Surgery Henry Ford Wyandotte (PGY-1)

Description of Rotation or Educational Experience

During the rotation, residents develop their core understanding and experience with surgical problems as appropriate for their level and future interests. They will strive to function as full members of the junior house officer front lines on the surgical team.

The purpose of this rotation is to provide you with hands-on experience in the realm of private practice general surgery. To that extent, you will be paired with Dr. Krishna Sawhney, one of the senior staff members of the department of surgery who has a patient care service at Wyandotte Hospital. The rotation shall provide you with the opportunity to hone your skills in the evaluation, operative and nonoperative management on inpatient as well as outpatient follow up of patients with general and vascular surgical problems. With your mentor, you are to provide day-to-day care of patients admitted to the Wyandotte surgical service as well as consultative service for other hospitalized and emergency department patients. In addition, you are responsible for providing coverage of the staff surgeon’s outpatient clinics, which encompass both new elective surgical evaluations as well as follow up visits. Administrative responsibilities are to include the timely completion of histories and physical examinations, operative notes, progress notes and discharge summaries. You will maintain the same call schedule as your preceptor, with the exception that you will be freed from all patient care responsibilities for one out of every seven days.

Upon completion of this rotation, you will have gained significant independent experience in the evaluation and management of both elective and acute surgical problems, in operative and in pre- and post-operative evaluation skills. In addition, you will learn responsibility and continuity of patient care as you follow your patients from outpatient or emergency room consultation and then through their operative and post-operative course in both the inpatient and outpatient settings. Constant consultation with and involvement of the staff surgeon is expected.

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:

• Perform a satisfactory history and physical for a surgical patient.
• Perform satisfactory abdominal examinations in the surgical patient.
• Efficiently evaluate and manage new surgical patients.

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;
• Incorporate formative evaluation feedback into daily practice
• Participate in the education of patients, families, students, residents and other health professionals, as documented by evaluations of a resident’s teaching abilities by faculty and/or learners

Objectives

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

• Gain exposure to surigical mobidity and mortality, operative logs, and trauma registries and demonstrate understanding of their use.
• Document outcomes and other follow-up of trauma and emergency abdomen cases.
• Keep a procedure log up to date on a daily basis
• Demonstrate effective teaching of medical students as appropriate for level of training.

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:

• Demonstrate understanding of the trauma systems
• Appropriately refer to rehab centers
• Work with patient care managers to coordinate patient discharge processes.

Professionalism

Goal

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

Competencies

• Compassion, integrity, and respect for others
• Accountability to patients, society, and the profession

Objectives

During the rotation, the resident is expected to:

• Be a role model for medical students
• Respond and incorporate constructive feedback
• Work effectively with ancillary staff
• Respond appropriately to difficult patient situations

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 patients and families across a broad range of socioeconomic and cultural backgrounds
• Maintain comprehensive, timely, and legible medical records

Objectives

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

• Demonstrate good history taking and listening skills

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
• Resident is to generate self-observed behavior reports in each competency at least weekly over the course of this rotation.

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 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 Eileen for your schedule
• Contact Dr Sawhney for clinic schedule & surgery days
• Make sure you get your evaluation completed