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

1.         Knowledge:

Mastery of surgical pathophysiology and critical care, pharmacology, physiology, and interpretation of hemodynamic data.  Familiarity with basic surgical literature and extensive areas of basic surgical diseases in general and GI surgery.

2.         Skills:

Mastery of a broad variety of general surgical cases including colon resections, gastric procedures, biliary tract procedures.  Upon completion of the 5^th year, the resident should be familiar with and have participated in major hepatic resections, pancreaticoduodenectomies, esophagogastrectomies, and complex colorectal procedures. 

Mastery of basic laparoscopic skills for cholecystectomy, appendectomy, bariatrics, and diagnostic laparoscopy.  Introduction to advanced laparoscopic procedures such as fundoplication and hernia repair.

3.         Other Attributes of Resident:

Ability to teach junior house staff introductory surgical level cases.  Ability to teach medical students surgical care and surgical principles of surgical diseases.  Development of leadership skills and ability to run an effective multi-level service with numerous residents and medical students on the service.  Development of organizational and time management skills and administrative skills in managing a large number of residents distributed over the surgical services at Vanderbilt.

4.         Objective Benchmarks:

Increasing ability to assist and perform under supervision, major resections for cancers of the GI tract:  transhiatal esophagectomy, pancreatoduodenectomy, low anterior resection of the rectum.

Increasing facility in advanced laparoscopic procedures such as antireflux procedure, knot tying skills, knowledge of biliary tract anatomy, pathology, and procedures.

Knowledge of inflammatory bowel disease pathology and treatment.  

Knowledge of disorders of foregut pathophysiology including GERD, achalasia, and PUD.

GI LAP 5 Score Performs complete dissection of Lap Nissen and cholecystectomy   Green Yellow Red Able to expose all parts of GI tract and perform small bowel and colon resections and anastomoses Green Yellow Red Able to manage intraabdominal sepsis or pancreatitis in the SICU Green Yellow Red Understands foregut pathophysiology in GERD and achalasia Green Yellow Red  Able to perform dissection for lap gastric bypass and perform jejunojejunostomy. Green Yellow Red

 

                                               

ROTATION:  General Surgery - (Oncology/Endocrinology)      LOCATION:  VUMC    LEVEL:          PGY V

1.         Knowledge: Upon completion of the rotation, the Chief resident should demonstrate mastery of the surgical care of patients with gastrointestinal malignancies and other complex surgical oncology cases. This includes a detailed knowledge of the pathophysiology, staging, prognosis, and multi-modality treatment of common solid tumors. Familiarity with the literature regarding surgical management of malignancy including areas of controversy is also expected. 2.         Skills: Upon completion or the rotation, the Chief resident demonstrate proficiency with a broad variety of oncologic procedures including esophagectomy, gastrectomy, pancreatico-duodenectomy, hepatic resection, resection of retroperitoneal tumors, complex colorectal oncologic procedures, splenectomy, and adrenalectomy. 3.         Other Attributes of Resident: The Chief resident should instruct medical students and residents about the preoperative and postoperative care of surgical patients and the principles of surgery. They should also demonstrate the ability to teach junior house staff basic surgical skills and assist them with introductory level cases. The Chief resident must display leadership skills and the ability to run an effective multi-level service with numerous residents and medical students on the service. Organization, time management and administrative skills for managing a team of residents and students should be demonstrated. 4.         Objective Benchmarks: Be able to perform major gastrointestinal oncologic procedures: Esophagectomy, gastrectomy, pancreatoduodenectomy, hepatic resection, splenectomy, resection of retroperitoneal and pelvic tumors and colorectal malignancies. Be able to perform the complex endocrine surgical procedures:  Reoperative thyroidectomy and parathyroidectomy, adrenalectomy. Be knowledgeable and conversant in the evaluation and management of the patient with cancer.  Participate actively in the VUMC Multidisciplinary Solid Tumor Conference. ONC ENDO 5 Score Verbally describes process of Pancreaticoduodenectomy Green Yellow Red Understands w/u of Pancreatic Mass Green Yellow Red Understands w/u of Esophageal CA Green Yellow Red Performs abdominal dissection of transhiatal esophagectomy Green Yellow Red Mobilizes duodenum during Whipple Green Yellow Red Understands decision making for recurrent colorectal and recurrent anal CA Green Yellow Red

 

ROTATION:  General Surgery - Gold      LOCATION:            VUMC     LEVEL:            PGY V

KPT Resident Manual

 1.         Knowledge:

                   Understanding of common hepatobiliary diseases such as hepatic and biliary neoplasms,
                        portal hypertension,    hepatic failure, biliary strictures, and biliary stone disease

                   Understanding all aspects of hepatic transplantation.

                   Understanding of common pancreatic disorders such as pancreatitis and pseudocyst.

2.         Skills:

                   Administration of personnel assigned to White General Surgery Service.

                   Appropriate evaluation of hepatobiliary, pancreatic and gastrointestinal disorders and understand
                      treatment options.

                   Management of pancreatitis, hepatic failure, encephalopathy, hemorrhage,
                      coagulopathy, immunosuppression, and prophylactic antibiosis.

                   Technical performance of hepatic resections, portosystemic shunts, donor hepatectomy, liver
                      transplantation, pancreas resection, and gastrointestinal procedures.

3.         Other Attributes of Resident:

                   Participate in:

1)       Hepatobiliary radiology conference (Tuesday afternoon),

2)       M & M (Wednesday morning),

3)       Liver transplant selection conference (Wednesday afternoon)

4)       Grand Rounds and resident teaching conference (Friday morning).

                  Run daily rounds and Monday noon afternoon team rounds. 

                  See preoperative and postoperative patients in weekly outpatient clinics

1)       Tuesday am (Chari clinic)

2)       Wednesday afternoon (Pinson clinic)

                   Initiate management decisions in conjunction with staff physicians and surgeons.

                   Demonstrate reliable, honest, appropriate judgment, good communication skills.

                  Function relatively independently.

                   Participate in student teaching.

Gold  5	Score
1)  Bookwalter & Thompson assembly for RUQ procedures	Green	Yellow	Red
2)  Able to mobilize liver completely except for retrohepatic veins	Green	Yellow	Red
3)  Can complete portal dissection during transplant process	Green	Yellow	Red
4)  Knowledge of liver mass w/u and therapeutic modalities	Green	Yellow	Red
5)  Management of metastatic colorectal CA to liver	Green	Yellow	Red
6)  Radiographic w/u of RUQ	Green	Yellow	Red

 

 

ROTATION:  General Surgery           LOCATION:  NVAMC        LEVEL:          PGY V

1.         Knowledge:

This is a general surgery rotation that cares for an older and, at times, an indigent population.  Knowledge base should include the essentials of both inpatient and outpatient diagnosis and work up of all major vascular and general surgery problems.  The general surgical principles should include the evaluation and treatment of patients in all the areas of general surgery with an emphasis on oncologic, endocrine, gastrointestinal and abdominal wall problems.

Knowledge should include the ability to work through diagnostic and therapeutic pathways.  There should be an extensive knowledge of surgical exposure of all general surgical systems.  The PGY-V should lead and participate in discussions about various operative and non-operative options and techniques in the treatment of the general surgical patient.

The PGY-V should also be able to discuss areas of controversy and the risks and benefits of operative vs. non-operative treatment for the various disorders encountered.

2.         Skills:

The skills required by a PGY-V include exposure of all major general surgical systems and the understanding of intraoperative decision making.  Intraoperative ultrasound, minimal access (laparoscopic) technicians, and other evolving technologies are to be utilized as appropriate and indicated.  The chief resident will direct the critical care of patients in the SICU.  The PGY-V will direct the postoperative care of the patient and follow-up the patient in clinic.  Each resident will spend one day per week in clinic to ensure continuity of care for patients under the resident's care.  

3.         Other Attributes of Resident:

Leadership: The PGY-V (chief resident) is the team leader of the more junior residents and the medical students. They should motivate and teach the junior house officers, attend and teach in all conferences including the weekly morbidity and mortality conference.  It is especially important to develop rapport and gain the confidence of the patient and family members.  The chief resident should speak to the family on a daily basis regarding the patient's progress.  The PGY-V should also develop the administrative and interpersonal skills needed for continuing on in their surgical training and/or practice.

4.         Objective Benchmarks:

The resident should be able to evaluate and care for patients with cancers of the alimentary tract with a knowledge of neoadjuvant, operation, and adjuvant options and treatments.

The resident should be knowledgeable about inflammatory and non-oncologic conditions of the alimentary tract: pancreatitis, biliary tract disease, IBD, motility disorders, peritonitis, etc., and know and be able to perform the major operations of abdominal surgery.

The resident should be knowledgeable in critical care and direct the perioperative and critical care management of patients in the General Surgery Unit.

The resident should gain an understanding and expertise in the management of surgical problems in the geriatric patient.

VA General Surgery 5	Score
Presents clearly at Tumor Board	Green	Yellow	Red
Performs colon resections independently	Green	Yellow	Red
Performs hernia repairs independently	Green	Yellow	Red
Performs appendectomies independently	Green	Yellow	Red
Uses EEA stapler appropriately	Green	Yellow	Red
Able to make good clinical decisions in the outpatient sector	Green	Yellow	Red
Critical care (SICU) management skills	Green	Yellow	Red