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PGY- 1 YEAR

Goal:   
- To obtain a basic understanding of the perioperative care of the surgical patient including non-operative management.
- To recognize and initiate management of post operative complications
- To care for the patient in a compassionate manner  
- To effectively communicate with the patients and their family and other health professionals
- To demonstrate professional behavior

Competency-Based Knowledge Objectives:
I. General Surgery

1A. Acquire skills needed to evaluate an elective or emergent general surgical patient and derive a differential diagnosis (including obtaining a patient's history and performing a physical examination).
1a. Assessment Measure - Review written H & P (Preceptor randomly reviews charts).
1b. Assessment Measure - Faculty and resident assessment and evaluations.

2. Understand the parameters to assess daily in the process of re-evaluating the patient's condition.   Understand why the plan of care is changed in response to these data elements.
2a. Assessment Measure - Daily Resident and Attending Rounds.

3. Recognize and/or anticipate complications in the patient's hospital care. Learn the timely and appropriate care of complications, and gain an appreciation for the appropriate interventions for major complications.
3a. Assessment Measure - Attending Rounds.

4a. Assessment Measure - ABSITE exam.
4b. Basic Science exam

5. Record accurate, concise and legible documentation in the patient's medical record, including but not limited to:
5a. History & Physical exams
5b. Pre and postoperative orders
5c. Progress notes
5d. Interventional notes
5e. Discharge summaries
5a. Assessment Measure - Preceptor chart review.

6. Prepare concise, well-organized presentations of cases for review at educational conferences (including important findings and important negative findings.)
6a. Assessment Measure - Resident and attending evaluations.
6b. Assessment Measure - Attending Rounds

7. Demonstrate professionalism and maturity at all times.   These attributes are judged by the resident's sensitivity to personal hygiene and attire eg, scrub suits are considered appropriate attire only when in the O.R.), and the quality of the resident's communication skills when interacting with patients, family members, peers, nursing, attending physicians and all levels of hospital staff.
7a. Assessment Measure - Faculty evaluations; Direct observation.

8. Competency-based Knowledge Objectives
8a. Predict patterns of presentation of malignant neoplasms.
8b. Describe the characteristics of the staging for colon cancer, breast cancer.
8c. Summarize the incidents, epidemiology, risk factors associated with breast cancer.
8d. Describe the anatomy of the GI tract including its blood supply.
8e. Explain the mechanism of referred pain in splenic rupture, biliary colic and basilar pneumonia.
8f. Define a Richter's hernia
8g. Understand normal bacterial flora and their concentrations in the GI tract
8h. Differentiate paralytic ileus from mechanical SBO
8i. Evaluate patient with abdominal pain.
8j. Explain different tests to define gall bladder disease.
8k. Explain the different laparoscopic instruments
Competency-based Performance Objectives
8l. Perform sigmoidoscopy
8m. Perform fine needle aspiration of a palpable mass
8n. Perform breast biopsy
8o. Perform an inguinal hernia repair
8p. Perform minor anorectal surgeries under supervision     
8q. Perform a complete history and physical exam on patients with cancer
8r. Perform wound suturing and knot tying
8s. Perform appendectomy
8t. Perform invasive bedside procedures - as outlined in House Staff Credentials Handbook.

II.   Surgical Specialties
1. Acquire the skills and knowledge outlined for the following specialties:
1a. Anesthesiology
Knowledge Objectives :
1a1. Medical risk assessment of patients undergoing general anesthesia, including management of pre-anesthetic medicines and dosages.
1a2. Techniques of regional anesthesia.
1a3. Techniques of general anesthesia.
1a4. Complications, contraindications and risks of each type of anesthesia.
1a5. Management of commonly occurring emergencies during anesthesia.
1a6. Management of airway with or without endotracheal intubation.
1a7. Pharmacology and physiology of anesthetic and muscle relaxant agents.
1a8. Fundamentals of intraoperative monitoring, including cardiovascular and pulmonary status, equipment usage, medical record documentation.
1a9. Treatment of common PACU problems.
1a10. Proper technique of endotracheal intubation.

1b. Emergency Medicine
1b1. Perform H & P and order appropriate laboratory data.
1b2. Derive a preliminary diagnosis and decide further assessment.
Assessment measure - Direct Observation
Assessment measure - Resident and attending evaluation.

1c. Vascular Surgery:
Competency-Based Knowledge Objectives:
1. Recognize physical findings suggestive of peripheral vascular disease.
2. Perform a history and physical exam directed at the vascular system.
3. Recognize and palpate aneurysms and discuss their natural history.
4. Explain evaluation of stroke/carotid bruit including the role of non-invasive and invasive tests.
Competency-Based Performance Objectives:
1 Perform varicose vein ligation
2 Perform Doppler evaluation of peripheral pulses
Assessment Measure - Rotation evaluation
Assessment Measure - Direct observation
Assessment Measure - ABSITE exam

1d. Head and Neck
Competency-Based Knowledge Objectives:
• Summarize the essential components of a focused history and physical examination for common ENT problems.
• Explain the principle causes of simple epistaxis and describe its management
• Describe the indications for tracheosotomy in adults and children
•  Discuss the indications for biopsy of lesions of the skin of the face and neck
•  Describe the work-up of a neck mass.
Competency-Based Performance Objectives:
•  Perform a focused ENT history and physical
•  Perform indirect laryngoscopy
•  Excise minor skin lesions
•  Perform a tracheostomy

1e. Plastic Surgery
Competency-Based Knowledge Objectives:
• Describe the basic elements of wound healing.
• Explain the basic techniques for surgical repair of superficial incisions and lacerations of the head, neck, trunk and extremities.
• Describe the physiology of various techniques of skin and tissue transplantation, including:   Skin grafts, skin flaps, muscle flaps, myocutaneous flaps.
• Explain the assessment of facial skeletal trauma (LaFort)
Competency-Based Performance Objectives:
•  Complete a comprehensive H&P   for the reconstructive surgical plastic patient
•  Evaluate and treat simple abrasions and burns of the face, trunk and extremities
•  Perform simple incisional biopsies and excise small lesions of the skin and subcutaneous tissue
•  Apply and remove dressings of the head, neck and hand
•  Debride and suture wounds and burns.
•  Harvest and apply full thickness and split thickness skin grafts

1f. Urology
Competency-Based Knowledge Objectives:
•  Discuss the components of a focused GU history and physical exam
•  Evaluate patient with renal colic
•  Evaluate patient with hematuria
•  Evaluate patient with obstructive urination
•  Discuss the differential diagnosis of a patient with testicular mass
Competency-Based Performance Objectives:
•  Complete and record a focused urological H&P
•  Manage the regulation of water, electrolytes and acid-base balance following TURP and ileal conduit
• Perform a suprapubic cystotomy
• Perform a orchiectomy under supervision
• Repair a hydrocele under supervision
•  Interpret CT scan for renal and ureteral calcification

1g. Neurosurgery
Competency-Based Knowledge Objectives:
• Discuss the components of a focused Neurosurgical history and physical exam.
• Demonstrate an understanding of the management of head injuries
• Apply knowledge of cervical and thoracolumbar spine injuries
• Demonstrate the ability to assess and manage disease of cervical and lumbar discs
• Demonstrate the ability to describe and diagnose intracranial and intraspinal mass lesions (neoplasm, abscess, hematoma).
• Discuss the different brain tumors.
Competency-Based Performance Objectives:
• Perform neurological history and physical examination of patients at various levels of consciousness
• Describe the Glascow coma scale
• Explain the effects of increased intracranial pressure.
• Perform a Burr hole under supervision.

1h. Trauma
Competency-Based Knowledge Objectives:
• Demonstrate an understanding of the pathophysiological effect of blunt and penetrating trauma.
• Describe the differences between hemorrhagic and neurogenic shock
• Outline the basic techniques of evaluation and resuscitation using the ATLS protocol.
• Discuss management of traumatic wounds.
• Discuss the management of trauma involving the muscular skeletal system including operating room treatment and placement of casts, splints and traction.
• Discuss the indications for nutritional support of a trauma patient.
• Outline the factors associated with rehabilitation in the initial and early patient care.
• Outline the indications for laparotomy, thoracotomy, and hemorrhage control.
Competency-Based Performance Objectives:

1. Recognize the patient in hemorrhagic shock.
• Insert a thoracostomy tube.
• Apply and remove all types of dressings
• Suture traumatic lacerations.