Competencies-Based CURRICULUM GUIDE

Transcription

1 University of Hawaii Surgical Residency Program Competencies-Based CURRICULUM GUIDE Property of: University of Hawaii Surgical Residency Program 1356 Lusitana Street, Sixth Floor Honolulu, HI 96813

2 Curriculum Guide Part 1 of 2 Goals and Objectives by Program Year

3 CURRICULUM GUIDE SURGERY TABLE OF CONTENTS Part 1 of 2 GOALS AND OBJECTIVES BY PROGRAM YEAR PAGE Introduction and Program Overview...1 General Program Goals, Objectives and Implementation...4 PATIENT CARE...4 MEDICAL KNOWLEDGE...4 PRACTICE-BASED LEARNING AND IMPROVEMENT...5 INTERPERSONAL AND COMMUNICATION SKILLS...5 SYSTEMS-BASED PRACTICE...5 PROFESSIONALISM...6 Required Readings...6 General Surgery Objectives by Program Year...7 PGY-I Specific Objectives...7 PGY-II Specific Objectives...7 PGY-III Specific Objectives...8 PGY-IV Specific Objectives...9 PGY-V Specific Objectives...10 Typical General Surgery Resident Rotation by Program Year...12

4 Introduction and Program Overview Welcome to the University of Hawaii Surgical Residency Program! Whether with us for one, two, or five years, this Curriculum Guide should answer many questions Residents may have about Program expectations and opportunities. The Program operates in an integrated and affiliated community hospital system in which patients are admitted and treated by University Faculty and University-affiliated, Private Surgical Attending Physicians with Clinical Faculty appointments. The Program Director is responsible for overall Program management, and delegates educational and administrative responsibilities to the Director of Surgical Education (DSE) at each participating hospital. The training of all Surgical Residents takes place primarily in five Honolulu community hospitals: Kaiser Permanente - Moanalua, Kapi olani Medical Center for Women and Children, Kuakini Medical Center, The Queen s Medical Center, Straub Clinic & Hospital. Residents will also rotate through The Endoscopy Institute of Hawaii, The Queen s Medical Center West Oahu, and at North Hawaii Community Hospital on the Hawaii Island. The Surgical Residency Program seeks to prepare Residents to become surgeons of the highest caliber by providing a rich educational experience in a variety of clinical settings. The three main program components: educational curriculum, research, and patient care are structured to offer the knowledge, skills, attitudes, and clinical judgment required for the independent practice of general surgery. The Surgical Residency Program is dedicated to the fulfillment of the six Accreditation Council for Graduate Medical Education (ACGME) competencies in the following domains: Patient Care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Medical Knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care. Practice-based Learning and Improvement that involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care. Interpersonal and Communication Skills that result in effective information exchange and teaming with patients, their families and other health professionals. Professionalism as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. Systems-based Practice as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system of healthcare and the ability to effectively call on system resources to provide care that is of optimal value. The educational tenets of the Program are also based on guidelines set forth by The American Board of Surgery, which state: Hawaii Surgical Residency Program Curriculum Guide Part 1 of 2 1 P age

5 The purpose of graduate education in surgery is to provide the opportunity to acquire a broad understanding of human biology as it relates to disorders of a surgical nature and the technical knowledge and skills appropriate to be applied by a specialist in surgery. The development of this Program s curricula was also shaped, in large part, by the Board s definition of general surgery, which is as follows: The Board interprets the term general surgery in a comprehensive, but specific manner, as a discipline having a central core of knowledge embracing anatomy, physiology, metabolism, immunology, nutrition, pathology, wound healing, shock and resuscitation, intensive care and neoplasia, which are common to all surgical specialties. A general surgeon is one who has acquired specialized knowledge and experience related to the diagnosis, preoperative, operative, and postoperative management, including the management of complications, in ten primary components of Surgery, all of which are essential to the education of a broadly based surgeon: Alimentary Tract Abdomen and its Contents Breast, Skin and Soft Tissue Head and Neck Surgery, including trauma, vascular, endocrine, congenital and oncologic disorders; particularly tumors of the skin, salivary glands, thyroid, parathyroid, and the oral cavity. Vascular Surgery, excluding the intracranial vessels and the heart. Endocrine Surgery, including thyroid, parathyroid, adrenal and endocrine pancreas. Pediatric Surgery Surgical Oncology, including coordinated multimodality management of the cancer patient by screening, surveillance, surgical adjunctive therapy, rehabilitation and follow- up. Trauma/Burns, including musculoskeletal, hand and head injuries. The responsibility for all phases of care of the injured patient is an essential component of general surgery. Surgical Critical Care, of patients with underlying surgical conditions in the Emergency Room, Intensive Care Unit, and Trauma/Burn Units. Additionally, the general surgeon is expected to have significant preoperative, operative, and postoperative experience in pediatric, plastic (including familiarity with the role of breast reconstruction after mastectomy), cardiothoracic, minimally invasive procedures (including basic and advanced laparoscopic procedures), and transplant surgery. Also, the surgeon must have an understanding of the management of the more common urgent and emergent problems in gynecologic, neurologic, orthopaedic, and urologic surgery, and of the administration of anesthetic agents, airway management, and conscious sedation. In addition, the surgeon must be familiar with the unique requirements of bariatric and geriatric surgical patients and must have knowledge and skills in preoperative care, operative care, postoperative care, counseling patients and families, and knowledge of palliative care, Hawaii Surgical Residency Program Curriculum Guide Part 1 of 2 2 P age

6 and the management of pain, cachexia and weight loss in patients with malignancy and chronic conditions. The general surgeon must be capable of employing endoscopic proctosigmoidoscopy, colonoscopy, esophagogastroduodenoscopy; operative choledochoscopy; and must have experience in other techniques, particularly, and laparoscopy, and relevant diagnostic and therapeutic techniques; including laryngoscopy, bronchoscopy, and fine needle aspiration cytology. The general surgeon should also have experience with sentinel lymph node mapping and biopsy techniques for breast cancer and melanoma, and have the opportunity to become familiar with evolving diagnostic and therapeutic methods, including the following: Investigation and manipulation of the distal common bile duct (including sphincterotomy) Stereotactic breast biopsy techniques, including core needle biopsy, and mammotome techniques Physiologic testing and evaluation of the gastrointestinal tract Diagnostic ultrasonography of the following areas: head and neck; breast; abdomen, including intraoperative and laparoscopic ultrasound; and endorectal Noninvasive diagnostic evaluation of the vascular system and invasive vascular interventional techniques Hawaii Surgical Residency Program Curriculum Guide Part 1 of 2 3 P age

7 General Program Goals, Objectives and Implementation In keeping with The American Board of Surgery s definition of general surgery and the ACGME requirements, at the end of five years (PGY-5) of training in our Program, a resident is expected to achieve the following competencies: 1. Patient Care a. Respect the needs of patients and their families, and provide surgical care in accordance with those needs. Implementation: The multi-cultural, multi-lingual nature of the community that our Program serves requires special attention to this. During the course of residency training varied experiences and education will provide the opportunity to gain competence in this vital component of patient care. A cultural competency initiative is also undergoing development in the Department by a PhD Community Psychologist. b. Teach patients and their families about the patient s health needs. Implementation: Before discharging a patient, remember to discuss not only their surgical problems (the wound, nutrition, thromboembolic prophylaxis), but also comorbidities, such as hypertension, hyperlipidemia and diabetes, for example. Practice in this realm of patient care is essential. c. Develop experience in the outpatient setting and continuity of patient care. Implementation: Ambulatory experiences at participating sites provide for education in this domain. 2. Medical Knowledge a. Manage surgical disorders, based on a thorough knowledge of basic and clinical science. Implementation: This will be achieved through daily interaction with Faculty at each of the participating sites, with specific reference to your assigned patients. Focused reading centering on your patients, or a problem-based learning approach to their surgical disorders is emphasized. Basic Science conferences and all University- wide conferences will be directed toward clinical problems, but cannot replace the role of patientspecific, problem-oriented reading. b. Demonstrate appropriate skill in those surgical techniques required of a qualified surgeon. Implementation: The large number of cases available and the devotion of our teaching Faculty have produced very technically facile residents for many years. Paying close attention to the technical implementation of an operation while you are first- or secondassisting is very helpful. In addition, gleaning technical advice from different Faculty members at different training sites will help you to develop your own style and approach. c. Demonstrate the use of critical thinking when making decisions affecting the life of a patient. Implementation: Thinking out loud in front of your senior resident or attending in the ICU, in the Emergency Room, in the Clinic, Operating Room, or on ward rounds is helpful. Asking questions and keeping the lines of communication open is important in your growth Hawaii Surgical Residency Program Curriculum Guide Part 1 of 2 4 P age

8 and in our ability to evaluate you, and to assist you in your development as a surgeon, as you transition to the independent practice of the specialty. 3. Practice-based Learning and Improvement a. Make sound ethical and risk averse judgments appropriate for a qualified surgeon. Implementation: Ethical issues are discussed during Journal Clubs, Morbidity & Mortality Conferences, other didactic sessions, and on teaching rounds at each of our participating sites. b. Teach and share knowledge with colleagues, residents, students, and other healthcare providers. Implementation: The roles of teacher and learner are inseparable in medicine in general, and in surgery, specifically. Working together with medical students will help to develop these skills at an early stage of your professional career. Supervising junior residents as you become more senior will solidify this. Emulate the teachers that you admire. c. Demonstrate acceptance of the value of life-long learning as a necessary prerequisite to maintaining surgical knowledge and skill. Implementation: Again, our devotion to problem-based learning will become evident as time goes by. You must read about your patients illnesses and medical conditions. d. Demonstrate a commitment to scholarly pursuits through the conduct and evaluation of research. Implementation: The Program will help you to identify a mentor for clinical (or if desired, basic science) science research. It is expected that every categorical resident will be involved in at least one research project during their training, with the goal being the submission of either an abstract for presentation at a local, regional, or national meeting, or the submission of a manuscript to a peer-reviewed journal. 4. Interpersonal and Communication Skills a. Develop leadership, communication, and administrative skills. Implementation: Being a senior resident at any of the participating hospitals or a chief resident in the Program requires the ability to delegate authority, make call schedules, communicate with administrators, Faculty and individuals in other fields of medicine. 5. Systems-based Practice a. Collaborate effectively with colleagues, nurses and other health professionals. Implementation: It is expected that you will observe the manner in which Faculty attendings interact with their colleagues and play a role in the management of your patients by obtaining appropriate consultation, discussing your patients with respiratory therapists, nurses, physical therapists, pharmacists, and other health care providers, routinely. b. Provide cost-effective care to surgical patients and families within the community. Implementation: Try to remember that if a test is not going to affect what you do, it may not be worth getting. You will be questioned routinely at Morbidity & Mortality Hawaii Surgical Residency Program Curriculum Guide Part 1 of 2 5 P age

9 Conferences, on daily ward rounds by your senior residents and on teaching rounds at each of the hospitals about the utility, or lack thereof, for tests, hospitalization or even operations. 6. Professionalism a. Demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Implementation: Residents are expected to demonstrate compassion, integrity and respect for others and to provide a responsiveness to patient needs that supersedes self- interest. Residents must maintain sensitivity and responsiveness to a diverse patient population, including, but not limited to, diversity in gender, age, culture, race, religion, disabilities, and sexual orientation. Online Resources The following resources will be utilized during a resident s training: Surgical Council on Resident Education (SCORE) Curriculum ACS Fundamentals of Surgery Curriculum True Learn Smartbank Hawaii Surgical Residency Program Curriculum Guide Part 1 of 2 6 P age

10 GENERAL SURGERY OBJECTIVES BY PROGRAM YEAR Overall Educational Goals for the Program PGY-I Specific Objectives At the end of the first year of surgical residency training, the resident will be able to: 1. Demonstrate progress in the understanding of basic and clinical sciences as outlined in the Residency Program s Rotation-specific Goals and Objectives for PGY-1 Residents. 2. Explain basic ethical principles inherent in surgical practice. 3. Present a coherent and precise patient case history, which includes the history and physical examination, differential diagnosis, diagnostic workup, and treatment plan (fundamental clinical skills acquisition). 4. Demonstrate and document competence in performing basic invasive diagnostic and therapeutic procedures, as outlined under the Resident Handbook, Section on Faculty Responsibility, Resident Supervision, and Progressive Responsibility. 5. Demonstrate the proper use of sterile techniques when performing or assisting with intraoperative or bedside procedures. 6. Demonstrate the ability to teach patients and their families about disease processes and their health, consistent with level of training, as outlined in the Residency Program s Rotationspecific Goals and Objectives for PGY-1 Residents. 7. Recognize responsibility for teaching fellow residents, students, and other healthcare providers, and develop effective teaching skills. 8. Develop and implement plans for study, reading, and research that promote personal and professional growth. 9. Use available resources to survey current surgical research. 10. Coordinate and manage the basic care of the surgical patient. 11. Demonstrate a basic understanding of cost-effective patient care. 12. Attend all Program-sponsored conferences. 13. Prepare for and take the American Board of Surgery In-Training Examination (ABSITE). 14. Develop experience in the outpatient setting and continuity of patient care. PGY-II Specific Objectives In addition to the knowledge and skills previously acquired (as a PGY-1), the resident at the end of the second year of surgical residency training will be able to: Hawaii Surgical Residency Program Curriculum Guide Part 1 of 2 7 P age

11 1. Progress in the acquisition of knowledge and skill in the practice of surgery as outlined in the Residency Program s Rotation-specific Goals and Objectives for PGY-2 Residents. 2. Use available data from basic and social sciences when planning preoperative, intraoperative, and postoperative patient care. 3. Relate scientific knowledge and research findings to the care of patients. 4. Discuss with team members the ethical aspects of surgical intervention. 5. Function in an effective collaborative role with faculty and other residents. 6. Provide appropriate informed consent to patients scheduled for surgical intervention as outlined in the Residency Program s Rotation-specific Goals and Objectives for PGY- 2 Residents. 7. Teach medical and other health profession students and junior residents about the management of surgical patients. 8. Demonstrate progress towards achievement of goals for personal and professional growth and development. 9. Evaluate current research and its relationship to surgical practice. 10. Demonstrate understanding of cost-effective diagnostic and therapeutic technology. 11. Develop and present a scholarly work on a surgical topic (Grand Rounds). 12. Attend all Program-sponsored conferences. 13. Demonstrate improvement over the previous year s performance in the standard score on the American Board of Surgery In-Training Examination (ABSITE). 14. Develop competence in the outpatient setting and in continuity of patient care. PGY-III Specific Objectives In addition to the knowledge and skills previously acquired (as a PGY-1 and PGY-2), the resident at the end of the third year of surgical residency training will be able to: 1. Begin to demonstrate leadership and administrative skills in managing a healthcare team. 2. Manage patients with complicated surgical conditions as outlined in the Residency Program s Rotation-specific Goals and Objectives for PGY-3 Residents. 3. Demonstrate the technical skill required of an accomplished assistant to the operating surgeon. Hawaii Surgical Residency Program Curriculum Guide Part 1 of 2 8 P age

12 4. Perform many standard general surgical procedures safely and under close supervision as outlined under the Resident Handbook, Section on Faculty Responsibility, Resident Supervision, and Progressive Responsibility. 5. Continue to use and refine critical thinking in making decisions about management of patient care. 6. Incorporate ethical concepts in the planning of pre-, intra- and postoperative care of patients and their families. 7. Collaborate with patients and their families when planning operative procedures and postoperative care. 8. Provide pre- and postoperative teaching to patients and their families as outlined in the Residency Program s Rotation-specific Goals and Objectives for PGY-3 Residents. 9. Continue to demonstrate appropriate skill in teaching students, other residents, and other healthcare professionals. 10. Analyze resources available for providing continued learning experiences (establish the practice of lifelong learning). 11. Attend all Program-sponsored conferences. 12. Demonstrate improvement over the previous year s performance in the standard score on the American Board of Surgery In-Training Examination (ABSITE). 13. Develop further competence in the outpatient setting and in continuity of patient care. PGY-IV Specific Objectives In addition to the knowledge and skills previously acquired (as a PGY-1, PGY-2 and PGY-3), the resident at the end of the fourth year of surgical residency training will be able to: 1. Further develop leadership and administrative skills in managing a healthcare team as outlined in the Residency Program s Rotation-specific Goals and Objectives for PGY- 4 Residents. 2. Assist more junior level residents and medical students in assuming, planning, and managing pre- and postoperative care for patients with common surgical disorders. 3. Teach surgical skills to junior residents and medical students as outlined under the Resident Handbook, Section on Faculty Responsibility, Resident Supervision, and Progressive Responsibility. 4. Perform more complex surgery under appropriate supervision as outlined in the Residency Program s Rotation-specific Goals and Objectives for PGY-4 Residents. Hawaii Surgical Residency Program Curriculum Guide Part 1 of 2 9 P age

13 5. Provide appropriate follow-up care until a patient is recovered and/or discharged to the care of another physician. 6. Incorporate appropriate ethical principles into critiques of patient care. 7. Collaborate with residents, faculty, and other health professionals to provide comprehensive healthcare for patients. 8. Evaluate acceptable standards for surgical practice. 9. Evaluate and revise, as necessary, identified goals for personal and professional growth. 10. Demonstrate the ability to conduct research studies in clinical settings. 11. Demonstrate leadership in planning changes for improving and managing patients in a variety of settings. 12. Demonstrate understanding of the impact of healthcare legislation and the third-party payment system on patient care. 13. Attend all program-sponsored conferences. 14. Demonstrate improvement over the previous year s performance in the standard score on the American Board of Surgery In-Training Examination (ABSITE). 15. Continue to develop proficiency in the outpatient setting and continuity of patient care. PGY-V Specific Objectives In addition to the knowledge and skills previously acquired (as a PGY-1, PGY-2 and PGY-3, and PGY- 4), the resident at the end of the fifth year of surgical residency training will be able to: 1. Organize and manage the administrative responsibilities associated with surgical team care. 2. Supervise and teach more junior level residents and medical students in caring for patients with complex surgical conditions. 3. Demonstrate a high level of scientific, clinical, and technical knowledge and skill during operative procedures as outlined in the Residency Program s Rotation-specific Goals and Objectives for PGY-5 Residents. 4. Demonstrate effective decision-making in the management of care of all types of surgical patients and their families as outlined in the Residency Program s Rotation- specific Goals and Objectives for PGY-5 Residents. 5. Discuss with more junior level residents and medical students the ethical issues related to surgical practice. 6. Demonstrate to more junior level residents and medical students the collaborative role of the surgeon in the practice of medicine in the community. Hawaii Surgical Residency Program Curriculum Guide Part 1 of 2 10 P age

14 7. Evaluate the teaching skills of more junior level residents and provide guidance for improving these skills. 8. Evaluate knowledge gained from continuing education and its relationship to professional development. 9. Conduct clinical research. 10. Provide leadership to medical students and more junior level residents in the management of complex patients. 11. Evaluate the cost-effectiveness of present and future surgical care of patients and families. 12. Attend all Program-sponsored conferences. 13. Demonstrate improvement over the previous year s performance in the standard score on the American Board of Surgery In-Training Examination (ABSITE). 14. Demonstrate mastery in the outpatient setting and in continuity of patient care. Hawaii Surgical Residency Program Curriculum Guide Part 1 of 2 11 P age

15 Typical General Surgery Resident Rotation by Program Year (Subject to change) PGY Length Rotation Level (Blocks) Location 1 General Surgery 2-4 The Queen s Medical Center 1 General Surgery 2-3 Kuakini Medical Center 1 General Surgery 0-2 Straub Clinic and Hospital 1 General Surgery 0-1 Kaiser Permanente 1 SICU 0-2 The Queen s Medical Center 1 Trauma 2 The Queen s Medical Center 1 Electives: Emergency Medicine; Anesthesia 0-1 The Queen's Medical Center 2 General Surgery 2-3 The Queen s Medical Center 2 General Surgery 0-2 Kuakini Medical Center 2 General Surgery 0-2 Straub Clinic and Hospital 2 General Surgery 2 Kaiser Permanente 2 SICU 4 The Queen s Medical Center 2 Trauma 2 The Queen s Medical Center 2 Electives: Anesthesia 0-1 The Queen s Medical Center 3 General Surgery 1-3 The Queen s Medical Center 3 General Surgery/Vascular 5 Straub Clinic and Hospital 3 Pediatric Surgery 2 Kapi olani Medical Center 3 Rural Surgery 1-2 North Hawaii Community Hospital 3 SICU 1-2 The Queen s Medical Center 3 Electives: Anesthesia 0-1 The Queen s Medical Center 3 Electives: Ultrasound 1 Kuakini Medical Center 4 General Surgery 1-2 The Queen s Medical Center 4 Endoscopy 2 The Queen's Medical Center and Kuakini Medical Center 4 Pediatric Surgery 2 Kapi olani Medical Center 4 Rural Surgery 1-2 North Hawaii Community Hospital 4 Vascular Surgery 2-3 Straub Clinic and Hospital 4 Elective: Rural Surgery 1 North Hawaii Community Hospital 4 Electives: Plastic Surgery 1 The Queen s Medical Center 5 Chief Surgical Resident General Surgery 8 The Queen s Medical Center 5 Chief Surgical Resident General Surgery 4 Kuakini Medical Center Hawaii Surgical Residency Program Curriculum Guide Part 1 of 2 12 P age

16 Curriculum Guide Part 2 of 2 Rotation Descriptions Resident Responsibilities

17 CURRICULUM GUIDE SURGERY TABLE OF CONTENTS Part 2 of 2 ROTATION DESCRIPTIONS, RESIDENT RESPONSIBILITIES PAGE Anesthesia (Elective)...1 Emergency Medicine (Elective)...4 General Surgery - Kaiser Permanente Moanalua Medical Center...8 General Surgery - Kuakini Medical Center...15 General Surgery The Queen s Medical Center...29 General Surgery Straub Clinic and Hospital...46 Minimally Invasive Surgery & Surgical Endoscopy...57 Pediatric Surgery...62 Plastic Surgery...68 Rural Surgery...71 Surgical Intensive Care Unit (SICU)...79 Trauma Service...86 Ultrasound...91 Vascular Surgery...94 Resident Responsibilities ABSITE Conference Participation Faculty and Rotation Evaluations Medical Records PGY-1 Resident Procedures Resident Advising System Resident Operative Experience Reporting Surgical Critical Care Documentation Surgical Morbidity & Mortality Case Submission Form Evaluation of Resident Progress

18 Anesthesia (Elective) Length: 4 weeks during PGY-1, PGY-2, or PGY-3 year Location: The Queen s Medical Center Primary Supervisor: Maimona Ghows, M.D., Jason Isa, M.D. Contact Telephone #: The Anesthesiology elective provides background theory (in both basic and clinical sciences) and clinical procedural exposure to the breadth of the specialty. The rotation also provides certification in the skill of tracheal intubation. The rotation provides anesthesia for a range of cases, including, but not limited to: Trauma, Orthopaedic, Vascular, General Surgery, Gynecologic, Cardiac, Thoracic, Urology, ENT, Obstetrics, Neurosurgery, Psychiatric (ECTs), Ophthalmology, and Acute Pain Services. Goals Upon completion of the Anesthesiology elective, a Resident will understand the principal concepts of regional and general anesthesia, and pain management, in the context of applicable anatomy and physiology. The Resident will be able to integrate pertinent principles into the management of surgical patients. Objectives Medical Knowledge 1. Demonstrate understanding of the physiology and pharmacology of drugs commonly used in anesthesia. This comprises inhalational anesthetic agents, local anesthetics, narcotics, nonsteroidal anti-inflammatory agents, sedatives, neuromuscular blocking agents, vasoactive agents, sympathomimetics, and neuroleptics. 2. The Resident should be able to discuss knowledge of metabolism, potential drug interactions, toxicities, and adverse reactions. 3. Demonstrate understanding of the various stages of anesthesia, including associated risks. 4. Demonstrate knowledge of blood product and volume expander usage, including rationale, indications, contraindications, and potential adverse side effects. 5. Understand special considerations, including risks, in pregnant and pediatric patients. 6. Develop a firm understanding of anatomic and physiologic conditions that affect the delivery of safe anesthesia, such as coronary artery disease, neuromuscular disorders, traumatic injuries and emergent situations. Patient Care 1. The Resident should be able to demonstrate the acquisition of skills in management of the airway, becoming technically facile in the performance of orotracheal intubation, laryngeal mask airway, and mask ventilation. 2. Demonstrate the ability to manage fluid requirements during anesthesia. 3. Demonstrate understanding of intraoperative physiologic monitoring and management of intraoperative complications (including acid-base abnormalities, malignant hyperthermia, hemorrhagic conditions, hemodynamic or pulmonary instability) 4. Appropriately recognize limitations imposed by the operative procedure on the conduct of anesthesia management. 1 P age

19 5. Recognize the limitations imposed by the anesthetic on the conduct of the operation. 6. Understand the potential benefits, risks, and limitations of regional anesthesia (including spinal, epidural, and limb blocks). 7. Must be able to perform a focused pre-anesthesia history and physical examination, and demonstrate skill in preoperative assessment, implications of concurrent diseases, and anesthesia risk determination. 8. Demonstrate skill in use of anesthetic systems and the pre-anesthetic checklist. Systems-based Practice 1. Become aware of efficient use of the operating room through appropriate scheduling. 2. Understand the multidisciplinary role of the anesthesiologist, surgeon, and the operating room team in the provision of safe and high quality patient care. Professionalism 1. Interact with anesthesiologists, nurse anesthetists, surgeons, nurses, and operating room personnel in a respectful and professional manner. 2. Demonstrate sensitivity, respect, and adherence to ethical principles when interacting with patients and their families. Practice-based Learning and Improvement 1. Demonstrate ability to utilize scientific studies to provide high quality anesthetic care. 2. Appropriately utilize hospital information technology systems to manage patient care, and to access on-line medical information to affect high quality care. 3. Facilitate the learning of medical and nursing students, and surgical technician students rotating in the operating rooms. Interpersonal and Communication Skills 1. Demonstrate effective and sensitive information exchange with patients, their families, and operating room personnel. 2. Demonstrate ability for accurate and timely information exchange between other members of the healthcare team, both verbally and in writing, with appropriate use of the medical record. Clinical Content The clinical activities will include: 1. Managing the airway in adults and children, including masking and endotracheal intubation. 2. Establishing vascular access. 3. Applying appropriate monitoring devices, including arterial lines and pulmonary artery catheters. 4. Inducing, maintaining and emerging from general anesthesia: a. Gas analysis b. Exhalation gas analysis c. Hemodynamic analysis 5. Performing regional anesthesia: epidural, plexus and local. 6. Managing patients pre- and post-anesthesia. 2 P age

20 Implementation Clinical Exposure: Residents will be assigned to an anesthesia attending on a daily basis, and will be given a list of that individual s cases the day prior. Residents will report between 6:30 a.m. and 7:00 a.m. to the preoperative holding area of the hospital to interview the patient, do a physical examination, and perform a chart review. After the exam and chart review, Residents will discuss the implication of their findings with the Faculty attending. Together, they will formulate a plan and discuss it with the patient. The Resident will then write a preoperative assessment in the patient medical record. Residents will also be required to set up the anesthesia machine and check it, draw up the relevant drugs, and set up the monitoring equipment under direct supervision by the Faculty member. The Resident/Faculty attending team will induce anesthesia and monitor the patient intraoperatively. At the end of surgery, the Resident and the Faculty attending will escort the patient to the Post-operative Anesthesia Care Unit or to the ICU, transition care, write postoperative orders, and ensure that the patient is stable and comfortable. Residents will also formulate learning issues relevant to the case. These will be discussed with the Faculty attending at the next meeting. Anesthesia procedures will be entered into the ACGME case log system. There is no call requirement for this elective. Required Readings Texts will be issued by the Surgical Residency Program for loan during a resident s anesthesia rotation [Basics of Anesthesia 5th Edition and Clinical Anesthesia 6th Edition] Evaluation Global Assessment and Focused Review. 3 P age

21 Emergency Medicine (Elective) Length: 4 weeks during PGY-1 year Location: The Queen s Medical Center Primary Supervisor: Gregory Suares, M.D., and Ron Kuroda, M.D. Contact Telephone #: Goals Prepare Preliminary Surgery Residents for their chosen categorical residency (Anesthesiology, Emergency Medicine) by providing them with a clinical experience in Emergency Medicine. The rotation will provide Residents with the opportunity to gain the knowledge, skills, behaviors, and attitudes required to care for patients in an Emergency Department. Objectives Patient Care Residents must provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. At the completion of the Emergency Medicine rotation, Residents will be able to demonstrate: 1. The ability to gather an accurate and focused patient history and physical examination that is appropriate to the clinical situation. 2. The ability to gather accurate and essential information from other sources including medical records and diagnostic/therapeutic procedures. 3. The ability to integrate available clinical date to identify, assess and prioritize patient problems, and generate an appropriate differential diagnosis. 4. The ability to make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment. 5. The ability to develop, negotiate and implement effective patient management plans under supervision. 6. The consistent application of universal precautions. 7. The ability to diagnose and treat common emergencies including: a. Cardiovascular emergencies b. Environmental and toxicological emergencies c. Gastrointestinal emergencies d. Head and neck emergencies e. Metabolic emergencies f. Musculoskeletal emergencies g. Neurologic emergencies h. Respiratory and intra-thoracic emergencies i. Miscellaneous emergencies such as anaphylaxis and sepsis 8. The ability to diagnose and treat common hematologic disorders. 9. The ability to diagnose and treat common urologic problems. 10. The ability to diagnose and manage common psychiatric problems in the emergency department. 11. The ability to perform basic emergent medical procedures competently. 12. The judicious and appropriate use of consultants in the emergency setting. 13. Competence in the principles and use of life support modalities. 4 P age

22 Medical Knowledge Residents must demonstrate medical knowledge about established and evolving biomedical, clinical, epidemiological and social-behavioral sciences, as well as the application of this knowledge to patient care. At the completion of their Emergency Medicine rotation, Residents will be able to demonstrate: 1. The ability to apply an open-minded, analytical approach to acquiring new knowledge. 2. Knowledge of common social problems presenting to the emergency department. 3. Knowledge of the common substances of abuse. 4. The ability to access and critically evaluate current medical information and scientific evidence relevant to their patients and emergency medicine. 5. The ability to develop clinically applicable knowledge of the basic and clinical sciences that underlie the practice of emergency medicine. 6. The ability to apply an evidence-based approach to clinical problem-solving, clinical decision-making, and critical thinking in the emergency department. Practice-based Learning and Improvement 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 selfevaluation and life-long learning. At the completion of their Emergency Medicine rotation, Residents will be able to demonstrate: 1. The ability to identify areas for improvement and implement strategies to enhance their knowledge, skills, attitudes and processes of care in emergency medicine. 2. The ability to develop and maintain a willingness to learn from errors and use errors to improve the system or processes of care in emergency medicine. 3. The habits and attitudes necessary to support independent, life-long, self-directed learning. 4. The ability to facilitate the learning of peers, students and other healthcare professionals. Interpersonal and Communication Skills Residents must demonstrate interpersonal and communication skills that result in effective exchange of information and collaboration with patients, their families, and other health professionals. At the completion of their Emergency Medicine rotation, Residents will be able to demonstrate: 1. The interpersonal skills needed to work effectively with other personnel in the emergency department setting. 2. The interpersonal skills necessary to manage common acute psychosocial problems in the emergency department. 3. The ability to use effective listening, nonverbal, questioning, and narrative skills to communicate with patients and families. 4. The ability to work effectively with others as a member or leader of a healthcare team or other professional group. 5. The ability to maintain comprehensive, timely, and legible medical records. 6. The ability to communicate pertinent medical information in a complete and concise manner to other medical professionals. 5 P age

23 Professionalism Residents must demonstrate a commitment to carrying out professional responsibilities; and an adherence to ethical principles. At the completion of their Emergency Medicine rotation, Residents will be able to demonstrate: 1. The qualities of compassion, integrity and respect for others. 2. Responsiveness to patient needs that supersedes self-interest. 3. Respect for patient privacy and autonomy. 4. Accountability to patients, society and the profession. 5. Sensitivity and responsiveness to a diverse patient population, including but not limited to, diversity in gender, age, culture, race, religion, disabilities, socioeconomic status and sexual orientation. 6. The ability to adhere to principles of confidentiality, scientific/academic integrity, and informed consent. 7. Participation in all required educational activities. Systems-based Practice Residents must demonstrate an awareness of responsiveness to the larger context and system of healthcare, as well as the ability to call effectively on other resources in the system to provide optimal healthcare. At the completion of their Emergency Medicine rotation, Residents will be able to demonstrate: 1. The ability to work effectively in the emergency department. 2. Coordination of patient care within the emergency department and the larger healthcare system. 3. Knowledge of the principles of pre-hospital triage. 4. Knowledge of the principles of the emergency medical services system including arranging follow-up, expeditious transfer and triage. 5. The ability to apply evidence-based, cost-conscious strategies to diagnosis and effect disease management in the emergency department. 6. The ability to collaborate with other members of the healthcare team to assist patients in dealing effectively with complex systems and to improve systematic processes of care. Implementation Residents will meet their educational objectives through direct patient care, assigned reading, planned educational sessions, and independent learning. They will be assigned work in an Emergency Doom with Faculty attending physicians who will directly supervise their activities. They will be offered equivalent educational opportunities as other PGY-1 Residents rotating in the Emergency Department. In addition, they will be given a set of journal and textbook reprints pertinent to emergency medicine and will complete a post-test based on the readings. Evaluation Resident Assessment: Residents will receive a formal written evaluation utilizing the Global Resident Competency Evaluation form that includes assessment of their patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and 6 P age

24 systems-based practice. This evaluation will be completed by the Emergency Room site coordinator(s), with input from other Faculty attending physicians. Additionally, Residents are counseled and provided with formative feedback on a timely basis. Rotation Evaluation: Residents are required to complete a confidential written evaluation of their emergency medicine experience. They also have the opportunity to evaluate their Faculty attending physicians confidentially. Residents are also encouraged to provide the Program with feedback about their various rotation experiences during their evaluation reviews with the Program Director. 7 P age

25 General Surgery Kaiser Permanente Medical Center Moanalua Medical Center Length: 1-1 months of PGY-1 year 2 months of PGY-2 year (Subject to Change) Location: Kaiser Permanente - Moanalua Primary Supervisor: Rebecca Sawai, M.D., F.A.C.S. Contact Telephone #: Ellen Pang, The training of Resident physicians for the independent practice of general surgery encompasses education in basic and clinical sciences, training in cognitive and technical skills, development of clinical knowledge and maturity, and acquisition of surgical judgment. This specialty education requires the development of knowledge, skills, and attitudes that lead to proficiency in all ACGME competency domains, and requires that Residents assume personal responsibility for the care of individual patients. With experience and demonstrable increasing level of competency, Residents will progressively assume greater responsibility for patient care commensurate with their ability, and under appropriate Faculty supervision, as they transition to the independent practice of surgery. PGY-1 Level Medical Knowledge The PGY-1 Resident will (1) acquire a fundamental understanding of common surgical diseases and disorders, and (2) acquire an understanding of how basic sciences translate into clinical care. 1. The Resident will demonstrate basic and clinical science knowledge of anatomy and pathophysiology as it pertains to both general surgical and surgical subspecialty disease processes encountered during this year. The Resident must prepare for and attend all Surgical Conferences (see Attendance Policy in Resident handbook for exceptions), completing all assigned reading, including assigned SCORE modules, and Journal Club articles. a. Weekly attending rounds and conferences b. Daily work rounds and faculty evaluations c. Annual American Board of Surgery In-Training Examination d. Academic quizzes on textbook reading and online modules (SCORE) e. Preparation for at least one lecture (or Morbidity and Mortality Conference) during the academic year f. End of rotation global evaluations Patient Care The PGY-1 Resident will (1) gain experience and develop competency in fundamental clinical skills, and (2) develop technical skills appropriate to level of training. 1. The Resident will demonstrate competency in obtaining a comprehensive medical history, performing a comprehensive physical examination, assessment of a patient s problems, appropriate use of diagnostic tests (such as serum chemistries, hematologic tests, coagulation 8 P age

26 tests, mammography, chest and abdominal radiographs, ultrasonography, CT and MRI, and gastrointestinal studies), developing a differential diagnosis, and implementing a treatment plan for patients presenting with surgical illnesses. The Resident will assume care of patients on the in-patient ward and be responsible for admissions and discharges of these patients, in addition to ensuring appropriate follow-up post-discharge. In this framework, the Resident will make daily assessments on these patients and enter their notes into the medical record. 2. The Resident will recognize a patient experiencing an acute clinical deterioration. 3. The resident will be able to recognize and understand treatment of common postoperative complications and conditions (such as post-operative ileus, atelectasis, urinary retention, and fever). 4. The Resident will demonstrate an understanding of postoperative fluid and electrolyte management of surgical patients. 5. The Resident will attend all PGY-1 Resident Boot Camp sessions and all technical skills training sessions. The Resident will demonstrate competency in basic open procedures (under supervision) and in basic laparoscopic skills (such as hernia repair [inguinal, femoral, umbilical], breast biopsy, excision of skin lesions and subcutaneous masses, open lymph node biopsy, and laparoscopic cholecystectomy). a. Faculty and senior/chief resident global evaluations and focused review Professionalism The PGY-1 Resident will gain an understanding and respect for adherence to ethical principles and develop a commitment to carrying out their patient care-related responsibilities. 1. The Resident will demonstrate professional conduct on a daily basis with regard to professional attire and grooming, punctuality, appropriate medical record keeping (clear, concise, accurate, and timely), and appropriate data gathering for daily rounds (adhering to HIPAA regulations). 2. The Resident will demonstrate impeccable ethical standards in regard to veracity and willingness to admit mistakes. 3. The Resident will professionally and respectfully interact with patients, their families, other physicians, consultants, and other hospital and ambulatory clinic personnel; and will place the needs of their patients above themselves. 4. The Resident will demonstrate sensitivity to issues of age, race, ethnicity, gender, religion, and sexual orientation, in their interactions with others. 5. The Resident will demonstrate a commitment to the continuity of patient care, either through carrying out professional responsibilities or through ensuring that those responsibilities are comprehensively and accurately conveyed to other members of the patient care team acting in the Resident s stead. 6. The Resident will remain compliant with all required training and fulfillment of responsibilities as designated by the Program and the participating sites. This includes being aware of the Program policy on duty hours and remaining compliant with all duty hour requirements, and concurrently entering all procedures and operative cases into the online database. Residents must also enter the hours spent in the hospital into New Innovations within one week, as the Program tracks this closely. a. Faculty and senior/chief resident global evaluations 9 P age

27 b. Attendance record at conferences c. Medical Records d. Operative Logs e. Evaluations from nursing staff and medical students (360 degree evaluations) f. Daily work rounds with senior and chief residents and formal rounds and conferences with attendings Systems-based Practice The PGY-1 Resident will gain an appreciation and understanding of the larger context and system of health care, including the appropriate use and allocation of resources available to provide optimum patient care. 1. The Resident will demonstrate a general understanding of hospital-based systems, including the appropriate use of social services, case managers, pharmacy, physician extenders, dietary services, physical and occupational therapy, and other ancillary services. 2. The Resident will demonstrate a basic understanding of cost-effective use of laboratory and other diagnostic tests and be able to justify usage. 3. The Resident will demonstrate an understanding of cost-effective care in the management of the routine, uncomplicated postoperative patient. a. Faculty and senior/chief resident global evaluations at end of rotation b. Nursing evaluations Practice-based Learning and Improvement The PGY-1 Resident will gain experience in (1) the evaluation of the care they provide to their patients, and (2) the use of information technology to appraise and assimilate scientific evidence as it translates to improved patient care; and (3) they will further gain an appreciation for the importance of continuous quality improvement (in patient care) and life-long learning. 1. The Resident will demonstrate competency in the use of the medical literature in developing care plans for patients. 2. The Resident will participate in morbidity and mortality conferences. 3. The Resident will mentor and teach medical students. a. Contributions in conferences and other didactics b. Faculty and senior/chief resident global evaluations c. Medical student evaluations Interpersonal and Communications Skills The PGY-1 Resident will gain the experience necessary for effective exchange of information and collaboration with patients and their families, and other health care professionals. 1. The Resident will demonstrate compassion and empathy for patients and their families. 10 P age