Wayne State | Department of Surgery (313) 745-8778

Surgical Residency Goals & Objectives

 

Detroit Medical Center and Wayne State University

General Surgery Residency Program

Goals and Objectives

2021-2022

 

General Surgery Residency Program

Overall Educational Goals for the Program

Academic Year: 2021-2022

Program Director:   David Edelman, M.D. 

Residents:   PGY 1 – 5

 

PATIENT CARE (PC1)

Patient Evaluation and Decision Making

GOAL:  The resident will provide patient care that is compassionate, appropriate and effective for the treatment of most “BROAD” conditions in the SCORE Curriculum and some “FOCUSED” conditions in the surgical patient.

PGY 1 Residents:

  • Acquire self-confidence and the ability to develop differential diagnoses and management plans through history and physical examination
  • Begin to develop the ability to diagnose some “BROAD” surgical conditions in the SCORE curriculum and recommend initial management for
  • Demonstrate the ability to perform a focused, efficient, and accurate initial history and physical of a full spectrum of patients admitted to the hospital (including critically-ill patients).

PGY 2 Residents:

  • Demonstrate responsibility for overall patient care.
  • Demonstrate proficiency in emergency room diagnosis and treatment for surgical diseases, including mastery of acute abdominal evaluation
  • Be adept at patient care including pain management; demonstrate proficiency at triage.
  • Demonstrate the ability to diagnose many “BROAD” surgical conditions in the SCORE Curriculum and initiate appropriate management for
  • Begin to develop the ability to accurately diagnose some of the “FOCUSED” surgical conditions and make recommendations for initial treatment for many BROAD conditions in the SCORE Curriculum.

PGY 3 Residents:

  • Perform overall evaluation and management of surgical patients
  • Demonstrate the ability to diagnose many “BROAD” surgical conditions in the SCORE Curriculum and initiate appropriate management for some common “BROAD” conditions.
  • Develop the ability to accurately diagnose some of the “FOCUSED” surgical conditions and initiate treatment for many BROAD conditions in the SCORE Curriculum.
  • Demonstrate the ability to develop diagnostic plans and implement initial care for patients seen in the Emergency Department.

PGY 4 Residents:

  • Demonstrate independence in the evaluation and management of all aspects of patient care including pain management
  • Understand the social and economic needs of patients; demonstrate good understanding of ethical dilemmas
  • Accurately diagnose most “BROAD” conditions in the SCORE curriculum and some “FOCUSED” conditions.
  • Initiate appropriate management for most “BROAD” surgical conditions independently.
  • Recognize atypical presentations of many “BROAD” surgical conditions.

PGY 5 Residents:

  • Understand surgical pathophysiology and therapeutic support systems in order to achieve optimal recovery for the patient with limited morbidity.
  • Demonstrate independence in the evaluation and management of all aspects of patient care including pain management
  • Demonstrate the ability to lead a team that cares for patients with common and complex conditions.
  • Delegate appropriate clinical tasks to other healthcare team members
  • Recognize atypical presentations for most “BROAD” surgical conditions.

 

PATIENT CARE (PC2)

Intra-Operative Patient Care – Performance of Procedures

GOAL:  The resident will develop the ability to manage common post-operative problems and the ability to recognize and manage complex post-operative problems (sepsis, systemic inflammatory response syndrome and multiple system organ failure) independently

PGY 1 Residents:

  • Perform pre- and post-operative care of patients including pain management, with the basic understanding of pathophysiology as applied to surgical diseases.
  • Demonstrate initial management of life threatening surgical illnesses and be adept at resuscitation.
  • Begin to develop the ability to recognize and manage common post-operative problems.

PGY 2 Residents:

  • Formulate diagnostic and treatment plans applicable to surgery
  • Recognize and manage common post-operative issues (hypotension, hypoxia, confusion and oliguria) with the assistance of senior residents or staff members.
  • Begin to develop the ability to recognize and manage complex post-operative problems (sepsis, systemic inflammatory response syndrome and multiple system organ failure with the assistance of senior residents or faculty.

PGY 3 Residents:

  • Be able to outline pre-, intra- and post-operative treatment plans in detail including pain management
  • Demonstrate a thorough understanding of operative indications and contraindications
  • Recognize and manage common post-operative problems (hypotension, hypoxia, confusion and oliguria, independently.

PGY 4 Residents:

  • Recognize the “limits” of surgical treatment and begin to develop the skills necessary to manage complex post-operative problems such as sepsis, systemic inflammatory response syndrome and multiple system organ failure, independently.
  • Manage overall ward care of patients and demonstrate progressive supervisory role for junior residents.

PGY 5 Residents:

  • Demonstrate the ability to lead a team and provide supervision in the evaluation and management of complex post-operative problems such as sepsis, systemic inflammatory response syndrome and multiple system organ failure.

 

PATIENT CARE (PC3)

Intra-Operative Patient Care – Technical Skills

GOAL:  The resident will develop proficiency in surgical skills, efficiency of motion during procedures, and intra-operative decision-making skills for the “ESSENTIAL-COMMON” procedures/operations in the SCORE Curriculum and will gain experience in the “COMPLEX” operations without the need for coaching during procedures.

PGY 1 Residents:

  • Understand the principles involved in operations, handling of tissues, dissection of tissues planes, suture-ligature techniques and master “simple” operative procedures
  • Master techniques of using and placing nasogastric tubes, urinary catheters, IVs, central venous lines, arterial lines, and standard aseptic techniques
  • Demonstrate good judgment, safety, and effective technical skills in operative cases
  • Demonstrate basic surgical skills (airway management, knot tying, simple suturing, suture removal, Doppler ultrasound, administration of local anesthetic, universal precautions and aseptic technique).
  • Demonstrate the ability to reliably perform basic procedures (venipuncture, arterial puncture, incision and drainage, minor skin excisions, IV placement, nasogastric tube, urinary catheter).
  • Demonstrate the ability to perform basic operative steps in the “ESSENTIAL-COMMON” operations/procedures in the SCORE Curriculum.
  • Begin to develop respect for tissue and skill in instrument handling.
  • Complete tasks for Surgical Skills Lab assignments.

PGY 2 Residents:

  • Continue to develop operative skills
  • Understand complex operative procedures; fine tune operative skills
  • Perform independently the placement of Hickman catheters, Swan Ganz catheters, and chest tubes; conduct advanced CPR, and place TPN ventilators for routine ICU patients.
  • Demonstrate good judgment, safety, and effective technical skills in operative cases
  • Develop skills in instrument handling.
  • Demonstrate respect for tissue and continue to develop skill in instrument handling.
  • Begin to develop the ability to move through portions of common operations without coaching.
  • Begin developing the ability to make straightforward intra-operative decisions.
  • Develop the ability to perform some of the “ESSENTIAL” operations in the SCORE curriculum with minimal assistance.

PGY 3 Residents:

  • Be adept at endoscopic procedures and surgical intensive care
  • Perform complex operative procedures and acquire a thorough understanding of abdominal surgery
  • Demonstrate good judgment, safety, and effective technical skills in operative cases
  • Demonstrate the ability to move through portions of “ESSENTIAL” operations without coaching.
  • Demonstrate the ability to make straightforward intra-operative decisions.
  • Perform some of the “ESSENTIAL” operations in the SCORE Curriculum with minimal assistance.
  • Continue to develop skill in instrument handling and begin to exhibit efficiency of motion during procedures.

PGY 4 Residents:

  • Be proficient at treating surgical diseases and handling standard operative procedures with a thorough understanding of surgical pathophysiology
  • Demonstrate good judgment, safety, and effective technical skills in operative cases.
  • Demonstrate proficiency in the handling of most instruments and exhibit efficiency of motion during procedures.
  • Move through the steps of most “ESSENTIAL” operations without much coaching and demonstrate the ability to make intra-operative decisions.
  • Demonstrate the ability to perform many of the “ESSENTIAL” operations and gain experience in the “COMPLEX” operations.

PGY 5 Residents:

  • Perform difficult surgical procedures; Continue to fine tune surgical skills both in and out of the operating room
  • Perform non-standard, or counter example cases; consider exceptions
  • Demonstrate good judgment, safety, and effective technical skills in operative cases
  • Demonstrate proficiency in the use of instruments and equipment required for “ESSENTIAL” operations.
  • Demonstrate the ability to guide the conduct of most operations and make independent intra-operative decisions.
  • Demonstrate the ability to perform all of the “ESSENTIAL” operations and demonstrate significant experience in the “COMPLEX” operations.
  • Effectively guide other residents in the “ESSENTIAL-COMMON” operations.

 

PATIENT CARE (PC4)

Post-Operative Patient Care

PGY 1 Residents:

  • Understand the principles involved in simple post-operative problems
  • Manage routine post-operative course for a common operation

PGY 2 Residents:

  • Continue to develop routine post-operative management skills
  • Evaluates complex post-operative problems
  • Manages simple post-operative problems
  • Evaluates patients in the ER with post-operative problems

PGY 3 Residents:

  • Evaluates complex post-operative problems in complex patients
  • Manages routine post-operative course for a complex operation
  • Evaluates post-operative problems in the ICU setting
  • Teach post-operative management to junior residents

PGY 4 Residents:

  • Anticipates and mitigates post-operative problems in complex patients
  • Manages complex post-operative problems

PGY 5 Residents:

  • Demonstrates proficiency managing post-operative problems in simple and complex patients
  • Demonstrates proficiency teaching post-operative management to junior surgery residents
  • Able to lead a team through the management of post-operative problems

 

MEDICAL KNOWLEDGE (MK1)

Pathophysiology and Treatment

GOAL:  The resident will demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social/behavioral sciences.  The resident will demonstrate significant knowledge about many “BROAD” diseases in the SCORE curriculum and a basic knowledge of the “FOCUSED” diseases in the SCORE curriculum.  The resident will demonstrate the application of this knowledge to the care of general surgical patients by making diagnoses and initiating appropriate initial management.

PGY 1 Residents:

  • Describe the pathophysiology applied to surgical diseases
  • Demonstrate knowledge of normal and distributed physiology causing surgical diseases
  • Apply physiological knowledge to the clinical management of surgical diseases
  • Apply investigatory, analytical, and evidence-based approaches to clinical decision making
  • Demonstrate a basic understanding of the symptoms, signs and treatments of many of the “BROAD” diseases in the SCORE Curriculum.
  • Demonstrate basic knowledge about common surgical conditions to which a medical student would be exposed in clerkship.
  • Complete the American Board of Surgery In-Training Examination once a year
  • Complete online modules in SCORE Curriculum as assigned
  • Complete readings in SCORE Curriculum on line for rotations
  • Attend required weekly Department of Surgery Morbidity and Mortality Conference and Grand Rounds.

PGY 2 Residents:

  • Formulate diagnostic treatment plans with thorough understanding of the basic science principles applicable to surgery
  • Read, understand and analyze classic articles on surgical cases
  • Understand the pathophysiology applied to surgical diseases
  • Understand the concepts of complex wound care
  • Demonstrate knowledge of normal and distributed physiology causing surgical diseases
  • Apply physiological knowledge to the clinical and operative management of surgical diseases
  • Apply investigatory, analytical, and evidence-based approaches to clinical decision making
  • Demonstrate basic knowledge about many of the “BROAD” diseases in the SCORE Curriculum.
  • Demonstrate this knowledge by making diagnoses and recommending appropriate initial management of many of the “BROAD” diseases in the SCORE Curriculum.
  • Begin to recognize variations in the presentation of common surgical conditions.
  • Complete the American Board of Surgery In-Training Examination once a year
  • Complete online modules in SCORE Curriculum as assigned
  • Attend required weekly Department of Surgery Morbidity and Mortality Conference and Grand Rounds.
  • Formulate research project plan and submit documentation (see Handbook) to program coordinator.

PGY 3 Residents:

  • Demonstrate an understanding of the anatomy, physiology, pathophysiology and presentations of diseases of the abdominal cavity and pelvis
  • Demonstrate an understanding of the physiology of wound healing
  • Demonstrate knowledge of the principles associated with the diagnosis and management of critically ill patients including multiple organ system normalities and abnormalities
  • Systematically read and analyze basic surgical literature
  • Demonstrate knowledge about many of the “BROAD” diseases in the SCORE Curriculum by making diagnoses and recommending appropriate initial management.
  • Recognize variations in the presentation of common surgical conditions.
  • Begin to demonstrate basic knowledge of the “FOCUSED” diseases in the SCORE Curriculum.
  • Conduct in depth reading on surgical cases
  • Complete course work and testing to obtain Basic and Advanced Cardiac Life Support and Advanced Trauma Life Support certification
  • Complete the American Board of Surgery In-Training Examination once a year
  • Complete online modules in SCORE Curriculum as assigned
  • Attend and actively participate in the Critical Care Didactic Reading Program
  • Carry out work on Research Project toward completion by end of residency.
  • Attend required weekly Department of Surgery Morbidity and Mortality Conference and Grand Rounds.

PGY 4 Residents:

  • Demonstrate competence in treating surgical diseases with a thorough understanding of pathophysiology
  • Demonstrate an understanding of the physiology of wound healing
  • Demonstrate knowledge of the principles associated with the diagnosis and management of critically ill patients including multiple organ system normalities and abnormalities
  • Systematically read and analyze basic surgical literature
  • Demonstrate significant knowledge about many of the “BROAD” diseases in the SCORE Curriculum by making diagnoses and initiating appropriate initial management.
  • Demonstrate basic knowledge of the “FOCUSED” diseases in the SCORE Curriculum.
  • Complete the American Board of Surgery In-Training Examination once a year
  • Complete online modules in SCORE Curriculum as assigned
  • Attend required weekly Department of Surgery Morbidity and Mortality Conference and Grand Rounds and make presentations.
  • Demonstrate medical knowledge and clinical perspectives at conferences by making presentations at conferences
  • Carry out work on Research Project toward completion by end of residency.
  • Participate in mock orals with SEMCME

PGY 5 Residents:

  • Master basic science, critical care principles, anatomy, and pathophysiology of surgical diseases.
  • Demonstrate a thorough understanding of surgical pathophysiology in order to achieve optimal chance of recovery for the patient with minimal morbidity
  • Demonstrate evidence of medical knowledge and clinical perspectives by conducting presentations at conferences
  • Systematically read and analyze basic surgical literature
  • Demonstrate comprehensive knowledge about the varying patterns of presentation and alternative and adjuvant treatments for many of the “BROAD” diseases in the SCORE Curriculum by making diagnoses and initiating appropriate management.
  • Diagnose and provide initial care for the “FOCUSED” diseases in the SCORE Curriculum
  • Complete American Board of Surgery In-Training Examination
  • Complete Mock Orals given by Department of Surgery and SEMCME once a year
  • Complete online modules in SCORE Curriculum as assigned
  • Attend required weekly Department of Surgery Morbidity and Mortality Conference and Grand Rounds and make presentations.
  • Carry out work on Research Project toward completion by end of residency.

 

MEDICAL KNOWLEDGE (MK2)

Anatomy

GOAL:  The resident will demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social/behavioral sciences.  The resident will develop knowledge of the operative steps, peri-operative care and post-operative complications for most of the “ESSENTIAL” operations in the SCORE Curriculum and a basic knowledge of some of the “COMPLEX” operations.  The resident will demonstrate the application of this knowledge in the care of general surgical patients.

PGY 1 Residents:

  • Apply physiological knowledge to the operative management of surgical diseases
  • Demonstrate a basic knowledge of the “ESSENTIAL-COMMON” surgical operations in the SCORE Curriculum to which a medical student would be exposed in clerkship.
  • Begin to understand the operative steps, peri-operative care and post-operative complications for many of the “ESSENTIAL” operations in the SCORE Curriculum.
  • Complete assignments in the Surgical Skills Lab (SSL)
  • Complete online modules in SCORE Curriculum as assigned
  • Complete readings in SCORE Curriculum on line for rotations

PGY 2 Residents:

  • Apply physiological knowledge to the clinical and operative management of surgical diseases
  • Understand the concepts of complex wound care
  • Demonstrate basic knowledge of the operative steps, peri-operative care and post-operative complications for many of the “ESSENTIAL” operations in the SCORE Curriculum.
  • Complete online modules in SCORE Curriculum as assigned
  • Begin to develop exposure to some of the “COMPLEX” operations in the SCORE Curriculum.

PGY 3 Residents:

  • Acquire a thorough understanding of abdominal procedures
  • Apply knowledge of anatomy to the diagnosis and treatment of patients, both in and out of the operating room
  • Read an entire text related to critical care surgery: ACS Surgery, Principles and Practice.
  • Attend and actively participate in the Surgical Anatomy Cadaver Course
  • Demonstrate basic knowledge of the operative steps, peri-operative care and post-operative complications for many of the “ESSENTIAL” operations in the SCORE Curriculum.
  • Begin to develop basic knowledge of some of the “COMPLEX” operations in the SCORE Curriculum.

PGY 4 Residents:

  • Define and describe the anatomic aspects of even the most complex general surgical operations (abdominoperineal aneurysm, Whipple procedure, pneumonectomy, liver resections, etc.)
  • Apply knowledge of anatomy to the diagnosis and treatment of patients, both in and out of the operating room.
  • Conduct in depth reading on surgical cases
  • Understand the “limits” of surgical treatment
  • Demonstrate significant knowledge of the operative steps, peri-operative care and post-operative complications for most of the “ESSENTIAL” operations in the SCORE Curriculum.
  • Demonstrate basic knowledge of some of the “COMPLEX” operations in the SCORE Curriculum.

PGY 5 Residents:

  • Master operative strategies and procedures
  • Demonstrate comprehensive knowledge of the operative steps, peri-operative care and post-operative complications for most of the “ESSENTIAL” operations in the SCORE Curriculum.
  • Demonstrate basic knowledge of many of the “COMPLEX” operations in the SCORE Curriculum.
  • Complete Fundamentals of Laparoscopic Surgery (FLS) and other American Board of Surgery Requirements for Board eligibility

 

SYSTEMS-BASED PRACTICE (SBP1)

Patient Safety and Quality Improvement

GOAL:  The resident will demonstrate the ability to efficiently arrange disposition planning for patients and understands the necessary resources to provide optimal coordination of care.

PGY 1 Residents:

  • Consult with other members of the healthcare team to provide cost-efficient healthcare for patients
  • Apply cost-effective care in ordering tests and planning interventions
  • Provide consultations for other services
  • Coordinate patient care within the healthcare system and understand the role of different healthcare professionals in overall patient management
  • Demonstrate a basic understanding of the resources available for coordinating patient care (social workers, visiting nurses, and physical and occupational therapists).

PGY 2 Residents:

  • Consult with other members of the healthcare team to provide cost-efficient healthcare for patients
  • Apply cost-effective care in ordering tests and planning interventions
  • Provide consultations for other services
  • Describe the therapeutic support systems necessary to achieve optimal chance of recovery for the patient
  • Practice overall patient management both in and out of the operating room
  • Coordinate patient care within the healthcare system and understand the role of different healthcare professionals in overall patient management.
  • Know the necessary resources to provide optimal coordination of care and how to access them, including home TPN or home antibiotic infusion.

PGY 3 – 5 Residents:

  • Apply efficient and informative consultations for other services
  • Consult with other members of the healthcare team to provide cost-efficient healthcare for patients
  • Apply cost-effective care when ordering tests and planning interventions
  • Describe the therapeutic support systems necessary to achieve optimal chance of recovery for patients
  • Practice overall patient management both in and out of the operating room
  • Coordinate patient care within the healthcare system and understand the role of different healthcare professionals in overall patient management
  • Demonstrate the ability to efficiently arrange disposition planning for patients and takes responsibility for preparing all materials necessary for patient discharge or transfer.
  • Coordinate the activities of residents, nurses, social workers, and other healthcare professionals to provide optimal care to the patient at the time of discharge or transfer.
  • Coordinate post-discharge ambulatory care that is appropriate for the patient’s particular needs.
  • Demonstrate good patient advocacy skills

 

SYSTEMS-BASED PRACTICE (SBP2)

System Navigation for Patient-Centered Care

GOAL:  The resident understands how patient care is provided within the system and recognizes system failures that can affect patient care.

PGY 1-2 Residents:

  • Follow protocols and guidelines for patient care.
  • Recognize and understand how different health insurance companies affect the treatment plan for patients.
  • Appropriately order tests in order to provide cost-efficient care for patients.
  • Develop an understanding of how health systems operate.
  • Understand system factors that contribute to medical errors and may create variations in patient care.

PGY 3-5 Residents:

  • Follow protocols and guidelines for patient care.
  • Recognize and understand how different health insurance companies affect the treatment plan for patients.
  • Appropriately order tests in order to provide cost-efficient care for patients.
  • Understand system factors that contribute to medical errors and may create variations in patient care.
  • Make suggestions for changes in the health care system that may improve patient care.
  • Report problems with technology or processes that could produce medical errors.
  • Participate in work groups or performance improvement teams designed to reduce errors and improve health outcomes.
  • Understand the appropriate use of standardized approaches to care and participates in creating such protocols of care.

 

SYSTEMS-BASED PRACTICE (SBP3)

Physician Role in Health Care Systems

PGY 1-2 Residents:

  • Describe basic health payment systems
  • Describe key components of documentation for billing and coding
  • Describe how working within the health care system impacts patient care
  • Document the key components required for billing and coding

PGY 3-5 Residents:

  • Analyze how personal practice affects the system
  • Describe basic elements needed to transition into practice
  • Identify resources and effectively plan for transition into practice

 

PRACTICE BASED LEARNING AND IMPROVEMENT (PBLI1)

Evidence-Based and Informed Practice

GOAL:  The resident will demonstrate a willingness to impart educational information clearly and effectively to medical students and other members of the healthcare team.

PGY 1 Residents:

  • Attend and actively participate in the Resident Competency Program Session on Personal Awareness / Self Care and Effective Teamwork
  • Teach and be a role model for medical students and other members of the healthcare team.
  • Use media in presentations appropriately and effectively.

PGY 2 Residents:

  • Teach and be a role model for medical students, residents and other members of the healthcare team.
  • Teach patients, their families, and other health professionals.
  • Communicate educational material accurately and effectively at the appropriate level for learner understanding.
  • Accurately and succinctly present cases in conferences.

PGY 3 Residents:

  • Demonstrate proficiency at teaching and being a role model for medical students and other residents.
  • Teach patients, their families, and other health professionals
  • Communicate educational material accurately and effectively at the appropriate level for learner understanding.
  • Accurately and succinctly present cases in conferences.

PGY 4 Residents:

  • Be highly proficient at teaching junior residents and medical students
  • Demonstrate leadership and practice management by organizing and running a resident service
  • Teach patients, their families, and other health professionals
  • Demonstrate an effective teaching style when asked to be responsible for a conference or formal presentation.
  • Develop the ability to recognize teachable moments and readily and respectfully engage the learner.

PGY 5 Residents:

  • Be highly proficient at teaching junior residents and medical students
  • Demonstrate leadership and management skills by coordinating and running a major resident service with greater independence; be accountable for all actions on the service with consultation and supervision by attending physicians
  • Teach patients, their families, and other health professionals
  • Recognize teachable moments and readily and respectfully engage the learner.
  • Be a highly effective teacher with an interactive educational style and engage in constructive educational dialogue.
  • Facilitate conferences and case discussions based on assimilation of evidence from the literature.

 

PRACTICE BASED LEARNING AND IMPROVEMENT (PBLI2)

Reflective Practice and Commitment to Personal Growth

GOAL:  The resident will engage in self-initiated, self-directed learning activities using multiple sources.

PGY 1 Residents:

  • Perform appropriate learning activities, while setting learning and improvement goals based on faculty evaluations
  • Assess annual ABSITE scores to develop an individual study plan as necessary
  • Participate in assigned skills, curriculum activities and simulation experiences to build surgical skills

PGY 2 Residents:

  • Perform appropriate learning activities, while setting learning and improvement goals based on faculty evaluations
  • Assess annual ABSITE scores to develop an individual study plan as necessary
  • Independently read the literature and use sources to answer questions related to patient care (e.g. SCORE modules, peer-reviewed publications, practice guidelines, textbooks, library databases, etc.)
  • Identify gaps in personal technical skills and work with faculty to develop a skills learning plan.

PGY 3 Residents:

  • Perform appropriate learning activities, while setting learning and improvement goals based on faculty evaluations
  • Assess annual ABSITE scores to develop an individual study plan as necessary
  • Attend and actively participate in the Critical Care Reading program
  • Independently read the literature and use sources to answer questions related to patient care (e.g. SCORE modules, peer-reviewed publications, practice guidelines, textbooks, library databases, etc.)
  • Identify gaps in personal technical skills and work with faculty to develop a skills learning plan.
  • Independently practice surgical skills in a simulation environment to enhance technical abilities.

PGY 4 Residents:

  • Review annual ABSITE scores and develop individual study plan as necessary
  • Seek opportunities to identify trends and patterns in the care of patients and use sources to understand such patterns.
  • Select appropriate evidence-based information tools to answer specific questions while providing care
  • Independently practice surgical skills in a simulation environment to enhance technical abilities.

PGY 5 Residents:

  • Understand one’s own clinical limitations and limitations of surgery in general
  • Assess annual ABSITE scores and develop an individual study plan as necessary
  • Participate in local, regional and national activities, optional conferences, and/or self-assessment programs.
  • Demonstrate use of a system or process for keeping up with changes in the literature and initiate assignments for other learners.
  • Lead surgical skills experiences for students and residents and participate in skills curriculum development.

 

PROFESSIONALISM (PROF1)

Ethical Principles

GOAL:   The resident will demonstrate a commitment to professional responsibilities, adherence to organizational and ethical principles, and sensitivity to a diverse patient population.

PGY 1 Residents:

  • Understand and use the chain of command on the resident service
  • Respond and answer pages promptly
  • Be respectful and responsive to the needs of patients
  • Demonstrate a commitment to ethical principles, maintain confidentiality of patient information, informed consent, and other business practices
  • Demonstrate commitment to continuity of patient care

PGY 2 Residents:

  • Be respectful and responsive to the needs of patients
  • Demonstrate ethical principles, maintain confidentiality of patient information, informed consent, and other business practices
  • Know the chain of command on the resident service
  • Respond and answer pages promptly
  • Display tolerance to another’s opinion
  • Accept responsibility for one’s own actions
  • Complete operative case logs and medical reports in a timely manner
  • Demonstrate commitment to continuity of patient care

PGY 3 Residents:

  • Demonstrate a high standard of personal conduct, be respectful and responsive to the needs of patients
  • Demonstrate ethical principles, maintain confidentiality of patient information, informed consent, and other business practices
  • Respond and answer pages promptly
  • Display tolerance to another’s opinion
  • Accept responsibility for one’s own actions
  • Complete operative case logs and medical reports in a timely manner
  • Demonstrate commitment to continuity of patient care

PGY 4 Residents:

  • Demonstrate a high standard of personal conduct, be respectful and responsive to the needs of patients
  • Demonstrate ethical principles, maintain confidentiality of patient information, informed consent, and other business practices
  • Coordinate and manage a resident service so as to lead and guide more junior residents
  • Respond and answer pages promptly
  • Display tolerance to another’s opinion
  • Accept responsibility for one’s own actions
  • Complete operative case logs and medical reports in a timely manner
  • Conduct case presentations at conferences to demonstrate professional leadership skills, medical knowledge, and clinical perspective
  • Demonstrate commitment to continuity of patient care

PGY 5 Residents:

  • Demonstrate a high standard of personal conduct, be respectful and responsive to the needs of patients
  • Demonstrate ethical principles, maintain confidentiality of patient information, informed consent, and other business practices
  • Display proficiency in managing a major resident service with greater independence
  • Demonstrate accountability for all actions and outcomes on the service with appropriate supervision and consultation by attending physicians
  • Respond and answer pages promptly
  • Display tolerance to another’s opinion
  • Accept responsibility for one’s own actions
  • Complete operative case logs and medical reports in a timely manner
  • Conduct case presentations at conferences to demonstrate professional leadership skills, medical knowledge, and clinical perspective
  • Demonstrate commitment to continuity of patient care
  • Demonstrate high standards of ethical behavior

 

PROFESSIONALISM (PROF2)

Professional Behavior and Accountability

GOAL:   The resident will demonstrate a commitment to manage his/her personal, physical and emotional health and create a healthy environment for colleagues and other members of the healthcare team.

PGY 1 Residents:

  • Apply time management principles as necessary to be accountable to patients, and other healthcare professionals
  • Comply with duty hour standards
  • Understand the principles of physician wellness and fatigue mitigation.
  • Understand the institutional resources available to manage personal, physical and emotional health (e.g., acute and chronic disease, substance abuse and mental health problems).
  • Demonstrate appropriate dress and decorum while on duty.

PGY 2 Residents:

  • Apply time management principles as necessary to be accountable to patients, and other healthcare professionals
  • Monitor personal health and wellness and appropriately mitigate stress and/or fatigue.
  • Comply with duty hour standards.
  • Demonstrate appropriate dress and decorum while on duty.

PGY 3 Residents:

  • Apply time management principles as necessary to be accountable to patients, and other healthcare professionals
  • Monitor personal health and wellness and appropriately mitigate stress and/or fatigue.
  • Comply with duty hour standards.
  • Demonstrate appropriate dress and decorum while on duty.

PGY 4 Residents:

  • Apply time management principles as necessary to be accountable to patients, and other healthcare professionals
  • Comply with duty hour standards
  • Promote healthy habits and create an emotionally healthy environment for all members of the healthcare team.
  • Demonstrate appropriate dress and decorum while on duty.

PGY 5 Residents:

  • Apply time management principles as necessary to be accountable to patients, and other healthcare professionals
  • Demonstrate appropriate dress and decorum while on duty.
  • Promote healthy habits and create an emotionally healthy environment for all members of the healthcare team.
  • Recognize and appropriately address personal health issues in other members of the healthcare team.
  • Be proactive in modifying schedules or intervening in other ways to assure that caregivers under his/her supervision maintain personal wellness and do not compromise patient safety.

 

PROFESSIONALISM (PROF3)

Administrative Tasks

GOAL:   The resident will demonstrate a commitment to complete operative case logs, duty hour logs, and other assigned and required administrative tasks in a timely fashion.

PGY 1-5 Residents:

  • Complete operative case logs, duty hour logs, medical reports and other required administrative tasks in a timely fashion.
  • Be prompt in attending conferences, meetings, operations and other activities.
  • Respond quickly to requests from faculty members and departmental staff members.
  • Ensure appropriate documentation requests from GME are handled efficiently and in a timely fashion.

PGY 4-5 Residents:

  • Assure that others under his or her supervision respond appropriately to responsibilities in a timely fashion.
  • Set an example for conference attendance, promptness and attention to assigned tasks.

 

PROFESSIONALISM (PROF4)

Self-Awareness and Help-Seeking

PGY 1 Residents:

  • Identify the institutional resources available to manage personal, physical, and emotional health
  • Demonstrate knowledge of the principles of physician well-being and fatigue mitigation

PGY 2 Residents:

  • Monitors his or her personal health
  • Demonstrates ability to mitigate fatigue and/or stress
  • Ability to assure self-fitness for duty

PGY 3 Residents:

  • Promotes healthy habits
  • Creates an emotionally healthy environment for colleagues
  • Models appropriate management of personal health issues
  • Models appropriate management of fatigue and stress

PGY 4 Residents:

  • Recognizes signs and symptoms of burnout, depression, suicidal ideation, potential for violence, and substance abuse in other members of the health care team
  • Proactively modifies schedules to assure personal wellness for self and team members

PGY 5 Residents:

  • Demonstrates proficiency in healthy habits
  • Demonstrates mastery of signs and symptoms of burnout, depression, suicidal ideation, potential for violence, and substance abuse

 

INTERPERSONAL AND COMMUNICATION SKILLS (ICS1)

Patient and Family-Centered Communication

GOAL:  The resident will demonstrate interpersonal and communication skills that result in effective exchange of information and collaboration with patients, their families, and health professionals.

PGY 1 Residents:

  • Listen to patients and their families
  • Gather essential information from patients; document patient encounters accurately and completely
  • Demonstrate effective communication strategies to interact with patients, families, and the public from diverse socioeconomic and cultural backgrounds
  • Provide therapeutic relationships with patients using effective listening skills and candid feedback
  • Educate patients and families about the pre-and post-operative care of the surgical patient
  • Demonstrate effective interpersonal skills with patients, their families, and health professionals
  • Manage the patient’s confidential information and medical records according to HIPAA standards.
  • Demonstrate a variety of techniques to ensure that communications with patients and their families is understandable and respectful.

PGY 2 Residents: 

  • Gather essential information from patients; document patient encounters accurately and completely
  • Provide therapeutic relationships with patients using effective listening skills and candid feedback
  • Educate patients and their families about the pre- and post-operative care of the surgical patient
  • Interact cooperatively with patients, families, nurses, and other healthcare professionals to achieve the health-related goals of the patient
  • Manage the patient’s confidential information and medical records according to HIPAA standards.
  • Demonstrate the ability to customize communication with patients and families by taking into account patient characteristics (e.g., age, literacy, cognitive disabilities, culture).
  • Provide timely updates to patients and their families during hospitalizations and clinic visits.

PGY 3 Residents:

  • Interact cooperatively with patients, families, nurses, and other healthcare professionals to achieve the health-related goals of the patient
  • Provide essential information from patients; document patient encounters accurately and completely
  • Provide therapeutic relationships with patients using effective listening skills and candid feedback
  • Educate patients and their families about their pre- and post-operative care
  • Manage the patient’s confidential information and medical records according to HIPAA standards.
  • Provide timely updates to patients and their families during hospitalizations and clinic visits.
  • Develop communication strategies to effectively interact with crucially ill patients and their families.
  • Demonstrate sensitivity when delivering bad news to patients and their families.

PGY 4 Residents:

  • Be highly proficient in interacting with patients, families, nurses, and other healthcare professionals to achieve the health-related goals of the patient
  • Develop therapeutic relationships with patients using effective listening skills and candid feedback
  • Educate patients and their families about their pre- and post-operative care
  • Gather essential information from patients; document encounters accurately and completely
  • Manage the patient’s confidential information and medical records according to HIPAA standards.
  • Communicate effective treatment plans with patients.
  • Develop the ability to negotiate and manage conflict with patients and their families
  • Apply grief counseling methods in calming the grieving relative.

PGY 5 Residents:

  • Be highly proficient in interacting with patients, families, nurses, and other healthcare professionals to achieve the health-related goals of the patient
  • Develop therapeutic relationships with patients using effective listening skills and candid feedback
  • Educate patients and their families about the pre- and post-operative care of the surgical patient
  • Gather essential information from patients; document encounters accurately and completely
  • Manage the patient’s confidential information and medical records according to HIPAA standards
  • Communicate effective treatment plans with patients.
  • Develop the ability to negotiate and manage conflict with patients and their families
  • Apply grief counseling methods in calming the grieving relative.
  • Customize emotionally difficult information when participating in end-of-life discussions.
  • Negotiate and manage conflict among patients and their families.

 

INTERPERSONAL AND COMMUNICATION SKILLS (ICS2)

Interprofessional and Team Communication

GOAL:  The resident will demonstrate interpersonal and communication skills that result in effective information exchange and teaming with all health care team members and professional associates.

PGY 1 Residents:

  • Write orders and progress reports in a timely and legible format
  • Willingly exchange patient information with team members.
  • Respond promptly and politely to requests for consults and care coordination activities.
  • Perform face-to-face handoffs.

PGY 2 Residents: 

  • Respond promptly and considerately to requests of other physicians/healthcare personnel
  • Write orders and progress notes in a timely and legible format
  • Acknowledge the contributions of other team members
  • Interact with peers regarding operative cases and provide feedback about the scientific literature at the Basic Science Reading program
  • Exhibit behaviors that invite information sharing with healthcare team members (respect, approachability, active listening).
  • Perform face-to-face handoffs using best practices (multiple forms of information transfer, confirm receipt of information, invite questions).

PGY 3 Residents:

  • Demonstrate professional competence in working as a team member
  • Interact, present information, and teach other members of the healthcare team
  • Write orders and progress notes in a timely and legible format
  • Interact with peers about operative cases and provide feedback about the scientific literature at the Critical Care Reading program
  • Perform face-to-face handoffs using best practices (multiple forms of information transfer, confirm receipt of information, invite questions).
  • Exhibit behaviors that invite information sharing with healthcare team members (respect, approachability, active listening).
  • Deliver timely, complete, and well-organized information to referring physicians and to providers of follow-up care at the time of patient care transitions.

PGY 4 Residents:

  • Interact as a lead member of the healthcare team
  • Write orders and progress notes in a timely and legible format
  • Deliver timely, complete, and well-organized information to referring physicians and to providers of follow-up care at the time of patient care transitions.
  • Discuss care plan with members of the healthcare team and keep them up-to-date on patient status and care plan changes.
  • Conduct case presentations at conferences and demonstrate clinical perspective
  • Begin to assume overall leadership of a health care team responsible for his/her patients.

PGY 5 Residents:

  • Interact as a lead member of the healthcare team
  • Write orders and progress notes in a timely and legible format
  • Conduct presentations at conferences and demonstrate clinical perspective
  • Deliver timely, complete, and well-organized information to referring physicians and to providers of follow-up care at the time of patient care transitions.
  • Discuss care plan with members of the healthcare team and keep them up-to-date on patient status and care plan changes.
  • Assume overall leadership of a health care team responsible for his/her patients, while also seeking and valuing input from the members of the team.
  • Negotiate and manage conflict among care providers.
  • Take responsibility for ensuring that clear hand-offs are given at transitions of care.

 

INTERPERSONAL AND COMMUNICATION SKILLS (ICS3)

Communication within Health Care Systems

GOAL:  The resident will demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, hospital staff and the senior surgeon in the operating room.

PGY 1 Residents:

  • Respond promptly and considerately to requests of other physicians/healthcare personnel in the operating room.
  • Exhibit behavior that invites information sharing with operating room team members (respect, approachability, active listening).
  • Display a friendly disposition that is conducive to successful interaction with patients, hospital staff and the senior surgeon in the operating room.
  • Communicate basic facts effectively with patients, hospital staff members and the senior surgeon in the operating room.
  • Demonstrate an understanding of the necessary elements of informed consent for procedures.

PGY 2 Residents: 

  • Respond promptly and considerately to requests of other physicians/healthcare personnel in the operating room.
  • Exhibit behavior that invites information sharing with operating room team members (respect, approachability, active listening).
  • Display a friendly disposition that is conducive to successful interaction with patients, hospital staff and the senior surgeon in the operating room.
  • Demonstrate the ability to perform clear informed consent discussions for some of the “ESSENTIAL” operations.
  • Begin to develop the ability to lead a pre-operative “time out”.
  • Effectively describe various aspects of the procedure and peri-operative care to the patient and his or her family and other operating room team members.

PGY 3 Residents:

  • Respond promptly and considerately to requests of other physicians/healthcare personnel in the operating room.
  • Exhibit behavior that invites information sharing with operating room team members (respect, approachability, active listening).
  • Display a friendly disposition that is conducive to successful interaction with patients, hospital staff and the senior surgeon in the operating room.
  • Demonstrate the ability to perform clear informed consent discussions for the “ESSENTIAL” operations and some of the “COMPLEX” operations.
  • Demonstrate the ability to lead a pre-operative “time out”.
  • Effectively describe various aspects of the procedure and peri-operative care to the patient and his or her family and other operating room team members.

PGY 4 Residents:

  • Respond promptly and considerately to requests of other physicians/healthcare personnel in the operating room.
  • Exhibit behavior that invites information sharing with operating room team members (respect, approachability, active listening).
  • Display a friendly disposition that is conducive to successful interaction with patients, hospital staff and the senior surgeon in the operating room.
  • Demonstrate the ability to perform clear informed consent discussions for “ESSENTIAL” and “COMPLEX” operations.
  • Anticipate logistical issues regarding “ESSENTIAL” procedures and engage appropriate members of the operating team to solve problems.
  • Effectively describe various aspects of the procedure and peri-operative care to the patient and his or her family and other operating room team members.
  • Demonstrate the ability to lead a “time out”

PGY 5 Residents:

  • Respond promptly and considerately to requests of other physicians/healthcare personnel in the operating room.
  • Exhibit behavior that invites information sharing with operating room team members (respect, approachability, active listening).
  • Display a friendly disposition that is conducive to successful interaction with patients, hospital staff and the senior surgeon in the operating room.
  • Demonstrate the ability to lead a “time out”
  • Demonstrate leadership when unexpected events occur in the operating room.
  • Communicate effectively with family when unexpected events occur in the operating room.

 

PRACTICE DOMAIN: CARE FOR DISEASES AND CONDITIONS (CDC)

MILESTONES: PC1 and MKI    “Cognitive Milestones”

 

CATEGORYROTATIONS

BROAD

Surgical Conditions

FOCUSED

Surgical Conditions

Trauma/Acute Surgery

DRH GOLD

 

DRH BLUE/GREEN

 

 

 

 

Abdominal Pain – Acute

Intra-abdominal Abscess

Rectus Sheath Hematoma

Pancreatitis – Biliary

Hepatic Abscess

Pancreatic Pseudocyst

Pancreatitis – Acute/Pancreatic Necrosis/Abscess

Postsplenectomy Sepsis

Splenic Abscess

Necrotizing Soft Tissue Infections

Paronychia

Aortic Injury

Bladder Injury

Blunt Trauma

Cardiac Tamponade

Colon and Rectal Injury

Diaphragmatic Injury

Esophageal Injury

Gastric Injury

Geriatric Trauma

Hemothorax – Injury-Related

Hepatic Injury

Laryngeal and Tracheal Injury

Myocardial Contusion

Pancreatic and Duodenal Injury

Pelvic Fractures

Penetrating Trauma

Pharyngeal and Cervical Esophageal Injury

Pneumothorax – Injury-Related

Pulmonary Contusion

Pulmonary Laceration

Renal Injury

Retroperitoneal Hematoma

Rib Fractures

Small Intestinal Injury

Splenic Injury

Sternal Fractures

Trauma in Pregnancy

Ureteral Injury

Vascular Injury – Abdomen

Vascular Injury – Extremities

Vascular Injury – Neck

Vascular Injury – Thorax

Ectopic Pregnancy

Ovarian Mass/Cyst – Incidental

Pelvic Inflammatory Disease

 

Bacterial Peritonitis – Spontaneous

Budd-Chiari Syndrome

Cirrhosis/Portal Hypertension (Ascites)

Esophageal Varices

Pancreatitis – Autoimmune

Pancreatitis – Chronic (Including Hereditary Pancreatitis)/Pancreatic Insufficiency

Animal and Insect Bites and Stings

Extremity Fractures and Traumatic Amputations

Head Injury – Penetrating and Closed

Human Bites

Nerve Injury – Neck

Spine Fracture

Sprains, Strains, and Dislocations

Tracheal and Bronchial Injury

Urethral Injury

Endometriosis

 

 

CATEGORYROTATIONS

BROAD

Surgical Conditions

FOCUSED

Surgical Conditions

 

General Surgery

 

HARPER A/C

 

SINAI-GRACE

 

VA COMBINED

 

ST. MARY

 

MUSKEGON

 

 

 

Mesenteric Cyst

Femoral Hernia

Inguinal Hernia

Miscellaneous Hernias

Prosthetic Mesh Infections – Management

Umbilical and Epigastric Hernias

Ventral Hernia

Bile Duct Injury – Iatrogenic

Cholangitis

Cholecystitis – Acalculous

Cholecystitis – Acute

Cholecystitis – Chronic

Choledocholithiasis

Gallbladder Cancer – Incidental

Gallbladder Polyps

Gallstone Ileus

Jaundice – Obstructive

Duodenal Ulcer

Gastric Polyps

Gastric Ulcer

Peptic Ulcer Disease with Obstruction

Peptic Ulcer Disease with Perforation

Enterocutaneous Fistula

Intussusception

Meckel’s Diverticulum

Paralytic Ileus

Pneumatosis

Small Intestinal Crohn’s Disease – Surgical Management

Small Intestinal Obstruction

Small Intestinal Polyps

Appendiceal Neoplasms

Appendicitis – Acute

Clostridium Difficile-Associated Diarrhea

Colitis – Ischemic

Colonic Crohn’s Disease – Surgical Management

Colonic Polyps

Colonic Volvulus

Diverticular Bleeding

Diverticulitis

Gastrointestinal Bleeding – Lower

Obstruction – Large Intestinal

Ulcerative Colitis – Surgical Management

Anal Fissure

Anorectal Abscess and Fistulae

Hemorrhoids

Perianal Condylomas

Apocrine Tumor

Basal Cell Carcinoma

Cellulitis

Dermatofibrosarcoma

Eccrine Tumor

Epidermal Cyst

Felon

Hidradenitis

Nevi

Pilonidal Cyst/Sinus

Surgical Site Infection

 

Abdominal Pain – Chronic

Ascites – Chylous

Desmoids/Fibromatoses

Ampullary Stenosis/Sphincter of Oddi Dysfunction

Choledochal Cyst

Sclerosing Cholangitis

Pancreas Divisum

Gastric Bezoars and Foreign Bodies

Gastroparesis

Postgastrectomy Syndromes

Enteric Infections and Blind Loop Syndrome

Short Bowel Syndrome

Appendicitis – Chronic

Constipation – Functional

Irritable Bowel Syndrome

Anal Dysplasia/Sexually Transmitted Diseases

Fecal Incontinence

Pelvic Floor Dysfunction

Rectal Prolapse

Thyroiditis

Decubitus Ulcer

 

 

CATEGORYROTATIONS

BROAD

Surgical Conditions

FOCUSED

Surgical Conditions

 

Surgical Oncology

 

HARPER A

 

Hepatic Mass – Evaluation

Gastric Cancer

Gastric Carcinoid Tumor

Gastric Lymphoma

Radiation Enteritis

Small Intestinal Adenocarcinoma

Small Intestinal Carcinoid Tumor

Small Intestinal GISTs

Small Intestinal Lymphoma

Colon Cancer

Colon Neoplasms – Miscellaneous

Anal Cancer

Rectal Cancer

Adrenal Cancer

Adrenal Mass

Hyperaldosteronism – Primary

Hypercortisolism – Cushing Syndrome/Disease

Hyperparathyroidism – Primary

Pheochromocytoma

Thyroid Cancer – Follicular

Thyroid Cancer – Papillary

Thyroid Nodule

Melanoma

Merkel Cell Tumor

Soft Tissue Masses – Evaluation

Squamous Cell Carcinoma

 

 

 

Peritoneal Neoplasms – Carcinomatosis

Peritoneal Neoplasms – Pseudomyxoma peritoneii

Bile Duct Neoplasms

Gallbladder Cancer

Hepatic Neoplasms – Benign

Hepatic Neoplasms – Malignant

Hepatic Neoplasms – Metastatic

Pancreatic Neoplasms – Cystic

Pancreatic Neoplasms – Endocrine

Pancreatic Neoplasms – Exocrine

Pancreatic Neoplasms – Exocrine (Intraductal Papillary Mucinous Neoplasms)

Periampullary Neoplasms – Other

Hemolytic Anemias

Hypersplenism – Secondary and Splenomegaly

Idiopathic Thrombocytopenic Purpura

Splenic Cysts and Neoplasms

Miscellaneous Thyroid Malignant Neoplasms

Multiple Endocrine Neoplasias

Parathyroid Cancer

Lymphedema/Lymphangitis

Soft Tissue Sarcomas

Post-transplant Malignancies

Ovarian Neoplasm – Benign and Malignant

Uterine Neoplasms – Benign and Malignant

Lymphoma/Hodgkin’s Disease

 

CATEGORYROTATIONS

BROAD

Surgical Conditions

FOCUSED

Surgical Conditions

 

Vascular Surgery

 

HARPER B

 

VA COMBINED

 

 

 

Acute Arterial Thrombosis

Acute Limb Ischemia

Aortic Thrombosis

Aortoiliac Disease

Cerebrovascular Disease

Compartment Syndromes

Diabetic Foot Infections

Peripheral Arterial Emboli

Peripheral Vascular Disease and Claudication

Thrombophlebitis – Acute and Suppurative

Varicose Veins

Venous Stasis/Chronic Venous Insufficiency

Venous Thrombosis/Pulmonary Embolism

Vascular Access for Dialysis

Venous Access for Long-Term Therapy

Mesenteric Ischemia – Acute (Arterial, Venous, and Nonocclusive)

 

Aortic Dissection

Arterial Aneurysms – Aortic

Arterial Aneurysms – Peripheral

Arterial Aneurysms – Visceral

Carotid Body Tumors

Chronic Visceral Disease

Hypercoagulable Syndromes

Nonatherosclerotic Occlusive Diseases

Renal Artery Disease

Thoracic Outlet Syndrome

Vascular Graft Infections

 

 

CATEGORYROTATIONS

BROAD

Surgical Conditions

FOCUSED

Surgical Conditions

 

Critical Care

 

HARPER  SICU

 

DRH

SICU/BURNS

 

 

Abdominal Compartment Syndrome

Anaphylaxis

Cardiac Arrythymia – Common

Cardiac Failure

Cardiogenic Shock

Coagulopathy

Derangements of Electrolytes and Acid-Base Balance

Endocrine Dysfunction

Gastrointestinal Failure

Hepatic Failure and Hepatorenal Syndrome

Hypovolemic Shock

Neurogenic Shock

Neurologic Dysfunction

Pneumonia – Hospital-Acquired

Renal Failure

Respiratory Failure

Septic Shock

Addisonian Crisis

Hyperthyroidism

Hypothyroidism – Postoperative

Brain Death

Indications for Transplantation (Kidney, Liver, Pancreas)

Pain, Acute – Management

 

Hepatitis – Viral (Occupational Risk)

Hyperparathyroidism – Recurrent or Persistent

Hyperparathyroidism – Secondary and Tertiary

Donor Selection Criteria

Opportunistic Infections

Organ Preservation

Pain, Chronic – Management

 

 

CATEGORYROTATIONS

BROAD

Surgical Conditions

FOCUSED

Surgical Conditions

Thoracic Surgery

HARPER TRANSPLANT/CT

VA COMBINED

 

Hemothorax

Pleural Effusion/Empyema

Pneumothorax

Achalasia

Dysphagia

Esophageal Diverticula

Esophageal Perforation – Iatrogenic

Esophageal Perforation – Spontaneous

Gastroesophageal Reflux/Barrett’s Esophagus

Hiatal Hernias

Mallory-Weiss Syndrome

Stricture

 

 

 

Chylothorax

Lung Cancer

Mediastinal Tumors and Cysts

Mediastinitis

Metastatic Tumors of the Lung

Superior Vena Cava Syndrome

Tracheoesophageal Fistula

Tracheoinnominate Fistula

Esophageal Caustic Ingestion

Esophageal Foreign Bodies

Esophageal Motility Disorders other than Achalasia

Esophageal Neoplasms – Benign

Esophageal Neoplasms – Malignant

 

CATEGORYROTATIONS

BROAD

Surgical Conditions

FOCUSED

Surgical Conditions

Pediatric Surgery

CHM

 

 

 

Pediatric Trauma

Abdominal Mass

Abdominal Pain – Acute

Gastrointestinal Bleeding – Lower

Hypertrophic Pyloric Stenosis

Inguinal Hernia

Intussusception

Malrotation

Meckel’s Diverticulum

Tracheal/Esophageal Foreign Bodies

Umbilical Hernia

Abdominal Wall Reconstruction

Hydrocele

 

Biliary Atresia

Choledochal Cysts

Congenital Aganglionosis (Hirschsprung’s Disease)

Congenital Diaphragmatic Hernia

Cryptorchidism

Duodenal Atresia/Stenosis

Esophageal Atresia/Tracheoesophageal Fistula

Gastroschisis/Omphalocele

Imperforate Anus

Intestinal Atresia/Meconium Ileus

Necrotizing Enterocolitis

Neuroblastoma

Wilms Tumor

 

 

CATEGORYROTATIONS

BROAD

Surgical Conditions

FOCUSED

Surgical Conditions

Endoscopy

DRH ENDOSCOPY

 

 

 

Gastrointestinal Bleeding – Upper

Peptic Ulcer Disease with Bleeding

Stress Gastritis

Clostridium Difficile-Associated Diarrhea

Colonic Polyps

Diverticular Bleeding

Gastrointestinal Bleeding – Lower

Hemorrhoids

 

Anal Dysplasia/Sexually Transmitted Diseases

Fecal Incontinence

Rectal Prolapse

 

 

CATEGORYROTATIONS

BROAD

Surgical Conditions

FOCUSED

Surgical Conditions

 

Breast

Surgery

 

KCC

BREAST

 

Atypical Ductal Hyperplasia

Benign Disease – Fat Necrosis

Breast Cancer – Hereditary

Breast Cancer – Inflammatory

Breast Cancer – Male

Breast Cancer – Occult with Axillary Metastasis

Breast Cancer – Paget’s Disease of the Nipple

Breast Cancer – Phyllodes Tumor

Breast Cancer during Pregnancy and Lactation

Breast Mass

Ductal Carcinoma In Situ

Fibroadenoma

Fibrocystic Breast Changes

Galactocele

Gynecomastia

Intraductal Papilloma

Invasive Ductal Carcinoma

Invasive Lobular Carcinoma

Lobular Carcinoma In Situ

Mastitis and Abscess

Mondor Disease

Nipple Discharge

Radial Scar

 

Postmastectomy Reconstruction Options

 

 

 

CATEGORYROTATIONS

BROAD

Surgical Conditions

FOCUSED

Surgical Conditions

 

Burn Surgery

 

DRH SICU/BURNS

 

 

 

Burns – Electrical and Chemical

Burns – Flame and Scald

Frostbite and Hypothermia

Smoke Inhalation Injury and Carbon Monoxide Poisoning

 

 

CATEGORYROTATIONS

BROAD

Surgical Conditions

FOCUSED

Surgical Conditions

 

Head and Neck Surgery

 

 

VA Combined

 

Neck Mass – Evaluation

Upper Airway Obstruction

 

Oral Cavity/Pharynx, Laryngeal, and Salivary Gland Cancer

 

 

CATEGORYROTATIONS

BROAD

Surgical Conditions

FOCUSED

Surgical Conditions

 

Minimally Invasive Surgery

 

HARPER D

 

 

Femoral Hernia

Inguinal Hernia

Miscellaneous Hernias

Prosthetic Mesh Infections – Management

Umbilical and Epigastric Hernias

Ventral Hernia

 

Morbid Obesity

 

 

CATEGORYROTATIONS

BROAD

Surgical Conditions

FOCUSED

Surgical Conditions

 

Urology

 

DRH Urology

 

 

Genitourinary Neoplasms

Obstructive Uropathy and Urolithiasis

Ureteral Injury – Iatrogenic

 

CATEGORYROTATIONS

BROAD

Surgical Conditions

FOCUSED

Surgical Conditions

Plastic Surgery

 

DRH Plastics

Abdominal Wall Reconstruction

 

 

The following tables represent the “technical milestones” in the Practice Domain of Performance of Operations and Procedures.  These operations/procedures are assigned to the indicated rotations for the 2018-2019 program year and can also be found within the individual rotational goals and objectives.

 

PRACTICE DOMAIN: PERFORMANCE OF OPERATIONS & PROCEDURES (POP)

MILESTONES: PC3 and MK2      “Technical Milestones”

 

CATEGORYROTATIONSEssential-Common Operations Essential-Uncommon OperationsComplex Operations

 

Trauma/Acute Surgery

 

DRH GOLD

 

DRH BLUE/

GREEN

 

 

 

Tracheostomy

Focused Abdominal Sonography for Trauma (FAST)

Gastrointestinal Tract Injury – Operation

Temporary Closure of the Abdomen

Wounds, Major – Debride/Suture

Exploratory Laparotomy – Open

Splenectomy – Open

Anorectal Abscess – Drainage

Soft Tissue Infections – Incision, Drainage, Debridement

 

 

 

Cricothyroidotomy

Abdominal Aorta or Vena Cava Injury – Repair

Bladder Injury – Repair

Cardiac Injury – Repair

Carotid Artery Injury – Repair

Duodenal Trauma – Management

Esophageal Injury – Operation

Exploratory Laparoscopy

Exploratory Laparotomy

Fasciotomy for Injury

Hepatic Injury – Packing and Repair

Neck Exploration for Injury

Pancreatic Injury – Operation

Renal Injury – Repair/Resection

Splenectomy/Splenorrhaphy

Thoracoscopy for Management of Hemothorax

Truncal and Peripheral Vessels – Repair

Ureteral Injury – Repair

Intra-abdominal Abscess – Drainage

Hepatic Abscess – Drainage

Pancreatic Debridement

Pancreatic Pseudocyst – Drainage

Splenectomy/Splenorrhaphy – Partial

Duodenal Perforation – Repair

Vagotomy and Drainage

Complex Wound Closure

 

Burn Debridement and Grafting of Major Burns

Hepatic Injury – Resection

Tendon – Repair

Pancreatectomy – Frey and Beger Procedures

Pancreaticojejunostomy – Longitudinal

 

 

CATEGORYROTATIONSEssential-Common Operations Essential-Uncommon OperationsComplex Operations

 

General Surgery

 

HARPER A/C

 

SINAI-GRACE

 

VA COMBINED

 

ST. MARY

 

MUSKEGON

 

 

 

Inguinal and Femoral Hernia – Open Repair

Ventral Hernia – Laparoscopic Repair

Ventral Hernia – Open Repair

Cholecystectomy with or without Cholangiography – Laparoscopic

Cholecystectomy with or without Cholangiography – Open

Gastrostomy – Open

Gastrostomy – Percutaneous Endoscopic

Adhesiolysis – Open

Feeding Jejunostomy – Laparoscopic

Feeding Jejunostomy – Open

Ileostomy

Ileostomy Closure

Small Intestinal Resection – Open

Appendectomy – Laparoscopic

Appendectomy – Open

Colectomy, Partial – Laparoscopic

Colectomy, Partial – Open

Colostomy

Colostomy Closure

Anal Fistulotomy/Seton Placement

Anal Sphincterotomy – Internal

Anorectal Abscess – Drainage

Banding for Internal Hemorrhoids

Hemorrhoidectomy

Perianal Condylomas – Excision

Pilonidal Cystectomy

Peritoneal Dialysis Catheter Insertion

Lymph Node Biopsy

 

Abdominal Wall Reconstruction – Components Separation

Miscellaneous Hernias – Repair

Cholecystostomy

Choledochoenteric Anastomosis

Choledochoscopy

Common Bile Duct Exploration – Open

Gallbladder Cancer, Incidentally Noted – Operation

Antireflux Procedure – Open

Paraesophageal Hernia – Open Repair

Gastrectomy – Partial/Total

Colectomy – Subtotal (with Ileorectal Anastomosis/Ileostomy)

Anal Cancer – Excision

Rectal Prolapse – Repair

Hysterectomy

Salpingo-Oophorectomy

Nerve Block – Digital

Nerve Block – Intercostal

 

 

Diaphragmatic Hernia – Repair

Bile Duct Cancer- Operation

Bile Duct Injury – Acute Repair

Transduodenal Sphincteroplasty

Ultrasound of the Biliary Tree

Postgastrectomy Syndromes – Revisional Procedures

Stricturoplasty for Crohn’s Disease

Coloproctectomy – Total (with Ileorectal Pull-Through)

Anorectal Fistulae – Complex Repair

Hemorrhoidectomy – Stapled

Incontinence/Constipation – Operation

En Bloc Abdominal Organ Retrieval

Live Donor Hepatectomy

Live Donor Nephrectomy

Liver Transplant

Pancreas Transplant

Renal Transplant

Renal-Pancreas Transplant

Cesarean Section

Nerve Block(s) – Peripheral other than Digital

 

 

CATEGORYROTATIONSEssential-Common Operations Essential-Uncommon OperationsComplex Operations

 

Surgical Oncology

 

HARPER A

 

Melanoma – Wide Local Excision

Sentinel Lymph Node Biopsy for Melanoma

Skin/Soft Tissue Lesions – Excisional and Incisional Biopsy

Peritoneal Lesion – Biopsy

Hepatic Biopsy – Open

 

 

Pancreatectomy – Distal

 

 

Adrenalectomy

Ilioinguinal – Femoral Lymphadenectomy

Soft Tissue Sarcoma – Resection

Pseudomyxoma – Operation

Retroperitoneal Lymph Node Dissection – Open

Bile Duct Neoplasms – Operation

Gallbladder Cancer – Operation, Planned

Hepatic Ultrasound – Intraoperative

Segmentectomy/Lobectomy – Open

Ampullary Resection for Tumor

Pancreatectomy – Total

Pancreatic Ultrasound – Intraoperative

Pancreaticoduodenectomy

Rectal Cancer – Abdominoperineal Resection and Pelvic Exenteration

Rectal Cancer – Transanal Resection

 

CATEGORYROTATIONSEssential-Common Operations Essential-Uncommon OperationsComplex Operations

 

Vascular Surgery

 

HARPER B

 

VA COMBINED

 

 

 

Amputations – Lower Extremity

Carotid Endarterectomy

Embolectomy/Thrombectomy – Arterial

Venous Insufficiency/Varicose Veins – Operation

Arteriovenous Graft/Fistula

Percutaneous Vascular Access

Venous Access Devices – Insertion

 

 

 

Abdominal Aortic Aneurysm – Endovascular/Open Repair

Aortofemoral Bypass

Extra-anatomic Bypass

Femoral-popliteal Bypass

Infrapopliteal Bypass

Sclerotherapy – Peripheral Vein

Superior Mesenteric Artery Embolectomy/Thrombectomy

 

 

 

Arterial Occlusive Disease – Endarterectomy

Endovascular – Therapeutic, Including Thrombolysis

Femoral Aneurysm – Repair

Graft-enteric Fistula – Management

Infrarenal and Aortoiliac Aneurysm – Repair

Popliteal Aneurysm – Repair

Pseudoaneurysm – Repair

Suprarenal Abdominal Aortic Aneurysm – Repair

Ultrasound in Diagnosis of Vascular Diseases

Visceral Occlusive Disease – Operation

Portal-Systemic Shunt

 

CATEGORYROTATIONSEssential-Common Operations Essential-Uncommon OperationsComplex Operations

 

Critical Care

 

HARPER

SICU

 

DRH

SICU/BURNS

 

 

Airway Management/Ventilator Management

Arterial Catheter Placement

Central Venous Catheter Placement

Compartment Pressures (Abdomen, Extremity) – Measurement

Defibrillation and Cardioversion

Endotracheal Intubation

Paracentesis

Pulmonary Artery Catheter Placement

Thoracentesis

Ultrasound Use for Intravascular Access

Urinary Catheterization

Bronchoalveolar Lavage

Bronchoscopy

 

 

Cardiac Pacing

Transvenous Temporary Pacemaker

 

 

CATEGORYROTATIONSEssential-Common Operations Essential-Uncommon OperationsComplex Operations

 

Thoracic Surgery

 

HARPER TRANSPLANT/CT

 

VA COMBINED

 

Chest Tube Placement and Management

 

 

 

 

Exploratory Thoracotomy – Open

Exploratory Thoracotomy – Thoracoscopic

Partial Pulmonary Resection – Open and Thoracoscopic

Pericardial Window for Drainage

Esophageal Perforation – Repair/Resection

 

Empyema – Management

Pleurodesis

Esophagectomy/Esophagogastrectomy

Esophagomyotomy (Heller)

Robotic Lung Resections

Robotic Mediastinal Tumor Resections

 

 

CATEGORYROTATIONSEssential-Common Operations Essential-Uncommon OperationsComplex Operations

 

Pediatric Surgery

 

CHM

 

 

 

Inguinal Hernia – Repair

Umbilical Hernia – Repair

 

 

Intussusception – Operation

Malrotation – Operation

Meckel’s Diverticulum – Excision

Pyloromyotomy

 

 

 

 

Branchial Cleft Anomaly – Excision

Chest Wall Deformity – Repair

Diaphragmatic Hernia – Repair

Esophageal Atresia/Tracheoesophageal Fistula – Repair

Hirschsprung’s Disease – Operation

Imperforate Anus – Operation

Intestinal Atresia/Stenosis – Repair

Meconium Ileus – Operation

Necrotizing Enterocolitis – Operation

Omphalocele/Gastroschisis – Repair

Orchiopexy

Thyroglossal Duct Cyst – Excision

Wilms Tumor/Neuroblastoma – Excision

Antireflux Procedure

 

CATEGORYROTATIONSEssential-Common Operations Essential-Uncommon OperationsComplex Operations

 

Endoscopy

 

DRH ENDOSCOPY

 

 

 

Colonoscopy

Esophagogastroduodenoscopy

Proctoscopy

 

 

ERCP

 

 

CATEGORYROTATIONSEssential-Common Operations Essential-Uncommon OperationsComplex Operations

 

Breast

Surgery

 

KCC

BREAST

 

Axillary Lymphadenectomy

Axillary Sentinel Lymph Node Biopsy

Breast Biopsy with or without Needle Localization

Breast Cyst – Aspiration

Duct Excision

Mastectomy – Modified Radical

Mastectomy – Partial

Mastectomy – Simple

 

Mastectomy – Radical

 

 

 

Breast Biopsy – Image-Guided

 

 

CATEGORYROTATIONSEssential-Common Operations Essential-Uncommon OperationsComplex Operations

 

Burn Surgery

 

DRH SICU/BURNS

 

 

 

Skin Grafting

 

 

Burn Debridement and Grafting of Major Burns

 

CATEGORYROTATIONSEssential-Common Operations Essential-Uncommon OperationsComplex Operations

 

Head and Neck Surgery

 

 

VA Combined

 

 

Laryngoscopy

Parathyroidectomy

Thyroidectomy – Partial or Total

 

Ultrasound of the Thyroid

Cricopharyngeal Myotomy with Zenker’s Diverticulum – Excision

 

Modified Neck Dissection

Parotidectomy

 

 

CATEGORYROTATIONSEssential-Common Operations Essential-Uncommon OperationsComplex Operations

 

Minimally Invasive Surgery

 

HARPER D

 

 

Exploratory Laparotomy – Laparoscopic

Inguinal and Femoral Hernia – Laparoscopic Repair

Ventral Hernia – Laparoscopic Repair

Cholecystectomy with or without Cholangiography – Laparoscopic

Hepatic Biopsy – Laparoscopic

Splenectomy – Laparoscopic

Antireflux Procedure – Laparoscopic

Adhesiolysis – Laparoscopic

Feeding Jejunostomy – Laparoscopic

Appendectomy – Laparoscopic

Colectomy, Partial – Laparoscopic

 

Paraesophageal Hernia – Laparoscopic Repair

Small Intestinal Resection – Laparoscopic

 

 

Retroperitoneal Lymph Node Dissection – Laparoscopic

Common Bile Duct Exploration – Laparoscopic

Segmentectomy/Lobectomy – Laparoscopic

Morbid Obesity – Operation

 

 

CATEGORYROTATIONSEssential-Common Operations Essential-Uncommon OperationsComplex Operations

 

Urology

 

DRH Urology

 

 

Cystostomy

Hydrocelectomy

Nephrectomy

Orchiectomy

Ureteral Injury, Iatrogenic – Repair

 

 

CATEGORYROTATIONSEssential-Common Operations Essential-Uncommon OperationsComplex Operations

 

Plastic Surgery

 

 

DRH Plastics

 

Skin Grafting

 

Complex Wound Closure

 

Burn Debridement

Grafting of Major Burns

 

 

Program Coordinator – Dana Cooley
6C, University Health Center
4201 St. Antoine
Detroit, MI 48201
Phone: (313) 577-5009
Email: dcoole@med.wayne.edu