GOALS AND OBJECTIVES OF THE CLINICAL ROTATIONS
ANESTHESIOLOGY
(Elective)
Goals and Objectives for the Transitional Year Resident
Operating Room
To be competent and have developed expertise or be exposed to multiple
airway management modalities including, but not limited to:
o Bag / mask ventilation
o Endotracheal intubation and extubation
o Flexible fiberoptic bronchoscopy
To understand principles and be exposed to all major subspecialties
(ambulatory, cardiac, critical care, endocrine, neurosurgical, obsterics, acute
and chronic pain, thoracic, trauma and vascular). The exposure will be on a
limited basis, with emphasis placed on the management of uncomplicated
patients in the Operating Room Suite.
To know and address important articles in recent literature.
Exposure to the management of as well as performance of (with faculty
supervision) anesthetic and invasive monitoring procedures.
To mentor and actively teach medical students.
Gain experience in basic airway management, hemodynamic monitoring and
patient care in Memorial Hermann Hospital and / or LBJ Hospital Operating
room suites.
Understand basic clinical anesthesia and its application pre-, intra-, and post
operatively.
Function as a team member involved in multi-disciplinary management of
patients in a major trauma center.
Methods Used to Assure that Transitional Residents are Accomplishing Their
Goals
Invasive procedures are done under direct supervision of senior residents,
critical care fellows and ICU faculty until competency in performing these
procedures has been demonstrated to the satisfaction of the ICU staff.
The resident or intern will make case presentations on rounds which will
include management data reflecting fluid and electrolyte status, nutritional
support, ventilator management, hemodynamic monitoring and management,
as well as medical ethical issues. The depth of understanding of these
principles will be explored from time to time by the ICU faculty, fellows, and
senior ICU residents. Based on a demonstration of satisfactory
comprehension of such matters, increased management responsibilities will be
offered to the transitional year resident.
Regular feedback from the nursing staff, ICU faculty and residents will be
provided to the transitional year resident to validate effectiveness with which
he/she functions as a team member on the multi-disciplinary management
team for the trauma patients. Such feedback will be offered in a timely fashion
such that unacceptable or suboptimal performance may be improved prior to
the time the final evaluation is completed for the transitional year resident. At
the end of the rotation, a formal evaluation is completed which involves input
from nursing staff as well as members of the ICU faculty.
Educational Opportunities Available to Transitional Year Resident
The educational opportunities that are available include clinical cases with isolated
neurologic as well as multi-system trauma. The educational opportunities with these
patients will be found in presentations made to senior residents, fellows and faculty
on patient care rounds; the patients are also significant stimulus for the transitional
year resident to consult reference material. The ICU handbook provides significant
educational value for the residents on this rotation. In addition, there are frequent
conferences and lectures which are scheduled through the critical care section of the
Department of Anesthesiology. These scheduled lectures are in addition to
departmental conferences which are available through the Departments of Surgery
and Anesthesiology.
Resident Responsibilities for Direct Patient Care and Decision Making in the
Operating Room
The transitional year resident is intimately involved in patient care and decision
making at a level consistent with other residents of equal training and experience, and
consistent with their demonstrated level of expertise. They serve under the direct
supervision of senior residents, critical care fellows and faculty assigned to the
service.
Resident Responsibilities for Planning, Record Keeping, Order Writing and
Continuing Management in the Operating Room
The transitional year resident is responsible for daily personal assessment, recording
daily progress notes and updated orders on assigned patients. They are to fully assess
patients new to the hospital who are assigned to them.
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DERMATOLOGY
(Elective)
Goals and Objectives for the Transitional Year Resident
To gain a general overview of dermatology through a wide variety of clinics
and hospital consult service.
To gain an understanding of the approach for evaluating skin lesions.
To observe the following procedures: skin biopsy, Tzanck smear, KOH
preparation, and excisional surgery.
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NEUROLOGY
(Elective)
Goals and Objectives for the Transitional Year Resident
Each intern is expected to perform a competent neurological examination.
Each intern should be able to interpret and recognize common neurological
signs.
Each intern should be able to evaluate and treat patients with common
neurological disorders.
Each intern should be familiar with utilization advantages and limitations of
common neurological investigative methods.
Responsibilities
Each intern is expected to write up his assigned patients and be ready to
present and discuss them with the attending physician or neurology resident.
Each intern should complete a patient roster list, listing all patients seen with
their age and diagnosis.
Each intern should see a minimum of fifteen patients, having done a complete
work up on all fifteen.
Educational Materials and Conferences
Interns are encouraged to read the book Clinical Neurology by Simon,
Aminoff, and Greenberg. Copies are available at the UT Bookstore. The
reading material is supplemented by more detailed reading in the neurology
sections in current editions of the Textbook of Medicine, Ohara's principals of
Internal Medicine. We also endorse the current editions of Principles of
Neurology by Adams and Victor who wish to pursue a more comprehensive
textbook devoted to this field of medicine.
Interns located at Hermann Hospital are required to attend Grand Rounds
weekly at noon on Friday.
Educational Opportunities Available to the Transitional Year Resident Include:
Morning Report 7.044-A/MSB at 8:00 AM at the Medical School (optional).
Resident Noon Conference at noon 7.044-A/MSB at the Medical School
(optional).
Resident Responsibilities for Planning, Record Keeping, Order Writing, and
Continuing Management on the Neurology Service
The transitional year resident is responsible for daily personal assessment, recording
daily progress notes, and daily and updated orders on assigned patients.
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OPHTHALMOLOGY
(Elective)
Goals and Objectives for the Transitional Year Resident
Transitional residents will work closely with the department faculty and residents
during their elective rotation. Their goals and objectives are as follows:
To gain understanding of the procedures involved in performing an ophthalmic
examination.
To be able to work with the basic equipment used in ophthalmology including the
slit lamp and ophthalmoscope.
To gain understanding of the identification and treatment of common ophthalmic
disorders including glaucoma, cataracts, and diabetic retinopathy.
To observe ophthalmic surgical procedures, and understand the general
indications and complications.
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ORTHOPAEDIC SURGERY
(Elective)
PURPOSE – To give the transitional resident an overall awareness of the nature of the practice
of Orthopaedics, and how to best prepare oneself in the assessment, management, treatment and
potential referral of patients with musculoskeletal complaints.
Common conditions encountered
Trauma-Open/closed fractures and related triage.
Arthrosis-DJD, RA, Traumatic, AVN, Sickle, etc.
Associated Disease states - Diabetes, Hypertension, Coronary Artery Dis.,
Hepatitis, Etoh
Drug abuse, steroids,
Immunocompromised, AIDS
Poverty/Homeless
Recognition
Safety
Infection-Acute & chronic
Emergency Center
Availability
Accurate patient assessment management recommendations
History
Physical Examination
Laboratory
X-ray / CT / MRI
Pre-operative assessment
Medical-Legal
Self-Preparation
Patient Preparation
Hazard & risks/informed consent.
Phraseology
Compassion
Medical Record – Accuracy / Timely Completion
Consultations
Where does the patient belong – medicine vs. ortho? (Who is the primary physician?)
Radiology
Routine X-rays
Special Studies
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Referral
Medicare Fraud / Abuse compliance
Mistakes
What to do immediately
When to ask for help
When to know you are getting in over your head
Common Clinical Problems (requiring familiarity)
Upper Extremity
Shoulder Fracture/dislocations
Forearm & wrist fractures
Tendon & Nerve injuries – how to diagnose and general management
Lower Extremity
Hip Fracture
Amputation concepts
Triage
Common Operative Procedure categories
Open reduction/internal fixation
Shoulder: hemiarthroplasty, Rotator Cuff Repair
Both Bone forearm fracture
Colles fracture
Total Joint Replacement
Ankle, Foot, Arthroscopy – Shoulder/Knee
Understanding Patient Evaluation
History
Physical Examination
Laboratory
X-ray
Special Studies
Preparation
Reading
Discussion
What are you doing?
Why are you doing it?
Staff Interaction
Faculty Interaction
Algorithm creation & development
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PATHOLOGY AND LABORATORY MEDICINE
(Elective)
Description of Rotation
The 1-month elective in the Department of Pathology and Laboratory Medicine is available to
transitional year residents at Lyndon B. Johnson General Hospital. The pathology department is
located on the 3rd floor of LBJGH, near the operating rooms. Transitional residents will function
mainly as observers but are expected to actively learn and participate in the service as much as
possible.
Goals for the Transitional Year Resident
To gain an understanding of the role of the surgical pathology service in medical care, including
intraoperative frozen section consultations.
To gain experience in handling routine surgical pathology specimens (e.g. gross description,
evaluation of tumor margins, selection of sections for microscopic examination).
To become acquainted with the steps involved in the processing of tissue submitted for
histopathologic examination (i.e. from tissue block to stained slide).
To become familiar with diagnostic histopathologic criteria for common diseases.
To become familiar with the essential components of the Bethesda system
To gain an understanding for the appropriate use of specialized testing, such as
immunohistochemistry and flow cytometry, in establishing a diagnosis.
To gain skills in the interpretation of clinical laboratory tests
To gain exposure to the techniques used in performing clinical laboratory testing
To recognize the role of the transfusion service in patient care
Objectives
To state the two broad categories of pathology and list at least 3 subcategories under each
To list the criteria for submission of specimens to the pathology department (i.e. accept vs. reject
specimen)
To give at least one example illustrating the importance of clinical history in rendering a
pathologic diagnosis
To perform a gross examination and gross description of at least 5 different biopsy specimens
(e.g. gastric biopsy) or simple surgical specimens (e.g. fallopian tubes for ligation) under direct
supervision of a pathology resident
To state at least 3 roles of the frozen section procedure in patient care
To describe the fine needle aspiration and bone marrow aspiration/biopsy procedures from start
to finish in lay terms
To read at least one complex surgical pathology report and at least one bone marrow
aspiration/biopsy report and orally summarize the results
To demonstrate the ability to recognize basic pathology processes under the microscope,
including: acute inflammation, chronic inflammation, necrosis/gangrene, granulomas, high-
grade malignancy
To name the major types of red and white blood cells when shown in a peripheral blood smear,
and to provide a differential diagnosis when abnormalities in cell number and/or type are
detected
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To read about pathology as a career on the website http://www.asip.net/career/index.htm
To select at least one specific topic per day, based upon current cases encountered, about which
to review basic pathophysiology and diagnostic criteria in a general pathology textbook such as
Robbins
Responsibilities of the Transitional Year Resident
Attend UT pathology department teleconferences daily at 8am in the LBJ pathology residents’
room (refer to posted conference calendar for specific topics)
Spend at least one week on each of the 3 pathology services (clinical pathology, surgical
pathology, cytopathology) and the remaining days on whatever service is most relevant to the
transitional resident’s career interests
Sit at the microscope to sign out with the residents and attending pathologists on the specific
service to which you are assigned for the week
Maintain regular working hours of 8am-5pm within the LBJ pathology department, unless prior
approval has been obtained from the chief of pathology
Observe and assist all fine needle aspiration procedures and bone marrow aspiration/biopsy
procedures when on the cytopathology service and the clinical pathology service, respectively
Attend interdepartmental conferences (e.g. tumor board, M&M) in which pathologists are
presenting cases
Review glass slide study sets or cases on the website http://www-
medlib.med.utah.edu/WebPath/webpath.html during free time
Present a topic of interest as an informal talk or as a powerpoint presentation if so requested by
the chief of pathology
Evaluation
Transitional residents will be evaluated by the chief of pathology based on their level of
participation, adherence to the above-stated responsibilities, and specific interactions with all
members of the health care team. Evaluations will be in the format provided by the LBJ Transitional
Residency Program Director.
Contact Information
Chief of LBJ Pathology Dept.: Peisha Yan, M.D.; 713-566-5284
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DIAGNOSTIC RADIOLOGY
(Elective)
Information Regarding Radiology Elective for Transitional Year Resident
Elective is one month in duration and will be completed at Lyndon B. Johnson
General Hospital.
Electives will be tailored toward each individual resident’s goals and
objectives while maintaining basic radiology goals and objectives.
Each resident should meet with Dr. Chitra Chandrasekhar at LBJ prior to
beginning the elective.
Goals and Objectives for the Transitional Year Resident
Upon completion of the elective, one will be expected to:
Develop a basic understanding of the purpose and role of common radiologic
examinations and procedures.
Understand the concept of an orderly imaging work-up for a variety of
common clinical problems.
Gain some insight into the patient experience for common radiologic
examinations.
Be able to identify major normal anatomical structures and recognize common
radiologic manifestations of disease on radiographs and other imaging
modalities.
Educational Opportunities Available to the Transitional Year Resident
Faculty/Resident readout sessions (required)
Daily resident noon conferences, LBJ Annex Rm 132 (required)
Radiology teaching file at Medical School (optional)
Recommended readings:
Squire’s Fundamentals of Radiology
by Robert Novelline, Harvard Press
Fundamentals of Diagnostic Radiology
by Brand & Helms
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