Surgical Clerkship in the Department of Surgery

Rotation-Specific Goals and Objectives in General Surgery

Emergency General Surgery- Vanderbilt Medical Center

EGS Service Overview
The Emergency General Surgery (EGS) service is comprised of faculty in the Department of Surgery, residents at the PGY-5, PGY-2, and PGY-1 levels, as well as dedicated Nurse Practitioners. The EGS service evaluates nearly 1,200 patients each year, and serves as the primary consult service for acute general surgical diseases from within Vanderbilt University Medical Center as well as surrounding communities. The primary mission of the EGS service is to provide timely surgical assessment and operative management of the patient with an acute general surgical problem.
Core competencies as defined by the ACGME form the basis of student evaluations.
1) Patient Care
Students must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.
Patient care by students on the EGS service will largely take place in the context of performing history and physical examinations and assisting in the operating room. All of this is done with support and guidance of residents and faculty. Morning report provides a forum to discuss new patients and review imaging studies with faculty and other residents.
2) Medical Knowledge
Students must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social-behavioral sciences, as well as the application of this knowledge to patient care.
3) Practice-based Learning and Improvement
Students must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning.
This objective is achieved with our VC3 small group discussions with all students, held four times per rotation, to review cases and for them to receive feedback.
4) Interpersonal and Communication Skills
Students must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals.
Examples include the following:
• Discussion of risk/benefit/nature of the operation with patients and families in the setting of informed consent.
• Communication with the surgical team.
• Transition of patient care, i.e. “sign out”
• Communication with consultants and nursing staff
• End-of-life discussions
5) Professionalism
Students must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Students are expected to demonstrate:
(a) compassion, integrity, and respect for others
(b) responsiveness to patient needs that supersedes self-interest
(c) respect for patient privacy and autonomy;
(d) accountability to patients, society and the profession; and,
(e) sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation.
(f) high standards of ethical behavior, and
(g) a commitment to continuity of patient care
6) Systems-based Practice
Students must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.
7) Technical Skills
Students will learn essential clinical skills in the evaluation and treatment of EGS patients. Time spent in the operating room is a critical part of training, regardless of whether or not one is “doing” the operation. The opportunity to master use of a 30 degree laparoscope (using right or left hands) while learning the steps and anatomy of an operation should not be overlooked. Knot tying, suturing, and learning to function as an effective first or 2nd assistant are other goals of the rotation.
Other skills will include management of complex wounds with a variety of dressing change techniques including negative-pressure wound therapy.
General Surgery – Nashville Veteran Affairs Medical Center
Medical Knowledge:
General Surgery knowledge should include the basics in examination and evaluation of patients with a broad spectrum of complaints and disorders encompassing general surgery.
Patient Care Skills:
This is the beginning of acquisition of the basic skills of operative technique. Students will assist in and then acquire skills in the placement of venous access devices and other student level cases both in vascular and general surgery. Students should also begin to understand the basic surgical anatomy in both general and vascular surgery and should be able to perform a complete vascular pulse exam and general surgical and oncological exam to be presented reliably and succinctly on rounds.
Systems-based Practice, Interpersonal & Communication Skills, & Professionalism - Other Attributes of Resident:
-The students should begin to develop good patient and family interaction skills. They should learn to organize. They should attend all teaching conferences.
-Each student will spend one day per week in the clinic to participate in pre-operative assessment and post-operative follow-up as part of the NVAMCs continuity of care experience.

Medical Knowledge & Patient Care Milestones:
-Manages oliguria systematically
-Understands perioperative risk assessment
-Débrides wounds independently
-Demonstrates systematic evaluation of an abdominal CT scan
-Demonstrates knowledge of assessing for appendicitis
-2-handed square knot
Colon & Rectal – Vanderbilt University Medical Center
Systems-based Practice, Practice-based Learning & Improvement, Professionalism, Interpersonal & Communication Skills, Patient Care & Medical Knowledge:
Medical Knowledge:
-Basic fundamentals of the pathophysiology, clinical presentation and natural history of common colon and rectal disease entities (colorectal cancer, inflammatory bowel disease, diverticular disease, hemorrhoids, perirectal infections, fissures, fistulas).
-Basic knowledge of diagnostic tests (indications, contraindications, and timing) utilized in the work-up of patients with colon and rectal disease processes.
-Basic knowledge of perioperative management including bowel preparations (what type and when to use them), peri-operative fluid management, and appropriate post-operative orders for both abdominal and anorectal cases.
-Basic knowledge of the anatomy related to the colon and the anus. (blood supply, innervation, spatial relationship to surrounding structures)
Patient Care and Technical Skills:
-Performs a complete and accurate history and physical examination, including a pertinent review of systems with regard to colon and rectal disease entities.
-Tie a two handed square knot

Medical Knowledge, Technical Skills, & Patient Care Milestones:
-Consistently ties square knots
-Clear concept of pathophysiology, work-up and appropriate treatment for colon and rectal cancer
-Clear understanding of anatomy related to the colon and rectum
Faculty and senior residents will evaluate the performance of each student using these goals and expectations.
GI/Laparoscopy – Vanderbilt University Medical Center
Medical Knowledge:
-Basic fundamentals of pathology and physiology of common surgical diseases and extensive knowledge of pharmacology of standard drugs and antibiotics.
-Basic knowledge of evaluation skills and pre and postoperative management of patients.
-Development of knowledge of basic skills in evaluating breast disease, hernias, and simple cutaneous lesions.
Patient Care Skills:
-Basic suturing, tying and assistance at surgery.
-Introduction to basic laparoscopic skills such as assisting with the camera and assisting in laparoscopic procedures.
Professionalism & Interpersonal & Communication Skills - Other Attributes of Resident:
-Energy and industriousness.
-Good interpersonal skills with nurses, patients and families.
-Reliability in obtaining important follow-up details of surgical patients.
Systems-based Practice, Patient Care, & Medical Knowledge Milestones:
-Clear concepts of GERD, and hiatal hernia repair
-Clearly understands cholelithiasis, cholecystitis, and cholangitis and operative indications
-Pre and peri-operative care of the morbidly obese patient undergoing bariatric surgery - knowledge needed - understanding of the co morbidities of morbidly obese patients including obstructive sleep apnea and potential hypoventilation in the postoperative period, knowledge of the anatomy of gastric bypass and lap adjustable gastric band, and the immediate post op care of the patients including diets.
-Understands biliary anatomy and the pitfalls of Lap Cholecystectomy
-Clear concepts of incisional hernia repair and operative intervention including laparoscopic operative techniques.
Hepatobiliary/Liver Transplant – Vanderbilt University Medical Center
Patient Care & Medical Knowledge, Problem-based Learning & Improvement (PBLI), and Systems-based Practice:
Medical Knowledge:
-Evaluation and management of preoperative and postoperative general surgery patients.
-Develop knowledge about hepatobiliary, pancreatic and gastrointestinal anatomy and physiology.
Patient Care Skills:
-Efficient data management and record documentation.
-Appropriate laboratory evaluation of gastrointestinal, pancreatic and hepatobiliary function.
-Basic interpretation of cholangiograms, CT & MRI, PET Scans related to upper abd organs and HBP diseases.
Interpersonal & Communication Skills & Professionalism - Other attributes of resident:
-Participate in daily rounds, afternoon multidisciplinary rounds, weekly outpatient clinic (1 1/2 days per week), M & M, hepatobiliary radiology conference, hepatobiliary surgery clinical case conference, grand rounds and resident teaching conference.
-Reliable, honest, appropriate judgment, good communication skills.
-Plan patient management decisions in consultation with residents on White General Surgery Service.

Patient Care & Medical Knowledge Milestones:
-Immunosuppression concepts for liver transplants
-Liver transplant candidate selection criteria
-Management of cirrhotic patient concepts
-Understanding of portal hypertension in surgical patients
-Imaging strategies in hepatobiliary surgery
Oncology/Endocrine – Vanderbilt University Medical Center
Medical Knowledge:
-Upon completion of the rotation, students should understand the basic fundamentals of pathology and physiology of cancer and endocrine diseases.
-Develop a basic knowledge of clinical evaluation and pre and postoperative management of surgical oncology and endocrine surgery patients.
-Understand the basic principles of multidisciplinary treatment of breast cancer, melanoma and alimentary tract neoplasms including AJCC staging.
Patient Care Skills:
-Students should gain skills in the perioperative management of the surgical patient including management of common postoperative problems such as fever, wound infection, hypoxia, hypotension, low urine output, mental status changes, nausea, vomiting and inadequate pain control.
-Students should gain skills in the interpretation of imaging studies including CXR, abdominal films, CT scans and mammograms.
Professionalism, Interpersonal & Communication Skills, Practice-based Learning & Improvement - Other Attributes:
-Students should develop good interpersonal skills with nurses, patients, and families.
-Demonstrate commitment to patient care and acquiring the necessary knowledge to successfully carry out the duties of the students.
-They are expected to attend surgical oncology and breast clinics as assigned the equivalent of at least one full day a week, as well as the VUMC Multidisciplinary Solid Tumor Conference and the VUMC Breast Conference as assigned weekly.
Patient Care & Interpersonal & Communication Skills - Objective Benchmarks:
-Upon completion of the rotation, students should be able to read a CXR, abdominal film, CT scan and mammogram. They should also be able to discuss the diagnosis, staging, treatment and prognosis for patients with breast cancer and melanoma.
Medical Knowledge & Patient Care Milestones:
-Ties 2-handed square knot
-Understands the process of evaluation of a breast mass and abnormal mammogram
-Understands the options for surgical management of breast cancer
-Understands the options for surgical management of melanoma
-Verbalizes algorithm for evaluating postop fever, low urine output, wound drainage
 General/Vascular Surgery - St. Thomas Hospital
Medical Knowledge & Practice-based Learning & Improvement:
-Demonstrate a clear understanding of the need for both continuous acquisition of knowledge and refinement of skills.
-Demonstrate acquisition of knowledge of surgical disease processes.
-Recognize the fundamental distinguishing features of the concept of continuity of care for surgical patients.
Patient Care Skills:
-Demonstrate the capacity to routinely perform an adequate surgical history and physical examination.
-Demonstrate the capacity to analyze and organize laboratory and/or consultative information.
-Demonstrate the skills involved in procedures common to surgical practice such as gastrointestinal and/or urologic tube insertions, peripheral vascular/venous line placement, et cetera.
-Demonstrate an understanding of the management of tubes/catheters commonly used in surgical patients.
-Demonstrate appropriate skills in basic surgical techniques such as suturing, wound closure, et cetera.

Professionalism, Interpersonal & Communication Skills, & Systems-based Practice - Other Attributes of Resident:
-Exhibit the dedication needed for a surgical career.
-Demonstrate an understanding of the need for continuous self-improvement in knowledge and in skills.
-Demonstrate understanding of the significant linkage between the acquisition of knowledge and skill as a mechanism of surgical growth and maturation that contribute to adequate performance and surgical competence.
-Demonstrate the effective use of available resources to acquire clinical data essential for the care of patients.

Medical Knowledge & Patient Care Milestones:
-Tie a two-handed square knot
-Understands cardiac risk assessment of vascular patients and optimal medical management
-Good vascular anatomy knowledge from neck to foot
-Understands how to assess oliguria in post-op patients

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