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PGY- 2 YEAR

Goals:
- To reinforce and enhance those knowledge-based and performance skills acquired in the first year of training.
- Recognize and manage complex critical care problems.
- To learn the management of burn-injured patients.
- To demonstrate an understanding of organ transplantation and  immunosuppression.
- To learn the fundamentals of trauma resuscitation.
- To become expert at bedside procedures and simple operations.
- To develop leadership and teaching skills.
- To enhance professional and ethical behavior
- To develop differential diagnosis for emergent surgical problems (e.g. abdominal pain)
- To effectively communicate with other residents and attending staff.

1. To manage more complex ICU problems.
Competency-Based Knowledge Objectives:
1a. Recognize and treat life-threatening physiological abnormalities such as shock, intracranial hypertension, cardiac arrhythmias, airway problems, acute acid-base and electrolyte abnormalities, cardiac and respiratory failure.
1b. Recognize perioperative abnormalities and initiate treatment.
1c. Formulate and initiate a plan of care for the critically ill patient.
1d. Present significant events from previous 24 hours at morning rounds, including physical exam, laboratory and radiographic data, and treatments administered.
1e. Safely transport critically ill patients within the hospital.
1f. Recognize and evaluate bleeding disorders.
1g. Recite the components of cardiac output
1h. Discuss nosocomial infections and their prevention.
1i. Explain arterial blood gases
1j. Discuss the mechanism of upper GI bleeding.
1k. Describe the different modes of surgical nutrition.
1l. Discuss the indications for supplemental nutrition
1m. Explain fluid and electrolyte balance.
1n. Describe the differences between septic, hypovolemic and neurogenic shock
1o. Discuss the mechanism of shock from pulmonary embolis.
1p. Explain the indications and side effects for various anti-arrthymic agents
1q. Describe the indications and complications of CVP catheter, Swan Ganz catheter, aterial line, pericardiocentesis and endotracheal intubation.
1r. Outline the indications for transfusion of different blood products.
1s. Describe the endocrine and metabolic effects of trauma.
1t. Describe the commonly used indications for initiation of ventilator support.
1u. Describe the difference between pre-renal and acute renal failure.
1v. Discuss the DNR rules and regulations.
1w. Identify potential organ donors.
1x. Describe the signs and symptoms of acute adrenal insufficiency.
Competency-Based Performance Objectives:
1. To explain indications and demonstrate proper technique for the safe performance of CVP, Swan-Ganz, arterial catheterization, endotracheal intubation, ICP monitoring, peritoneal lavage, CAVH (credentials book list).
-  To effectively communicate with patients' family and medical staff.
-  To be ACLS certified.
-  To control external blood loss.
-  To perform a tracheostomy
-  To manage fluid orders
-  To determine ventilator settings
-  To determine the need for and duration of antibiotic therapy
-  To manage non-operative multi-organ system trauma patients.
-  To manage the septic patient.
1a. Assessment Measure - Attending and resident evaluations.
1b. Assessment Measure - Direct observation.
1c. Assessment Measure - ACLS certification
1d. Assessment Measure - ABSITE exam.

2. Burn Management:
Competency-Based Knowledge Objectives:
2a. Recognize and initiate transfer of appropriate patients to a Burn Center.
2b. Evaluate burn center admissions and formulate resuscitative maneuvers including fluid and electrolyte replacement and wound management.
2c. Explain physiology of burns including fluid, electrolyte, airways, nutrition, wound care, etc.
2d. Describe the histologic and functional anatomy of the skin and subcutaneous tissues
2e. Discuss an initial treatment plan for stabilization and fluid resuscitation and stabilization of a burn patient.
2f. Describe the clinical factors necessitating immediate intervention to preserve life, limb, and function.
2g. Analyze the principles of systemic and local antibacterial agents.
2h. Explain the special circumstances created by electrical, chemical and inhalation burn injury.
2i. Describe compartment syndromes.
Competency-Based Performance Objectives:
2j. Become proficient at debridement, fasciotomy, skin grafts, etc.
2k. Implement fluid resuscitation for children and adults.
2j. Select and apply appropriate dressings and antibacterials
2a. Assessment Measure - Rotation evaluation.
2b. Assessment Measure - ABSITE exam
2c. Assessment Measure - Observation of skills

3. Organ Transplantation and Immunosuppression:
Competency-Based Knowledge Objectives:
3a. Explain delayed hypersensitivity reaction, and B and T cell function.
3b. List criteria for major organ transplantation (i.e. kidney, liver, pancreas, heart, lung.).
3c. Discuss pre-operative evaluation of transplant patient.
3d. Recognize early complications including rejection, technical, infection, etc.
3e. List immunosuppressive drugs and their mode of action.
3f. Explain and recognize specific complications related to immunosuppression.
3g. Assist at surgery and diagram necessary anatomy.
3h. Learn techniques of dialysis (hemodialysis, peritoneal dialysis) and their complications.
3i. Explain tissue typing (HLA, etc.)
Competency-Based Performance Objectives:
3j. Evaluate potential candidates for living related and cadaveric organ transplantation.
3k. Perform vascular access for hemodialysis.
3j. Perform peritoneal dialysis catheter placement.
3l. Assist during renal and hepatic transplants.            
3a. Assessment Measure - Rotation Evaluation
3b. Assessment Measure - ABSITE exam.

4. Emergency Medicine
Competency-Based Knowledge Objectives:
4a. Describe the initial management of the injured patient.
4b. Outline the basic principles of triage in the ER.
4c. Derive a differential diagnosis for the patient with abdominal pain.
4d. Differentiate medical from surgical causes of abdominal pain.
4e. Determine appropriateness of admission or discharge from ER.
4f. Determine when consultation is needed.
4g. Evaluate patients with airway obstruction, hematuria and soft tissue injuries.
4h. Evaluate patient with gastrointestinal bleeding.
4i. Evaluate young women with lower abdominal and pelvic pain.
4j. Describe the requirements for an informed consent in the emergency setting.
4k. Describe the indications for emergency thoracotomy
4l. Function as a surgical consultant to the emergency room.
4m. Manage common benign gynecologic conditions (e.g. PID, ovarian cysts).
Competency-Based Performance Objectives
4n. Perform credentialed procedures (e.g. CVP, chest tube placement)
4o. Perform peritoneal lavage.
4p. Transport intubated patients to radiology and operating room.
4q. Evaluate need for blood product replacement.
4r. Splint simple extremity fractures.
4s. Dress wounds.
4t. Obtain hemostatis
4u. Learn to perform pelvic examinations and correlate this with diagnostic tests and operative findings (including emergency lower abdominal/pelvic pain).

5. Trauma:
Competency-Based Knowledge Objectives:
5a. Explain the ABC's of resuscitation.
5b. Discuss pathophysiology of hemorrhagic shock.
5c. Recite fluid, electrolyte, and blood replacement in the trauma patient.
5d. Recognize associated injuries including CNS, neck fracture, orthopedic, etc.
5e. Become certified in ATLS.

6. Orthopedic Surgery
Competency-Based Knowledge Objectives:
6a. Fracture assessment and basics of fracture management.
6b. Physiology of bone healing.
6c. Basic understanding of techniques of closed and open reduction.
6d. Complications of orthopedic trauma, including potential for neurovascular injury and hematologic emergencies.
6e. Wound management.

4,5,6. Assessment Measure - Rotation evaluation.
4,5,6. Assessment Measure - Trauma presentation
4,5,6. Assessment Measure - ABSITE exam
4,5,6. Assessment Measure - ATLS Certification
4,5,6. Assessment Measure - Direct Observation
4,5,6 Assessment Measure - Credentials Handbook

6. Leadership and Teaching
Competency-Based Knowledge Objectives:
6a. Present cases to senior/chief residents and attendings including differential diagnosis and treatment outline.
6b. Teach medical students, interns and junior PA's and review their patient work-up.
6c. Prepare formal didactic lectures for conferences.
6d. Become facile and experienced with research resources, including computer searches and library.
6e. Perfect communication skills
6a. Assessment Measure - Faculty evaluation.
6b. Assessment Measure - Resident evaluations.
6c. Assessment Measure - Medical Student evaluations.