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Electives - General Surgery

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Transition to Surgical Residency

Elective Number: 3025 (arranged)

Rotation Supervisor: Drs. Anneke Schroen & Philip W. Smith

Designated Signer: Dr. Anneke Schroen (ats2x@virginia.edu)

Duration: 2 weeks

Available: 13b (3/21-4/1/2016) - Class of 2016

Report to: TBA

Time to Report: 9:00 am

Place to Report: TBA

Typical day: 9:00 am - 4:00 pm (see sample schedule)

Attendance: Attendance is mandatory - no time off allowed

Number of students per rotation: 16

Course Description: Goal:

  1. Improve student readiness for residency in a surgical discipline by allowing them to apply practical knowledge and skills needed to respond to common internship demands in standardized / simulated scenarios, such as
    1. Serving as first-responder to critically ill or unstable patients
    2. Prioritizing multiple simultaneous demands
    3. Navigating difficult or essential communications
    4. Performing basic technical skills and bedside procedures
    5. Gaining better familiarity with basic surgical equipment and procedures
    6. Executing basic documentation and order-writing tasks
    7. Functioning effectively and professionally in an inter-professional team

Content:

  1. Curricular content will be taught in all of the following settings:
    1. Classroom and small group discussion sessions
    2. Cadaver lab
    3. UVA Simulation Center
    4. UVA Clinical Skills Center
    5. Mock page program from Southern Illinois University

Course Participants:
This elective is designed for 4th year students about to enter residency in a surgical discipline. This includes general surgery, surgical subspecialties (urology, ENT, plastics, neurosurgery, orthopedics), or OB-GYN.

Learning Objectives:

  1. Outline and apply the common components of preoperative, postoperative, and admission orders.
  2. Identify the signs and symptoms of common electrolyte abnormalities in the surgical patient.
  3. Outline the management of and write appropriate orders for patients with common electrolyte abnormalities.
  4. Interpret normal and common abnormal findings on radiographs of the abdomen and chest.
  5. Interpret a standard 12-lead EKG or rhythm strip and identify common abnormalities.
  6. Interpret renal function lab abnormalities, specifically elevated BUN and/or Cr, calculate the FeNA and interpret the results.
  7. Identify and manage the patient with common or urgent perioperative problems, such as
    1. Fever
    2. Chest pain
    3. Arrhythmia
    4. Hypotension
    5. Hypertension
    6. Respiratory distress/Shortness of breath
    7. Tachycardia
    8. Mental status changes/Unresponsiveness
    9. Hypoxemia
    10. Oliguria/Anuria
    11. Urinary retention
    12. Nausea/Vomiting
    13. Hyperglycemia
    14. Venous thromboembolism
  8. Detail the standard dosages for commonly used antibiotics, pain medications, and perioperative steroid use
  9. Demonstrate the ability to follow ACLS protocols when responding to patients in cardiac or respiratory arrest
  10. Demonstrate the ability to appropriately prioritize tasks as the dynamics of a patient’s needs change
  11. Demonstrate the ability to obtain a patent airway (including Bag-Mask ventilation) and to establish IV access to support resuscitation (Technical Skills overlap)
  12. Demonstrate the ability to appropriately direct other members of the team to facilitate the care of the patient in an urgent or emergent patient care situation.
  13. Discuss role of universal precautions in all patient care settings, including utilization of contact precautions and infection control principles
  14. Demonstrate ability to maintain sterile technique in prepping and draping a patient for a procedure
  15. Outline appropriate drain management protocols for various types of surgical drains and tubes, including safe removal
  16. Demonstrate proficiency in placing a nasogastric tube
  17. Demonstrate proficiency in performing venipuncture and inserting a peripheral IV catheter
  18. Utilize doppler and ultrasound to identify relevant vasculature to facilitate safe placement of intra-vascular catheters
  19. Demonstrate proper technique for placement and removal of a central venous catheter
  20. Demonstrate proper technique in performing basic suturing and knot tying techniques.
  21. Demonstrate ability to properly dose and administer local anesthetics.
  22. Demonstrate proper technique for skin and soft tissue closure.
  23. Demonstrate ability to incise and drain a superficial abscess.
  24. Demonstrate proper technique for applying various types of surgical dressings and describe indications for each.
  25. Describe the signs and management of a postoperative superficial site infection
  26. Delineate indications for superficial wound debridement and describe appropriate techniques
  27. Demonstrate proficiency in performing bag mask ventilation
  28. Demonstrate proficiency in performing endotracheal intubation
  29. Demonstrate ability to perform CPR in accordance with ACLS protocols
  30. Describe indications for tube thoracostomy and demonstrate performance in an inanimate model
  31. Identify common surgical instruments by name that are utilized in the operating room and describe the appropriate use for each
  32. Demonstrate ability to perform basic laparoscopic skills in a simulated environment
  33. Review and prepare for the safe and appropriate use of surgical energy devices
  34. Describe the elements of and perform a pre-procedural Time-Out
  35. Perform intern level procedures in a cadaver or simulated lab setting under the supervision of a faculty member
  36. Dictate a cohesive and articulate operative report for a procedure performed in a cadaver or simulated lab setting
  37. Display compassionate communication skills and nonjudgmental behaviors
  38. Discuss the importance of timeliness as it relates to professional behavior (for example, clinic activities, documentation, timeliness for the operating room)
  39. Discuss or model constructive means of resolving unprofessional behavior in the training environment
  40. Discuss and review the ACGME resident duty hour requirements and identify professional situations in which it is acceptable to remain engaged in patient care activities beyond the duty hour restrictions.
    41. Discuss, model or review the negative connotations of communication failures
  41. Provide a framework for evaluating the facts surrounding the adverse event (e.g. presence of error or system failure, results of event analysis, etc)
  42. Demonstrate appropriate language and communication techniques for expressing regret for unanticipated outcomes, and for providing a formal apology if an unanticipated outcome was caused by an error or system failure
  43. Develop effective techniques for working with difficult patients
  44. Demonstrate effective and professional communication with nurses and/or other non-physician medical professionals through standardized clinical scenarios (e.g. mock page exercises)
  45. Demonstrate effective communication styles with patients through standardized clinical scenarios
  46. Describe and model effective methods for patient handoff during transitions of care.
  47. List the important elements of the informed consent process
  48. Develop a personalized reading plan to cover the core topics of general surgery
  49. Summarize appropriate resources to be used for ABSITE preparation
  50. Review the proper steps for preparing for an operation and identify resources to assist with this process
  51. Discuss the importance of self-reflection and incorporation of formative feedback into daily practice
  52. Review the importance of reviewing all complications, near-misses, and errors with a focus on future prevention of similar events
  53. Describe the role of morbidity and mortality conference in health care quality and patient safety
  54. Demonstrate the ability to efficiently navigate an electronic or written health record to facilitate care for a patient
  55. Demonstrate the ability to appropriately document a progress note, operative note, and consult note in a patient’s chart
  56. Demonstrate the ability to appropriately document supervision and chain of command for decisions, e.g. “Discussed with Dr. X”
  57. Demonstrate the ability to disagree in a professional manner with consultants in writing