The purpose of the surgery rotation is to prepare
the resident for recognition of the importance of family physician and
surgeons collaborating as partners in evaluation and decision making for
the care of surgical patients. In this six-week rotation, the
PGYIl resident will develop an awareness of the principles involved in
differentiating the causative origin of clinical symptoms resulting in
the need for medical versus surgical interventions. The resident
will learn to show sensitivity to the concerns of the patients and
families regarding the potential need for surgical intervention and
post-op follow-up.
Goal I: The resident will be able to
recognize, diagnose, manage and refer for consultation the surgery
problems that may present in his/her practice.
Goal II: To provide in-patient and
out-patient learning opportunities in the area of surgery through a
two-month block rotation and continuous longitudinal experience
throughout the residency.
The Resident is expected to:
Make hospital rounds with the surgeon and provide inpatient and
outpatient surgical assistance.
Follow the surgeon in his office to gain experience in
outpatient pre-op and post-op management.
Participate in the
Outpatient Surgery Clinic held at the Northwest Family Medical
Center on every other Wednesday afternoon with Dr. Wayne Hudec,
Board Certified Surgeon.
Participate in the
Outpatient Surgery Clinic held at the Family Medical Center every
other Thursday afternoon with Dr. Wayne Hudec, Board Certified
Surgeon.
Attend two ½ day continuity clinics per week in the FMC.
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
The resident will:
Learn how to work with and consult with general
surgeons.
Be able to work in the surgical arena (OR, OP
Surgery, ER).
Understand basic surgical techniques, surgical
scrub and OR protocols.
Objectives
Residents will be oriented to the surgical
arena and will be instructed about hospital protocols and procedures
that will help facilitate a safe surgical outcome.
Residents will be involved in the “team
approach” to patient care and will learn to interact with surgical
nurses and staff, faculty, and attending physicians.
Make informed decisions about diagnostic and
therapeutic interventions based on patient information and
preferences, up to date scientific evidence and clinical judgment.
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 become familiar with:
Competencies
Competencies
The surgical approach to
:
Psychomotor Skills:
Acute Abdomen
Pre- and post-op care
Chest Trauma
Pre-op scrub
Multiple Trauma
First assist in the OR
Breast Disease
Suturing
Foreign Bodies
Central Line Placement
Lacerations
Ingrown Toenail
Thyroid Disease
Paronychia
Abscesses
Skin Lesion Removal
Cholecystectomy (Laps)
Removal Foreign Bodies
Appendectomy
Excision small cyst/tumors
Peripheral Vascular
I & D of abscess
Exploratory Laps
Thoracentesis
Emergency Airway
Treatment of Burns
Counseling Patients
Office surgical procedures
Objectives
The resident will:
Become familiar with surgical technique.
Learn and understand surgical anatomy.
Gain experience in the diagnosis and management of the following
problems/conditions:
Pancreatitis
Peptic ulcer disease
Bowel obstruction
Diverticulitis
Ischemic bowel problems
Diabetic and venous stasis foot ulcers
GI bleeding
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;
Objectives
Surgical care and trauma require an understanding of the
limitation of the family physician’s ability to provide appropriate
care and the need for consultation.
Locate, appraise, and assimilate evidence from scientific
studies related to their patients’ health problems
Obtain and use information about their own population of
patients and the larger population from which their patients are
drawn.
Use information technology to manage information, access on-line
medical information, and support their own education
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
Advocate for quality patient care and optional patient care
systems.
Know how types of medical practice and delivery systems differ
from one another including methods of controlling health care costs
and allocating resources
Practice cost-effective health care and resource utilization
that does not compromise quality of care
Objectives
The resident will:
Demonstrate an understanding of options available for surgical
treatments.
Demonstrate an understanding of the indications,
contraindications and risk of common surgical procedures.
Demonstrate competence in the informed consent process.
Professionalism
Goal
Residents must demonstrate a commitment to carrying
out professional responsibilities and an adherence to ethical
principles. Residents are expected to demonstrate:
Competencies
Sensitivity and responsiveness to a diverse patient population,
including but not limited to diversity in gender, age, culture,
race, religion, disabilities, and sexual orientation
Objectives
Surgery occurs in all areas of family medicine and the resident
will learn that cost and availability limit access to some
patients. The resident will take action on behalf of patient
regardless of ability to pay in a varied population.
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.
Objectives
Communication with surgeons requires precise description of
patient history, physical findings, lab, x-ray reports, and possible
diagnosis. The resident will increasingly become able to perform in
this area.
Communication with patients and families must be tailored to
their knowledge and ability to understand benefits and negative
outcomes of surgery. The residents will learn this skill.
Teaching Methods
In and outpatient discussion, evaluation of x-rays
and lab reports, preceptor rounds.
Assessment Method
At the conclusion of each resident rotation, the
residency coordinator sends a formative-type, rotation-specific
performance evaluation form to the rotations’ supervising physician.
When the completed evaluation is returned, the resident physician and
the resident’s faculty advisor review the evaluation and attest to
reviewing it by signing/initialing the form. Next, the program
director reviews and attests to the document. Once all three have
reviewed and attested the evaluation, it is included in the resident’s
permanent file.
Each resident is asked to evaluate the rotation and
supervising physician(s) at the end of the rotation. The
resident’s faculty advisor and program director review the evaluation
and attest to reviewing it by signing/initialing the form. These
evaluations are filed together by resident year.
Educational Resources
References available at the AHEC Library:
Pfenninger JL, Fowler GC. Procedures for primary
care physicians. St. Louis, Mo.: Mosby,
Sabiston DC Jr., Lyerly HK. Textbook of surgery: the
biological basis of surgical practice. 16th ed. Philadelphia:
Saunders
Schwartz SI. Principles of surgery. 7th
ed. McGraw-Hill
Doherty GM. Washington manual of surgery. Little,
Brown and Company
Lynge DC, Weiss BD. Surgical Problems and procedures
in primary care (20 common problems). 1st ed. McGraw-Hill
Brown, JS. Minor surgery, a text and atlas. 4th
ed. London, Arnold Publishers
