Surgery Rotation

GOALS:

  1. Recognize and evaluate patients who may require major surgery and refer appropriately.
  2. Stabilize a patient with a surgical emergency until transport or consultation available
  3. Competently evaluate and manage patients in the pre-op and post-op phases of care.
  4. Have appropriate minor surgical skills.
  5. Provide advice, counseling, and support to the patient facing therapeutic options that include surgery, and to the family of a surgical patient.
  6. Be a technically skillful first assistant in the operating room.

 

OBJECTIVES:

Knowledge:

  1. Know the indications for the major common surgical procedures, including but not limited to the following:  Appendectomy, Cholycystectomy, Heniorrhaphy, Bowel resection and bypass, Exploratory Laparotomy, Coronary Artery Bypass, Heart Valve Replacement, Thorascopy, Pulmonary Lobectomy, Thyroidectomy, Amputations, and Arterial Grafts.
  2.  Explain common surgical procedures to a lay person discussing the procedure itself, the risks, benefits, and therapeutic alternatives. 
  3. Know the legal obligations to informed consent and manage informed consent conferences skillfully.
  4. Discuss pre-operative assessment, demonstrating familiarity with assessment of cardiac, pulmonary and renal function.
  5. Discuss metabolic and hormonal responces to surgery.
  6. Discuss the role of nutrition in surgical recovery, demonstrating expertise in evaluating nutritional status and tailoring nutritional therapy accordingly.
  7. Discuss principles of wound healing.
  8. Discuss postoperative pain management.
  9. Discuss signs and symptoms and the workup of the acute abdomen.
  10. Discuss the management of burns.

Skills:

  1. Preoperatively assess the patient's pulmonary, cardiac, renal, fluid and nutritional status and make appropriate plans to minimize complications.
  2. Proficiently manage post op fluid and electrolyte balance, nutrition, pain, respiratory status and wound care.
  3. Identify and manage wound infections appropriately.
  4. Maintain ACLS certification.
  5. Be proficient in sterile technique and basic tissue handling principles.
  6. Be proficient in handling surgical instruments, tying surgical knots and providing exposure of the operating site for the primary surgeon.
  7. Be able to perform office surgery in a technically and psychosocially proficient manner.
  8. Be able to perform the following minor surgical procedures as required in the course of patient care in the Ambulatory Continuity Clinic, emergency department and hospital.

Required Procedures:

Central venous access
Incision and Drainage
Simple Laceration Repair
Debridement
Biopsy and excision of skin lesions.
CPR
Intubation
Toenail removal
Digital Blocks
Hemostasis
Wart Removal
Joint Aspiration
Removal of simple foreign body (eye, ear, nose)

Option Procedures

Vasectomy
Arterial Line Placement
Paracentesis
Thoracentesis
Venous Cutdown
Chest Tube Insertion
Treatment of thrombosed hemorrhoids
Swan-Ganz placement.
Bladder Aspiration
Gastric Lavage
Laryngoscopy
Regional Blocks
Cyst Aspiration.

TEACHING STRATEGIES:

  1. 8 weeks of general surgery is required in 2 one month long block rotations in the first and second year.
  2. Experience with stabilization of major trauma or major surgical emergencies will be obtained longitudinally in the Emergency Room
  3. Opportunities to perform elective and emergent office procedures occur throughout the residents Ambulatory Continuity Clinic.
  4. ACLS is offered each summer.
  5. ATLS is not mandatory but is recommended for residents who will be staffing major Emergency Rooms in the future.

Required reading material for the Surgery Rotation

Office Surgery
Perioperative Care

Resident Advice:

Getting ready: Find out when/where to meet & the clinic schedule.

Dress: Scrubs on non-clinic days. White coat for walking around the hospital. Professional attire for clinic days.

Doctor Profile:

Dr. Lane is very enthusiastic, full of energy, and does a lot for our patients.  You may work with 

Dr. Smith if Dr. Lane is on vacation. He is particular about his IV Fluid & antibiotics. Confirm with him before ordering changes.

Dr Girard.

Dr. Schaeffer is someone you may work with in the future. She is an SCFM residency advocate.

What to expect/do:
o       Round on pts with Dr. Lane. Usually no pre-rounding is required. Find out.
o       Excellent time to get experience with colonoscopy, wound care, etc.
o       The more interest you show, the more opportunities you will be given.
o       Dr. Lane will work you as hard as you let him. He will try to recruit your help often. The reward is opportunities for lots of experience in procedures.
o       You will also see inpatient consults before attending & then report back to them.  You will then likely dictate the Consult H&P (consult dictation code is 04)

You may also asked to be on general surgery call or trauma call with attendings.

Operative Note

Preop Diagnosis:
Postop Diagnosis:
Procedure:
Surgeon:
Assist:
Findings:
Anesthesia:
Fluids:
Estimated Blood Loss:
Drains:
Specimens:
Complications:
Condition: