Surgery (PGY-1)

Henry Ford Hospital

Description of Rotation or Educational Experience

This is a one-month rotation in one of the three General Surgery/Trauma services (Red, Blue, Green), each staffed by a minimum of three senior staff surgeons. This rotation provides a concentrated experience in the evaluation, operative, and nonoperative management, an inpatient as well as outpatient follow up of patients with surgical problems. Responsibilities of the service are to provide day-to-day care of patients admitted to the surgical service as well as consultative service for other hospitalized patients. In addition, each teach is responsible for providing resident coverage for the outpatient clinics, which encompasses both new elective surgical evaluations as well as follow up visits. Red and Blue surgery services have weekly dedicated outpatient clinics that form the core outpatient clinic responsibilities for the general surgery house officers; as such, attendance at those clinics is mandatory. While on the Green Service, the house officers will be assigned by the senior level resident to attend the individual senior staff clinics. As a part of this coverage the team "on call" provides surgical consultative coverage of the emergency department and serves as the "trauma team".

Patient Care

Goal

Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Residents are expected to:

Competencies

• Receive training to perform those clinical procedures required for their future practices in the ambulatory and hospital environments.
• Receive training that focuses on the core principles of Family Medicine: including Continuity of Care, Family-Oriented Comprehensive Care Experience, Family Medicine Center Experience, Patient Care Experience, FMC Continuity and Accessibility, Medical/Surgical Experiences, and Inpatient Experiences.

Objectives

By the end of the rotation the resident is expected to be able to:

• Recognize proper treatment course for most common surgical issues by subspecialty.

The resident is encouraged to familiarize themselves with the following procedures:

• Laceration repair
• Lipoma removal

· Incision and drainage of abcesses

• Wound debridement
• Cyst aspiration
• Local anesthesia
• Central line placement
• Wound closure
• Skin excision

Medical Knowledge

Goal

Residents 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. Residents are expected to:

Competencies

• This rotation fulfills family medicine-specific training and educational requirements for Care of the Surgical Patient, with special emphasis on the diagnosis and management of surgical disorders and emergencies and the appropriate and timely referral of surgical cases for specialized care.

Objectives

By the end of the rotation the resident is expected to be able to:

• Demonstrate basic knowledge of surgical and anesthetic risks for common general surgeries and common anesthetic modalities.
• Demonstrate proficiency in preoperative assessment, including appropriate use of preoperative labs, the need for blood consent, EKG, cardiac risk assessment, bowel preparation, and fluid management.

Practice- Based Learning and Improvement

Goal

Residents 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. Residents are expected to develop skills and habits to be able to :

Competencies

• Identify strengths, deficiencies and limits in one’s knowledge and expertise;
• Locate, appraise and assimilate evidence from scientific studies related to their patients’ health problems

Objectives

By the end of the rotation the resident is expected to be able to:

• Review operative logs and complete a simplified log to track patients and procedures during rotiation.
• Attend weekly morbidity and mortality conceferences and complete at least one full M&M.
• Attend a session regarding trauma registries and pass the post-test.

Systems Based Practice

Goal

Residents 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. Residents are expected to:

Competencies

• Work effectively in various health care delivery settings and systems relevant to their clinical specialty
• Coordinate patient care within the health care system relevant to their clinical specialty

Objectives

By the end of the rotation the resident is expected to be able to:

• Utilize cost-effective resources in order to integrate in-hospital and out-patient medical care.

Professionalism

Goal

Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to demonstrate:

Competencies

• Responsiveness to patient needs that supersedes self-interest
• Respect for patient privacy and autonomy

Objectives

By the end of the rotation the resident is expected to be able to:

• Approach patients in a cultural sensitive way, while preserving confidentiality.

Interpersonal and Communication Skills

Goal

Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates. Residents are expected to:

Competencies

• Communicate effectively with physicians, other health professionals, and health related agencies
• Act in a consultative role to other physicians and health professionals

Objectives

By the end of the rotation the resident is expected to be able to:

• Listen to patient’s concerns regarding surgery or anesthetic modalities.
• Communicate surgically-relevant information to patients in a caring and effective way.
• Effectively communicate consultant recommendations to primary care teams in order to optimize patient care.

Teaching Methods

What teaching methods are you using on this rotation or educational experience?

• Didactic lecture
• Direct role-modeling and observation

Assessment Method (residents)

How do you measure the resident’s performance on this rotation or educational experience?

• Faculty evaluations of the rotator’s performance
• Real-time feedback during direct observation
• Trauma registry post-test
• Successful completion of M&M report

Assessment Method (Program Evaluation)

How do you evaluate whether this educational experience is effective?

• Resident evaluation of rotation

Level of Supervision

How is the resident supervised on this rotation?

• Directly by senior resident
• Directly by attending physicians

Educational Resources

List the educational resources

• Relevant orientation materials are indicated and/or given at the beginning of the rotation and used throughout.

Resources and people residents have identified as useful, and encourage new rotators to become familiar with:

• Contact Tony Hadad for access to Surgery website “Blades” and your team
• Ask Chief of Surgery about schedule, rounding times, lists of dates, etc.
• Be ready to start early in a.m.
• Have proper sign out from other team when on call