Goals and Objectives Pediatric Surgery PGY 1 MCVH

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1 Goals and Objectives Pediatric Surgery PGY 1 MCVH

2 PGY-1 Clinical Duties and Privileges Lines of Supervision During the PGY-1 each resident begins his/her clinical experience in the General Surgery Residency at the Virginia Commonwealth University Health System on a variety of clinical rotations at The Medical College of Virginia Hospital and The Veterans Administration Medical Center. Your training will include education and experience in inpatient care and outpatient care for the surgical patient. In addition to daily patient care you will attend didactic sessions on each specific rotation, as well as, required departmental conferences. You will learn: Basic history/physical techniques. Care of the surgical patient including preoperative evaluation, perioperative, and postoperative care. Writing pre and postoperative orders. Basic pathophysiology of surgical disease. ACLS and ATLS certification. Basic procedures: start IV, placement of central lines, swan ganz catheters, and chest tubes. Surgical Skills: basic techniques, sterile technique, surgeon in simple procedures, excisions subcutaneous lesions, breast biopsies, hernia repair, and first assist on more complex procedures. Communications skills: communicate as a professional with patients, patient families, hospital staff, students, colleagues, and attending staff. All residents are expected to utilize web-based resources, journals, surgical texts, and other material in preparing for regular weekly conferences and daily patient care. All PGY-1 residents will present interesting cases at the Tuesday Noon Case Conference with the Chairman of the Department.

3 PGY-1 Pediatric Surgery MCVH PATIENT CARE GOALS: Provide appropriate and effective treatment of surgical diseases that may or may not require surgical intervention. Communicate effectively, compassionately and professionally with patients, families and colleagues. Make evidence based decisions about diagnostic and therapeutic interventions, utilizing up-to-date scientific literature and clinical judgment. Use information technology to support patient care decisions and patient education. Acquire skills to work with healthcare professionals including those from other disciplines to provide multidisciplinary patient-focused care. PGY-1 and/or PGY-2 upon completion of a clinical rotation in pediatric surgery residents must demonstrate the ability to: Evaluate pre-operative pediatric patients and formulate a diagnosis and treatment and/or management plan to discuss with the chief resident and/or attending. Utilize the EMR to review previous history and hospitalizations. Take a complete history and physical examination and present findings to senior resident and/or attending. Evaluate acute surgical conditions and discuss with senior resident and/or attending. Report fluid volume and electrolytes in post-operative pediatric surgery patients. Solicit patients preferences and incorporate into therapeutic intervention. Prioritize patient acuity in the outpatient clinic. Review, track, evaluate and report clinical data. Manage post-operative patients. Present patient information in a concise manner to senior resident and/or attending. Exhibit manual dexterity appropriate for PGY-1 and/or PGY-2 Exhibit awareness of psychomotor skills and judgment related to his/her role in the performance of operative surgical procedures. Arrive in the OR prepared for the cognitive components of his/her role in individual operative surgical procedures. Proceed through various steps of operative procedures in a manner that is consistent with the flow of the operation with supervision. Develop awareness of timely decisions with respect to the operative procedure. Demonstrate competence in performing less complex surgical procedures. Identify the benefits and limitations of operative surgical techniques. Assist attending staff with surgical procedures. Perform competently all essential medical and invasive procedures with supervision. Provide health care services aimed at preventing health problems and maintaining health. Cooperate with health care professionals, including those from other disciplines, to provide patient-focused care. Employ active listening while interviewing patients and their families to consider specific preferences and/or needs.

4 MEDICAL KNOWLEDGE GOALS: Apply established and evolving biomedical and clinical sciences to patient care. Build upon the fundamental basic science knowledge and apply to the clinical surgical practice. Illustrate clinical knowledge necessary to treat a broad range of pediatric diseases. Identify the pathophysiologic and pharmacologic basis for pediatric diseases treated and operations performed. The PGY-1 and/or PGY-2 upon completion of self-directed study, conference attendance the resident should demonstrate the ability to: Review surgical pathophysiology and critical care, pharmacology, physiology, and interpretation of hemodynamic data. Discuss current literature and surgical texts on daily rounds and in the OR. Explain the embryology, anatomy and physiology of common neonatal surgical diseases. Formulate a diagnostic and treatment plan for pediatric diseases based upon the evolving biomedical and clinical sciences of pediatric surgical intervention. Consult with referring physician and consider previous history in decision making process. Outline the basics of the multimodality treatment for pediatric patients. Apply surgical literature and extensive areas of basic surgical disease to daily patient care. Critically evaluate and incorporate pertinent scientific information into daily patient care. Illustrate surgical competence using acquired surgical knowledge and skill to achieve a performance that produces appropriate and anticipated outcomes. Integrate surgical continuity of care principles into the total care plan for all pediatric surgical patients. Through leadership and teaching medical students, demonstrate an understanding of the significance of the natural history of pediatric surgical disease, the consequence of surgical care (both positive and negative), and the influence of continuity of care upon surgical outcomes. Incorporate the knowledge of ethical, legal, economic, and/or social factors into the activities of the entire surgical team for all components of surgical care. Demonstrate a broad scope of medical knowledge in educating pediatric patients and their parents. The resident must attend the following mandatory conferences: Grand Rounds Basic Science Journal Club, Monthly Mortality and Morbidity (D&C Conference) Intern Noon Case Conference, (PGY-1 only) Pediatric Service Conference PRACTICE-BASED LEARNING AND IMPROVEMENT GOALS Identify strengths, deficiencies, limits in one s knowledge and expertise and set learning and improvement goals. Identify and perform appropriate learning activities, and analyze practice using quality

5 improvement methods. Locate, appraise and assimilate evidence from scientific studies related to patients health problems. Use information technology to optimize learning and to participate in the education of the patients and their families. Continually improve patient care based on constant self-evaluation and life-long learning. The PGY-1 and/or PGY-2 upon completion of a clinical rotation in pediatric surgery the resident should demonstrate the ability to: Receive and integrate constructive criticism to improve your delivery of patient care. Recognize strengths and build upon them. Identify weaknesses and set learning goals. Analyze and discuss personal practice outcomes with senior level resident and/or attending to improve patient care. Review scientific literature concerning patient management questions and incorporate in daily patient care. Identify and employ the concepts of best practice and evidence-based medicine. Utilize technology and medical informatics in day to day patient care decisions. Use current available technology, medical informatics and current literature to gain insight into practices using quality improvement through review of cases at D&C conferences and on patient rounds. Apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness. Analyze practice experience using a systematic methodology and develop a plan of action to reduce the chance of unfavorable outcomes. Obtain and apply information about the population of patients and the larger population from which patients are drawn. Facilitate the learning of medical students. Complete weekly reading assignments related to Basic Science and FSC. INTERPERSONAL COMMUNICATION SKILLS GOALS Effectively exchange information and collaborate with patients, their families from a broad range of socioeconomic and cultural backgrounds. Participate in didactic sessions clearly and precisely referencing current literature. Discuss patients on daily rounds with senior level resident and/or attendings referring to current literature and current patient information in the EMR. Interact and communicate respectfully with multidisciplinary teams to deliver optimal patient care. Upon completion of a clinical rotation in pediatric surgery residents at the PGY-1 and/or PGY-2 level should: Cultivate ethical, respectful and trusting relationships with patients, their families, referring physicians, colleagues, and other health care professionals. Create and sustain therapeutic and sound relationships with patients and families. Exhibit empathy and compassion for all patients and their families. Appraise the senior resident of all progress of all patients and alert them of any new

6 problems on the service. Develop effective and complete note writing skills. Enter patient information in EMR promptly and correctly. Clearly, accurately, and succinctly present pertinent information to faculty and senior residents regarding newly admitted patients. Clearly and respectfully communicate with patients and appropriate members of their families about identified disease processes (including complications), the expected courses, operative findings, and operative procedures with assistance from upper level resident and/or attending/ Execute effective and thorough patient hand-off/sign out to include: Patient Complaint, diagnosis, treatment plan and patient s wants and needs Vital signs, list of medications Lab results Identify pending labs Outline what needs to be done over the next few hours Questions and answers Exhibit skill and sensitivity for appropriate counseling and educating patients and their families in a variety of clinical situations. Present all patients and conference material in a concise, organized, chronologic, logical and knowledgeable manner. Utilize input from all collaborative interactions with all personnel contributing to the pediatric surgery patients care. Model effective communication techniques to medical students and exhibit proper interpersonal skills when interacting with patients, their families, and other health care providers. Clearly, accurately, and respectfully communicate with nurses, referring and consulting physicians, peers, ancillary support staff, and administrative staff. Maintain clear, concise, accurate, and timely electronic medical records including (but not limited to) admission history and physical examination notes, consultation notes, progress notes, written and verbal orders, operative notes, and discharge summaries. Teach medical students about the procedures performed on this rotation. Involve medical students in daily patient care in outpatient clinical activities. Log all procedures and operative cases in which he/she is the surgeon of record into the system database within 24 hours of completing the procedure or operation. Dictate an accurate and descriptive narration of the operative procedure in which he/she is the primary surgeon within 24 hours. PROFESSIONALISM GOALS Develop a respectful, trusting and professional relationship with colleagues, patients, their families, and other health care providers. Exemplify high ethical behavior in all professional activities. Accept personal responsibility for actions and decisions regarding patient care. Know and follow institutional behavior policies (i.e. Sexual harassment, etc.), privacy policies, informed consent, business and medical ethics. The PGY-1 and/or PGY-2 resident upon completion of this rotation should: Practice continuity of care of pediatric surgery patients, without regard to time of day.

7 Practice honesty with all individuals at all times in conveying issues related to the care of patients. Be cognizant of when patient needs supersede self-interest. Receive constructive criticism and incorporate into practice to improve patient care outcomes. Participate in end-of-life discussions and decisions with senior level residents and/or attendings. Exhibit sensitivity to gender, age, race, and cultural issues. Model ethical and professional behavior in clinical setting by example. Display leadership qualities that can be cultivated throughout training. Practice proper and professional grooming at all times when engaged in patient care. Exhibit professionalism through timely completion of required administrative responsibilities; o Evaluations o Complete timely medical record documentation in the EMR o Answering pages promptly and professionally etc. o Enter cases into ACGME Operative Log o Enter duty hours weekly SYSTEMS-BASED PRACTICE GOALS Demonstrate an awareness of and responsiveness to the larger context and system of health care to provide optimal patient care. Coordinate patient care within the health care system calling upon system resources available to provide optimal patient outcomes. Participate in cross disciplinary discussions and patient care to work in teams to enhance patient safety and patient care. Elicit available system resources and ancillary services to reduce errors and improve patient care. Understand the impact system resources have on patient outcomes. Develop understanding of coding, billing and finances. Participate in identifying system errors and implementing potential systems solutions. The PGY-1 AND/OR PGY-2 resident should: Appropriately utilize, in a timely and cost efficient manner, ancillary services including social services, discharge planning, physical therapy, nutrition services, pharmacy, and physician extenders. Practice cost-effective health care and resource allocation that does not compromise quality of care. Practice quality patient care and assist patients and their families in dealing with system complexities. Partner with health care managers and health care provides to assess, coordinate, and improve health care and understands how these activities can affect system performance. Justify all diagnostic tests (including laboratory studies) ordered and document when needed. Appreciate and guide the continuity between outpatient clinic and hospital based care. Practice cost-effective and appropriate preoperative evaluation and postoperative follow up. Recognize resource allocation issues.

8 Practice sensitivity regarding medical-legal issues Utilize hospital information technology to provide cost effective and optimal patient care. Know and understand how patient care and other professional practices affect other health care professionals, the health care organization, and the larger society. Investigate the various system elements and apply to patient care for optimal outcomes. Know how types of medical practice and delivery systems differ from one another, including methods and controlling health care costs and allocating resources. Seek out assistance in identifying additional system resources to maximize outcomes for patients. Participate in inter-disciplinary conversations to understand problematic system issues. Participate in root cause analysis to understand solutions that address the problems. PROCEDUDRES AND TECHNICAL SKILLS GOALS Develop proficiency in skills and procedures needed to care for pediatric patients. Technical Skills in Patient Care PGY-1: Actively participate in the patient evaluation and management. Review EMR and take initial history and physical. Participate in pre-operative, operative, and post-operative management of simple pediatric surgical problems. (Procedures listed below) Develop a working relationship with members of the pediatric intensive care unit in managing postoperative pediatric patients. Perform basic manual skills in operating room including Knot tying Handling of scissors/basic dissection Scalpel and electrocautery Patient positioning and OR-table draping Perform basic suture techniques including Layered closures Running and interrupted suturing techniques Subcuticular skin closures Execute basic trocar and camera placement for laparoscopic procedures Procedures: Integument and soft tissue Craniocervical region Thoracic region Gastrointestinal system Oncologic Genitourinary system Musculoskeletal system Hernia operations of the groin and umbilicus Appendectomies laparoscopic and open Pyloromyotomy, cholecystectomy

9 The ACGME requires a minimum of 20 pediatric cases.

10 PGY-1 Pediatric Surgery - MCVH and St. Mary s PATIENT CARE MEDICAL KNOWLEDGE PRACTICE-BASED LEARNING PROFESSIONALISM INTERPERSONAL RELATIONSHIPS & COMMUNICATION SYSTEMS-BASED PRACTICE PROCEDURES AND TECHNICAL SKILLS ASSESSMENT Weekly basic science conference New Innovations evaluations by Faculty (including mid-rotation feedback sessions) Attending Rounds Annual ABSITE Written evaluation by faculty (including mid-rotation feedback sessions) Annual Mock Oral examinations Attending Rounds Faculty evaluation Weekly D and C Attending rounds 360 evaluations Evaluation by Faculty (including mid-rotation feedback sessions) Evaluation by other resident staff members Feedback from administrative staff 360 evaluations Evaluation by Faculty (including mid-rotation feedback sessions) Faculty evaluation Evaluation by senior level resident Skills lab Simulation lab Feedback from faculty in clinic and OR Feedback from senior level resident on team

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