The purpose of the Wound Care rotation is to familiarize
family medicine residents with all aspects involved in the diagnosis,
treatment, and management of wound care patients. Residents will gain
confidence and improved skills in treating patients with both acute as well as
chronic wounds in an outpatient clinic, the Washington Regional Medical Center
Wound Care Clinic, with the support of a multidisciplinary team including
surgeons and certified wound care nurses. This second year required
rotation will be two weeks in length. Supervision is provided by the staff
physicians at the Wound Care Clinic.
Goal I: To gain the knowledge and skills to
manage patients with acute and chronic wounds.
Goal II: Recognize the need for proper referral
and consultation to a wound care specialist for those problems that are beyond
his/her capabilities.
Patient Care
Goal
Residents will provide patient care under the supervision of the Wound Care
Clinic staff physicians that is effective and appropriate. Residents are
expected to:
Competencies
Learn basic wound care management.
Objectives
The resident will
Make informed decisions about diagnostic and therapeutic interventions based on
patient preference, evidence based medicine and clinical judgment.
Carry out incision and drainage as well as wound packing and dressing.
Medical Knowledge
Goal
Residents will demonstrate established and evolving biomedical, clinical,
epidemiological, and socio behavioral sciences as well as the application of
this knowledge to patient care. Residents are expected to:
Competencies
The resident will gain cognitive knowledge and experience in
the diagnosis and management of the following:
1.Peripheral artery disease
2.Venous insufficiency
3.Lymphedema
4.Pressure ulcers
5.Diabetic ulcers
6.Non-healing surgical wounds
7.Burns
8.MRSA abscesses
9.Skin cancers
Objectives
1.Performance of history and problem-focused physical examination
2. Wound Assessment including:
a. Measurements including length, width, depth,
undermining, tracks and tunnels
b.Evaluation of wound base
c. Evaluation of periwound tissue
d. Bedside vascular assessment
3.Interpretation of radiographs, nuclear medicine exams, TCPO2 exams, and vascular studies
4. Interpretation of laboratory tests
5. Performance of procedures under supervision:
a.Sharp debridement
b.Apligraf application
c.Biopsy
d.Application of compression wraps
e.Chemical cauterization
f.Incision and drainage
g.Removal of various foreign bodies
h.Nail and callous care
6.Efficient interaction with other physicians and hospital support staff
7.Familiarity with community resources and utilization of appropriate services
8.Patient education and preventative health care
9.Timely and proficient medical records documentation
10. Compassionate patient and family counseling
11. Cost effective case management as patient advocate
12. Selection of appropriate topical dressings and treatment modalities
13. Awareness that informed consent applies not only to invasive surgical procedures,
but also to every clinical decision. If the patient lacks decision-making
capacity, the physician should seek consent from the appropriate substitute
decision maker
14. Awareness of the importance of identifying goals of treatment with the
patient. Is the goal curative or palliative?
15. Awareness of the benefits and limitations of advance directives, living
wills, and durable powers of attorney
16. The importance of assessing pain levels with these patients with each visit
and making modifications in pain management as needed or referral to specialist
in pain management
17. Basic understanding of the role of hyperbaric oxygen, its benefits and
limitations in wound healing
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
The resident will understand the limitations of the family physician's ability
to provide appropriate care and the need for consultation.
The resident will locate, appraise, and assimilate evidence from scientific
studies related to their patients' problems.
The resident will use
information technology to support their education such as UpToDate
and DynaMed.
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 optimal patient care systems.
Practice cost effective health care and resource utilization that does not
compromise quality of care.
Objectives
The resident will be able to:
1.Understand available options for treatment.
2.Understand the indications and risks of certain procedures.
3.Understand informed consent
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
The resident will learn to advocate for the patient regardless of their
diversity or socioeconomic status
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 communicate effectively with other physicians, staff, patients and
families.
Competencies
The resident will communicate effectively with physicians, other health
professionals, health related agencies, patients and their families.
Objectives
The resident will learn to communicate with patients and families tailored to
the knowledge and ability to understand the need for specific treatments.
Teaching Methods
Direct preceptor/resident interaction in the treatment of
wound care patients with the support of a multidisciplinary team.
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 Regional Wound Care Clinic:
Barbul, A, Pines, E, Caldwell, M, Hunt, T, Growth Factors and
Other Aspects of Wound Healing: Biological and Clinical Implications. New York,
Liss, Inc, .
Davis, JC, Hunt, TK, Problem Wounds: The Role of Oxygen. New
York, Elsevier Science Publishing.
Kindwall, EP, Hyperbaric Medicine Practice, Flagstaff, AZ,
Best Publishing.
