesenteric ischemia, renovascular hypertension, DVT/PE.  Understand different treatment options available (medical, percutaneous, operative)	Green	Yellow	Red
Demonstrates independent clinical decision making for management of AAA, carotid occlusive disease, acute/chronic limb ischemia, acute/chronic mesenteric ischemia, renovascular hypertension, DVT/PE.  Understand different treatment options available (medical, percutaneous, operative)	Green	Yellow	Red
Able to perform lower extremity bypass and CEA with minimal assistance	Green	Yellow	Red
Able to manage intraabdominal sepsis or pancreatitis in the SICU	Green	Yellow	Red
Able to perform segmental or total mastectomy with minimal assistance	Green	Yellow	Red