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Electives - Internal Medicine - General Medicine

General Medicine- Perioperative (formerly Gen Med Consult Service)- 1520

Selective Number: (Oasis E20p) 1520

Rotation Supervisor: Dr. Rahul Mehta

Available: all Rotations

Duration: 2 weeks

Report to: Hospitalist Co-management attending (PIC 9826)

Time to Report: 7:30 am

Place to Report: 6 East

Typical Day: 7:30 am - 5:00/6:00 pm

Number of students per rotation: 1

Course Description:

Goals and objectives:
• master the preoperative cardiac and pulmonary risk assessments of patients undergoing a variety of surgical interventions, usually noncardiac procedures
• practice evidence-based perioperative cardiac and pulmonary risk modification
• assist in the perioperative management of common stable chronic medical conditions, such as diabetes mellitus, hypertension, chronic obstructive pulmonary disease and asthma
• assist in the workup and management of acute medical problems such as infections (pneumonia, urinary tract infection, wound infection), venous thromboembolism, hypertension, atrial fibrillation, myocardial infarction, heart failure, delirium and pain management in both postoperative and other nonsurgical settings (e.g. psychiatric unit)
• assist in the management of perioperative thromboembolism prophylaxis

Student expectations:
• refine history and physical examination skills in both initial and follow-up consultations on surgical (primarily orthopedic), obstetric and psychiatric patients
• practice evidence-based medical assessments, plans and patient care on non-medical service patients
• participate in preoperative clinic assessments on surgical and obstetric patients
• enhance communication skills and professionalism with other healthcare providers in a consultative model of medical care
• enhance understanding of practice-based and systems-based learning, especially in the inpatient medical setting
• attend regular didactic teaching sessions with General Medicine Perioperative Selective housestaff and attending to enhance general medicine knowledge base
• deliver a 30 minute presentation on topic related to interesting case seen on the rotation or on a core topic related to the consult service.

References:

A. Preoperative CV and Pulmonary Risk Assessment
1. Derivation and Prospective Validation of a Simple Index for Prediction of Cardiac Risk of Major Noncardiac Surgery
2. Development and Evaluation of the Universal ASC NSQIP Surgical Risk Calculator
3. Development and Validation of a Risk Calculator for Prediction of Cardiac Risk After Surgery
4. Preoperative Assessment of the Patient with Cardiac Disease Undergoing Noncardiac Surgery
5. Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery
6. Prospective External Validation of a Predictive Score for Postoperative Pulmonary Complications

B. Perioperative Medicine Update
1. Updates in Perioperative Medicine
2. Clinical Pearls in Perioperative Medicine 2016

C. Cardiology
1. Practical Management of Postoperative Atrial Fibrillation after Noncardiac Surgery
2. Perioperative Atrial Fibrillation and the Long-term Risk of Ischemic Stroke
3. Perioperative Bridging Anticoagulation in Patients with Atrial Fibrillation
4. Myocardial Injury after Noncardiac Surgery
5. Risk of Major Adverse Cardiac Events Following Noncardiac Surgery in Patients with Coronary Stents
6. Non-cardiac Surgery in Patients with Coronary Stents: the RECO study
7. Aortic Stenosis and Perioperative Risk with Noncardiac surgery

D. Venous Thromboembolism
1. Risk Assessment as a Guide for the Prevention of the Many Faces of Venous Thromboembolism

E. Pulmonology
1. Prevention of Postoperative Pulmonary Complications
2. A Matched Cohort Study of Postoperative Outcomes in Obstructive Sleep Apnea
3. Outcomes of Noncardiac, Nonobstetric Surgery in Patients with PAH: an International Prospective Study

F. Endocrinology
1. NHS Diabetes Guideline for the Perioperative Management of the Adult Patient with Diabetes
2. Optimal Glucose Management in the Perioperative Period

G. Gastroenterology/Hepatology
1. Risk Factors for Mortality after Surgery in Patients with Cirrhosis