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					 UNIVERSITY OF MINNESOTA
   GRADUATE MEDICAL
       EDUCATION

      2011-2012
      RESIDENT
  PROGRAM POLICY &
 PROCEDURE MANUAL


Department of Surgery
General Surgery
Residency Training
Program

                 University of Minnesota   1
                                               Table of Contents
INTRODUCTION

   Introduction to Program Manual .......................................................................................5
   Department of Surgery Mission Statement ......................................................................5
   General Surgery Training Program Mission Statement....................................................5

SECTION 1 - STUDENT SERVICES
(Please refer to Institution Policy Manual at
http://www.med.umn.edu/gme/residents/instpolicyman/home.html for Medical School Policies on
the following: Academic Health Center (AHC) Portal Access; Child Care; Computer
Discount/University Bookstore; Credit Union; Disability Accommodations; Legal Services;
Library Services; Medical School Campus Maps; Nursing Mothers Resources; Resident
Assistance Program; University Card (UCard); University Events Box Office; University
Recreation Sports Center(s)

   Universal University Pagers .............................................................................................6
   Email and Internet Access ...............................................................................................6
   University Mailboxes and Campus Mail ...........................................................................7
   Laboratory Coats and Laundry Service ............................................................................7
   UMMC Photo ID Badge ...................................................................................................7
   HIPAA Privacy Regulations .............................................................................................7

SECTION 2 - BENEFITS
(Please refer to Institution Policy Manual at
http://www.med.umn.edu/gme/residents/instpolicyman/home.html for Medical School Policies on
the following: Insurance: Dental Insurance; Health Insurance; Life Insurance; Voluntary Life
Insurance; Long-Term Disability; Short-Term Disability; Insurance Coverage Changes;
Immunization Services; Exercise Room at UMMC-FV; Bereavement Leave; Family Medical
Leave Act (FMLA); Holidays; Medical Leave; Military Leave; Parental Leave; Personal Leave;
Professional Leave; Vacation/Sick Leave; Witness/Jury Duty; Effect of Leave for Satisfying
Completion of Program; Loan Deferment; Loan Program: Emergency Loan Program through
Minnesota Medical Foundation; Minnesota Medical Association Membership; Professional
Liability Insurance; Stipends; Veterans Certification for Education Benefits; Workers’
Compensation Benefits).
       Stipends .....................................................................................................................9
       Health and Dental Insurance Coverage .................................................................... 10
       Life Insurance, Standard and Voluntary ................................................................... 10
       Short Term Disability Insurance ............................................................................... 10
       Long Term Disability Insurance ............................................................................... 10
       Professional Liability Insurance ................................................................................ 10
       Employee Health Services ....................................................................................... 10
       Meal Tickets ............................................................................................................. 11
       Parking ..................................................................................................................... 12
       Time Away Policy for General Surgery Residents .................................................... 13
         Policy on Effect of Leave for Satisfying Completion of Program ......................... 13
                                                                                         University of Minnesota        2
          Academic and Vacation Leave ............................................................................ 13
          Parental Leave .................................................................................................... 14
          Sick Leave Policy ................................................................................................ 16
          Bereavement Leave ............................................................................................ 16
          Extended Illness/Injury Leave ............................................................................. 16
          Jury/Witness Duty ............................................................................................... 16
          Military Leave ...................................................................................................... 16
          Personal Leave of Absence ................................................................................ 16

SECTION 3 - Institution Responsibility
(Please         refer           to        Institution            Policy        Manual          at
http://www.med.umn.edu/gme/residents/instpolicyman/home.html for Medical School Policies
on the following: ACGME Resident Survey Requirements; ACGME Site Visit Preparation
Services; Master Affiliation Agreements or Institution Affiliation Agreements; Program Letters of
Agreement; Confirmation of Receipt of Program Policy Manuals; Designated Institution Official
Designee Policy; Duty Hour Monitoring at the Institution Level Policy and Procedure;
Experimentation and Innovation Policy; Funding; GME Competency Teaching Resources and
Core Curriculum; Graduate Medical Education Committee (GMEC) Responsibilities; Graduate
Medical Education Committee Resident Leadership Council Responsibilities; Institution and
Program Requirements; Internal Review Process; International Medical Graduates Policy; New
Program Process; Orientation; Visa Sponsorship Policy).


SECTION 4 - DISCIPLINARY AND GRIEVANCE PROCEDURES
(Please refer to Institution Policy Manual at
http://www.med.umn.edu/gme/residents/instpolicyman/home.html for Medical School Policies on
the following: Discipline/Dismissal/Nonrenewal; Conflict Resolution Process for Student
Academic Complaints; University Senate on Sexual Harassment Policy; Sexual Harassment
and Discrimination Reporting; Sexual Assault Victim’s Rights Policy; Dispute Resolution Policy)

SECTION 5 - GENERAL POLICIES AND PROCEDURES
(Please refer to Institution Policy Manual at
http://www.med.umn.edu/gme/residents/instpolicyman/home.html for Medical School Policies
on the following: Academic Health Center (AHC) Student Background Study Policy; Background
Study Policy and Procedure; Academic Incivility: Resources for Dealing with Harassment;
Applicant Privacy Policy; Appointment Letter Policy and Procedure; Blood Borne Pathogen
Exposure Policy; Certificate of Completion Policy; Classification and Appointment Policy;
Compact for Teaching and Learning; Disability Policy; Disaster and Local Extreme Emergent
Situation Planning Policy and Procedure; Documentation Management Requirements Policy;
Dress Code Policy; Duty Hours/On-Call Schedules; Duty Hours Policy; Duty Hours/Prioritization
of On-Call Room Assignments; ECFMG/J1 Visa Holders: Documentation Required for FMLA;
Effective Date for Stipends and Benefits Policy; Eligibility and Selection Policy; Essential
Capacities for Matriculation, Promotion and Graduation for U of M GME Programs; Evaluation
Policy; Health Insurance Portability and Accountability Act; Immunizations and Vaccinations;
Immunizations: Hepatitis B Declination Form; Impaired Resident/Fellow Policy and Procedure;
Licensure Policy: Life Support Certification Policy; Moonlighting Policy; National Provider
Identification (NPI) Policy and Procedure; National Residency Matching Program (NRMP) Fees
Policy; Nepotism Policy; Observer Policy; Post Call Cab Voucher Policy (UMMC-F; HCMC);
Registered Same Sex Domestic Partner Policy; Release of Contact Information for Solicitation
Purposes Policy; Residency and Fellowship Agreement Policy and Procedure; Residency

                                                                                     University of Minnesota       3
Management Suite (RMS): Information Maintenance for Participating Hospitals; Residency
Management Suite (RMS): Updating and Approving Assignments and Hours in the Duty Hours
Module of RMS; Restrictive Covenants; Social Networking Policy; Standing and Promotion
Policy; Stipend Level Policy; Stipend Funding from External Organizations Policy; Supervision
Policy; Trainee File and Document Retention Policy; Training Program and/or Institution Closure
or Reduction Policy; Transitional Year Policy; USMLE Step 3 Policy; Vendor and Conflict of
Interest Policy; Verification of Training and Summary for Credentialing Policy; Without Salary
Appointment Policy ).
      Surgical Education Council……………………………………………………… ............ 17
      Program Goals and Objectives and Resident Advancement .................................... 19
      Resident Evaluation System ..................................................................................... 23
      Rotation Specific Plans ............................................................................................. 35
      Teaching Medical Students .................................................................................... 138
      American Board of Surgery - Requirements for Certification in Surgery ................. 142
      ACGME Program Requirements for Residency Education in Surgery ................... 142
      ACGME Surgical Operative Log Program .............................................................. 142
      Surgery Research Resident Manual……………………………………………… ...... 144
      Residency Management Suite ................................................................................ 144
      Duty Hours Policy ................................................................................................... 145
      Resident Duty Hours in the Learning and Working Environment ............................ 145
      Supervision of Residents/Surgery Resident Supervision & Procedure Passport .... 146
      On-Call Schedule/Transition of Care/Regions PGY-1 Call System/Call Schedule
       Procedures ............................................................................................................. 150
      Moonlighting Policy................................................................................................. 155
      Resident Rotation Dates ......................................................................................... 155
      ABSITE Performance Standards Department of Surgery Policy ............................ 157
      Communication Policy ............................................................................................ 158
      Grand Rounds Compliance .................................................................................... 158
      Dress Code Policy .................................................................................................. 158
      UMMC On Call Rooms ........................................................................................... 158
      UMMC General Surgery Resident Workroom......................................................... 159
      UMMC Resident Lounge ........................................................................................ 159
      Support Services .................................................................................................... 159
      Laboratory/Pathology/Radiology Services .............................................................. 159
      Medical Records ..................................................................................................... 160
      Security/Safety University of Minnesota Medical Center ........................................ 160
      Monitoring of Resident Well-Being ......................................................................... 160


SECTION 6 DEPARTMENT AND PROGRAM ADMINISTRATIVE CONTACTS
(Please refer to Institution Policy Manual at
http://www.med.umn.edu/gme/residents/instpolicyman/home.html for Medical School Policies
on the following: University of Minnesota Physicians, GME Administration Contact List, GME
Administration by Job Duty; GME Organization Chart)

      Administrative Contact List ..................................................................................... 161

                                                                                     University of Minnesota       4
Introduction to Program Manual


The majority of information contained in this Program Manual pertains to general surgery
residents in the Department of Surgery. Please contact the individual fellowship program
coordinators for the fellowship Program Manuals.
For information that applies to all residents/fellows in a residency/fellowship training program at
the University of Minnesota, please consult the Institution Manual,
http://www.med.umn.edu/gme/residents/instpolicyman/home.html
Information in the Institution Manual takes precedence over that in Program Manual, in cases
where there is conflict.


Department of Surgery Mission Statement


Vision
To be the preeminent Department of Surgery in Minnesota serving patients of the world where
ground breaking research and exceptional training come together to produce the unrivaled care
we demand for our loved ones.

Mission
Driven to deliver:
Clinical excellence
Compassionate patient care
Pioneering research
Education of surgical leaders


General Surgery Training Program Mission Statement


The academic charge of the Department of Surgery at the University of Minnesota is to provide
a superb environment to facilitate the training of individuals at all levels – medical student,
resident, and fellow – in the discipline of clinical surgery and surgical sciences.




Section 1 Student Services


                                                                      University of Minnesota   5
Universal University Pager Your UMMC pager assigned to you remains the same for the
duration of your training. Do not turn it in when you rotate off site. For malfunctioning pagers
please contact Niea or Michelle in the Surgical Education Office or go to the UMMC main
Information Desk for assistance. New batteries can be obtained from the Department of
Surgery Education, 11-145 Phillips-Wangensteen Building.

Email and Internet Access

To set up email account:

Check to make sure you are in the University of Minnesota system. You can do this by going to
   the U of MN-Twin Cities home page at http://www1.umn.edu/twincities/. Click on Search
   icon. Under search for people, type in your name and click on search. If you are not
   registered, you won’t be in the system, and you should contact the Surgical Education Office
   at 612-626-2590 to make sure all of your paperwork is complete.

Go to the website https://www.umn.edu/initiate. Enter your University of Minnesota ID number
   and birthday (you do not need to enter your Social Security number). You then need to set
   your Internet Account Password that needs to be at least six characters long.

To access your email account:

Any computer with Internet access can be used to access your email. (See below for
setting up access from home.)

1. Go to http://www.mail.umn.edu/ (if you forget this address, there is a link to this page on the
   Department of Surgery homepage at http://www.surg.umn.edu ).
2. Click on Check your email via your Web browser.
3. Enter your X500 ID, NOT YOUR EMAIL ADDRESS.
       Ex: If your email address is smith999@ umn.edu, your X500 ID is smith999.
4. Enter your password.
5. Click on Login.

Forwarding email:
If you want to forward your University email address to your personal email address, please go
to the website http://www.umn.edu/dirtools. You will be asked to enter your X500 and
password. After you are logged in, go to ―Set email forwarding and auto reply.‖ Once you are
there, go to ―Set Email Forwarding,‖ and check ―other.‖ Enter your personal email address and
submit.



To set up Internet access from home:

   Faculty, staff, and students at the University of Minnesota can purchase internet kits from
    any of the three walk-in locations of the Academic & Distributed Computer Services: 152
    Shepherd Labs (East Bank), 93 Blegen Hall (West Bank), or 50 Coffey Hall (St. Paul), or
    from the Bookstore Computer Store in Coffman Memorial Union.
   You will need to bring a photo ID with you, preferably your U Card.
   The cost of the kits is $6.00, and they accept cash or checks only.

                                                                    University of Minnesota   6
   The kits are available on CD.
   The Internet kit on CD contains software and installers for Windows 95/98/NT4, Windows
    2000, XP and Macintosh, as well as other useful programs and utilities.
More information about the internet kits can be found at
http://www1.umn.edu/adcs/help/kits.html

University Mailboxes and Campus Mail
Mailboxes have been assigned to you. They are located on the 11th floor of the Phillips-
Wangensteen Building. You will have access to these boxes 24 hours a day. It is essential that
you pick up your mail at least 2-3 times per month. These boxes are not locked.
Your campus mail address is:
420 Delaware St. SE, MMC 195,
Minneapolis, MN 55455.

Laboratory Coats and Laundry Services
Categorical residents in the Department of Surgery, receive 3 laboratory coats, embroidered
with their name and the Department of Surgery, they will also receive lab coats as needed when
they enter their PGY-4 year.       Both PGY-1 designated preliminary and non-designated
preliminary residents receive 2 lab coats embroidered with their name and the Department of
Surgery.
Soiled coats can be dropped off in the hamper in the Surgery Department, not in the hospital.
Clean coats may be picked up one to two weeks later at the same location.
UMMC Photo ID Badge
You can obtain a UMMC photo ID badge on either the Riverside campus or the University
campus. To obtain a badge on the Riverside campus go to the Parking Office MB218, East
Building. They are open Monday- Friday, 8:00 -4:30. To get there, board the shuttle to the
Riverside campus at the entrance of University of Minnesota Mayo Building — you may obtain
the schedule from the UMMC Information Desk. The shuttle drops you off at the West Building.
Follow directions to the East building. Go in the main entrance or the East Building and follow
the signs to the Main Parking Office. The office will have a list of Department of Surgery
residents. You will be required to fill out a form giving your name, address, Social Security
Number, etc. On the University campus, go to the Mayo Building, B340.                Hours at the
University location are 7:30-4:00. You must have either a driver’s license or state ID with photo.
You will receive your badge right away if you go to the Riverside campus. If you go to the
University campus, normally you can pick it up the next day. For further information, call 612-
672-4544.

HIPAA Privacy Regulations

There are new privacy standards reflected in the HIPAA legislation. In order to be in
compliance with the new HIPAA privacy regulations, every University of Minnesota student,


                                                                   University of Minnesota   7
faculty member, researcher, and staff person are required to complete at least three on-line
courses about privacy and data security.

To access training, log on to http://www.myu.umn.edu. Everyone will need to complete the
following three courses:

The Video Awareness course
The Privacy and Confidentiality in the Clinical Setting course
The Privacy and Confidentiality in Research course

Step-by-step instructions can be found on the Privacy and Security Projects Web Site at
http://www.privacysecurity.umn.edu. Follow the link entitled ―University HIPAA Training.‖

Technical assistance is available by calling 301-HELP or 1-Help (internal). If access to a
computer is an issue, the computer lab in the Bio-Medical Library on the 2nd Floor of Diehl Hall
has been made available. Please feel free to call the Privacy Office at 612-624-7447 if you
have any questions or concerns. EVERY EFFORT will be made to assist you in completing this
process.

Accessing the Online HIPAA Courses

   1. Go to http://www.myu.umn.edu
   2. Select ―Click here to Sign-in‖, located in the upper left hand corner of the portal
       homepage.
   3. Authenticate using your U of M Internet ID and password.
   4. Confirm that authentication was successful by looking for the ―Signed in as (your name)‖
       in the upper left hand corner where you selected ―Click here to Sign-in‖.
   5. Select my Toolkit.
   6. Go to the section titled ―(Your Name) Projects To Do lists‖.
   7. Look for the title of the training course that you need to complete. Select the course and
       a new window will open up. You can begin taking the course.
   8. After you complete the course, close the window to return to your To Do list. You can
       then proceed with the next course or if you are finished, you can log out of the portal.
   9. If you have to quit the training in the middle of a course that is in WebCT, you can go
       back into the course and select the ―Resume Course‖ button in the upper navigation to
       get back to the page you were on.
   10. You will receive an email confirming your completion of the course. Print out the
       confirmation for your records. Your completion of the courses will be tracked
       electronically.
   11. Please remember to LOG OUT of the portal when you are finished. If you leave the
       computer while you are logged in, others could use your log in to access your private
       information such as HR information.

Accessing the Introduction to HIPAA Privacy and Security Video

   1. From the To Do list choose the course link.
   2. There are 3 options for viewing the video:
          View the video using QuickTime, speakers or headset required (Recommended)
          View the video with captions using QuickTime
          View the video using Real Video, speakers or headset required


                                                                  University of Minnesota   8
          Choose the option indicated in the instructions from your privacy coordinator if
          viewing the video on your work computer. If viewing it in a computer lab, ask or look
          for instructions regarding the best format: QuickTime or Real Video. If viewing it on
          your personal computer, you may have to download QuickTime. A link is provided
          on the page to do this.
   3. Once you complete the video, close the window and you will return to your To Do list to
      continue with the next training. The completion of the video will be tracked
      electronically. By the next day you should receive an email confirming the completion of
      the introductory course.

Accessing HIPAA courses in WebCT
NOTE: The remainder of the online courses will be in WebCT.

   1. From your To Do list on my Toolkit page in the portal, choose the course that you need
      to take.
            Privacy and Confidentiality in Clinical Setting
            Privacy and Confidentiality in Research
   2. You are now in WebCT at the course site that you have selected. You will see a list of
      the modules for the course you have chosen and the last item listed is a link to the
      Privacy and Security Web Site. Select the first module in the list.
   3. Now you will see the Table of Contents for the first module. Select page 1 of ___, to
      begin the course.
   4. You are now on the first page of the first module of the course and you will use the
      NEXT button in the Action Menu to go on to the next page. The first part of the course
      will explain the features available in the WebCT course including navigation options.
   5. At the end of the first module of the course, select COURSE MAP to continue on to the
      next module. (If you get a message that states, ―This is the last page of the content‖,
      then you need to select COURSE MAP to go on to the next module.)
   6. On the Course Map, select the next module in the sequence of modules for the course.
      You will repeat this process until you have finished all of the modules for the course.
      The last module will include a post-test.
   7. When you have completed all of the course modules, print out the last page to provide a
      date stamp of when you have completed the course for your records. Close the window
      and you will return to your To Do list and you can continue with the next course of log
      out of the portal. The completion of the courses will be tracked electronically. You will
      receive an email confirmation for each course that you complete. The courses will
      remain on your To Do list and will have a ―completed‖ after them.
   8. Please remember to LOG OUT of the portal when you are finished. If you leave the
      computer while you are logged in, others could use your log in to access your private
      information such as HR information.

Section 2 Benefits

Stipends

It is mandatory that all residents /fellows set up direct deposit the Employee Self-Service
website www.hrss.umn.edu.




                                                                 University of Minnesota   9
When direct deposit is used, paychecks will be posted to the bank accounts on the pay dates
listed on the following website.
http://www.med.umn.edu/gme/residents/stipendinfo/home.html


Insurance
Benefits including: Health, Dental, Life standard and voluntary Short and Long Term Disability
are facilitated through the Office of Student Health Benefits:
http://www.shb.umn/twincities/residents-fellows-medical.html


Professional Liability Insurance
Information regarding professional Liability Insurance can be located at:
http://www.med.umn.edu/gme/residents/instpolicyman/beneprofliabilins/home.html


Employee Health Services
Employee Health Serives at UMMC Fairview (University Campus – Mayo B364, Riverside East
– MB247A), Regions Hospital, Hennepin County Medical Center, and the Veterans Affairs
Medical center are open for immunization services for residents and fellows at no cost to you.
These services include annual Mantoux updates, hepatitis B vaccinations, chicken pox, and
other immunizations.
When you receive an email notice from AHC UTrack, the immunization database, that you are
noncompliant:

             Present a hard copy of the email to the Employee Health staff at the hospital
              training site
            Request walk-in immunization service or make an appointment
If you are unable to print the email or need information for the Employee Health Services staff,
you will be permitted to use a computer in the Employee Health Service office to access your U
of M portal at www.myu.umn.edu (login using your x.500 and password) to obtain your latest
immunization information.     Employee Health staff must have this information to provide
immunization services.
If you have questions, please contact Carol Sundberg via email at sundb001@umn.edu or by
phone at 626-3317 or visit the Office of Occupational Health and Safety.




                                                                   University of Minnesota   10
Meal Tickets
Meal Tickets will be provided for you on all rotations. Meal tickets are electronic in the UMMC
cafeteria and the Eastside Market Cafeteria (Riverside). At the VA, the kitchen has a list of who
is on call. At all other sites, the on-site Education Office will provide you with the details of your
meal allowances.
                         University of Minnesota Medical Center, Fairview
                                   Meal Card Policy and Procedure


I.PURPOSE
To provide food service for resident and fellows who have been assigned to provide on-call
services in the hospital on either campus, Riverside or University, for a specific period of time
other than a normal work day.

II. POLICY
     A. On-call meals (dinner & breakfast) will be provided for residents and fellows who work
        24 consecutive hours on site, interns that are scheduled to work the maximum number
        hours allowed(16 hrs), are pre-scheduled 5 or more 12 hour night shifts (night float), or
        are called from home to return to the hospital while on home call. No meal will be
        provided if they are on call from home or stay at home.

   B. ID Badge Requirement - Residents and fellows are required to have a Fairview ID badge
      visible and present in order to obtain on-call meals.

   C. Bulk Purchase Limitation – Bulk purchases (i.e...extra sodas/waters, bags of candy) are
      not allowed. Limit of 3 bottles and one half pound of candy or snacks may be purchased
      at one time.

   D. Sharing Restriction – This privilege is for the resident and/or fellow use in the hospital
      and may not be shared with medical students, families, or other hospital staff.



III. PROCEDURE
     A.   Each resident and/or fellow involved in clinical duties and meets the above criteria
          will receive a meal card at the start of the academic year. The dollar amount on each
          card will be determined by the number of on-call months the department designates
          to the resident and/or fellow.

   B.      Changes to a resident and/or fellow schedule throughout the academic year that
           increases the amount of time spent on-call will be eligible for an increase in their
           meal card allotment. The department will contact the GME office at UMMC-F with the
           resident name and increase request for approval.

   C.      Non-compliance with this policy may result in short-term suspension of meal card
           privileges or termination of privileges. The Vice President of Medical Affairs at
           UMMC-F reserves the right to suspend or terminate meal card privileges at any time,
           without notice.




                                                                      University of Minnesota   11
   D.       Each resident and/or fellow eligible for meal card privileges must sign the statement
            of understanding (attachment A), in order to receive their meal card for the academic
            year.

   E.       Questions and/or issues regarding meal cards at UMMC-F may be directed to the
            UMMC-F GME office at 612-273-7482.



                      University of Minnesota Medical Center, Fairview
                              Meal Card Policy and Procedure
                                       Attachment A


STATEMENT OF ACKNOWLEDGEMENT OF ON-CALL MEAL POLICY

This is to acknowledge that I have read the On-Call Meal Card Policy and understand that this is
a privilege provided in recognition of my on-call responsibilities. I also understand the limits of
the policy and I agree to honor the limits within the policy. I understand that the on-call meal is
provided for my benefit and not to be shared with others or to be used at times when I am not
on-call. I understand not complying with this policy can result in suspension or termination of my
meal card privileges.




Program Name


Signature


Printed Name


Date



Parking
The Department of Surgery provides a parking contract for the Oak Street Ramp on Oak Street
and Delaware for residents on service at UMMC. Parking cards at UMMC are service and
resident-level designated. It is the resident’s responsibility to exchange parking cards
properly. Parking at Regions is available through the Surgical Education Office at Regions; at
the VA no parking card is required, the surface lot is open to all. At all other sites, the on-site
Education Office will provide you with the details of how and where to park. When not on
service at UMMC, parking is provided for you in the Washington Avenue Ramp and East

                                                                    University of Minnesota   12
River Road Garage when attending Department of Surgery Grand Rounds.                        Parking
stamps can be obtained from the Surgical Education Office and are stamped on the
parking ramp ticket only.




Time Away Policy for General Surgery Residents 2011-2012

American Board of Surgery Requirements for Time in Training
Based on the requirements set forth by the American Board of Surgery (ABS) for Board
Eligibility, the number of weeks of full-time surgical experience needed to complete residency
training is as follows:
1. First three clinical years; 144 weeks completed of 156 calendar weeks.
          Time Away permitted: 3 weeks/year (9 weeks over 3 years). Three additional days over
    the holidays are provided (nine days over three years). This allows an additional 12 days
    available for academic leave (meetings, interviews, USMLE exams, etc.)
2. Fourth and Fifth clinical years; 96 weeks completed of 104 calendar weeks.
          Time Away permitted: 3 weeks/year (6 weeks over 2 years). Three additional days over
    the holidays are provided (six days over two years). This allows an additional 9 days
    available for academic leave (meetings, interviews, etc.)
3. The ABS endorses one additional 2-week period within the first three clinical years  for
Family Leave and one additional 2-week period in the last two clinical years       for   Family
Leave. Any additional time taken may require additional training time      in order to meet the
ABS requirements for certification.

Time Away Leave is allowed in one week blocks only, Monday through Sunday.
The one week block, 7 days, Monday- Sunday, must be taken during each of the 4-month
periods:
July 1 - October 30
October 31- February 26
February 27- June 30

Time Away not taken during a 4-month period may not be carried forward. Greater than 7
days of Time Away may be taken only under special circumstances (e.g., marriage,
overseas travel, etc.) with a maximum of 14 days, and must be split at the end of one
rotation and the beginning of another.

Time Away requests MUST be submitted in writing/email using the Department of Surgery
Time Away form and will be approved if the Resident has days available and the service and
on-call schedule is covered. Academic Leave includes but is not limited to: fellowship
interviews, conferences, USMLE exams, meetings, teaching ATLS, etc. Academic Leave and
Parental Leave requests MUST be submitted as soon as you know the dates.
Maternity/Paternity leave dates are scheduled using the projected date of delivery. All residents
in the General Surgery Training program must submit all time away requests in writing/e-mail to
Niea Johnson in the Surgical Education Office. Time Away requests CANNOT be prearranged
with other departments/services.

At a minimum, time away requests must be submitted by the last working day of the
month two months prior to the intended month of vacation, ex. May 31, 2011 is the last

                                                                  University of Minnesota   13
date to submit for a July vacation. We encourage Residents to plan ahead so as not to lose
allowed days. For compliance of the Duty Hour Restrictions as outlined by the ACGME, our
program will maintain a minimum of one-in-four call for all residents whenever possible. These
criteria may result in leave request denials. Any exception to this policy will be reviewed on an
individual basis.

Time Away and Rotation Schedule 2011-2012
                                                     Rotation/Vacation
                                  Materials          Schedule Due to               Vacation Schedule
                                  Provided                  Niea                  Closed for PGY level

Chiefs                            2/21/2011               3/1/2011                       3/4/2011

PGY-4                              3/7/2011              3/15/2011                       3/18/2011

PGY-3                             3/21/2011              3/29/2011                       4/1/2011

PGY-2                              4/4/2011              4/12/2011                       4/15/2011

PGY-1                             4/18/2011              4/26/2011                       4/29/2011
Vacation Schedule
open for all 5/23/2011

Time Away and Rotation Schedule for the Academic Year may be submitted in advance
according to the schedule listed above. Requests submitted by the due date will be granted
according to availability and seniority.

Beginning May 23, 2011 remaining vacation blocks will be granted on a first come, first serve
basis with consideration to service coverage and rotation call schedules.

Blackout periods:
There will be no leave allowed during the period between December 23-January 1, see below
Holiday Vacation, the last week of January (In-Training exam) and the last two weeks of June
and the week of the Annual Course.

No Time Away will be allowed for the following rotations:
      PGY-1 UMMC & Regions Night Float
      PGY-2 UMMC Acute Care Surgery Rotation
      PGY-3 Regions Night Float

Holiday Vacation
If you choose the program will arrange for you to have three days off, these days will count
against up to 3 of your 1 in 7 days off during the rotation period, for the period of December 23-
January1. Holidays that occur during a leave of absence run concurrent with the leave and are
NOT in addition to the leave.


Graduate Medical Education Policy:

Policy: Parental Leave                                    Policy #

                                                                     University of Minnesota   14
Original Approval: 2003; 04.24.07                           Effective Date:
Approved by GM EC: 02.26.08                                 Revision Date:
                                                            01.29.08

                                                            3.27.07
Distribution: R/F; PD; PC; Institution Policy Manual;       Policy Owner:
GME website                                                 GME
                                                            Administration

Policy
The resident/fellow (trainee) as defined below must give notice, in writing, of intent to use
parental leave and other leaves used in conjunction with parental leave to their program director
at least four (4) weeks in advance, except under unusual circumstances.

Please see your Program Manual for specific departmental policies and procedures.

Birth mother:
A birth mother shall be granted, upon request to the program director, up to six weeks parental
(maternity) leave for the birth of a child. The maternity leave shall begin at the time requested
by the trainee, although the leave may not begin more than six weeks after the birth. The leave
must be consecutive and without interruption.

Trainees on maternity leave will receive the first two weeks of their leave as paid parental
leave. This paid parental leave shall not be charged against the trainees’ vacation, sick or PTO
allocation.

Note: The first two weeks of this paid parental leave covers the required fourteen day wait
period before they may be eligible to receive the short-term disability benefit, see Short Term
Disability Policy.

Birth father:
A birth father shall be granted, upon request to the program director, up to two weeks paid
parental leave for the birth of a child. The leave must commence no sooner than two weeks
prior to the anticipated delivery date and no later than six weeks after the delivery. The leave
must be consecutive and without interruption. This paid parental leave shall not be charged
against the trainees’ vacation, sick or PTO allocation.




Policy: Parental Leave                                      Policy #




                                                                       University of Minnesota   15
Registered same sex domestic partner:
Registered same sex domestic partner of someone giving birth shall be granted, upon request
to the program director, up to two weeks paid parental leave. The leave must commence no
sooner than two weeks prior to the anticipated delivery date and no later than six weeks after
the delivery. The leave must be consecutive and without interruption. This paid parental leave
shall not be charged against the trainees’ vacation, sick or PTO allocation.

Adoption:
An adoptive parent shall be granted, upon request to the program director, up to two weeks paid
parental leave for the adoption of a child. Trainees who are registered same sex domestic
partners of someone adopting a child shall be granted two weeks paid leave. The leave must
commence no sooner than two weeks prior to the anticipated adoption date and no later than
six weeks after the adoption. The leave must be consecutive and without interruption. This paid
parental leave shall not be charged against the trainees’ vacation, sick or PTO allocation.

Clarification:
Holidays that occur during a leave of absence run concurrent with the leave and are NOT in
addition to the leave.

Please see the University of Minnesota Institution Manual for additional information on the
following leave policies:
http://www.med.umn.edu/gme/residents/instpolicyman/home.html

      Parental Leave
      Family Medical Leave Act (FMLA)
      Medical Leave
      Personal Leave
      Professional Leave
      Vacation and Sick Leave
      Witness/Jury Duty


2/11/11
Surgical Education Council



Section 3 - Institution Responsibilities
(Please refer to Institution Policy Manual at
http://www.med.umn.edu/gme/residents/instpolicyman/home.html for Medical School Policies on
the following: ACGME Resident Survey Requirements; ACGME Site Visit Preparation Services;
Master Affiliation Agreements or Institution Affiliation Agreements; Program Letters of
Agreement; Confirmation of Receipt of Program Policy Manuals; Designated Institution Official
Designee Policy; Duty Hour Monitoring at the Institution Level Policy and Procedure;
Experimentation and Innovation Policy; Funding; GME Competency Teaching Resources and
Core Curriculum; Graduate Medical Education Committee (GMEC) Responsibilities; Graduate
Medical Education Committee Resident Leadership Council Responsibilities; Institution and
Program Requirements; Internal Review Process; International Medical Graduates Policy; New
Program Process; Orientation; Visa Sponsorship Policy).


                                                                   University of Minnesota   16
Section 4 – Disciplinary and Grievance Procedures
Please refer to Institution Policy Manual at
http://www.med.umn.edu/gme/residents/instpolicyman/home.html or Medical School Policies on
the following: Discipline/Dismissal/Nonrenewal; Conflict Resolution Process for Student
Academic Complaints; University Senate on Sexual Harassment Policy; Sexual Harassment
and Discrimination Reporting; Sexual Assault Victim’s Rights Policy; Dispute Resolution Policy)



Section 5 General Policies and Procedures

Surgical Education Council


The Surgical Education Council (SEC) is composed of surgeons from the four integrated
institutions and one affiliated institution, a Resident Representative, and the Residency
Coordinator. This council is responsible for management of all aspects of the teaching program.
The Program Director, Dr. Michael A. Maddaus, has overall responsibility for the teaching
program and the SEC reports directly to him. There are four levels in the hierarchy of
responsibility:


                                      Program Director
                                               |
                                 Surgical Education Council
                                               |
                            Integrated Site Directors of Education
                                               |
                           Surgical Services Directors of Education

Specifically the council includes:

Name                                 Role on SEC

Al-Refaie, Waddah B.         VA Site Director
Acton, Robert                Medical Student Course Director
Antonoff, Mara               Administrative Chief Resident
Chipman, Jeff                Associate Program Director & PGY-2/3 Mentor
D’Cunha, Jon                 Associate Program Director
Deveney, Gina                Surgery Education Program Coordinator
Druck, Paul                  VA Gen/Vasc & SICU
Dunn, Ty                     UMMC Trasnplant Surgery
Harmon, James                UMMC General Surgery & SICU
John, Ranjit                 UMMC Cardiovascular Surgery
Kwaan, Mary                  UMMC Colorectal Surgery
Larson, Cathy                Surgical Residency Coordinator
Leslie, Dan                  UMMC Minnimally Invasive Surgery
Lunden, Michelle             Surgical Education Office Support Staff
Maddaus, Michael             Program Director
McGonigal, Michael           Regions TACS

                                                                 University of Minnesota   17
Melin, Mark                   Methodist Site Director
Mendeloff, Jeffrey            Methodist Hospital
Mohr, William                 Regions Burn
Reil, Todd                    UMMC Vascualr Surgery
Rosenthal, Gary               Regions Vascular Surgery
Schmitz, Connie               Professional Educator
Swanson, Jennifer             Administrative PGY-4 Resident
Tuttle, Todd                  UMMC Surgical Oncology
Vickers, Selwyn               Department Chair
Wolpert, Seth                 Regions Site Director


The specific responsibilities of the SEC are:

   Development, modification, and implementation of the core teaching program

   Ensure compliance with ACGME/RRC requirements



   Meet to review:

           Faculty evaluations of residents

           Resident operative/patient experience

Ongoing issues of importance to the teaching program

       Review American Board of Surgery In-Training Examination Scores

       Review and recommend options for residents with poor academic and/or clinical
       performance

       Encourage and promote excellence among trainees and teachers

Apart from their responsibilities as members of the SEC, the Integrated Site Directors of
Education also are responsible for implementation of and compliance with policies and
directives that constitute the departmental teaching program at their integrated institutions, as
outlined by the Program Director and the SEC. The specific responsibilities of the Integrated
Site Directors are:

Implementation of core teaching program at their integrated site

Work with Service Directors of Education to:

       Oversee, troubleshoot, rectify problems, and modify the core teaching program on an
             iterative basis

       Review evaluations of residents completing rotations at their institutions

       Ongoing assessment and refining of integrated site teaching goals

                                                                   University of Minnesota   18
Implement other SEC directives

The next level of responsibility, the Service Director of Education, is a designated surgeon on
each surgical service at each integrated site who is selected and appointed based upon their
commitment to surgical education. The specific responsibilities of the Service Directors of
Education are:

Implementation of the portion of core didactic program assigned to their surgical service

Conduct exit interviews with individual residents at the end of their rotation as follows:

       Review evaluations of the residents by service faculty

       Confirm completion of operative reports and discharge summaries

       Review resident operative experience (updated operative log) for service

       Discuss other pertinent issues related to service, program, career plans

3.     Organization and oversight of patient teaching round

                                     Department of Surgery

                                     University of Minnesota

                               General Surgery Training Program

                      Goals and Objectives and Resident Advancement

                                   By Service and PGY Level

Overview of the UM General Surgery Training Program

Our goal is to train academic general surgeons who will provide the highest level of clinical care
and advance the frontiers of surgical science through research and education.

To achieve this goal, we engage residents in a planned curriculum delivered via lectures and
conferences, simulation (standardized patient encounters, inanimate and animate labs), online
course materials, at bedside and in the operating room during structured rotations. Most
residents also spend two years in a research lab, acquiring knowledge of basic and translational
science and associated research skills under the guidance of a faculty mentor. Through
appropriate supervision and guidance and a structured evaluation system, residents develop a
high level of professionalism, as well as the requisite clinical and surgical skills.

Throughout the course of training, residents receive multiple layers of supervision. The staff
physician is available daily for patient care and the formulation of treatment plans. Newer
residents will be constantly relying on more senior residents for assistance, supervision, and
reassurance.

The rotation schedule is designed to allow maximum exposure to both the Core General

                                                                     University of Minnesota   19
Surgery Requirements and the important Additional Components outlined by the Surgery
Residency Review Committee (RRC). Our program comprises training take at four core facilities
(University of Minnesota Medical Center, the Veterans Administration Medical Center, Regions
Hospital, and Methodist Hospital) and several affiliated private hospitals. This experience
exposes residents to the full range of surgical care environments, running the gamut from busy
community hospitals to tertiary referral centers.
Education Goals

Our goal is to train residents so that they are competent in the six core competency areas as
defined by the Accreditation Council of Graduate Medical Education (ACGME) and the RRC:


1. Patient Care that is compassionate, appropriate, and effective for the treatment of health
   problems and the promotion of health. Surgical residents must:

      Specifically demonstrate technical proficiency and manual dexterity appropriate for their
       training level
      Develop and execute patient care plans appropriate for their level.

2. Medical Knowledge about established and evolving biomedical, clinical, and cognate (e.g.,
   epidemiological and social-behavioral) sciences, as well as the application of this knowledge
   to patient care. Surgical residents are expected to:

      Critically evaluate and demonstrate knowledge of pertinent scientific information.

3. Practice-Based Learning and Improvement that involves the investigation and evaluation
   of care for their patients, the appraisal and assimilation of scientific evidence, and
   improvements in patient care. Surgical residents are expected to:

      Critique personal practice outcomes
      Demonstrate recognition of the importance of lifelong learning in surgical practice.

4. Interpersonal and Communication Skills that result in effective exchange of information
   and collaboration with patients, their families, and other health professionals. Surgical
   residents are expected to:

      Communicate effectively with other health care professionals
      Counsel and educate patients and families
      Effectively document practice activities

5. Professionalism, as manifested through a commitment to carrying out professional
   responsibilities, adherence to ethical principles, and sensitivity to patients of diverse
   backgrounds. Surgical residents are expected to:

      Maintain high standards of ethical behavior
      Demonstrate a commitment to continuity of patient care
      Demonstrate sensitivity to age, gender and culture of patients and other health care
       professionals

6. Systems-Based Practice, as manifested by actions that demonstrate an awareness of an
   responsiveness to the larger context and system of health care, as well as the ability to call

                                                                     University of Minnesota   20
   effectively on other resources in the system to provide optimal health care. Surgical
   residents are expected to:

      Practice high quality, cost-effective patient care
      Demonstrate a knowledge of risk-benefit analysis
      Demonstrate an understanding of the role of different specialists and other health care
       professionals in overall patient management.

Education Components

Education activities occur in four main components: Lectures and Conferences, Simulation,
Online Education, and Structured Surgical Rotations.

1. Lectures and Conferences

   Tuesday mornings constitute our formal ―Education Day.‖ Each Tuesday hosts a
   Complications Conference, a Grand Rounds presentation, and Core Curriculum sessions for
   junior (PGY 1-2) and senior (PGY 3-5) residents. Attendance for the entire morning is
   mandatory for all residents at all training levels and sites, including those in the research lab,
   and is recorded. If the junior (PGY 1-2) Core Curriculum is cancelled those residents are
   asked to join the PGY 3-5 Core Curriculum.

      Core Curriculum sessions are one hour in length; they focus on basic science and
       clinical management and follow a case-based format. Prior reading assignments and
       resident interaction is expected. Session topics comprise a two-year cycle; they follow
       the Association of Program Directors in Surgery (ADPS) national core curriculum and
       topics in identified textbooks. Assigned readings may be found in the RMS conference
       calendar. A required textbook is supplied by the Department to categorical residents.
       Residents are free to supplement with other texts on their own. In addition, textbooks
       are available from the U of MN library.

      Surgery Grand Rounds (45 minutes) provide a forum for national and local guest
       speakers, faculty members, and senior residents to present on important topics related
       to basic science research, clinical best practices, ethics, patient safety, health care
       systems, and the like. This venue also allows for spirited debate and in-depth instruction
       for attendees.

      Complications Conferences (45 minutes) are conducted at all integrated institutions in
       addition to the Tuesday morning conference at the University main campus. These
       conferences emphasize patient safety, systems analysis of root causes, and institutional
       NSQIP data as well as pertinent aspects of surgical basic science and clinical care.




                                                                     University of Minnesota   21
2. Simulation

Simulation constitutes one of the fastest growing training approaches to emerge in recent years.
At the University of Minnesota, we use standardized patients to prepare and assess residents’
interpersonal and communications skills and professionalism. We also have a comprehensive
schedule of inanimate and animate labs in which we develop and assess basic technical skills,
critical response and team skills, and more advanced surgical procedures (open and
laparoscopic). Residents in their first through third years of training participate regularly in
planned curricula delivered in the SimPORTAL, a fully-accredited Education Institute (Level 1)
by the American College of Surgeons. Some of the curriculum elements are unique to the
University of Minnesota; some are drawn from the ACS Surgical Simulation Skills curriculum
available online. We also rely on the Fundamentals of Surgery (FLS) curriculum as developed
and certified by SAGES. Residents in their second through fifth year of training also participate
in animate labs focusing on minimally invasive procedures. The content of simulation training is
shown below by PGY training level:

      PGY-1 Residents
         o ATLS
         o ACLS
         o Asepsis + skin prep
         o Instrument identification and handling
         o Knot tying
         o Suturing
         o Excision of a skin lesion
         o Surgical airway management
         o Central lines
         o Chest tubes and thoracentesis
         o Ultrasound
         o Managing hypoxia and hypotension
         o Responding to dysrhythmias
         o Glucose + electrolyte management
         o Nasogastric tube placement
         o Arterial line placement
         o Wound care
         o Introduction to Fundamentals of Laparoscopic Surgery

      PGY-2 Residents
         o Critical response review (ATLS)
         o Critical response review (ACLS)
         o Critical response review (ICU, Sepsis)
         o Introduction to endoscopy
         o Knot tying (revisited)
         o Suturing (complex)
         o Stapled bowel anastomosis
         o Hand bowel anastomosis
         o Vascular anastomosis
         o Animate labs covering: lap Nissen, lap jejunostomy, lap hernia repair

      PGY 3-5 Residents
         o Animate labs covering: lap Nissen, lap jejunostomy, lap hernia repair


                                                                  University of Minnesota   22
3. Online Education

In 2005, our Department developed the ―Rotation as a Course‖ (RAC) program. Selected
rotations were developed as hybrid, online / on-ground courses supported by the WebCT /
VISTA (Blackboard) online course management system. The goal of RAC is to organize
teaching and support learning, as it occurs during a rotation. RAC courses include rotation-
specific learning objectives, pre- and post-tests, online lecture presentations, electronic links to
assigned readings and other resources, weekly case-based discussion topics (face to face), and
end-of-rotation oral exams. Current RAC rotations (listed below) are all based at the University
campus.

      Thoracic + Foregut Surgery
      Surgical Critical Care
      Surgical Oncology
      MIS + Bariatric Surgery
      Pediatric Surgery

4. Structured Surgical Rotations

All rotations in the residency program have been structured to help residents achieve specific
learning objectives aligned with the ACGME core competency areas. These objectives are
delineated by training level as well as training site and rotation in the following sections.
Education activities vary by training site and by rotation, but all contain the following elements:

      Daily clinical rounds
      Site and specialty conferences


                                    Department of Surgery
                             Surgical Residency Training Program
                                 Resident Evaluation System

                                    University of Minnesota

                        General Surgery Residency Training Program

                                  Program Mission and Goals
                             Description of the Training Program
                             Evaluation of Resident Performance



1. Program Mission and Goals

   As stated in our 2010 Education Excellent Committee Action Plan, our mission is to educate
   surgeon leaders. We seek to achieve:

      Positive faculty engagement and sense of ownership in the education mission
      High quality rotations and faculty teaching

                                                                    University of Minnesota   23
   High performance by residents on American Board of Surgery in-training exams, written
    and oral boards
   High standards of professionalism and resident leadership in patient care, education,
    and service
   Scholarly accomplishment by residents in biomedical and clinical research, as well as
    surgical education research
   Local innovation in surgical education methods and collaboration with national partners

Education Goals

Specifically, we train residents so that they are competent in the six core competency areas
as defined by the Accreditation Council of Graduate Medical Education (ACGME) and the
Residency Review Committee (RRC):

1. Patient Care that is compassionate, appropriate, and effective for the treatment of
   health problems and the promotion of health. Surgical residents must:

       Specifically demonstrate technical proficiency and manual dexterity appropriate for
        their training level
       Develop and execute patient care plans appropriate for their level.

2. Medical Knowledge about established and evolving biomedical, clinical, and cognate
   (e.g., epidemiological and social-behavioral) sciences, as well as the application of this
   knowledge to patient care. Surgical residents are expected to:

       Critically evaluate and demonstrate knowledge of pertinent scientific information.

3. Practice-Based Learning and Improvement that involves the investigation and
   evaluation of care for their patients, the appraisal and assimilation of scientific evidence,
   and improvements in patient care. Surgical residents are expected to:

       Critique personal practice outcomes
       Demonstrate recognition of the importance of lifelong learning in surgical practice.

4. Interpersonal and Communication Skills that result in effective exchange of
   information and collaboration with patients, their families, and other health professionals.
   Surgical residents are expected to:

       Communicate effectively with other health care professionals
       Counsel and educate patients and families
       Effectively document practice activities

5. Professionalism, as manifested through a commitment to carrying out professional
   responsibilities, adherence to ethical principles, and sensitivity to patients of diverse
   backgrounds. Surgical residents are expected to:

       Maintain high standards of ethical behavior
       Demonstrate a commitment to continuity of patient care



                                                                 University of Minnesota   24
          Demonstrate sensitivity to age, gender and culture of patients and other health care
           professionals

   6. Systems-Based Practice, as manifested by actions that demonstrate an awareness of
      an responsiveness to the larger context and system of health care, as well as the ability
      to call effectively on other resources in the system to provide optimal health care.
      Surgical residents are expected to:

          Practice high quality, cost-effective patient care
          Demonstrate a knowledge of risk-benefit analysis
          Demonstrate an understanding of the role of different specialists and other health
           care professionals in overall patient management.

2. Description of the Training Program

   Residents receive training at four core facilities and one affiliated hospital:

          University of Minnesota Medical Center
          Veterans Administration Medical Center
          Regions Hospital
          Methodist Hospital
          North Memorial (affiliated)

   This experience exposes residents to the full range of surgical care environments, from busy
   community hospitals to tertiary referral centers. The rotation schedule is designed to allow
   maximum exposure to both the Core General Surgery Requirements and the important
   Additional Components outlined by the Surgery Residency Review Committee (RRC).

   Several components, described below, help us to achieve these program and education
   goals:

      1.   Extended PGY-1 Resident Orientation (―Boot Camp‖)
      2.   Enrollment in the SCORE General Surgery Resident Curriculum Website Portal
      3.   Weekly M+M, Grand Rounds, and Core Curriculum sessions for all residents
      4.   Structured simulation skills labs and standardized patient assessment
      5.   Structured (online) curricula at the rotation level
      6.   A two-year research lab after the PGY-3 clinical year
      7.   A robust resident evaluation and remediation system

   Extended PGY-1 Orientation

   Scheduled the week prior to residents’ first day on rotation, the PGY-1 Orientation consists
   of approximately 24 hours of didactic and experiential learning and baseline skills testing.
   Residents who perform well in the Baseline PGY-1 OSATS may be excused from some of
   the simulation skills labs.

   Enrollment in SCORE




                                                                      University of Minnesota   25
All residents (non-categorical as well as categorical) are enrolled in the SCORE Website
Portal. The Portal contains weekly assignments for Department Core Curriculum sessions,
as well as suggested readings for rotation conferences and teaching sessions.

Weekly M+M / Quality Improvement Conferences, Grand Rounds, and Core
Curriculum

Tuesday mornings constitute our formal ―Education Day‖ with protected time for residents.
Attendance for these sessions is mandatory for all residents at all training levels and sites.
Attendance (including those in the research lab) is taken and is recorded.

   M+M / Quality Improvement Conferences

    Three Tuesdays a month the Department holds an M+M conference which is attended
    by all residents, students, and faculty from the University along with other professional
    staff. These conferences run 30-45 minutes in length. On the fourth Tuesday, we hold a
    longer (1 hour) QI Conference which is attended by hospital staff as well as faculty and
    residents from the Department of Surgery and other departments. Case information is
    sent out to attendees prior to each conference. Starting in 2011, M+M case data will be
    logged in a new database classification system that supports further quality improvement
    efforts. In addition to the Department’s M+M conferences, individual hospitals also hold
    weekly M+M sessions.

   Grand Rounds Sessions

    Our Department hosts approximately 40 CME accredited Grand Rounds speakers a
    year, including six that are national speakers sponsored by endowed chairs and
    services. Faculty members within the University (at least one per Division per year) are
    also asked to present. Senior residents give several case presentations per year.
    Topics range from basic science research and clinical best practices to ethics and
    medical mission work; patient safety, health care systems, and practice management;
    and education (e.g., simulation-based teaching).

   Core Curriculum

    These sessions are one hour in length; they focus on basic science and clinical
    management and follow a case-based format. Prior reading assignments and resident
    interaction is expected. Session topics cover a two-year cycle based on the Association
    of Program Directors in Surgery (ADPS) Core Curriculum and the more recent SCORE
    Curriculum modules. Assigned readings are posted in the RMS conference calendar
    and on the SCORE Website Portal.

Structured Simulation Skills Labs and Assessments

Since 2007, we’ve used a research-based standardized patient OSCE to prepare and
assess residents’ interpersonal and communications skills and professionalism. We also
have a comprehensive schedule of inanimate labs in which we develop and assess basic
technical skills, critical response and team skills, and more advanced surgical skills.
Residents in their first through third years of training participate regularly in planned curricula
delivered in the SimPORTAL, a fully-accredited Education Institute (Level 1) by the
American College of Surgeons. Some of the curriculum elements are unique to our

                                                                   University of Minnesota   26
Department; some are drawn from the ACS Surgical Simulation Skills curriculum. We also
rely on the Fundamentals of Surgery (FLS) curriculum as developed and certified by
SAGES. The content of simulation training is shown below and on the following page by
PGY training level:

  Department of Surgery: Simulation Curriculum across the Training Continuum

   MS3                 MS4               PGY-1              PGY-1              PGY 2+3
 Clerkship         Preparation         Orientation        Curriculum          Curriculum;
                   for Surgery                                                   FLS
  Course                                 (“Boot
   7500           Course 7501            Camp”)
Asepsis,                              OSATS              Asepsis
sterile                               Asepsis
technique,
universal
precautions
Scrubbing,                            OSATS              Scrubbing,
gowning,                              Scrubbing,         gowning,
gloving                               gowning,           gloving
                                      gloving
 Clerkship           4th Year            PGY-1              PGY-1               PGY 2-3
                     Elective          Orientation
Skin prep                             OSATS Skin         Skin prep
                                      prep
                                      OSATS              Instruments
                                      Instruments
Knot tying        Knot tying          OSATS Knot         Knot tying           G2 Knots
                                      tying                                   revisited
Suturing          Suturing            OSATS              Suturing             G2-G3
                                      Suturing                                Anastomosis
                                                                              Unit: (3
                                                                              sessions)
                                      OSATS              Excisions
                                      Excisions
Local             Local
anesthetics       anesthetics
Arterial          Arterial lines                         Arterial line
puncture for                                             (w/central
blood gas                                                line)
sampling
Peripheral
IVs
Foley
catheters

                                                           University of Minnesota   27
NG tubes
Central lines      Central lines                          Central line
+ ultrasound                                              (w/ arterial)
                                                          ACS
                                                          Ultrasound
                                                          Course (2
                                                          sessions)
Chest tubes        Chest tubes,                           Chest tube +
                   Doppler                                thoracentesis
                   Critical              Critical                              G2 Critical
                   response              response                              response
                                         Lecture                               (ATLS)
                   Hypoxia,
                   hypotension           Hypoxia,
                                         hypotension
                   Critical              Critical                              G2 Critical
                   response              response                              response
                                                                               (ACS)
                   Glucose +             Glucose +
                   electrolyte           electrolyte
                   Critical              Critical                              G2 Critical
                   response              response                              response
                                                                               (Sepsis)
                   Cardiac,              Cardiac,
                   LVAD                  LVAD
                   Ventilators
                                                          Surgical
                                                          airway
                                                          Laparoscopy          Intro to FLS
                                                          (4+                  / FLS Chiefs
                                                          sessions)
                Endoscopy/
                bronchoscopy

                   Trauma
                   systems and
                   initial
                   management
                Pt Care Tasks:       Pt Care Tasks:
                 Patient tracking    Patient tracking
                 Patient hand-       Patient hand-
                  offs                 offs
                 Post-op care        Post-op care
                 Patient             Patient
                  discharge            discharge
                 Basic operations    Basic

                                                            University of Minnesota   28
                   Pre-op                 operations
                    evaluation            Pre-op
                   Medical dosing         evaluation
                   IV fluids +           Medical dosing
                    nutrition             IV fluids +
                   Post-op care           nutrition
                    cardiac               Post-op care
                   Radiologic tests       cardiac
                                          Radiologic tests
                                             Team
                                             STEPPS
                      Teaching:                                 Teaching:
                      Coaching and                              Coaching
                      Supervision                               and
                                                                Supervision
                                                                Family                Family
                                                                Conference            Conference
                                                                OSCE                  OSCE
   Structured (online) Curricula at the Rotation Level

   Our Department was one of the first in the nation to experiment with web-based learning as
   an adjunct to specifically defined curriculum at the rotation level. Our 2005-07 ―Rotation as
   a Course‖ (RAC) pilot program preceded the SCORE Website Portal by about two years. In
   2010-11, faculty representing 18 core rotations on the Surgical Education Council spent
   several months realigning the core topics taught on rotations with the SCORE Curriculum.
   The result is a formalized education plan for each rotation, complete with a syllabus (list of
   core topics), assigned readings and other resources; a schedule for weekly seminars and
   specialty conferences as well as teaching rounds; and an end-of-rotation oral exam based
   on core topics. For 14 of these rotations, faculty members created websites via the
   University’s Moodle system for managing these resources.

   Research Lab

   Our mission is to train academic surgeons. Most residents matched into our program
   choose to take advantage of the opportunity to spend two years in a funded research lab
   with an assigned mentor. This program has long been a part of the Department’s history,
   and it continues to be a hallmark of our training. A resident career development plan, begun
   in the second year of training, helps the Department match residents to appropriate labs. In
   addition to basic science and clinical research labs organized under the Department’s Basic
   and Translational Research Division, the Surgical Education Division hosts a 1-2 year lab
   program for residents interested in surgical education research.


3. Evaluation of Resident Performance

   The General Surgery Training Program is committed to comprehensive, regular and timely
   evaluation of the educational and professional performance of surgical residents. This
   section presents the goals, components, and processes of the resident evaluation system.


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The Goals of the Evaluation System are to:

   1. Promote professionalism and the maintenance of a life-long portfolio of career
      accomplishments

   2. Provide information on resident progress and performance in order to:

          Make informed decisions on resident promotion
          Provide data to specialty boards for certification
          Write letters of recommendations
          Identify performance deficits and thereby improve performance
          Identify program strengths and weaknesses and target areas for modification in
           the training curriculum or program structure



General Expectations

Residents are expected to achieve at high standards of performance. Further, we consider
residents to be adult learners, and as such, responsible for self-directed, proactive learning
throughout their training. We expect them to monitor their own progress, and to consciously
work to acquire the habits of mind, the professional attitudes and demeanor, as well as the
knowledge and skills of a consummate surgeon. We expect residents to:

   1. Develop a personal program of self-study and professional growth with guidance
      from faculty advisors.

   2. Participate in safe, effective and compassionate patient care under supervision,
      commensurate with their level of responsibility.

   3. Participate fully in the education activities of the program and, as required, assume
      responsibility for teaching and supervising other residents and students.

   4. Participate in institutional programs and activities involving the medical staff; and
      adhere to established practices, procedures, and policies of the institutions.

   5. Serve on institutional committees and councils, especially those that relate to
      education and patient care review activities.

   6. Annually, compose elements of an electronic portfolio and present this portfolio to
      members of the Surgical Education Council (SEC) and Program Director for review.

Components of the Evaluation System

The evaluation system is based on the ACGME core competencies as presented previously:

      Patient Care
      Technical Skills
      Medical Knowledge
      Practice-Based Learning + Improvement
      Interpersonal Skills + Communication

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       Professionalism
       Systems-Based Practice

The Department has developed evaluation tools that provide the program, as well as the
residents, with information pertinent to these areas. We use a Portfolio-based, Biannual
Evaluation system. The elements listed below are to be reported in resident portfolios.
Unless indicated, they apply to all residents during their clinical years.

       Personal essay summarizing learning highlights from the past year, self-assessment
        of their strengths and areas for improvement, and their professional and personal
        goals for the coming year
       American Board of Surgery In-Training Exam (ABSITE) scores
       Faculty clinical evaluations, for each rotation assignment
       Peer evaluations of resident teaching and leadership
       Medical student evaluations of resident teaching in skills lab and on rotation
       Operative logs
       Tuesday conference attendance
       Family Conference OSCE (Objective Structured Clinical Exam) (PGY 1 + 3 only)
       OSATS (Objective Structured Assessment of Technical Skills) (PGY 1 + 2 only)
       Mock oral exams (PGY 4 + 5 only)
       Certification in the Fundamentals of Laparoscopic Skills by chief year

Other elements that may comprise a resident’s portfolio include:

       Presentations at M+M and Grand Rounds
       Lecture materials, teaching presentations, or curricula
       Participation in professional development courses, conferences
       Membership in professional organizations
       List of papers, abstracts, posters, presentations

Biannual Review Process

Members of the SEC meet twice a year to review resident progress. For the first review,
they meet without the resident present and review data from the previous six months. After
reviewing key evaluation elements, they write a brief summary of feedback. Residents meet
individually with their assigned advisors to review this feedback.

Adviser Assignments

   1.   PGY 1 residents:        PGY-1 Director
   2.   PGY 2 + 3 residents:    PGY-2/3 Mentor
   3.   Laboratory residents:   Laboratory Mentor
   4.   PGY 4 + 5 residents:    Program Director and Surgical Education Council faculty.

For their second biannual review, residents prepare their electronic portfolio covering the
academic year for presentation to members of the SEC and their adviser. To assist them,
the Surgical Educator Office provides each resident with PDF documents covering many of
the required elements of the portfolio (e.g., ABSITE scores, aggregate clinical evaluation
results). Residents upload these documents into the portfolio, along with other elements of
their choosing, and complete other required sections (e.g., personal essay). Presentations
to the SEC are scheduled during Tuesday afternoons. SEC members receive electronic

                                                               University of Minnesota   31
links to the portfolio in the week prior to the presentation to review. Residents are asked to
give a 10-15 minute oral presentation, summarizing the highlights of their portfolio.
Feedback is given at that time. A written summary of the meeting is documented.



Annual Promotion

There is no single criterion for successful promotion and no single criterion for academic
probation or dismissal. Rather, the SEC looks at the totality of the resident’s progress and
becomes concerned only if there is a pattern of ―red flags.‖ In reviewing the mid-year or
end-of-year portfolios, the SEC becomes concerned if:

       Faculty evaluations fall consistently below average for any ACGME competencies.
       Professional indiscretions are identified by faculty, nurses, students, or peers.
       ABSITE scores (Total Test Percentile Score) fall below the 30th percentile.

ABSITE Performance Standards

Because of the centrality of medical knowledge as a foundation for surgical competency, the
Department has adopted a clear set of expectations regarding performance on the ABSITE.
The Department desires to ―leave no resident behind,‖ and requires remediation if
performance falls bellows the 30th percentile. This cut-point has been shown to be
predictive of performance on the ABS written boards (Qualifying Exam). The ABSITE
performance expectations are as follows:

   Scoring below the 30th percentile (Total Test Score) on the ABSITE for the first time
    places a resident at risk for academic probation. The at-risk status is removed if the
    resident’s subsequent year’s performance exceeds the 30th percentile.

   Scoring two times in a row below the 30th percentile results in automatic academic
    probation. The probationary status is removed from the resident’s file if the subsequent
    year’s performance exceeds the 30th percentile.

   Scoring below the 30th percentile for a second time in three or more years, after one or
    more years of improved performance, places the resident back in the at-risk status for
    academic probation.

   Scoring three times below the 30th percentile (either sequentially or intermittently),
    despite attempts at remediation, and in combination with poor performance in other
    areas, places a resident at risk for dismissal from the program. The ABSITE score will
    never constitute the sole criterion for promotion decisions or dismissal, however it has
    been shown to be a valid predictor of performance on the written ABS board exam, and
    as such will be taken very seriously in determining satisfactory progress towards
    graduation.

   Residents at-risk for academic probation, and those on probation due to their
    performance on the ABSITE, are required to participate in remediation as directed by the
    Department.



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   Residents who are at risk or on academic probation during any year they are scheduled
    for the research lab will have their moonlighting privileges significantly reduced or
    removed. Privileges will be regained if performance on the subsequent year’s ABSITE
    exceeds the 30th percentile.

Review Decisions

The Surgical Education Council concludes its discussion of each resident with one of the
following recommendations:

    1. Advancement with statement of exemplary performance and any areas to develop.
    2. Advancement with statement of deficiencies to be improved.
    3. Advancement with notification of one-year probation and statement of deficiencies to
       be improved.
    4. No advancement with one-year probation and discussion of alternative career
       choices.
    5. Unsatisfactory performance and dismissal from program.

Appeal Process

A resident may exercise the right to appeal any decision regarding plans for non-renewal of
contract or dismissal from the program. This process is outlined in the resident contract as
well as the resident manual. The Department of Surgery, General Surgery Residency
Training Program in such case will carefully follow the University of Minnesota, School of
Medicine appeal guidelines.

Overview of Expectations, by Resident Level

The first two years of residency training are designed to produce a surgical trainee who can
thoroughly evaluate patients for elective and emergency operations, and who can
competently manage nonsurgical illness (e.g., acute pancreatitis, trauma, portal
hypertension, acute renal failure, acute respiratory failure, sepsis syndrome) by applying a
broad knowledge of basic and applied physiology. The PGY-1 and PGY-2 resident is
exposed to a wide number of surgical subspecialties to promote an understanding of wound
healing and management (burns, plastics), general and cardiac critical care, fracture care
and hand evaluation (trauma, plastics), care of neurological trauma and emergencies
(neurosurgery), urology, and gynecology.

       The PGY-1 resident will be expected to do a complete preoperative evaluation and
        postoperative care plan, using his or her mastery of physical examination skills, fluid
        and electrolyte management, nutrition, wound healing, microbiology, and metabolic
        response to stress. During each rotation, the resident will accomplish these goals
        through structured lecture material, clinical experience, and self-motivated learning.
        By the end of the first year of training, the resident should be competent in
        performing bedside procedures (central venous catheterization, pulmonary artery
        catheterization, tube thoracostomy, pericardiocentesis, fine-needle aspiration),
        advanced cardiac life support, and advanced trauma life support protocols. PGY-1
        residents are tested on many of these skills in the SimPORTAL.

       The PGY-2 resident will build on a foundation of knowledge in physiology, anatomy,

                                                                 University of Minnesota   33
          microbiology, and clinical patient care to care for increasingly complex general
          surgery, cardiovascular, transplantation, and critical care patients. Skills will include:
          opening and closing the abdomen, obtaining abdominal access for laparoscopy, and
          performing open hernia repair, appendectomy, and gastrointestinal anastomoses.

         The PGY-3 resident will focus on the general surgery services. Advanced surgical
          skills will be developed. The resident will independently evaluate surgical consults
          and emergency room patients, and prepare patients for elective surgery. He or she
          will be expected to independently formulate differential diagnoses and develop
          diagnostic evaluations for complex surgical problems. Surgical skills will include
          increasingly complex operations (e.g., thyroidectomy, tracheostomy, small and large
          bowel resection, laparoscopic cholecystectomy, splenectomy, Nissen fundoplication),
          performed with appropriate assistance. In addition, the PGY-3 resident will develop
          increasing responsibility in the education of more junior residents and medical
          students, through both formal and informal teaching sessions.

         During the laboratory years, the resident will be devoted to surgical research, with
          careful mentoring and appropriate graduate-level course work. He or she will
          develop the skills necessary to independently generate and test hypotheses, apply
          for and obtain extramural research funding, and critically evaluate published
          literature. For many of our residents, this experience has a profound impact on the
          direction of their future research careers.

         The PGY-4, or senior, resident will perform core surgery procedures with the
          assistance of staff. He or she will have an understanding of the medical and surgical
          literature beyond textbooks and review articles, as well as advanced knowledge of
          available diagnostic tests and nonsurgical therapeutic alternatives. Beyond this, the
          resident will develop the skills and confidence to function independently in evaluating
          and caring for general surgery patients and their families. The PGY-4 resident will
          function with the highest degree of professionalism and integrity in all interactions
          with all levels of hospital staff. By the end of the fourth year, the resident will have
          developed all the skills necessary to function as a chief resident.

         The PGY-5, or chief, resident will develop an ability to function in accordance with
          independent surgical practice. He or she will become facile in the conduct of all
          aspects of surgical care, will coordinate the service, and will serve as the first-line
          leader and role model for residents and medical students. The chief resident will
          build on the skills formalized during the fourth year, gaining additional independence
          and experience in patient evaluation, decision-making, operative conduct, and post-
          operative and follow-up care. The chief resident will conduct complex multistep
          procedures (e.g., esophago- gastrectomy, abdominoperineal resection, low anterior
          resection, pancreatico-duodenectomy) with minimal direction and intervention by the
          supervising surgeon. The chief resident will be able to anticipate and treat the
          complications of general surgery procedures and synthesize an understanding of
          these complications through morbidity and mortality conference presentations. The
          chief resident will be able to speak publicly in an authoritative, articulate manner,
          serving as a repository of knowledge for more junior residents.

Rotation Specific Plans



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                              ROTATION PLAN FOR 2011-12

ROTATION NAME UNIVERSITY OF MINNESOTA,                    General/Vascular
TRAINING LEVELSSurgery
                    ON SERVICE: PGY -5; PGY-2; PGY-1
SERVICE DIRECTOR: James Harmon, M.D.
TEACHING FACULTY:
Kaysie Banton, M.D.
Gregory Beilman, M.D.
Matthew Byrnes, M.D.
Jeffrey Chipman, M.D.
Mollie James, M.D.
Raja Kandaswamy, M.D.
Samuel Marquez, M.D.
William Payne, M.D.
Todd Reil, M.D.
David Sutherland, M.D.

ROTATION’S WEEKLY EDUCATION SCHEDULE

    Monday           Tuesday at        Wednesday            Thursday                Friday
                       UMMC
                  6:30 G4+G5                             7:00 Teach.           2:00 Bedside
                  7:00 M+M                               Confer.               rounds
                  7:45 Grand
                  Rounds
                  8:30 Core
                  Curriculum
                  9:45-noon Skills
                  Lab



Activity                             Who is responsible?               When does this
                                                                       occur?
Orientation to the Rotation          Dr. James Harmon                  First day of rotation.
Bedside Teaching Rounds              Attending on call                 Fridays 2:00 pm
Weekly Core Topic Teaching           Dr. James Harmon                  Thursdays 7:00 am
Mid-Rotation Review                  Dr. James Harmon                  Mid rotation
End-of-Rotation Oral Exam            Dr. James Harmon                  Last day of rotation
End-of-Rotation Meeting w/           Dr. James Harmon                  Last day of rotation
Resident

ROTATION GOALS AND OBJECTIVES FOR MEDICAL KNOWLEDGE AND PATIENT
CARE, BY CORE TOPIC AND RESIDENT TRAINING LEVEL
Core Topic 1: Nutrition
Medical Knowledge


                                                               University of Minnesota    35
G-Level    Objectives
PGY-1      Understand the selection of GVS patients who will benefit from nutritional
           assessment and the initiation of supplemental nutrition.
PGY-2      Supervise the management of supplemental nutrition for appropriate GVS patients.
PGY-5      Demonstrate an understanding of the nutritional options, the indications and the
           potential complications for General Surgery patients.

Patient Care
G-Level Technical / Procedural Skills                   Care Plans
PGY-1      Place NJ tubes and evaluate proper           Select and follow appropriate GVS
           position and function of NG tubes.           patients for supplemental nutritional
           Understand the elements of wound care        support.
           including the opening of infected surgical
           wounds. Initiate wet to dry dressings.
           Perform bedside procedures including
           the placement of central venous
           catheters with supervision.
PGY-2      Teach and supervise the placement of         Supervise nutritional support for the
           central line placement. Teach and            appropriate GVS patients. Evaluate and
           supervise the placement of open G-tube       manage over and under feeding
           or J-tubes and the placement of PEG          syndromes in GVS patients.
           tubes in appropriate GVS patients.
PGY-5       Provide leadership for the GVS service       Prioritize, organize, and implement care
           regarding evaluation of appropriate          plans for complex General Surgical
           intravenous access. Provide direct           patients with regard to their nutritional
           supervision, and teach safe central line     management, assessment, and support.
           placement techniques. Manage technical
           complications. Interpret unexpected
           radiologic imaging findings associated
           with line placements.

Core Topic 2: Septic Shock
Medical Knowledge
G-Level Objectives
PGY-1     Understand the pathophysiology of shock. Identify and classify shock with the
          understanding of the initial treatment with IV fluids, central venous monitoring, and
          electrolyte evaluation and replacement.
PGY-2     Supervise the intitial resuscitation, evaluation, and characterization of shock in GVS
          patients. Understand the pathophysiology and evidence based practice guideline for
          early goal directed resuscitation of sepsis.
PGY-5      To be able to clearly communicate an understanding of the clinical and physiological
          mechanisms associated with septic shock in the General Surgery patient. To
          teaching and communicate the relationship between the fundamental clinical science
          associate was shock and the evaluation and treatment appropriate for General
          Surgery patients in shock.

Patient Care
G-Level Technical / Procedural Skills                   Care Plans
PGY-1      Place central venous catheters in            Identify and evaluate patient in shock.
           appropriate GVS patients with                Initiate care and communicate the need

                                                                   University of Minnesota   36
           supervision.                                  for urgent care for GVS patient in shock.
PGY-2      Perform and supervise the placement of        Coordinate and supervise the care for
           central venous catheters in appropriate       GVS patient in shock. Balance the use
           GVS patients.                                 of goal directed fluid resuscitation and
                                                         pressor physiologic support in septic
                                                         GVS patients.
PGY-5       To provide direct supervision and             Implement, coordinate, and re-evaluate
           leadership for the GVS Service by             patient’s care plans regarding IV fluid
           prioritizing, coordinating, initiating, and   resuscitation, source control, and
           evaluating all technical procedures           administration of antibiotic and advanced
           associated with the treatment of General      medical therapies for General Surgery
           Surgery patients in shock.                    patients in shock.

Core Topic 3: Acute Appendectomy
Medical Knowledge
G-Level Objectives
PGY-1     Understand the clinical presentation and the pathophysiology of acute appendicitis.
PGY-2     Teach and instruct in the assessment of patient with acute appendicitis.
PGY-5      Demonstrate an understanding and provide instruction to medical students and
          Surgery residents regarding the pathophysiology, the regional anatomy, the
          expected clinical course, and the surgical decision-making associate with the
          diagnosis of acute appendicitis. To provide leadership for the General Surgery
          Service regarding the triage and coordination of acute surgical care for multiple
          General Surgical patients.

Patient Care
G-Level Technical / Procedural Skills                    Care Plans
PGY-1      Perform, as assistant surgeon, both           Initiate care plans for GVS patient with
           open and laparoscopic appendectomies.         acute appendicitis. Provide post-
                                                         operative care and management for GVS
                                                         patients following appendectomy.
PGY-2      Perform, as surgeon, both open and            Understand and triage GVS patients who
           laparoscopic appendectomy procedures.         require urgent surgery, non-operative
                                                         care or observation, and those patients
                                                         who would benefit from nonsurgical
                                                         interventions complex problems
                                                         associated with acute appendicitis such
                                                         as peri-appendicieal abscess.
PGY-5       Supervise, teach, and coordinate open         Provide leadership for the GVS Service:
           and laparoscopic appendectomy                 prioritize, coordinate, and evaluate care
           procedures.                                   plans for patients with both
                                                         straightforward acute appendicitis and
                                                         for patients with usual problems
                                                         associated with complicated acute
                                                         appendicitis.

Core Topic 4: Cancer of the Appendix
Medical Knowledge
G-Level Objectives
PGY-1     Appreciate the various types and incidents of cancer of the appendix.

                                                                    University of Minnesota   37
PGY-2      Understand the surgical approach and indications for additional surgical procedures
           in the setting of cancer of the appendix. To appreciate the need for additional
           oncology consultation and adjuvant therapy. To be aware of the prognosis for
           carcinoid tumors of the appendix, mucoceles of the appendix, and adenocarcinoma
           of the appendix.
PGY-5       Demonstrate a clear understanding of the types of malignancy and the types of
           benign neoplasia that can present in association with the appendix, the cecum, and
           the mesentery of the distal small bowel. To be able to communicate the
           relationships between the pathology and the recommended surgical care to patients,
           to the patient’s family members, and to the members of the GVS Service. To
           discuss treatment options and formulate treatment plans with the GVS faculty
           members for patients with malignancy.

Patient Care
G-Level Technical / Procedural Skills                   Care Plans
PGY-1      Assist in open and laparoscopic              Understand the very operative care plan
           appendectomy. To assist in open and          for patients undergoing right
           laparoscopic right hemicolectomy.            hemicolectomy.
PGY-2      Function as surgeon for laparoscopic         Appreciate the indications for right
           and open right hemicolectomy.                hemicolectomy in the setting of
                                                        carcinoma the appendix, or for advanced
                                                        carcinoid tumors of the appendix.
                                                        Coordinate oncology consultation for
                                                        patients with cancer of the appendix.
PGY-5      Supervise and teach the performance of        Effectively coordinate and evaluate care
           open and laparoscopic right                  plans for patients with tumors of the
           hemicolectomy as a surgical option for       appendix.
           patients with tumors of the appendix.

Core Topic 5: Acute Pancreatitis
Medical Knowledge
G-Level Objectives
PGY-1     Identify the risk factors and diagnostic findings associated with acute pancreatitis. To
          know the classical criteria for grading the severity of acute pancreatitis (Ranson
          criteria).
PGY-2     Understand the surgical indications and need for surgical critical care for patients
          with acute pancreatitis. To understand the therapeutic options and effectiveness of
          the use of a octriotide and IV antibiotics in the setting of acute pancreatitis. To
          identify the setting for ERCP for patients with acute pancreatitis. To understand the
          indication for percutaneous aspiration and culture in the setting of acute pancreatitis.
          To appreciate the surgical options in the setting of infected pancreatic necrosis.
PGY-5      Demonstrate a firm understanding of the pathophysiology of acute pancreatitis and
          the various underlying causes of acute pancreatitis. Demonstrate an understanding
          of both the open and minimally invasive surgical options for patients with acute
          pancreatitis. To use evidence based surgical decision making to optimize patient
          outcomes.

Patient Care
G-Level Technical / Procedural Skills                   Care Plans
PGY-1      Perform central line placement under her     Appreciate the admission status and

                                                                   University of Minnesota   38
           supervision.                                    orders associated with patients with
                                                           acute pancreatitis. To be able to identify
                                                           patients who fail standard nonoperative
                                                           surgical care.
PGY-2      Teach and supervise the placement of            Care for and coordinate multidisciplinary
           central lines. Perform open and                 care for patients with acute pancreatitis.
           laparoscopic pancreatic necrosectomy            Identify and coordinate the care of
           under supervision. Perform as surgeon           patients who fail standard nonoperative
           re-operative washout procedures in the          care for in the setting of acute
           setting of pancreatic necrosis. Perform         pancreatitis. Coordinate consultation for
           temporary abdominal closure                     percutaneous aspiration of infected
           procedures. Participate in performing           pancreatic necrosis. To coordinate
           split thickness skin grafts in the setting of   urgent ERCP procedures. To coordinate
           complex open abdominal wounds                   urgent surgical interventions in the
           associated with severe and advanced             setting of acute pancreatitis.
           pancreatic necrosis.
PGY-5       Supervise and coordinate and evaluate           Prioritize, supervise, and evaluate care
           performance of both laparoscopic and            plans for patients with acute pancreatitis.
           open necrosectomy for patients with             Identify and manage patients with
           advanced acute pancreatitis associated          complications associated with acute
           with infected necrosis.                         pancreatitis.

Core Topic 6: Acute Diverticulitis
Medical Knowledge
G-Level Objectives
PGY-1     Identify and diagnose acute diverticulitis. To appreciate the CT scan findings
          associated with acute diverticulitis. To understand the criteria for the clinical grading
          of acute pancreatitis. (Hinchey classification). To identify patients who fail to
          improve with non-operative care.
PGY-2     Identify and appropriately characterize the severity of disease in patients with acute
          diverticulitis. To understand the surgical options and surgical approaches for patients
          with acute diverticulitis. To appreciate the potential complications and need for
          surgical intensive care in the setting of acute diverticulitis.
PGY-5      Demonstrate an understanding of the clinical and pathophysiologic issues
          associated with acute diverticulitis.

Patient Care
G-Level Technical / Procedural Skills                      Care Plans
PGY-1      Participate as assistant in open and            Understand the perioperative
           laparoscopic sigmoid resections for             assessment of patients with acute
           patients with acute severe diverticulitis.      diverticulitis.
           To participate as assistant in colostomy
           formation.
PGY-2      Participate in surgeon in open and              Coordinate and care for patients with
           laparoscopic sigmoid resections and             acute diverticulitis. To coordinate
           related colon procedures in the setting of      multidisciplinary care for patients with
           acute diverticulitis.                           severe in advanced diverticulitis.
PGY-5      To supervise and teach open and                  Provide leadership regarding the safe
           laparoscopic surgical procedures for            and effective care for patients with
           patients with acute diverticulitis and          surgical problems associated with

                                                                      University of Minnesota   39
           chronic surgical problems associated          diverticulitis.
           with diverticulitis.

Core Topic 7: Management of Post-Op Complications
Medical Knowledge
G-Level Objectives
PGY-1     Understand and appreciate methods to decrease the chances of postoperative
          complications in the setting of General Surgery. To know and identify common
          postoperative complications in the setting of general surgery.
PGY-2     Understand the postoperative care, the evaluation and diagnosis of postoperative
          complications, the surgical and nonsurgical options for the care of patients with
          postoperative complications in the setting of general surgery.
PGY-5      Demonstrate a clear understanding of the clinical presentation, the evaluation, and
          the surgical and nonsurgical treatment options for a wide variety of postoperative
          complications that can occur in General Surgery patients.

Patient Care
G-Level Technical / Procedural Skills                    Care Plans
PGY-1      Perform the placement of nasogastric          Understand the need for and coordinate
           tubes. Perform under supervision the          postoperative IV fluid resuscitation. To
           placement of central lines. Perform the       understand the need for additional
           placement of Foley catheters.                 diagnostic evaluation in the setting of
                                                         postoperative complications.
PGY-2      Perform as assistant re-operative              Understand and coordinate
           laparotomy, abdominal washout, and            multidisciplinary care for patients with
           temporary abdominal closure, dressing         severe postoperative complications.
           changes associated with complex
           abdominal wounds.
PGY-5        Perform as surgeon or first assistant for    Coordinate, reassess, and redesign
           abdominal explorations, abdominal             care plans used to provide
           washouts, and the application of              multidisciplinary care for patients with
           temporary abdominal closures                  complex surgical complications.
           procedures used in the management of          Participate in family meetings and
           complex postoperative complications in        discussions related to unexpected
           General Surgery.                              surgical complications.

Core Topic 8: Short Gut
Medical Knowledge
G-Level Objectives
PGY-1     Understand the definition of intestinal failure. Appreciate the need for nutritional
          support in the setting of intestinal failure.
PGY-2     Understand the pathophysiology of intestinal failure. Appreciate the surgical and
          nonsurgical options in caring for patients with intestinal failure.
PGY-5      Demonstrate an understanding of the clinical scenarios associated with intestinal
          failure and appreciate the surgical and nonsurgical options associated with the care
          of patients who develop intestinal failure.

Patient Care
G-Level Technical / Procedural Skills                    Care Plans
PGY-1      Perform under supervision the                 Understand and coordinate nonsurgical

                                                                      University of Minnesota   40
           placement of central lines.                care for patients with intestinal failure.
PGY-2      Perform under supervision surgical         Coordinate multidisciplinary care for
           STEP procedures.                           patients with intestinal failure.
PGY-5       Demonstrate a clear understanding of       Prioritize and supervise multidisciplinary
           the STEP procedure and the other           care plans appropriate for patients with
           surgical approaches and alternatives for   intestinal failure.
           patients with intestinal failure.

Core Topic 9: Carotid Artery Disease (Open and Endo)
Medical Knowledge
G-Level Objectives
PGY-1     Resident should be able to demonstrate understanding of the epidemiology and
          pathophysiology of ischemic stroke, related to carotid artery disease. Also should
          describe and define stroke, transient ischemic attack, and amaurosis fugax.
          Understand the diagnostic testing for patients with suspected carotid artery disease.
          To understand and describe the medical and surgical management of carotid artery
          disease
PGY-2     To understand and describe the surgical management of patients with carotid artery
          disease, incorporating evidence based data/literature.
PGY-5      Demonstrate an understanding of the clinical scenarios and pathophysiology of
          advanced carotid artery disease and acute stroke. Understand, identify, evaluate,
          and treat other types of carotid artery disease such as carotid dissection and trauma
          to the carotid artery.

Patient Care
G-Level Technical / Procedural Skills                 Care Plans
PGY-1      Assist in the performance of carotid       Understand the perioperative risk
           endarterectomy. Be able to identify        assessment for patients with carotid
           carotid artery and jugular vein when       disease.
           using the portable ultrasound device.
PGY-2      Assist in the performance of carotid       Recognize and anticipate complications
           endarterectomy. Be able to identify        following carotid endarterectomy.
           carotid artery and jugular vein when
           using the portable ultrasound device
PGY-5      Function as surgeon or first assist for     Prioritize, coordinate, and re-evaluate
           carotid artery endarterectomy              care plans for patients with carotid artery
           procedures.                                disease and for patients following carotid
                                                      endarterectomy.

Core Topic 10: Abdominal Aortic Aneurysms (Open and Endo)
Medical Knowledge
G-Level Objectives
PGY-1     Define the epidemiology and pathophysiology of AAA. Demonstrate an
          understanding of the diagnostic work-up for patients with AAA. Describe the risk of
          rupture related to AAA size. Describe a treatment algorithm for management of
          AAA.
PGY-2     Describe a treatment algorithm for management of AAA. Describe the morbidity and
          mortality related to the surgical management of AAA. Understand and recognize
          potential complications of AAA surgery and their management.
PGY-5      Demonstrate an understanding of the pathophysiology of aortic aneurysm and the

                                                                  University of Minnesota   41
           assessment of abdominal aortic aneurysms. Demonstrate an understanding of the
           criteria used for endovascular and vascular repairs for abdominal aortic aneurysms.

Patient Care
G-Level Technical / Procedural Skills                    Care Plans
PGY-1      Assist in the performance of open and         Understand the perioperative risk
           endovascular repair of AAA.                   assessment for patients with abdominal
                                                         aortic disease.
PGY-2      Assist in the performance of open and         Recognize and anticipate complications
           endovascular repair of AAA.                   following repair of AAA.
PGY-5       Function as surgeon or first assist for       Coordinate and assess multidisciplinary
           open or endovascular AAA repairs.             care plans for patients with abdominal
                                                         aortic aneurysm.

Core Topic 11: Mesenteric Vascular Disease
Medical Knowledge
G-Level Objectives
PGY-1     Describe the anatomy of the vascular supply to the small bowel and colon. Describe
          the presentation of ischemic bowel, both chronic and acute. Demonstrate an
          understanding of the pathophysiology of ischemia and reperfusion.
PGY-2     Describe the evaluation and the medical and surgical management of acute and
          chronic mesenteric ischemia. Demonstrate and understanding of the potential
          complications in patients treated with mesenteric ischemia.
PGY-5      Demonstrate an understanding of the pathophysiology and the clinical presentation
          and initial assessment of patients with ischemic bowel.

Patient Care
G-Level Technical / Procedural Skills                    Care Plans
PGY-1      Resident must be able to assist in the        Understand the perioperative risk
           exposure of the mesenteric vasculature.       assessment for patients with mesenteric
                                                         vascular disease.
PGY-2      Resident must be able to assist in the        Recognize and anticipate complications
           exposure of the mesenteric vasculature.       following surgery for acute mesenteric
                                                         ischemia.
PGY-5       Function as first assistant or surgeon for    Prioritize coordinate and evaluate care
           revascularization procedures for patients     plans for patients with ischemic bowel.
           with mesenteric ischemia.

Core Topic 12: Peripheral Artery Disease
Medical Knowledge
G-Level Objectives
PGY-1     Describe the anatomy of the aorta, iliac, and lower extremity arterial tree. Define the
          presentation of claudication and ischemic rest pain. Describe the physical exam
          findings consistent with PAD. Understand the diagnostic evaluation for patients with
          PAD.
PGY-2     Understand the diagnostic evaluation for patients with PAD. Understand and
          describe the indications for surgery and intervention in patients with PAD.
PGY-5      Demonstrate an understanding of the clinical presentation, the assessment, and the
          treatment options for patients with peripheral vascular disease.


                                                                    University of Minnesota   42
Patient Care
G-Level Technical / Procedural Skills                    Care Plans
PGY-1      Assist in the exposure of the arterial tree   Understand the perioperative risk
           including common femoral artery. Also         assessment for patients with PAD.
           must be able to perform bedside ankle
           brachial index measurements.
PGY-2      Assist in the exposure of the arterial tree   Recognize and anticipate complications
           including common femoral artery. Also         following intervention for PAD.
           must be able to perform bedside ankle
           brachial index measurements.
PGY-5       Function as a surgeon for peripheral          Coordinate and assess care plans for
           artery bypass procedures for patients         patients with peripheral vascular
           with severe peripheral vascular disease.      disease. Integrate and involved multiple
           Function as surgeon and teach                 members of the care team to provide
           amputation procedures as indicated for        optimal patient care for patients with
           patients with advanced peripheral             peripheral vascular disease.
           vascular disease.

Core Topic 13: Anal Fistula
Medical Knowledge
G-Level Objectives
PGY-1     By the end of the rotation PGY-1 residents should know:
               The clinical features of a variety of perianal issues including:
               Perianal abscess
               Anal fissure
               Pilonidal cyst
               Hemorrhoids
PGY-2     By the end of the rotation PGY-2 residents should know:
               Indications for exam under anesthesia
               Placement of seton in the setting of complex perianal fistulas.
PGY-5      Demonstrated and be able to communicate a clear understanding of anal
          pathologies and functional anatomy. Appreciate the clinical presentation of
          advanced anal surgical conditions. Be able to discuss the surgical and non-surgical
          options for advanced anal issues.

Patient Care
G-Level Technical / Procedural Skills                    Care Plans
PGY-1      Recognize the perianal landmarks for          Organize an appropriate pre-op and
           acute surgical management. Perform            post-op care plans for patient with
           acute perianal surgical procedures under      perianal surgical disease.
           supervision.
PGY-2      Supervise the acute perianal surgical         Supervise the pre and post-op care for
           procedures with staff supervision.            patients with peri-anal surgical problems.
           Participate in the use of sedation and
           analgesia for perianal surgical
           procedures with staff supervision.
PGY-5       Supervise, teach, and perform both            Coordinate and assess care plans for
           routine and complex anal surgical             patients with anal disease. Anticipate
           procedures.                                   common problems associated with the
                                                         care for patients following the surgical

                                                                    University of Minnesota   43
                                                        care of anal disease.

Core Topic 14: Diverticulitis
Medical Knowledge
G-Level Objectives
PGY-1     Know the clinical features of acute diverticulitis.
          Appreciate the abdominal CT features of acute diverticulitis.
PGY-2     Identify and classify clinical acute diverticulitis.
          Be very comfortable interpreting the abdominal CT features of acute diverticulitis.
          Properly identify and select patients with acute diverticulitis for percutaneous, open,
          or laparoscopic interventions. Appreciate the surgical options or open procedures in
          the acute diverticulitis.
PGY-5      Demonstrate an understanding of the relationship between the pathophysiology of
          diverticulitis and the clinical presentation and grading systems for patients with acute
          diverticulitis.

Patient Care
G-Level Technical / Procedural Skills                   Care Plans
PGY-1      Participate in open and laparoscopic         Recognize the patient needs and
           surgical procedures in the setting of        organize the plan the follow up and
           acute diverticulitis.                        surgical options for patients with routine
                                                        surgical issues related to acute
                                                        diverticulitis.
PGY-2      Perform and assist open and                  Recognize plan the follow up and
           laparoscopic surgical procedures in the      surgical options for patients with complex
           setting of acute diverticulitis with staff   surgical issues related to acute
           supervision.                                 diverticulitis.
PGY-5       Perform as surgeon both open and             Provide leadership for the GVS Service
           laparoscopic procedures for acute            by communicating and directing the care
           diverticulitis. Recognize, evaluate, and     of patients with acute diverticulitis.
           treat complications associated with          Coordinate, prioritize, and assess care
           surgical procedures used to treat            plans for patients with acute diverticulitis.
           patients with complex or advanced
           diverticulitis.

ROTATION GOALS AND OBJECTIVES FOR PROBLEM-BASED LEARNING AND
IMPROVEMENT, INTERPERSONAL SKILLS AND COMMUNICATION, PROFESSIONALISM,
AND SYSTEMS BASED PRACTICE

Problem-Based Learning and Improvement
G-Level Objectives
PGY-1       Identify own learning needs or goals at the onset of the rotation.
            Following a surgical procedure, debrief what went well, and what could have
              been improved.
            Identify differences in incidence, prognosis, and outcomes of cancer treatment
              according to race and gender.
            Diagnose personal learning needs associated with any medical errors,
              complications, or ―near misses‖ that occurred during your watch.
            Use feedback gained from others, and the experience gained on this rotation,

                                                                    University of Minnesota   44
               to formulate future learning goals and steps.
PGY-2      Same as above
PGY-5      Same as above

Interpersonal Skills and Communication
G-Level Objectives
PGY-1        Communicate patient information clearly to other health providers in written
                notes and oral presentations.
             Apply appropriate communication skills with patients and families (i.e. effective
                listening, awareness of nonverbal cues, and use of open-ended questions).
             Counsel and educate patients and families on their treatment options, their
                surgical outcomes and prognosis, and home care needs.
             Explain to medical students / junior residents the fundamentals of your job, as
                well as their jobs.
PGY-2      Same as above
PGY-5      Same as above

Professionalism
G-Level Objectives
PGY-1         Adhere to patient privacy and informed consent policies at all times.
              Adhere to University behavior policies (e.g., sexual harassment, duty hours,
                dress code) at all times.
              Demonstrate respect, compassion, integrity, and honesty in all interactions with
                patients, families, and other health care providers.
              Demonstrate personal responsibility for patient welfare.
                Articulate ethical issues underlying clinical decisions made for at least once
                complex case seen during this rotation.
PGY-2     Same as above
PGY-5     Same as above

Systems-Based Practice
G-Level Objectives
PGY-1       Know when to call for help from attending physicians.
            Understand when, how, and why to request a consult from medical oncology
              and radiation oncology, and how to use the information gained as a result.
            Provide timely and pertinent consultation when asked by medical or surgical
              colleagues.
            Use the talents and skills of other health providers in the OR and ward.
            Estimate the costs / benefits of cancer screening (mammography,
              colonoscopy), staging (CT, PET, etc.), and treatment.
            Consider patient characteristics (e.g., age, race and ethnicity, family support,
              socio-economic status, type of insurance) in evaluating treatment options and
              developing an appropriate care plan.
            Discuss the distinction between medically necessary care and over care, and
              its implications for our patients.

                                                                  University of Minnesota   45
               Diagnose any ―systems issues‖ associated with medical errors, complications,
               and ―near misses‖ that occurred during this rotation.
PGY-2      Same as above
PGY-5      Same as above

LEARNING RESOURCES FOR TRAINEES
SCORE Website Portal:

       Modules, chapters, videos, and radiographic images (STAT dx) pertinent to the core
        topics enumerated above
       Evidence-Based Reviews in Surgery
       MD Content Course on Health Care (economics, operations, legal/financial, leadership)

UMMC GENERAL VASCULAR SURGERY Moodle Website

       See assignments and additional resources




                               ROTATION PLAN FOR 2011-12

ROTATION NAME        UMMC Acute Care Surgery

TRAINING LEVELS ON SERVICE: 1 PGY-2 (night float)
SERVICE DIRECTOR: James Harmon, M.D.
TEACHING FACULTY:
Greg Beilman, M.D.
Matthew Byrnes, M.D.
Mollie James, M.D.
Kaysie Banton M.D., PhD
James Harmon, MD
Melissa Brunswald, MD
Torfi Hoskuldson, MD




                                                                 University of Minnesota   46
ROTATION’S WEEKLY EDUCATION SCHEDULE
   Monday        Tuesday at       Wednesday                   Thursday              Friday
                   UMMC
              6:30 G4+G5       1st Wed/month                                  7:00 General
              7:00 M+M         7:00 Fellows                                   Surgery
              7:45 Grand       conference                                     Teaching
              Rounds           (journal                                       conference
              8:30 Core        club/topic)
              Curriculum       4th Wed/month
              9:45-noon Skills 7:30 Combined
              Lab              MICU/SICU
              12:00 SICU       conference
              Conference



Activity                               Who is responsible?             When does this
                                                                       occur?
Orientation to the Rotation            Resident (online)               First day or before
Bedside Teaching Rounds                Call Person                     Daily, 8:00 a.m.
Weekly Core Topic Teaching             All                             Friday 7:00 a.m.
Mid-Rotation Review                    Faculty will vary               Critical Care/Acute Care
End-of-Rotation Oral Exam              Faculty will vary               Office will remind you to
End-of-Rotation Meeting w/             Faculty will vary               set up.
Resident


ROTATION GOALS AND OBJECTIVES FOR MEDICAL KNOWLEDGE AND PATIENT CARE, BY CORE
TOPIC AND RESIDENT TRAINING LEVEL


Core Topic 1: Shock
Medical Knowledge
                     PGY-1                                            PGY-2
By the end of the rotation PGY-1 residents       By the end of the rotation PGY-2 residents
should know:                                     should know:
     The clinical appearance of shock                The PGY-1 objectives
     Examples of distributive, cardiogenic,          Early, goal-directed treatment of shock
       neurogenic, obstructive, and                   How to restore oxygen delivery
       hypovolemic shock                              Relationship of oxygen delivery (DO2)
     How to determine oxygen delivery                  to oxygen consumption (VO2)
       (DO2)                                          Endpoints of resuscitation

Patient Care
                     PGY-1                                            PGY-2
By the end of the rotation PGY-1 residents       By the end of the rotation PGY-2 residents
should be able to perform:                       should be able to perform:
     A history and physical exam to identify         The PGY-1 objectives
       the shock state                                Recognize the proper indication for
     Write and initiate orders to treat the            vasoactive agents and initiate their use
       shock state and achieve resuscitative          Prescribe proper antibiotic coverage
       end-points including: intravenous fluid        Recognize the emergence of organ
       rates and boluses, DVT & ulcer                   failure
       prophylaxis, blood transfusions
      Recognize the need for antibiotics
      Recognize the need for vasoactive
       agents

Core Topic 2: Role of Intensivist
Medical Knowledge
                     PGY-1                                           PGY-2
By the end of the rotation PGY-1 residents      By the end of the rotation PGY-2 residents
should know:                                    should know:
     What an intensivist does                       How an intensivist can improve patient
                                                       outcome and supportive data from the
                                                       literature



Patient Care (Role of Intensivist)
                    PGY-1                                           PGY-2
N/A                                             N/A


Core Topic 3: Ventilator Management and Lung Injury
Medical Knowledge
                     PGY-1                                           PGY-2
By the end of the rotation PGY-1 residents      By the end of the rotation PGY-2 residents
should know:                                    should know:
     The clinical and laboratory indicators of      The PGY-1 objectives
       acute respiratory failure                     Indicators for intubation and
     Basic ventilator modes (CMV, SIMV,               mechanical ventilation
       PC, PS)                                       Indications for different methods of
                                                       mechanical ventilation
                                                     Predictors of successful liberation from
                                                       the ventilator

Patient Care
                     PGY-1                                           PGY-2
By the end of the rotation PGY-1 residents      By the end of the rotation PGY-2 residents
should be able to:                              should be able to:
     Order basic ventilator settings (tidal         PGY-1 objectives
       volume, respiratory rate, mode, and           Modify the ventilator based on blood
       PEEP)                                           gas interpretation by changing rate,
     Interpret blood gases and recognize              tidal volume, and PEEP
       acute and compensated, respiratory            Recognize potentially lung damaging
       and metabolic acid base disorders               situations such as high peak airway
                                                       pressures
                                                     Troubleshoot patient-ventilator
                                                       disynchrony
Core Topic 4: Sepsis
Medical Knowledge
                     PGY-1                                           PGY-2
By the end of the rotation PGY-1 residents      By the end of the rotation PGY-2 residents
should know:                                    should know:
     The distinction between the systemic        PGY-1 objectives
                                                      48
       inflammatory response syndrome              The distinction between sepsis, severe
       (SIRS), bacteremia, and sepsis.              sepsis, and septic shock
      SIRS criteria                               The SIRS response and the
      The physiologic response that defines        compensatory anti-inflammatory response
       sepsis                                       syndrome (SIRS)
                                                   How sepsis leads to multisystem organ
                                                    dysfunction and failure
Patient Care
                     PGY-1                                           PGY-2
By the end of the rotation PGY-1 residents      By the end of the rotation PGY-2 residents
should be able to:                              should be able to perform:
     Recognize SIRS and when it becomes             PGY-1 objectives
       sepsis                                        Escalate care from sepsis to septic
     Resuscitate from sepsis (see                     shock
       objectives for Shock)                         Initiate vasoactive and inotropic agents

Core Topic 5: Blood Transfusion
Medical Knowledge
                     PGY-1                                           PGY-2
By the end of the rotation PGY-1 residents      By the end of the rotation PGY-2 residents
should know:                                    should know:
     Risks and benefits of blood transfusion        PGY-1 objectives
     Current opinions of ―transfusion               Contribution of hemoglobin level to
       triggers‖                                       oxygen delivery
                                                     Indications for fresh frozen plasma,
                                                       platelets, and cryoprecipitate

Patient Care
                     PGY-1                                           PGY-2
By the end of the rotation PGY-1 residents      By the end of the rotation PGY-2 residents
should be able to:                              should be able to:
     Order proper blood products                    Recognize the need for blood
                                                       transfusion
                                                     Recognize the ability to avoid blood
                                                       transfusions

Core Topic 6: Renal Failure
Medical Knowledge
                     PGY-1                                           PGY-2
By the end of the rotation PGY-1 residents      By the end of the rotation PGY-2 residents
should know:                                    should know:
     Biochemical indicators of renal failure        PGY-1 objectives
                                                     Distinguish and diagnose

Patient Care
                     PGY-1                                           PGY-2
By the end of the rotation PGY-1 residents      By the end of the rotation PGY-2 residents
should be able to perform:                      should be able to perform:
NA                                              NA



Core Topic 7: Family Conferences
                                                     49
Medical Knowledge
                     PGY-1                                             PGY-2
By the end of the rotation PGY-1 residents        By the end of the rotation PGY-2 residents
should know:                                      should know:
     The meaning of DNR/DNI and comfort               PGY-1 objectives
       care                                            Controversies regarding end-of-life
                                                         care, specifically the definition of futility

Patient Care
                     PGY-1                                             PGY-2
By the end of the rotation PGY-1 residents        By the end of the rotation PGY-2 residents
should be able to:                                should be able to:
     Recognize the signs and symptoms of              PGY-1 objectives
       pain, anxiety or other discomfort at            Write orders for anxiolytics, analgesics,
       end-of-life                                       and other drugs for the relief of pain
                                                         and suffering at end-of-life
                                                       Perform an end-of-life discussion with a
                                                         family member

Core Topic 8: Tracheostomy
Medical Knowledge
                     PGY-1                                             PGY-2
By the end of the rotation PGY-1 residents        By the end of the rotation PGY-2 residents
should know:                                      should know:
     Indications for tracheostomy                     PGY-1 objectives
     Risks and benefits of tracheostomy               Advantages and disadvantages of
                                                         percutaneous versus open
                                                         tracheostomy

Patient Care
                     PGY-1                                             PGY-2
By the end of the rotation PGY-1 residents        By the end of the rotation PGY-2 residents
should be able to:                                should be able to perform:
     Recognize the landmarks both                     Percutaneous tracheostomy
       bronchoscopically and externally for a          Provide sedation and analgesia for
       tracheostomy location                             percutaneous tracheostomy

ROTATION GOALS AND OBJECTIVES FOR PROBLEM-BASED LEARNING AND IMPROVEMENT,
INTERPERSONAL SKILLS AND COMMUNICATION, PROFESSIONALISM, AND SYSTEMS BASED
PRACTICE

Problem-Based Learning and Improvement
                     PGY-1                                             PGY-2
By the end of the rotation PGY-1 residents        By the end of the rotation PGY-2 residents
should be able to:                                should:
     Recognize his/her limitations                    Present a list of deaths and
     Utilize available resources to answer               complications (readmissions within 24
       questions regarding critical illness and           hours of discharge, procedural
       patient care issues                                complications) occurring during the
                                                          rotation.
                                                       Present some data from the literature
                                                          to address the specific complication


                                                       50
Interpersonal Skills and Communication
                     PGY-1                                               PGY-2
By the end of the rotation PGY-1 residents         By the end of the rotation PGY-2 residents
should:                                            should be able to perform:
     Have witnessed an end-of-life exam                PGY-1 objectives
     Have communicated a status update to              A family conference to update a
        family                                            patient’s condition or discuss
     Present effectively and organized on                alternative care plans
        daily rounds                                    Communicate critical events (see when
     Use SBAR to communicate                             to call the attending card) with SICU
                                                          Fellows and attendings
                                                        Respectfully communicate status
                                                          changes with primary surgical services
                                                        Comprehend the rationale for primary
                                                          service patient care requests
                                                        Collaborate with nursing

Professionalism
                     PGY-1                                              PGY-2
By the end of the rotation PGY-1 residents         By the end of the rotation PGY-2 residents
should be able to perform:                         should be able to perform:
     Resolve conflict with nursing                     PGY-1 objectives
     Be prepared for rounds                            Resolve conflict with primary services
     Take ownership of all patients on                 Solve critical issues with other service’s
       service, not just the ones ―you are                patients in the ICU
       covering‖                                        Respond to requests for SICU transfer
                                                          with respect and in a timely manner
                                                          (may need to go see the transfer on
                                                          the floor)


Systems-Based Practice
                     PGY-1                                              PGY-2
By the end of the rotation PGY-1 residents         By the end of the rotation PGY-2 residents
should:                                            should:
     Recognize the need for timely order               PGY-1 objectives
        writing and SICU discharge
     Communicate ongoing care needs to
        services providing care after SICU
        discharge, including to other facilities

LEARNING RESOURCES FOR TRAINEES
SCORE Website Portal:
    Modules, chapters, videos, and radiographic images (STAT dx) pertinent to the core topics enumerated
     above
    Surgical Critical Care, Second Edition. Jerome Abrams, Paul Druck, and Frank B Cerra Eds. Taylor &
     Francis, 2005,

UMMC Surgical Critical Care Moodle site
UMMC Acute Care Surgery Moodle site


SPECIFIC READING ASSIGNMENTS

                                                        51
See Moodle site




                                ROTATION PLAN FOR 2011-12

ROTATION NAME       SURGICAL ONCOLOGY, UMMC

TRAINING LEVELS ON SERVICE: 1 Chief; 1 PGY-3
SERVICE DIRECTOR: Todd Tuttle, M.D.
TEACHING FACULTY:
Waddah Al-Refaie
Maria Evasovich, M.D.
Erik Jensen, M.D.
Selwyn Vickers, M.D.

ROTATION’S WEEKLY EDUCATION SCHEDULE
    Monday       Tuesday at      Wednesday                Thursday          Friday
                   UMMC
12:00 Noon    6:30 G4+G5       7:00 Surgical        7:00 Sarcoma       7:00 Breast
G1 Tumor      7:00 M+M         Oncology             conference         Tumor
Conference    7:45 Grand       Teaching                                Conference
              Rounds           Conference                              8:00 Teaching
              8:30 Core                                                rounds
              Curriculum
              9:45-noon Skills
              Lab


Activity                        Who is responsible?             When does this
                                                                occur?
Orientation to the Rotation     Tuttle                          Week 1, Day 1 (varies)
Bedside Teaching Rounds         Attending on call               Friday 8 am
Weekly Core Topic Teaching      All                             Wednesday 7am
Mid-Rotation Review             Tuttle                          Week 4 (varies)
End-of-Rotation Oral Exam       Not routinely performed
End-of-Rotation Meeting w/      Tuttle                          Week 8 (varies)
Resident



ROTATION GOALS AND OBJECTIVES FOR MEDICAL KNOWLEDGE AND PATIENT CARE, BY CORE
TOPIC AND RESIDENT TRAINING LEVEL
Core Topic 1: BREAST CANCER
Medical Knowledge
G-Level Objectives
G3 and    By the end of the rotation PGY-3 residents should know:
G5             History of breast cancer treatment
               Risk factors for breast cancer
                                               52
                 Types of hereditary breast cancer
                 The evaluation of palpable mass
                 The evaluation of abnormal mammogram
                 The management of ductal carcinoma in situ
                 The management of lobular carcinoma in situ
                 The management of invasive breast cancer
                 Role of sentinel lymph node staging
                 Role of partial breast irradiation

Patient Care
G-Level Technical / Procedural Skills
G3 and     By the end of the rotation PGY-3 residents should be able to perform:
G5              Skin-sparing mastectomy
                Lumpectomy
                Standard mastectomy
                Axillary lymph node dissection
                Port-a-cath placement
                Sentinel lymph node biopsy

Core Topic 2: MELANOMA
Medical Knowledge
G-Level Objectives
G3        By the end of the rotation PGY-3 residents should know:
               Risk factors for melanoma
               Melanoma staging
               Width of surgical margins
               Regional lymph node staging
               The adjuvant therapy for melanoma

Patient Care
G-Level Technical / Procedural Skills
G3         By the end of the rotation PGY-3 residents should be able to perform:
                Wide local excision
                Sentinel lymph node biopsy

G5         By the end of the rotation PGY-5 residents should be able to perform:
                Wide local excision
                Sentinel lymph node biopsy
                Femoral lymph node dissection

Core Topic 3: GASTRIC MALIGNANCIES
Medical Knowledge
G-Level Objectives
G3 and    By the end of the rotation PGY-3 residents should know:
G5             Epidemiology of adenocarcinoma of the stomach
               Controversies in surgical management of adenocarcinoma
                    o D1 vs. D2, total vs. subtotal, pouch vs. no pouch reconstruction
               Adjuvant therapy for adenocarcinoma
               Diagnosis and treatment of GIST
               Role of Imitanib for GIST
               Management of gastric lymphoma


                                                      53
Patient Care
G-Level Technical / Procedural Skills
G3
G5         By the end of the rotation PGY-5 residents should be able to perform:
                Subtotal gastrectomy
                Total gastrectomy
                D2 lymphadenectomy
                Resection of gastric GIST
Core Topic 4: PANCREATIC MALIGNANCIES
Medical Knowledge
G-Level Objectives
G3         By the end of the rotation PGY-3 residents should know:
                Epidemiology of pancreatic cancer
                Evaluation of jaundice
                Treatment for adenocarcinoma of pancreas
                Cystic neoplasms of the pancreas
                Endocrine tumors
G5         By the end of the rotation PGY-5 residents should know:
                Epidemiology of pancreatic cancer
                Evaluation of jaundice
                Treatment for adenocarcinoma of pancreas, including: surgery, adjuvant
                  treatment, results
                Cystic neoplasms of the pancreas
                Endocrine tumors


Patient Care
G-Level Technical / Procedural Skills
G3         By the end of the rotation PGY-3 residents should be able to perform:
                Cholecystectomy

G5         By the end of the rotation PGY-5 residents should be able to perform:
                Whipple
                Distal pancreatectomy
                Pancreatic ultrasound

Core Topic 5: HEPATIC MALIGNANCIES
Medical Knowledge
G-Level Objectives
G3 and    By the end of the rotation PGY-3 residents should know:
G5             Hepatic anatomy
               Indications for hepatic resection for hepatocellular carcinoma and colorectal
                 liver metastases
               Neuroendocrine liver metastases

Patient Care
G-Level Technical / Procedural Skills
G3
G5         By the end of the rotation PGY-5 residents should be able to perform:
                Intra-operative hepatic ultrasound
                Major and minor hepatic resections
                Hepatic RFA

                                                      54
Core Topic 6: SARCOMA
Medical Knowledge
G-Level Objectives
G3 and    By the end of the rotation PGY-3 residents should know:
G5             Histologic subtypes
               Evaluation
               Extremity-sparing resection
               Retroperitoneal sarcoma
               Adjuvant therapy

Patient Care
G-Level Technical / Procedural Skills
G3
G5         By the end of the rotation PGY-5 residents should be able to perform:
                Resection of extremity sarcoma
                Resection of retroperitoneal sarcoma


Core Topic 7: PERITONEAL METASTASES
Medical Knowledge
G-Level Objectives
G3 and    By the end of the rotation PGY-3 residents should know:
G5             Natural history of peritoneal metastases
               Results of cytoreductive surgery and hyperthermic intraperitoneal
                 chemotherapy

Patient Care
G-Level Technical / Procedural Skills
G3
G5         By the end of the rotation PGY-5 residents should be able to perform:
                Cytoreductive surgery, plus hyperthermic intraperitoneal chemotherapy

Core Topic 8: CLINICAL RESEARCH
Medical Knowledge
G-Level Objectives
G3 and    By the end of the rotation PGY-3 residents should know:
G5             Elements of informed Consent
               Clinical trial designs

Patient Care (NA)

Core Topic 9: THYROID
Medical Knowledge
G-Level Objectives
G3 and    By the end of the rotation PGY-3 residents should know:
G5             Anatomy of thyroid
               Work-up of thyroid nodule
               Non-surgical thyroid problems
               Thyroid cancers (well-differentiated and undifferentiated)
               Prognostic scoring
               Management of post-thyroidectomy hypocalcemia
               Neck Metastasis
                                                      55
Patient Care
G-Level Technical / Procedural Skills
G3 and     By the end of the rotation, residents should be able to perform:
G5              Total thyroidectomy
                Thyroid lobectomy and isthmusectomy
                Central neck dissection
                Modified neck dissection
                Re-implantation of parathyroid gland

Core Topic 10: PARATHYROID
Medical Knowledge
G-Level Objectives
G3 and    By the end of the rotation, residents should know:
G5             Anatomy and physiology
               Diagnostic Tools
               Imaging options
               Primary, secondary and tertiary hyperparathyroidism
               Work-up of missed or second parathyroid adenoma

Patient Care
G-Level Technical / Procedural Skills
G3         By the end of the rotation PGY-3 residents should be able to perform:
                Parathyroidectomy
G5         By the end of the rotation PGY-5 residents should be able to perform:
                Minimally invasive parathyroidectomy
                Central neck dissection or exploration for parathyroid glands
                Use of gamma probe and / or intraoperative PTH testing
                Substernal / mediastinal parathyroidectomy

Core Topic 11: ADRENAL GLAND
Medical Knowledge
G-Level Objectives
G3 and    By the end of the rotation PGY-3 residents should know:
G5             Anatomy and physiology
               MEN 1/2
               Evaluation of incidental adrenal mass
               Management of functional adrenal tumors
               Management of adrenocortical carcinoma
               Surgical approaches to the adrenal gland

Patient Care
G-Level Technical / Procedural Skills
G3
G5         By the end of the rotation PGY-5 residents should be able to perform:
                Laparoscopic adrenalectomy

ROTATION GOALS AND OBJECTIVES FOR PROBLEM-BASED LEARNING AND IMPROVEMENT,
INTERPERSONAL SKILLS AND COMMUNICATION, PROFESSIONALISM, AND SYSTEMS BASED
PRACTICE

Problem-Based Learning and Improvement
G-Level Objectives
                                                       56
G3 and         Identify own learning needs or goals at the onset of the rotation.
G5             Following a surgical procedure, debrief what went well, and what could have
                been improved.
               Identify differences in incidence, prognosis, and outcomes of cancer treatment
                according to race and gender.
               Diagnose personal learning needs associated with any medical errors,
                complications, or ―near misses‖ that occurred during your watch.
               Use feedback gained from others, and the experience gained on this rotation,
                to formulate future learning goals and steps.

Interpersonal Skills and Communication
G-Level Objectives
G3 and       Communicate patient information clearly to other health providers in written
G5              notes and oral presentations.
             Apply appropriate communication skills with patients and families (i.e. effective
                listening, awareness of nonverbal cues, and use of open-ended questions).
             Counsel and educate patients and families on their treatment options, their
                surgical outcomes and prognosis, and home care needs.
             Explain to medical students / junior residents the fundamentals of your job, as
                well as their jobs.

Professionalism
G-Level Objectives
G3 and        Adhere to patient privacy and informed consent policies at all times.
G5            Adhere to University behavior policies (e.g., sexual harassment, duty hours,
                dress code) at all times.
              Demonstrate respect, compassion, integrity, and honesty in all interactions with
                patients, families, and other health care providers.
              Demonstrate personal responsibility for patient welfare.
              Articulate ethical issues underlying clinical decisions made for at least once
                complex case seen during this rotation.



Systems-Based Practice
G-Level Objectives
G3 and      Know when to call for help from attending physicians.
G5          Understand when, how, and why to request a consult from medical oncology
              and radiation oncology, and how to use the information gained as a result.
            Provide timely and pertinent consultation when asked by medical or surgical
              colleagues.
            Use the talents and skills of other health providers in the OR and ward.
            Estimate the costs / benefits of cancer screening (mammography,
              colonoscopy), staging (CT, PET, etc.), and treatment.
            Consider patient characteristics (e.g., age, race and ethnicity, family support,
              socio-economic status, type of insurance) in evaluating treatment options and
              developing an appropriate care plan.

                                                      57
                Discuss the distinction between medically necessary care and over care, and
                 its implications for cancer patients.
                Diagnose any ―systems issues‖ associated with medical errors, complications,
                 and ―near misses‖ that occurred during this rotation.

LEARNING RESOURCES FOR TRAINEES
SCORE Website Portal:
    Modules, chapters, videos, and radiographic images (STAT dx) pertinent to the core topics enumerated
     above
    Evidence-Based Reviews in Surgery
    MD Content Course on Health Care (economics, operations, legal/financial, leadership)

The M.D. Anderson Surgical Oncology Handbook; 4th edition (given to all residents at start of rotation)




                                       ROTATION PLAN FOR 2011-12

ROTATION NAME
                      UNIVERSITY OF MINNESOTA, Thoracic Surgery
TRAINING LEVELS ON SERVICE: PGY-3; PGY-1
SERVICE DIRECTOR: Jonathan D'Cunha, MD PhD
TEACHING FACULTY:
Michael Maddaus, MD (Program Director)
Rafael Andrade, M.D.
Mohi Mitiek, M.D.

ROTATION’S WEEKLY EDUCATION SCHEDULE

    Monday             Tuesday at         Wednesday            Thursday              Friday
                         UMMC
                    6:30 G4+G5                              7am Rotation       7am Once per
                    7:00 M+M                                Teaching           Month
                    7:45 Grand                              Conference         Teleconference
                    Rounds                                                     with Mexico
                    8:30 Core
                    Curriculum                                                 7am Once per
                    9:45-noon Skills                                           Month
                    Lab                                                        Multidisciplinary
                                                                               Pulmonary
                    12 noon                                                    Nodule
                    Thoracic                                                   Conference
                    Oncology
                    Clinical
                    Conference



Activity                               Who is responsible?              When does this
                                                                        occur?
Orientation to the Rotation            Staff on call                    Within the first week of
                                                                        starting the rotation
                                                       58
Bedside Teaching Rounds                 Staff on call                  Weekly
Weekly Core Topic Teaching              Rotating basis on schedule     Thursdays at 7am
Mid-Rotation Review                     Staff on call                  Scheduled mid-rotation
                                                                       with faculty
End-of-Rotation Oral Exam               Staff on call                  Scheduled with faculty
                                                                       at exit interview
End-of-Rotation Meeting w/              Staff on call                  Scheduled with faculty
Resident

ROTATION GOALS AND OBJECTIVES FOR MEDICAL KNOWLEDGE AND PATIENT CARE, BY CORE
TOPIC AND RESIDENT TRAINING LEVEL

Core Topic 1: Pre-Op Assessment
Medical Knowledge
G-Level Objectives
PGY-1     General principles of surgery
           Describe the work-up of a patient being prepared for pulmonary surgery with
              attention to the pre-operative details that enable one to make a decision on
              whether the patient is "fit" for a particular surgery
           Interpret cardiopulmonary fitness and the risk assessment for pulmonary
              resection
           Interpret pulmonary function tests accurately to determine whether a patient may
              safely undergo a procedure
           Understand the natural history of emphysema and the confounding variables it
              creates in the thoracic patient being prepared for the operating room

PGY-3         Describe the work-up of a patient being prepared for pulmonary surgery with
               attention to the pre-operative details that enable one to make a decision on
               whether the patient is "fit" for a particular surgery
              Interpret cardiopulmonary fitness and the risk assessment for pulmonary
               resection
              Interpret pulmonary function tests accurately to determine whether a patient may
               safely undergo a procedure
              Interpret chest CAT scan in the context of the disease process
              Describe the various imaging or diagnostic options for a patient undergoing
               pulmonary resection and ensuring that they may safely undergo the procedure
              Understand the natural history of emphysema and the confounding variables it
               creates in the thoracic patient being prepared for the operating room
              Utilize scientific literature in patient management questions.
              Apply the concepts of ―best practice‖ and ―evidence-based medicine‖ as it relates
               to pre-operative assessment


Patient Care
G-Level Technical / Procedural Skills
PGY-1      Using a patient(s) on rotation:

              Make an accurate assessment of cardiopulmonary fitness for a patient
               undergoing a thoracic procedure
              Interpret PFTS and DLCO in a patient being prepared for operation

PGY-3      Using a patient(s) on rotation:

              Make an accurate assessment of cardiopulmonary fitness for a patient
                                                        59
              undergoing a thoracic procedure
             Interpret PFTS and DLCO in a patient being prepared for operation
             Interpret a perfusion scan in a patient that is a questionable candidate for surgery
             Interpret exercise testing as it relates to selection of the marginal patient
              undergoing pulmonary resection
             Describe the echo findings signaling pulmonary hypertension and relate why it is
              a contraindication to major pulmonary resection


Core Topic 2: Non-Small Cell Lung Cancer
Medical Knowledge
G-Level Objectives
PGY-1     Know the stages of NSCLC
          Explain the following elements of NSCLC:
           Cell types
           Clinical vs. pathologic staging
           Staging system and TNM designations
           Surgical treatment based on clinical stage
           Survival based on stage and surgery
           Standards for use of chemotherapy and radiation
           Assessment for lung resection and interpretation of tests

PGY-3     Know the stages and be able to categorize new cases of NSCLC
          Know the OR procedure associated with each stage
          Explain the following elements of NSCLC:
           Cell types
           Clinical vs. pathologic staging
           Staging system and TNM designations
           Surgical treatment based on clinical stage
           Survival based on stage and surgery
           Standards for use of chemotherapy and radiation
           Pulmonary assessment for lung resection and interpretation of tests


Patient Care
G-Level Technical / Procedural Skills
PGY-1       Function as an independent operating of the flexible bronchoscope and
             adequately evaluate the normal airway and a pathologic airway
            Function as a first assistant to a patient undergoing any procedure for lung
             cancer
PGY-3       Independently perform flexible bronchoscopy
            Perform endobronchial ultrasound staging of the mediastinum with assistance
            Perform mediastinoscopy with assistance
            Know the steps and function as an first surgeon to a lobectomy or other cancer
             resection

Core Topic 3: Gastroesophageal Reflux Disease
Medical Knowledge
G-Level Objectives
PGY-1     Know the diagnosis and treatment of GERD
          Know the indications for operative intervention
          Know the complications associated with a fundoplication
          Explain the following aspects of GERD:
                                                       60
              Typical vs. atypical symptoms
              Complications of GERD
              Evaluation for possible surgery
              Types of antireflux operations
              Complications of antireflux operations

PGY-3      Know the diagnosis and treatment of GERD
           Know the indications for operative intervention
           Know the steps of a fundoplication
           Explain the types of antireflux operations and approaches for each
           Know the complications associated with a fundoplication and treatment

Patient Care
G-Level Technical / Procedural Skills                   Care Plans
PGY-1       Function as a first assistant during a
             fundoplication
            Perform
             esophagogastroduodenoscopy with
             assistance
PGY-3       Function as a first surgeon to a
             fundoplication
            Perform
             esophagogastroduodenoscopy
             independently


Core Topic 4: Esophageal Cancer
Medical Knowledge
G-Level Objectives
PGY-1     Know the pathology and etiology of esophageal cancer
          Know the work-up and differential diagnosis for dysphagia/esophageal mass
          Know the stages and treatment of esophageal ca

               Barrett’s esophagus
                   Definition/Incidence
                   Diagnosis
                   Management

           Explain the following elements of esophageal carcinoma:
                   Cell types and etiologic differences
                   Clinical vs. pathologic staging
                   Tests/exams used in evaluation and staging
                   Staging system and TNM designations
                   Surgical treatment based on clinical stage
                   Survival based on stage and surgery
                   Standards for use of chemotherapy and radiation
                   General principles of esophagectomy:
                      o Anatomy
                      o Gastric conduit construction
                      o Functional results
                      o Approaches to esophagectomy:
                            Ivor Lewis
                            Three-port
                                                        61
                            Transhiatal
                            Minimally invasive

PGY-3     Know the pathology and etiology of esophageal cancer
          Know the work-up and differential diagnosis for dysphagia/esophageal mass
          Know the stages and treatment of esophageal ca
          Describe the different approaches to an esophagectomy
          Know the adjuvant therapy for esophageal cancer

              Barrett’s esophagus
                  Definition/Incidence
                  Diagnosis
                  Management

          (cont.)
          Explain the following elements of esophageal carcinoma:
              Cell types and etiologic differences
              Clinical vs. pathologic staging
PGY-3         Tests/exams used in evaluation and staging
              Staging system and TNM designations
              Surgical treatment based on clinical stage
              Survival based on stage and surgery
              Standards for use of chemotherapy and radiation
              General principles of esophagectomy:
                  o Gastric conduit construction
                  o Functional results
                  o Approaches to esophagectomy:
                      Ivor Lewis
                      Three-port
                      Transhiatal
                      Minimally invasive


Patient Care
G-Level Technical / Procedural Skills
PGY-1
            Function as a first assistant to the abdominal portion of an esophagectomy
            Perform esophagogastroduodenoscopy with assistance

PGY-3
             Function as a first surgeon for an esophagectomy including the thoracic portion
             Perform esophagogastroduodenoscopy independently
             Perform endoscopic ultrasound with assistance


Core Topic 5: Pleural Effusion
Medical Knowledge
G-Level Objectives
PGY-1
          Know the etiology and pathology of pleural effusions
          Know the differential diagnosis and treatment of pleural effusions
          Understand malignant pleural effusion and the treatment options Perform a work-up
          on a patient with a pleural effusion and interpret pleura fluid studies
PGY-3
                                                     62
           Know the etiology and pathology of pleural effusions
           Know the differential diagnosis and treatment of pleural effusions
           Understand malignant pleural effusion and the treatment options Perform a work-up
           on a patient with a pleural effusion and interpret pleural fluid studies

Patient Care
G-Level
PGY-1       Be able to place a chest tube
            Function as first assistant on a VATS procedure to address a pleural effusion

PGY-3        Be able to place a chest tube
             Function as surgeon on a VATS procedure to address a pleural effusion

Core Topic 6: Solitary Pulmonary Nodule
Medical Knowledge
G-Level Objectives
PGY-1     Know the etiology and pathology of pulmonary nodules
          Know the diagnosis and work-up of pulmonary nodules
          Know the treatment of different pulmonary nodules
PGY-3     Know the etiology and pathology of pulmonary nodules
          Know the diagnosis and work-up of pulmonary nodules
          Know the treatment of different pulmonary nodules
          Describe the various diagnostic approaches to the pulmonary nodule
          Correctly characterize distinct radiographic features which leads one to suggest a
          more narrowed differential diagnosis
          Provide definitive therapy for the undiagnosable pulmonary nodule and explain the
          risks/benefits of the approach

Patient Care
G-Level Technical / Procedural Skills
PGY-1       Function as a first assistant to a wedge biopsy

PGY-3        Function as first surgeon to a wedge biopsy


Core Topic 7: Mediastinal Mass
Medical Knowledge
G-Level Objectives
PGY-1     Know the diagnosis and work-up for mediastinal mass
          Diagnose a mediastinal mass from a CT scan

PGY-3      Know the diagnosis and work-up for mediastinal mass
           Diagnose a mediastinal mass from a CT scan
           Know the treatment for different medistinal masses


Patient Care
G-Level Technical / Procedural Skills
PGY-1       Function as a first assistant to a thymectomy (or other mediastinal mass)

PGY-3        Function as a first surgeon to an thymectomy (or other mediastinal mass)



                                                     63
Core Topic 8: Perforated Esophagus
Medical Knowledge
G-Level Objectives
PGY-1     Know the diagnosis and work-up for a perforated esophagus
          Know the a treatment option of a perforated esophagus
PGY-3     Know the diagnosis and work-up for a perforated esophagus
          Know the various treatment options of a perforated esophagus
          Describe the operative details of the standard approach to a lower third esophageal
          perforation

Patient Care
G-Level Technical / Procedural Skills
PGY-1       Place a chest tube

PGY-3         Assist in sewing an esophageal perforation, know type of suture and closure



Core Topic 9: Leiomyoma
Medical Knowledge
G-Level Objectives
PGY-1     Know the diagnosis and treatment for leiomyoma

PGY-3      Know the diagnosis and treatment for leiomyoma


Patient Care
G-Level Technical / Procedural Skills
PGY-1       Function as a first assistant during an enucleation
            Assist with flexible esophagoscopy

PGY-3         Function as a first surgeon during an enucleation
              Perform esophagoscopy independently


Core Topic 10: Achalasia
Medical Knowledge
G-Level Objectives
PGY-1     Know the etiology and diagnosis of achalsia
          Know the treatment of achalasia (non-operative and operative)
PGY-3     Know the etiology and diagnosis of achalsia
          Know the treatment of achalasia (non-operative and operative)
          Describe steps in a Heller myotomy Dor Fundoplication

Patient Care
G-Level Technical / Procedural Skills
PGY-1       Be able to function as a first assistant to a botox injection
            Be able to function as a first assistant to a LES dilation

PGY-3         Be able to function as a first surgeon to a botox injection
              Be able to function as a first surgeon to a LES dilation
              Be able to function as an assistant on a Heller/Dor


                                                        64
Core Topic 11: Thoracic Trauma
Medical Knowledge
G-Level Objectives
PGY-1     Understand the etiology and work-up for thoracic trauma
          Know the mechanism of thoracic trauma
          Understand the treatments of various thoracic trauma cases with attention to the
          operative approaches
PGY-3     Understand the etiology and work-up for thoracic trauma
          Know the mechanism of thoracic trauma
          Understand the treatments of various thoracic trauma cases with attention to the
          operative approaches and complicated ventilatory situations

Patient Care
G-Level Technical / Procedural Skills
PGY-1       Be able to place a chest tube
            Perform flexible bronchoscopy with assistance

PGY-3         Be able to place a chest tube
              Independently perform flexible bronchoscopy



ROTATION GOALS AND OBJECTIVES FOR PROBLEM-BASED LEARNING AND IMPROVEMENT,
INTERPERSONAL SKILLS AND COMMUNICATION, PROFESSIONALISM, AND SYSTEMS BASED
PRACTICE



Problem-Based Learning and Improvement
G-Level Objectives
All         Identify own learning needs or goals at the onset of the rotation.
            Following a surgical procedure, debrief what went well, and what could have
              been improved.
            Identify differences in incidence, prognosis, and outcomes of cancer treatment
              according to race and gender.
            Diagnose personal learning needs associated with any medical errors,
              complications, or ―near misses‖ that occurred during your watch.
            Use feedback gained from others, and the experience gained on this rotation,
              to formulate future learning goals and steps.

Interpersonal Skills and Communication
G-Level Objectives
All          Communicate patient information clearly to other health providers in written
                notes and oral presentations.
             Apply appropriate communication skills with patients and families (i.e. effective
                listening, awareness of nonverbal cues, and use of open-ended questions).
             Counsel and educate patients and families on their treatment options, their
                surgical outcomes and prognosis, and home care needs.
             Explain to medical students / junior residents the fundamentals of your job, as
                well as their jobs.
                                                      65
Professionalism
G-Level Objectives
All           Adhere to patient privacy and informed consent policies at all times.
              Adhere to University behavior policies (e.g., sexual harassment, duty hours,
                dress code) at all times.
              Demonstrate respect, compassion, integrity, and honesty in all interactions with
                patients, families, and other health care providers.
              Demonstrate personal responsibility for patient welfare.
              Articulate ethical issues underlying clinical decisions made for at least once
                complex case seen during this rotation.
              Work collegially with a physician assistant.


Systems-Based Practice
G-Level Objectives
All         Know when to call for help from attending physicians.
            Understand when, how, and why to request a consult from pulmonary
              medicine, medical oncology, radiation oncology, palliative medicine and how to
              use the information gained as a result.
            Provide timely and pertinent consultation when asked by medical or surgical
              colleagues.
            Use the talents and skills of other health providers in the OR and ward.
            Estimate the costs / benefits of cancer staging (CT, PET, etc.) and treatment.
            Consider patient characteristics (e.g., age, race and ethnicity, family support,
              socio-economic status, type of insurance) in evaluating treatment options and
              developing an appropriate care plan.
            Discuss the distinction between medically necessary care and over care, and
              its implications for our patients.
            Discuss the importance of palliative care for the end stage thoracic oncology
              patient
            Diagnose any ―systems issues‖ associated with medical errors, complications,
              and ―near misses‖ that occurred during this rotation.

LEARNING RESOURCES FOR TRAINEES
SCORE Website Portal:

      Modules, chapters, videos, and radiographic images (STAT dx) pertinent to the core topics enumerated
       above
      Evidence-Based Reviews in Surgery
      MD Content Course on Health Care (economics, operations, legal/financial, leadership)

UMMC THORACIC AND FORGUT SURGERY Moodle Website

      See assignments and additional resources




                                                      66
                                       ROTATION PLAN FOR 2011-12
                   UNIVERSITY OF MINNESOTA,
                   Minimally Invasive and Bariatric Surgery

ROTATION NAME
TRAINING LEVELS ON SERVICE: PGY-5; PGY -2; part-time PGY-1
SERVICE DIRECTOR: Sayeed Ikramuddin, MD
TEACHING FACULTY:
Henry Buchwald, MD, PhD
Sayeed Ikramuddin, MD
Todd Kellogg, MD
Daniel Leslie, MD

ROTATION’S WEEKLY EDUCATION SCHEDULE

    Monday            Tuesday at          Wednesday              Thursday           Friday
                        UMMC
8:00 Dr. Leslie    6:30 G4+G5          3:00 Core Topic        7:00 Bedside     7:00 first Friday
follow-up and      7:00 M+M            Teaching               Teaching         of month; MIS
consultation       7:45 Grand                                 Rounds           video conference
clinic             Rounds
                   8:30 Core
                   Curriculum
                   9:45-noon Skills
                   Lab



Activity                               Who is responsible?               When does this
                                                                         occur?
Orientation to the Rotation            Leslie                            Mon
Bedside Teaching Rounds                All                               Thurs am
Weekly Core Topic Teaching             Ikramuddin                        Wed pm
Mid-Rotation Review                    Leslie                            Mon pm
End-of-Rotation Oral Exam              Ikramuddin                        Thurs am
End-of-Rotation Meeting w/             Leslie                            Fri pm
Resident

ROTATION GOALS AND OBJECTIVES FOR MEDICAL KNOWLEDGE AND PATIENT CARE, BY CORE
TOPIC AND RESIDENT TRAINING LEVEL

Core Topic 1: Overview of Obesity
Medical Knowledge
G-Level Objectives
PGY-1      Identify / diagnose obesity classification and treatment of obesity.
PGY-2      Identify / qualification for bariatric surgery and treatment options.
PGY-5      Know the medical and surgical alternatives for achieving weight loss.
           Understand the epidemiology and etiology of the obesity epidemic.
           Understand the basic science principles of weight maintenance in the normal and
            obese state.
           Understand the natural history of morbid obesity including the associated
            comorbidities.
                                                       67
Patient Care
G-Level Technical / Procedural Skills                 Care Plans
PGY-1      N/A                                         Review and understand care plans
PGY-2      Peritoneal access laparoscopically.        Review and understand care plans
PGY-5      Explain basic laparoscopic principles
             and types of equipment used.

Core Topic 2: Obesity and Diabetes
Medical Knowledge
G-Level Objectives
PGY-1      Identify / diagnose metabolic conditions related to obesity.
PGY-2      Identify therapies for diabetes control.
PGY-5      Evaluate and compare/contrast outcomes of different surgical interventions for
            treatment of type 2 diabetes.

Patient Care
G-Level Technical / Procedural Skills                 Care Plans
PGY-1      N/A                                         Treat type 2 dm post-bariatric surgery
PGY-2      Perform enteroenterostomy                  Understand dynamics of glucose
                                                        control post-bariatric surgery
PGY-5      Perform performs or all of upper          Same as above.
            endoscopy.
           Interpret impedance manometry and
            pH probe test.
           Open and close open operations
            independently.



Core Topic 3: Primary Bariatric Operations
Medical Knowledge
G-Level Objectives
PGY-1      Identify principles and anatomy of accepted bariatric procedures, including Roux-
PGY-2       en-Y gastric bypass, adjustable gastric banding, and duodenal switch.
PGY-5      View videos of bariatric procedures and learn steps of laparoscopic and open
            bariatric procedures.


Patient Care
G-Level Technical / Procedural Skills                 Care Plans
PGY-1      Assist with laparoscope manipulation       Recognize clinical needs of various
             and skin closure.                          procedures.
           Perform portions of intestinal stapling
             procedures.
PGY-2      Learn laparoscopic port placement for       Coordinate care plans for patients with
             bariatric operations.                       different bariatric anatomy.
           Perform portions of upper endoscopy.
           Interpret impedance manometry and
             pH probe tests.
           Open and close open abdominal

                                                      68
              procedures with increasing sense of
              independence.
             Construct jejunojejunostomy during
              open bariatric operation.
             Construct portions of laparoscopic
              gastrojejunostomy and
              jejunojejunostomy.
PGY-5        Understand appropriate access, port          Supervise MIS team members in
              placement, and conduct of the primary         appropriate care plans.
              bariatric operations.
             Construction of a gastro-jejunostomy
              and jejuno-jejunostomy during open
              operations.
             Construction of a gastric pouch, gastro-
              jejunostomy, and jejuno-jejunostomy
              during advanced laparoscopic
              procedures.
             Perform adjustable band implantation.
             Adhesiolysis in complex revision
              operations.

Core Topic 4: Bariatric Complications
Medical Knowledge
G-Level Objectives
PGY-1      Recognize spectrum of inpatient adverse events.
PGY-2      Recognize, diagnose, and manage post-bariatric complications.
PGY-5      Understand the fundamental complications and treatment of stapled bariatric
            operations:
              Deep venous thrombosis and pulmonary embolism
              Gastric remnant distention
              GI leak
              Wound infection
              Internal hernia
              Gastro-jejunal anastomosis stricture
              Adverse metabolic sequelae
           Understand the fundamental complications and treatment of adjustable band
            surgery:
             Acute gastric prolapse
             Concentric dilatation
             Band erosion
             Overtightened band
             Port rotation; port or tubing leak; port infection
             Band intolerance

Patient Care
G-Level Technical / Procedural Skills                    Care Plans
PGY-1      Perform fluid removal from band.              Communicate with surgical team
                                                           regarding complication treatment plan.
PGY-2      Assist with exploratory laparoscopy,          Treat complications under supervision.
            endoscopy, and adjustments of the
            band in band assessment clinic. Use
            wire-guided and radiologic/endoscopic
            approaches for treating bariatric

                                                         69
            complications.
PGY-5      Definitively treat surgical complications  Diagnose, manage, and treat
            related to bariatric surgery. Place         complications preoperatively and
            minimally invasive gastrostomy tube for     postoperatively.
            malnutrition.


ROTATION GOALS AND OBJECTIVES FOR PROBLEM-BASED LEARNING AND IMPROVEMENT,
INTERPERSONAL SKILLS AND COMMUNICATION, PROFESSIONALISM, AND SYSTEMS BASED
PRACTICE



Problem-Based Learning and Improvement
G-Level Objectives
PGY-1       Identify own learning needs or goals at the onset of the rotation.
            Following a surgical procedure, debrief what went well, and what could have
              been improved.
            Identify differences in incidence, prognosis, and outcomes of cancer treatment
              according to race and gender.
            Diagnose personal learning needs associated with any medical errors,
              complications, or ―near misses‖ that occurred during your watch.
            Use feedback gained from others, and the experience gained on this rotation,
              to formulate future learning goals and steps.
PGY-2    Same as above.
PGY-5    Same as above.

Interpersonal Skills and Communication
G-Level Objectives
PGY-1        Communicate patient information clearly to other health providers in written
                notes and oral presentations.
             Apply appropriate communication skills with patients and families (i.e. effective
                listening, awareness of nonverbal cues, and use of open-ended questions).
             Counsel and educate patients and families on their treatment options, their
                surgical outcomes and prognosis, and home care needs.
             Explain to medical students / junior residents the fundamentals of your job, as
                well as their jobs.
PGY-2      Same as above.
PGY-5      Same as above.

Professionalism
G-Level Objectives
PGY-1         Adhere to patient privacy and informed consent policies at all times.
              Adhere to University behavior policies (e.g., sexual harassment, duty hours,
                dress code) at all times.
              Demonstrate respect, compassion, integrity, and honesty in all interactions with
                patients, families, and other health care providers.
              Demonstrate personal responsibility for patient welfare.
                Articulate ethical issues underlying clinical decisions made for at least once
                complex case seen during this rotation.
                                                      70
PGY-2      Same as above.
PGY-5      Same as above.

Systems-Based Practice
G-Level Objectives
PGY-1       Know when to call for help from attending physicians.
            Understand when, how, and why to request a consult from gastroenterology,
              and how to use the information gained as a result.
            Understand the concept of the Bariatric Surgery Center of Excellence and the
              need for all bariatric patients to have ongoing chronic care in a bariatric center.
            Provide timely and pertinent consultation when asked by medical or surgical
              colleagues.
            Use the talents and skills of other health providers in the OR and ward.
            Estimate the costs / benefits of undergoing bariatric surgery compared to
              remaining morbidly obese.
            Consider patient characteristics (e.g., age, race and ethnicity, family support,
              socio-economic status, type of insurance) in evaluating treatment options and
              developing an appropriate care plan.
            Discuss the distinction between medically necessary care and over care, and
              its implications for our patients.
              Diagnose any ―systems issues‖ associated with medical errors, complications,
              and ―near misses‖ that occurred during this rotation.
PGY-2    Same as above.
PGY-5    Same as above.

LEARNING RESOURCES FOR TRAINEES
SCORE Website Portal:

       Modules, chapters, videos, and radiographic images (STAT dx) pertinent to the core topics enumerated
        above
       Evidence-Based Reviews in Surgery
       MD Content Course on Health Care (economics, operations, legal/financial, leadership)

UMMC MIS & BARIATRIC SURGERY Moodle Website

       See assignments and additional resources




                                       ROTATION PLAN FOR 2011-12
                    UNIVERSITY OF MINNESOTA, Transplant Service

ROTATION NAME
TRAINING LEVELS ON SERVICE: PGY -1
SERVICE DIRECTOR: Ty Dunn, M.D.
TEACHING FACULTY:
                                                       71
Srinath Chinnakotla, M.D.
Eric Finger, M.D.
Raja Kandaswamy, M.D.
William Payne, M.D.
Timothy Pruett, M.D.
Arthur Matas, M.D.
David Sutherland, M.D.
John S. Najarian, M.D.
ROTATION’S WEEKLY EDUCATION SCHEDULE

    Monday             Tuesday at           Wednesday             Thursday            Friday
                         UMMC
11:00 Transplant    6:30 G4+G5           1:00 K/P Listing     3:00 Pancreas
Curriculum          7:00 M+M             Meeting              Patient Review
                    7:45 Grand           3:30 M&M
                    Rounds               4:00 Transplant
                    8:30 Core            Conference
                    Curriculum
                    9:45-noon Skills
                    Lab
                    3:00 Liver
                    Conference



Activity                                 Who is responsible?               When does this
                                                                           occur?
Orientation to the Rotation              Dr. Dunn                          1st Day of rotation
Bedside Teaching Rounds                  MD of the Week on Kidney          Mid-Day Thursday
Weekly Core Topic Teaching               Assigned Faculty                  Monday
Mid-Rotation Review                      MD on Kidney Service              Mid-Rotation Week
End-of-Rotation Oral Exam                MD on Kidney Service              Last Week of Rotation
End-of-Rotation Meeting w/               MD on Kidney Service              Last Week of Rotation
Resident

ROTATION GOALS AND OBJECTIVES FOR MEDICAL KNOWLEDGE AND PATIENT CARE, BY CORE
TOPIC AND RESIDENT TRAINING LEVEL
1. Fluid, Electrolyte, and Glucose management in surgical patients with organ
failure
2. Side effects and Drug interactions of Immunosuppressants
3. Vascular Access (short term, long-term, and permanent) - indications and
complications

4. Recognition and management of common postoperative complications of
kidney transplantation

5. Be able to describe at least 2 surgical techniques for ureteral, biliary, and
duodenal anastomoses


Core Topic 1:
Fluid, Electrolyte, and Glucose management in surgical patients with organ
failure
                                                         72
Medical Knowledge
G-Level Objectives
PGY-1     Exhibit knowledge and thought process in discussing organ failure patients with Core
          Topic Problem.

Patient Care
G-Level Technical / Procedural Skills                   Care Plan
PGY-1      N/A                                          Demonstrate ability to form appropriate
                                                        treatment plan.

Core Topic 2: Side effects and Drug interactions of Immunosuppressants Medical Knowledge
G-Level Objectives
PGY-1     Exhibit knowledge and thought process in discussing organ failure patients with Core
          Topic Problem.


Patient Care
G-Level Technical / Procedural Skills                   Care Plans
PGY-1      N/A                                          Demonstrate ability to form appropriate
                                                        treatment plan.

Core Topic 3: Vascular Access (short term, long-term, and permanent) - indications and complications
Medical Knowledge
G-Level Objectives
PGY-1     Exhibit knowledge and thought process in discussing organ failure patients with Core
          Topic Problem.

Patient Care
G-Level Technical / Procedural Skills                   Care Plans
PGY-1      N/A                                          Demonstrate ability to form appropriate
                                                        treatment plan.

Core Topic 4: Recognition and management of common postoperative complications of kidney transplantation

Medical Knowledge
G-Level Objectives
PGY-1     Exhibit knowledge and thought process in discussing organ failure patients with Core
          Topic Problem.

Patient Care
G-Level Technical / Procedural Skills                   Care Plans
PGY-1      Demonstrate safe and effective NGT           Demonstrate ability to form appropriate
           placement, troubleshooting, and Foley        treatment plan.
           Irrigation.

Core Topic 5: Be able to describe at least 2 surgical techniques for ureteral, biliary, and duodenal
anastomoses

Medical Knowledge
G-Level Objectives
PGY-1     Exhibit knowledge and thought process in discussing indications, contraindications,
          advantages and disadvantages unique to each technique.

Patient Care
                                                       73
G-Level    Technical / Procedural Skills              Care Plans
PGY-1      Participate in vascular, ureteral and      N/A
           bowel anastomoses during rotation

ROTATION GOALS AND OBJECTIVES FOR PROBLEM-BASED LEARNING AND IMPROVEMENT,
INTERPERSONAL SKILLS AND COMMUNICATION, PROFESSIONALISM, AND SYSTEMS BASED
PRACTICE



Problem-Based Learning and Improvement
G-Level Objectives
PGY-1       Identify own learning needs or goals at the onset of the rotation.
            Following a surgical procedure, debrief what went well, and what could have
              been improved.
            Identify differences in incidence, prognosis, and outcomes of cancer treatment
              according to race and gender.
            Diagnose personal learning needs associated with any medical errors,
              complications, or ―near misses‖ that occurred during your watch.
            Use feedback gained from others, and the experience gained on this rotation,
              to formulate future learning goals and steps.

Interpersonal Skills and Communication
G-Level Objectives
PGY-1        Communicate patient information clearly to other health providers in written
                notes and oral presentations.
             Apply appropriate communication skills with patients and families (i.e. effective
                listening, awareness of nonverbal cues, and use of open-ended questions).
             Counsel and educate patients and families on their treatment options, their
                surgical outcomes and prognosis, and home care needs.
             Explain to medical students / junior residents the fundamentals of your job, as
                well as their jobs.

Professionalism
G-Level Objectives
PGY-1         Adhere to patient privacy and informed consent policies at all times.
              Adhere to University behavior policies (e.g., sexual harassment, duty hours,
                dress code) at all times.
              Demonstrate respect, compassion, integrity, and honesty in all interactions with
                patients, families, and other health care providers.
              Demonstrate personal responsibility for patient welfare.
                Articulate ethical issues underlying clinical decisions made for at least once
                complex case seen during this rotation.


Systems-Based Practice
G-Level Objectives
PGY-1       Know when to call for help from attending physicians.
            Understand when, how, and why to request a consult from medical oncology

                                                      74
                and radiation oncology, and how to use the information gained as a result.
               Provide timely and pertinent consultation when asked by medical or surgical
                colleagues.
               Use the talents and skills of other health providers in the OR and ward.
               Estimate the costs / benefits of cancer screening (mammography,
                colonoscopy), staging (CT, PET, etc.), and treatment.
               Consider patient characteristics (e.g., age, race and ethnicity, family support,
                socio-economic status, type of insurance) in evaluating treatment options and
                developing an appropriate care plan.
               Discuss the distinction between medically necessary care and over care, and
                its implications for our patients.
                Diagnose any ―systems issues‖ associated with medical errors, complications,
                and ―near misses‖ that occurred during this rotation.

LEARNING RESOURCES FOR TRAINEES
ASTS Academic Universe:
    >100 web-based modules specific to transplant, with posttest quizzes.

SCORE Website Portal:

      Modules, chapters, videos, and radiographic images (STAT dx) pertinent to the core topics enumerated
       above
      Evidence-Based Reviews in Surgery
      MD Content Course on Health Care (economics, operations, legal/financial, leadership)

UMMC TRANSPLANT Moodle Website

      See assignments and additional resources




                                       ROTATION PLAN FOR 2011-12
       UNIVERSITY OF MINNESOTA, Cardiovascular Service

ROTATION NAME
TRAINING LEVELS ON SERVICE: PGY -3
SERVICE DIRECTOR: Ranjit John,M.D.
TEACHING FACULTY:
Herb Ward, M.D., PhD
Kenneth Liao, M.D.
Sara Shumway, M.D.

ROTATION’S WEEKLY EDUCATION SCHEDULE

    Monday            Tuesday at         Wednesday             Thursday              Friday
                        UMMC
                   6:30 G4+G5          7:00 Heart          7:00 Lung
                   7:00 M+M            Failure             Transplant
                   7:45 Grand          Conference          Conference

                                                      75
                    Rounds
                    8:30 Core
                    Curriculum
                    9:45-noon Skills
                    Lab



Activity                               Who is responsible?              When does this
                                                                        occur?
Orientation to the Rotation            Dr. John                         1st three days of rotation
Bedside Teaching Rounds                Faculty of the week (Drs         Once per week
                                       John, Liao or Shumway)
Weekly Core Topic Teaching             Dr. John                         Once per week
Mid-Rotation Review                    Dr. John                         Mid rotation
End-of-Rotation Oral Exam              Dr. John                         Within last 7 days of
                                                                        rotation
End-of-Rotation Meeting w/             Dr. John                         Within last 7 days of
Resident                                                                rotation

ROTATION GOALS AND OBJECTIVES FOR MEDICAL KNOWLEDGE AND PATIENT CARE, BY CORE
TOPIC AND RESIDENT TRAINING LEVEL

Core Topic 1: Post-Op Management
Medical Knowledge
G-Level Objectives
PGY-3     Know the management physiologic response of patients that have undergone
          procedures requiring cardiopulmonary bypass

           Know the concepts important in heart failure and how this differs from the post-op
           patient with valvular or ischemic disease

           Know the post op physiologic differential diagnosis of the cardiac surgery patient that
           includes: septic shock, cardiogenic shock, hypovolemic/hemorrhagic shock

Patient Care
G-Level Manual Dexterity
PGY-3      Correctly manage the acute and sub-acute physiologic changes post-operative
           patient following cardiopulmonary bypass (ischemic/valvular) or ventricular assist
           device placement

Core Topic 2: Coronary Artery Disease
Medical Knowledge
G-Level Objectives
PGY-3     Accurately diagram the anatomy of the coronary system

           Describe the correct pre-operative work-up of the ischemic patient

           Describe the operative and non-operative approaches to the patient with
           atherosclerotic coronary vascular disease

           Know the indications for coronary revascularization

           Know the steps to a coronary revascularization procedure using cardiopulmonary
                                                       76
           bypass

Patient Care
G-Level Manual Dexterity
PGY-3      Perform a sternotomy
           Assist in performance of cardiopulmonary bypass
           Assist with sternal closure

Core Topic 3: Post-Op Complications
Medical Knowledge
G-Level Objectives
PGY-3     Describe the most common post-operative complications for the cardiac surgery
          patient and the various options for management (including sub-acute conditions
          such as mediastinitis)

Patient Care
G-Level Manual Dexterity
PGY-3      Correctly and efficiently manage post-operative bleeding in a cardiac surgery
           patient.
           Understand the indication for surgical re-exploration
           Recognize and initiate treatment for life-threatening conditions such as tamponade

Core Topic 4: Valvular Heart Disease
Medical Knowledge
G-Level Objectives
PGY-3     Learn the anatomy of the mitral and aortic valve
          Understand the indications for surgical valve replacement
          Learn the alternatives to surgical treatment
          Describe the differences in the approach to surgery in that patient with valvular
          disease (when compared to coronary artery surgery alone)

Patient Care
G-Level Manual Dexterity
PGY-3      Perform a sternotomy
           Assist in performance of cardiopulmonary bypass
           Assist with sternal closure
Core Topic 5: Cardiogenic Shock
Medical Knowledge
G-Level Objectives
PGY-3      Understand the presentation of patients with cardiogenic shock
           Learn the surgical and non-surgical management of patients with cardiogenic shock
           Learn the indications of placement of intraaortic balloon pump (IABP)
           Understand the complications associated with placement and removal of IABP
           Describe how a IABP works and recognize basic trouble-shooting maneuvers

Patient Care
G-Level Manual Dexterity
PGY-3      Observe placement of IABP
           Perform removal of IABP


Core Topic 6: LVAD / Heart Transplant
Medical Knowledge
G-Level Objectives
                                                       77
PGY-3      Understand indications for LVAD and heart transplantation
           Understand post op management of patients undergoing LVAD and heart
           transplantation
           Describe the basic immunosuppression for the heart transplant patient

Patient Care
G-Level Manual Dexterity
PGY-3      Perform a sternotomy
           Assist in performance of cardiopulmonary bypass
           Assist with sternal closure

Core Topic 7: Aortic Disease
Medical Knowledge
G-Level Objectives
PGY-3     Describe the pathophysiology of aortic disease
          Describe the presentation of the patient with aortic dissection and the indications for
          operative and non-operative management based on anatomy of aortic dissection
          Understand diagnosis and management of patients with aortic dissection

Patient Care
G-Level Manual Dexterity
PGY-3      Perform a sternotomy
           Assist in performance of cardiopulmonary bypass
           Assist with sternal closure

Core Topic 8: Pericardial Disease
Medical Knowledge
G-Level Objectives
PGY-3     Understand diagnosis and management of pericardial effusion and tamponade

Patient Care
G-Level Manual Dexterity
PGY-3      Learn performance of pericardial window (subxiphoid approach)

ROTATION GOALS AND OBJECTIVES FOR PROBLEM-BASED LEARNING AND IMPROVEMENT,
INTERPERSONAL SKILLS AND COMMUNICATION, PROFESSIONALISM, AND SYSTEMS BASED
PRACTICE



Problem-Based Learning and Improvement
G-Level Objectives
PGY-3       Identify own learning needs or goals at the onset of the rotation.
            Following a surgical procedure, debrief what went well, and what could have
              been improved.
            Identify differences in incidence, prognosis, and outcomes of cardiovascular
              disease treatment according to race and gender.
            Diagnose personal learning needs associated with any medical errors,
              complications, or ―near misses‖ that occurred during your watch.
            Use feedback gained from others, and the experience gained on this rotation,
              to formulate future learning goals and steps.


                                                       78
Interpersonal Skills and Communication
G-Level Objectives
PGY-3        Communicate patient information clearly to other health providers in written
                notes and oral presentations.
             Apply appropriate communication skills with patients and families (i.e. effective
                listening, awareness of nonverbal cues, and use of open-ended questions).
             Counsel and educate patients and families on their treatment options, their
                surgical outcomes and prognosis, and home care needs.
             Explain to medical students / junior residents the fundamentals of your job, as
                well as their jobs.

Professionalism
G-Level Objectives
PGY-3         Adhere to patient privacy and informed consent policies at all times.
              Adhere to University behavior policies (e.g., sexual harassment, duty hours,
                dress code) at all times.
              Demonstrate respect, compassion, integrity, and honesty in all interactions with
                patients, families, and other health care providers.
              Demonstrate personal responsibility for patient welfare.
                Articulate ethical issues underlying clinical decisions made for at least once
                complex case seen during this rotation.


Systems-Based Practice
G-Level Objectives
PGY-3       Know when to call for help from attending physicians.
            Understand when, how, and why to request a consult from cardiology, critical
              care, and how to use the information gained as a result.
            Provide timely and pertinent consultation when asked by medical or surgical
              colleagues.
            Use the talents and skills of other health providers in the OR and ward.
            Consider patient characteristics (e.g., age, race and ethnicity, family support,
              socio-economic status, type of insurance) in evaluating treatment options and
              developing an appropriate care plan.
            Discuss the distinction between medically necessary care and over care, and
              its implications for our patients.
              Diagnose any ―systems issues‖ associated with medical errors, complications,
              and ―near misses‖ that occurred during this rotation.
LEARNING RESOURCES FOR TRAINEES
SCORE Website Portal:

      Evidence-Based Reviews in Surgery
      MD Content Course on Health Care (economics, operations, legal/financial, leadership)

UMMC CARDIOVASCULAR Moodle Website

      See assignments and additional resources



                                                      79
                                   ROTATION PLAN FOR 2011-12

                   UMMC Surgical Critical Care

ROTATION NAME

TRAINING LEVELS ON SERVICE: 1 Fellow; 1 PGY-2; 1 PGY-1; occasionally a medical ICU fellow;
intermittent 4th year medical students
SERVICE DIRECTOR: Jeffrey Chipman, M.D.
TEACHING FACULTY: Matthew Byrnes, M.D.
Mollie James, D.O., M.P.H.
Kaysie Banton M.D., PhD
James Harmon, MD
Melissa Brunswald, MD
Torfi Hoskuldson,

ROTATION’S WEEKLY EDUCATION SCHEDULE
   Monday        Tuesday at       Wednesday              Thursday           Friday
                   UMMC
              6:30 G4+G5       1st Wed/month
              7:00 M+M         7:00 Fellows
              7:45 Grand       conference
              Rounds           (journal
              8:30 Core        club/topic)
              Curriculum       4th Wed/month
              9:45-noon Skills 7:30 Combined
              Lab              MICU/SICU
              12:00 SICU       conference
              Conference


Activity                           Who is responsible?          When does this
                                                                occur?
Orientation to the Rotation        Resident (online)            First day or before
Bedside Teaching Rounds            Call Person                  Daily, 8:00 a.m.
Weekly Core Topic Teaching         All                          Daily
Mid-Rotation Review                Faculty will vary            Critical Care/Acute Care
End-of-Rotation Oral Exam          Faculty will vary            Office will remind you to
End-of-Rotation Meeting w/         Faculty will vary            set up.
Resident

ROTATION GOALS AND OBJECTIVES FOR MEDICAL KNOWLEDGE AND PATIENT CARE, BY CORE
TOPIC AND RESIDENT TRAINING LEVEL

                                                  80
Core Topic 1: Shock
Medical Knowledge
                     PGY-1                                            PGY-2
By the end of the rotation PGY-1 residents       By the end of the rotation PGY-2 residents
should know:                                     should know:
     The clinical appearance of shock                The PGY-1 objectives
     Examples of distributive, cardiogenic,          Early, goal-directed treatment of shock
       neurogenic, obstructive, and                   How to restore oxygen delivery
       hypovolemic shock                              Relationship of oxygen delivery (DO2)
     How to determine oxygen delivery                  to oxygen consumption (VO2)
       (DO2)                                          Endpoints of resuscitation

Patient Care
Greg Beilman, M.D.
                     PGY-1                                            PGY-2
By the end of the rotation PGY-1 residents       By the end of the rotation PGY-2 residents
should be able to perform:                       should be able to perform:
     A history and physical exam to identify         The PGY-1 objectives
       the shock state                                Recognize the proper indication for
     Write and initiate orders to treat the            vasoactive agents and initiate their use
       shock state and achieve resuscitative          Prescribe proper antibiotic coverage
       end-points including: intravenous fluid        Recognize the emergence of organ
       rates and boluses, DVT & ulcer                   failure
       prophylaxis, blood transfusions
     Recognize the need for antibiotics
     Recognize the need for vasoactive
       agents

Core Topic 2: Role of Intensivist
Medical Knowledge
                     PGY-1                                            PGY-2
By the end of the rotation PGY-1 residents       By the end of the rotation PGY-2 residents
should know:                                     should know:
     What an intensivist does                        How an intensivist can improve patient
                                                        outcome and supportive data from the
                                                        literature

Patient Care
                     PGY-1                                           PGY-2
N/A                                              N/A



Core Topic 3: Ventilator Management and Lung Injury
Medical Knowledge
                     PGY-1                                           PGY-2
By the end of the rotation PGY-1 residents      By the end of the rotation PGY-2 residents
should know:                                    should know:
     the clinical and laboratory indicators of      The PGY-1 objectives
       acute respiratory failure                     Indicators for intubation and
     Basic ventilator modes (CMV, SIMV,               mechanical ventilation
       PC, PS)                                       Indications for different methods of
                                                       mechanical ventilation
                                                       81
                                                           Predictors of successful liberation from
                                                            the ventilator

Patient Care
                     PGY-1                                           PGY-2
By the end of the rotation PGY-1 residents      By the end of the rotation PGY-2 residents
should be able to:                              should be able to:
     Order basic ventilator settings (tidal         PGY-1 objectives
       volume, respiratory rate, mode, and           Modify the ventilator based on blood
       PEEP)                                           gas interpretation by changing rate,
     Interpret blood gases and recognize              tidal volume, and PEEP
       acute and compensated, respiratory            Recognize potentially lung damaging
       and metabolic acid base disorders               situations such as high peak airway
                                                       pressures
                                                     Troubleshoot patient-ventilator
                                                       disynchrony

Core Topic 4: Sepsis
Medical Knowledge
                     PGY-1                                           PGY-2
By the end of the rotation PGY-1 residents      By the end of the rotation PGY-2 residents
should know:                                    should know:
     The distinction between the systemic           PGY-1 objectives
       inflammatory response syndrome                The distinction between sepsis, severe
       (SIRS), bacteremia, and sepsis.                 sepsis, and septic shock
     SIRS criteria                                  The SIRS response and the
     The physiologic response that defines            compensatory anti-inflammatory
       sepsis                                          response syndrome (SIRS)
                                                     How sepsis leads to multisystem organ
                                                       dysfunction and failure


Patient Care
                     PGY-1                                           PGY-2
By the end of the rotation PGY-1 residents      By the end of the rotation PGY-2 residents
should be able to:                              should be able to perform:
     Recognize SIRS and when it becomes             PGY-1 objectives
       sepsis                                        Escalate care from sepsis to septic
     Resuscitate from sepsis (see                     shock
       objectives for Shock)                         Initiate vasoactive and inotropic agents

Core Topic 5: Blood Transfusion
Medical Knowledge
                     PGY-1                                           PGY-2
By the end of the rotation PGY-1 residents      By the end of the rotation PGY-2 residents
should know:                                    should know:
     Risks and benefits of blood transfusion        PGY-1 objectives
     Current opinions of ―transfusion               Contribution of hemoglobin level to
       triggers‖                                       oxygen delivery
                                                     Indications for fresh frozen plasma,
                                                       platelets, and cryoprecipitate

Patient Care
                                                       82
                     PGY-1                                           PGY-2
By the end of the rotation PGY-1 residents      By the end of the rotation PGY-2 residents
should be able to:                              should be able to:
     Order proper blood products                    Recognize the need for blood
                                                       transfusion
                                                     Recognize the ability to avoid blood
                                                       transfusions

Core Topic 6: Renal Failure
Medical Knowledge
                     PGY-1                                           PGY-2
By the end of the rotation PGY-1 residents      By the end of the rotation PGY-2 residents
should know:                                    should know:
     Biochemical indicators of renal failure        PGY-1 objectives
                                                     Distinguish and diagnose
Patient Care
                     PGY-1                                           PGY-2
By the end of the rotation PGY-1 residents      By the end of the rotation PGY-2 residents
should be able to perform:                      should be able to perform:
                                                    
   


Core Topic 7: Family Conferences
Medical Knowledge
                     PGY-1                                           PGY-2
By the end of the rotation PGY-1 residents      By the end of the rotation PGY-2 residents
should know:                                    should know:
     The meaning of DNR/DNI and comfort             PGY-1 objectives
       care                                          Controversies regarding end-of-life
                                                       care, specifically the definition of futility

Patient Care
                     PGY-1                                           PGY-2
By the end of the rotation PGY-1 residents      By the end of the rotation PGY-2 residents
should be able to:                              should be able to:
     Recognize the signs and symptoms of            PGY-1 objectives
       pain, anxiety or other discomfort at          Write orders for anxiolytics, analgesics,
       end-of-life                                     and other drugs for the relief of pain
                                                       and suffering at end-of-life
                                                     Perform an end-of-life discussion with a
                                                       family member

Core Topic 8: Tracheostomy
Medical Knowledge
                     PGY-1                                           PGY-2
By the end of the rotation PGY-1 residents      By the end of the rotation PGY-2 residents
should know:                                    should know:
     Indications for tracheostomy                   PGY-1 objectives
     Risks and benefits of tracheostomy             Advantages and disadvantages of
                                                       percutaneous versus open
                                                       tracheostomy


                                                     83
Patient Care
                     PGY-1                                             PGY-2
By the end of the rotation PGY-1 residents        By the end of the rotation PGY-2 residents
should be able to:                                should be able to perform:
     Recognize the landmarks both                     Percutaneous tracheostomy
       bronchoscopically and externally for a          Provide sedation and analgesia for
       tracheostomy location                             percutaneous tracheostomy


ROTATION GOALS AND OBJECTIVES FOR PROBLEM-BASED LEARNING AND IMPROVEMENT,
INTERPERSONAL SKILLS AND COMMUNICATION, PROFESSIONALISM, AND SYSTEMS BASED
PRACTICE

Problem-Based Learning and Improvement
                     PGY-1                                             PGY-2
By the end of the rotation PGY-1 residents        By the end of the rotation PGY-2 residents
should be able to:                                should:
     Recognize his/her limitations                    Present a list of deaths and
     Utilize available resources to answer               complications (readmissions within 24
       questions regarding critical illness and           hours of discharge, procedural
       patient care issues                                complications) occurring during the
                                                          rotation.
                                                       Present some data from the literature
                                                          to address the specific complication

Interpersonal Skills and Communication
                     PGY-1                                              PGY-2
By the end of the rotation PGY-1 residents        By the end of the rotation PGY-2 residents
should:                                           should be able to perform:
     Have witnessed an end-of-life exam               PGY-1 objectives
     Have communicated a status update to             A family conference to update a
        family                                           patient’s condition or discuss
     Present effectively and organized on               alternative care plans
        daily rounds                                   Communicate critical events (see when
     Use SBAR to communicate                            to call the attending card) with SICU
                                                         Fellows and attendings
                                                       Respectfully communicate status
                                                         changes with primary surgical services
                                                       Comprehend the rationale for primary
                                                         service patient care requests
                                                       Collaborate with nursing

Professionalism
                     PGY-1                                             PGY-2
By the end of the rotation PGY-1 residents        By the end of the rotation PGY-2 residents
should be able to perform:                        should be able to perform:
     Resolve conflict with nursing                    PGY-1 objectives
     Be prepared for rounds                           Resolve conflict with primary services
     Take ownership of all patients on                Solve critical issues with other service’s
       service, not just the ones ―you are               patients in the ICU
       covering‖                                       Respond to requests for SICU transfer
                                                         with respect and in a timely manner
                                                         (may need to go see the transfer on

                                                       84
                                                              the floor)


Systems-Based Practice
                     PGY-1                                              PGY-2
By the end of the rotation PGY-1 residents         By the end of the rotation PGY-2 residents
should:                                            should:
     Recognize the need for timely order               PGY-1 objectives
        writing and SICU discharge
     Communicate ongoing care needs to
        services providing care after SICU
        discharge, including to other facilities


LEARNING RESOURCES FOR TRAINEES
SCORE Website Portal:
    Modules, chapters, videos, and radiographic images (STAT dx) pertinent to the core topics enumerated
     above
    Surgical Critical Care, Second Edition. Jerome Abrams, Paul Druck, and Frank B Cerra Eds. Taylor &
     Francis, 2005,

UMMC Surgical Critical Care Moodle site
   Specific readings and resources




                                          ROTATION PLAN FOR 2011-12

                           UNIVERSITY OF MINNESOTA, Colorectal Surgery
ROTATION NAME
TRAINING LEVELS ON SERVICE: PGY -1
SERVICE DIRECTOR: Mary Kwaan, M.D.
TEACHING FACULTY:
Robert Madoff, M.D.
Genevieve Melton-Meaux, M.D.
David Rothenberger, M.D.

ROTATION’S WEEKLY EDUCATION SCHEDULE

    Monday              Tuesday at           Wednesday              Thursday         Friday
                          UMMC
12 noon Rectal       7:00 M+M             Surgical              Gen and
Cancer               7:45 Grand           Oncology              vascular surgery
Conference           Rounds               Colorectal            y (GVS) core
every other week     8:30 Core            conference            conference
                     Curriculum           (SOCR)                (every 6 weeks)
                     9:45-noon Skills     (every other
                     Lab                  week)
                                                         85
Activity                                Who is responsible?                 When does this
                                                                            occur?
Orientation to the Rotation             Service director                    The first week of the
                                                                            rotation
Bedside Teaching Rounds                 All attendings                      Mon-Fri
                                                                            When the PGY1 is
                                                                            available and when the
                                                                            attending is not out of
                                                                            town
Weekly Core Topic Teaching              Service Director                    At the PGY-1’s
                                                                            discretion (take home
                                        RDM, GMM, MRK, DAR                  quiz).
                                        Rectal Cancer Conference            Every other Wednesday
                                                                            (SOCR).
                                                                            Every 6 weeks on
                                                                            Thursday (GVS).
                                                                            Every other Monday
Mid-Rotation Review                     Service Director                    Last week of rotation
End-of-Rotation Oral Exam               Service Director                    Last week of the rotation
End-of-Rotation Meeting w/              Service Director                    Last week of rotation
Resident

ROTATION GOALS AND OBJECTIVES FOR MEDICAL KNOWLEDGE AND PATIENT CARE, BY CORE
TOPIC AND RESIDENT TRAINING LEVEL


Core Topic 1: Anorectal Abscess and Fistula
Medical Knowledge
G-Level Objectives
PGY-1     Anatomy of the anus, rectum, and surrounding soft tissue structures. Clinical
          presentation of anorectal abscess. Treatment options.



Patient Care
G-Level Technical / Procedural Skills                      Care Plans
PGY-1      Dressing changes, Proctoscopy, Seton            Develop a treatment plan for patients in
           selection and placement                         the emergency room with an anorectal
                                                           abscess.

Core Topic 2: Inflammatory Bowel Disease
Medical Knowledge
G-Level Objectives
PGY-1     Differential diagnosis, clinical presentation, work up, surgical treatment options.

Patient Care
G-Level Technical / Procedural Skills                      Care Plans
PGY-1      Dressing changes, Drain removal,                Management of post-operative
           Proctoscopy, Enterostomy pouching and           hypotension, oliguria, bleeding, DVT
           care, Skin and fascia closure                   prophylaxis, surgical site infection, post-
                                                           operative ileus, discharge planning.
                                                         86
Core Topic 3: Diverticular Disease
Medical Knowledge
G-Level Objectives
PGY-1     Differential diagnosis, clinical presentation, work up, surgical treatment options.

Patient Care
G-Level Technical / Procedural Skills                   Care Plans
PGY-1      Dressing changes, Drain removal,             Management of post-operative
           Proctoscopy, Skin and fascia closure         hypotension, oliguria, bleeding, DVT
                                                        prophylaxis, surgical site infection, post-
                                                        operative ileus, discharge planning.

Core Topic 3: Colon and Rectal Cancer
Medical Knowledge
G-Level Objectives
PGY-1     Differential diagnosis, clinical presentation, work up, surgical treatment options.

Patient Care
G-Level Technical / Procedural Skills                   Care Plans
PGY-1                                                   Management of post-operative
                                                        hypotension, oliguria, bleeding, DVT
                                                        prophylaxes, surgical site infection, post-
                                                        operative ileus, discharge planning.

ROTATION GOALS AND OBJECTIVES FOR PROBLEM-BASED LEARNING AND IMPROVEMENT,
INTERPERSONAL SKILLS AND COMMUNICATION, PROFESSIONALISM, AND SYSTEMS BASED
PRACTICE


Problem-Based Learning and Improvement
G-Level Objectives
PGY-1       Identify own learning needs or goals at the onset of the rotation.
            Diagnose personal learning needs associated with any medical errors,
              complications, or ―near misses‖ that occurred during your watch.
            Use feedback gained from others, and the experience gained on this rotation,
              to formulate future learning goals and steps.

Interpersonal Skills and Communication
G-Level Objectives
PGY-1        Communicate patient information clearly to other physicians and nurses in
                written notes and oral presentations.
             Apply appropriate communication skills with patients and families (i.e. effective
                listening, awareness of nonverbal cues, and use of open-ended questions).
             Effectively communicate needs when calling an inpatient consultation to
                physicians from other specialties.
             Explain to medical students the fundamentals of your job, as well as their jobs.

Professionalism
G-Level Objectives
PGY-1         Adhere to patient privacy and informed consent policies at all times.

                                                        87
               Adhere to University behavior policies (e.g., sexual harassment, duty hours,
                dress code) at all times.
               Demonstrate respect, compassion, integrity, and honesty in all interactions with
                patients, families, and other health care providers.
               Demonstrate personal responsibility for patient welfare.
                Articulate ethical issues underlying clinical decisions made for at least once
                complex case seen during this rotation.

Systems-Based Practice
G-Level Objectives
PGY-1       Know when to call for help from attending physicians.
            Understand how to order and negotiate prioritization of advanced testing (i.e.
              Endoscopy, image based procedures) for patients in the hospital
            Provide timely and pertinent consultation when asked by medical or surgical
              colleagues.
            Use the talents and skills of other health providers in the OR and ward.
            Consider patient characteristics (e.g., age, race and ethnicity, family support,
              socio-economic status, type of insurance) in evaluating treatment options and
              developing an appropriate care plan.
            Discuss the distinction between medically necessary care and over care, and
              its implications for our patients.
            Diagnose any ―systems issues‖ associated with medical errors, complications,
              and ―near misses‖ that occurred during this rotation.

LEARNING RESOURCES FOR TRAINEES
SCORE Website Portal:
    Modules, chapters, videos, and radiographic images (STAT dx) pertinent to the core topics enumerated
     above
    Evidence-Based Reviews in Surgery
    MD Content Course on Health Care (economics, operations, legal/financial, leadership)

UMMC COLORECTAL Moodle Website
   Modules, articles, videos, and radiographic images pertinent to the core topics enumerated above and
     supplementary topics
   See assignments and additional resources




                                      ROTATION PLAN FOR 2011-12
                      UNIVERSITY OF MINNESOTA, Pediatric Surgery

ROTATION NAME
TRAINING LEVELS ON SERVICE: PGY -4; PGY-1
SERVICE DIRECTOR: Daniel Saltzman, M.D., Ph.D.
TEACHING FACULTY:
Robert Acton, M.D.
                                                      88
Donavon Hess, M.D., Ph.D.
Arnold Leonard, MD, Ph.D.

ROTATION’S WEEKLY EDUCATION SCHEDULE

    Monday            Tuesday at          Wednesday              Thursday            Friday
                        UMMC
                   6:30 G4+G5                                 7:00 – Weekly
                   7:00 M+M                                   Teaching Conf
                   7:45 Grand                                 Noon -Surgery /
                   Rounds                                     GI Conference –
                   8:30 Core                                  every other
                   Curriculum                                 week
                   9:45-noon Skills
                   Lab



Activity                               Who is responsible?               When does this
                                                                         occur?
Orientation to the Rotation            All                               First day
Bedside Teaching Rounds                Call Person                       Daily
Weekly Core Topic Teaching             All, Dr Leonard                   Thursday 7am
Mid-Rotation Review                    All
End-of-Rotation Oral Exam              All
End-of-Rotation Meeting w/             Acton                             Last week
Resident

ROTATION GOALS AND OBJECTIVES FOR MEDICAL KNOWLEDGE AND PATIENT CARE, BY CORE
TOPIC AND RESIDENT TRAINING LEVEL

Core Topic 1: Abdominal Wall Defects
Medical Knowledge
G-Level Objectives
PGY-1     Difference between a gastroschisis and omphalocele
          Treatment options and plan for both.
          Associated anomalies
PGY-4     Above and
          Syndromes that contain omphaloceles and their treatment
          Long term outcomes of both

Patient Care
G-Level Technical / Procedural Skills                    Care Plans
PGY-1      Daily reduction of silos                      Be able to recognize bowel ischemia
           Suture close the defect
PGY-4      Same
Core Topic 2: Bowel Obstructions: Atresias
Medical Knowledge
G-Level Objectives
PGY-1      Understand the theory of jejunal / ileal / colonic atresia and how it differs from
           duodenal atresia and imperforate anus.
           Associated anomalies with all atresias
           Categorize the various atresias
PGY-4      Above and
                                                         89
           Know the history behind the description of jejunal / ileal atresia
           Describe and categorize esophageal atresia

Patient Care
G-Level Technical / Procedural Skills                    Care Plans
PGY-1      Repair a straight forward type 1 jejunal      Understand and be able to describe the
           atresia under direct supervision              work-up and evaluation.
PGY-4      Be able to sew the repairs under direct       Describe the operative plan for repair of
           supervision.                                  all atresia

Core Topic 3: Bowel Obstructions: Hirschprings and GI Bleeds
Medical Knowledge
G-Level Objectives
PGY-1     Understand the physiology of Hirschsprung’s
          List the differential diagnosis for Pediatric GI Bleeds and how they differ for age
PGY-4     Above and
          Describe the various causes of pediatric bowel obstruction and their treatments

Patient Care
G-Level Technical / Procedural Skills                    Care Plans
PGY-1      Assist in an open rectal biopsy and lysis     Develop treatment plans for post-
           of adhesions                                  operative patients
PGY-4      Be able to identify and treat operatively a   Be able to develop appropriate pre and
           patient with midgut volvulus                  post op plans for pediatric patients with
           Perform a suction rectal biopsy               GI obstructions.

Core Topic 4: Congenital Diaphragmatic Hernia
Medical Knowledge
G-Level Objectives
PGY-1     Understand and describe the development of the diaphragm.
          Compare and contrast the two most common forms of CDH.
PGY-4     Above and
          Describe the clinical treatment of CDH and associated issues.

Patient Care
G-Level Technical / Procedural Skills                    Care Plans
PGY-1      Correctly interpret a CXR of a patient        Participate in the post-operative care of a
           with a CDH                                    CDH patient.
PGY-4      Be able to reduce the viscera from a          Make decisions about when it is
           chest and decide about primary or patch       appropriate to repair a CDH
           repair.

Core Topic 5: Pectus
Medical Knowledge
G-Level Objectives
PGY-1      Understand and describe the cardiopulmonary physiology of pectus excavatum and
           how it differs from pectus carinatum.
PGY-4      Describe the most common operative repairs of all types of pectus.
Patient Care
G-Level Technical / Procedural Skills               Care Plans
PGY-1      Evaluate a patient with pectus carinatum Demonstrate proper pain management
           for a pectus brace. Participate in a     of a post-op patient.
           pectus operation.

                                                         90
PGY-4      Participate in dissection and repair of    Same as above
           pectus

Core Topic 6: Congenital Cystic Adenoid Malformation
Medical Knowledge
G-Level Objectives
PGY-1     Understand and describe the various congenital lung masses and how they differ.
PGY-4     Describe the clinical treatment of the above lung masses

Patient Care
G-Level Technical / Procedural Skills                 Care Plans
PGY-1      Correctly interpret a CXR of a patient     Proper care of a post-op thoracotomy
           with a CCAM and describe the changes       patient.
           from normal
PGY-4      Same                                       Same

Core Topic 7: Abdominal Mass and Tumors
Medical Knowledge
G-Level Objectives
PGY-1     Develop and describe the differential diagnosis of pediatric abd masses
PGY-4     Same as above and describe their treatment and pre-operative management.

Patient Care
G-Level Technical / Procedural Skills                 Care Plans
PGY-1      Demonstrate the proper physical exam       Describe the labs need for diagnosis
           of an abd mass.
PGY-4      Assist in the operation for removal of a   Proper pre and post-operative care of
           mass                                       the patient.


ROTATION GOALS AND OBJECTIVES FOR PROBLEM-BASED LEARNING AND IMPROVEMENT,
INTERPERSONAL SKILLS AND COMMUNICATION, PROFESSIONALISM, AND SYSTEMS BASED
PRACTICE


Problem-Based Learning and Improvement
G-Level Objectives
PGY-1       Identify own learning needs or goals at the onset of the rotation.
            Following a surgical procedure, debrief what went well, and what could have
              been improved.
            Identify differences in incidence, prognosis, and outcomes of cancer treatment
              according to race and gender.
            Diagnose personal learning needs associated with any medical errors,
              complications, or ―near misses‖ that occurred during your watch.
            Use feedback gained from others, and the experience gained on this rotation,
              to formulate future learning goals and steps.
PGY-4    Same as above

Interpersonal Skills and Communication
G-Level Objectives
PGY-1        Communicate patient information clearly to other health providers in written
                notes and oral presentations.
                                                      91
              Apply appropriate communication skills with patients and families (i.e. effective
               listening, awareness of nonverbal cues, and use of open-ended questions).
             Counsel and educate patients and families on their treatment options, their
               surgical outcomes and prognosis, and home care needs.
             Explain to medical students / junior residents the fundamentals of your job, as
               well as their jobs.
PGY-4      Same as above

Professionalism
G-Level Objectives
PGY-1         Adhere to patient privacy and informed consent policies at all times.
              Adhere to University behavior policies (e.g., sexual harassment, duty hours,
                dress code) at all times.
              Demonstrate respect, compassion, integrity, and honesty in all interactions with
                patients, families, and other health care providers.
              Demonstrate personal responsibility for patient welfare.
                Articulate ethical issues underlying clinical decisions made for at least once
                complex case seen during this rotation.
PGY-4     Same as above

Systems-Based Practice
G-Level Objectives
PGY-1       Know when to call for help from attending physicians.
            Understand when, how, and why to request a consult from medical oncology
              and radiation oncology, and how to use the information gained as a result.
            Provide timely and pertinent consultation when asked by medical or surgical
              colleagues.
            Use the talents and skills of other health providers in the OR and ward.
            Estimate the costs / benefits of cancer screening (mammography,
              colonoscopy), staging (CT, PET, etc.), and treatment.
            Consider patient characteristics (e.g., age, race and ethnicity, family support,
              socio-economic status, type of insurance) in evaluating treatment options and
              developing an appropriate care plan.
            Discuss the distinction between medically necessary care and over care, and
              its implications for our patients.
              Diagnose any ―systems issues‖ associated with medical errors, complications,
              and ―near misses‖ that occurred during this rotation.
PGY-4    Same as above

LEARNING RESOURCES FOR TRAINEES
SCORE Website Portal:

       Modules, chapters, videos, and radiographic images (STAT dx) pertinent to the core topics enumerated
        above
       Evidence-Based Reviews in Surgery
       MD Content Course on Health Care (economics, operations, legal/financial, leadership)

UMMC PEDIATRIC SURGERY Moodle Website See assignments and additional resources


                                                      92
                                     ROTATION PLAN FOR 2011-12
                     REGIONS HOSPITAL, Trauma & Acute Care Surgery
                     (TACS)
ROTATION NAME
TRAINING LEVELS ON SERVICE: 1 PGY-5, 1 PGY-3 (Night Float), 1 PGY-2, 2 to 3 PGY-1
SERVICE DIRECTOR: Michael D. McGonigal, M.D.
TEACHING FACULTY:
Bruce Bennett, M.D.
Gary Collins, M.D.
Cassandra Palmer, M.D.
David Dries, M.D.

ROTATION’S WEEKLY EDUCATION SCHEDULE


    Monday           Tuesday at        Wednesday           Thursday              Friday
                       UMMC
                  7:00 M+M                              6:30 M+M            11:00 Core
                  7:45 Grand                            7:30 Trauma         Curriculum
                  Rounds                                Conference
                  8:30 Core
                  Curriculum
                  9:45-noon Skills
                  Lab



Activity                             Who is responsible?             When does this
                                                                     occur?
Orientation to the Rotation          Dr. McGonigal                   1st weekday 11:00 am
Bedside Teaching Rounds              Attending on service            Daily 9:30 am
Weekly Core Topic Teaching           Dr. McGonigal                   Fridays 11:00 am
Mid-Rotation Review                  Dr. McGonigal                   3rd Monday 11:00 am
End-of-Rotation Oral Exam            Trauma faculty member           Last 3 days of rotation
End-of-Rotation Meeting w/           Dr. McGonigal                   Last weekday 11:00 am
Resident

ROTATION GOALS AND OBJECTIVES FOR MEDICAL KNOWLEDGE AND PATIENT CARE, BY CORE
TOPIC AND RESIDENT TRAINING LEVEL


Core Topic 1: Trauma Mechanism and Physiology
Medical Knowledge
G-Level Objectives
   All    Understand normal and abnormal responses to shock
   All    Describe classes of hemorrhage and physiologic responses
   All    List basic mechanisms of injury
   All    Describe common injury patterns based on mechanism
                                                   93
   All    Understand basic concepts of ballistics and firearm injury
   All    Review management of DVT and PE in trauma patients
   All    Describe the concepts of damage control surgery


Core Topic 2: Resuscitation
Medical Knowledge
G-Level Objectives
   All    Describe classes of hemorrhage and their physical manifestations
   All    Understand the differences between commonly used resuscitation fluids
   All    List uses for commonly administered blood products
   All    Describe causes and treatment of coagulopathy due to trauma

Patient Care
G-Level Technical / Procedural Skill                  Care Plans
    I      Participate in Trauma Team Activations
           as MD1
  II-III   Participate in Trauma Team Activations
           as MD2
    V      Participate in Trauma Team Activations
           as Team Leader


Core Topic 3: Head & Neck Trauma
Medical Knowledge
G-Level Objectives
All       Review the anatomic types of brain injury
All       Understand manifestations of concussion and post-concussive syndrome
All       Describe airway management principles in trauma
All       Review findings in and management of cervical spine and cord injury


Patient Care
G-Level Technical / Procedural Skill                  Care Plans
II-III     Perform cervical spine clearance
V          Perform percutaneous tracheostomy in
           ventilated patients

Core Topic 4: Chest Trauma
Medical Knowledge
G-Level Objectives
All       Describe the 12 major chest injuries and their management
All       Understand the implications and management of cardiac contusion

Patient Care
G-Level Technical / Procedural Skill                  Care Plans
All        Insert chest tube                          Implement chest tube management
                                                      protocol when appropriate

Core Topic 5: Abdominal Trauma
Medical Knowledge
G-Level Objectives
All       Describe the principles of solid organ injury management
                                                     94
All        Recognize signs and symptoms of hollow viscus injury and detail their management

Patient Care
G-Level Technical / Procedural Skill                  Care Plans
All                                                   Implement solid organ injury protocol
                                                      when appropriate


Core Topic 6: Specialty Surgery
Medical Knowledge
G-Level Objectives
All       Describe management of injuries to kidney, ureter, bladder and urethra
All       Review diagnosis and management of pelvic fractures
All       Review diagnosis and management of spine fractures and spinal cord injury
All       List signs and symptoms of extremity compartment syndrome and detail
          management

ROTATION GOALS AND OBJECTIVES FOR PROBLEM-BASED LEARNING AND IMPROVEMENT,
INTERPERSONAL SKILLS AND COMMUNICATION, PROFESSIONALISM, AND SYSTEMS BASED
PRACTICE


Problem-Based Learning and Improvement
G-Level Objectives
   All      Identify own learning needs or goals at the onset of the rotation.
            Following a trauma activation, debrief what went well, and what could have
              been improved.
            Following a surgical procedure, debrief what went well, and what could have
              been improved.
            Diagnose personal learning needs associated with any medical errors,
              complications, or ―near misses‖ that occurred during your watch.
            Use feedback gained from others, and the experience gained on this rotation,
              to formulate future learning goals and steps.

Interpersonal Skills and Communication
G-Level Objectives
    All      Communicate patient information clearly to other health providers in written
                notes and oral presentations.
             Work constructively with all members of the trauma care team, including nurse
                clinicians, floor nurses, social workers and therapists.
             Apply appropriate communication skills with patients and families (i.e. effective
                listening, awareness of nonverbal cues, and use of open-ended questions).
             Counsel and educate patients and families on their treatment options, their
                surgical outcomes and prognosis, and home care needs.
             Explain to medical students / junior residents the fundamentals of your job, as
                well as their jobs.

Professionalism
G-Level Objectives
   All         Adhere to patient privacy and informed consent policies at all times.

                                                      95
                 Adhere to Regions Hospital behavior policies (e.g., sexual harassment, duty
                  hours, dress code) at all times.
                 Demonstrate respect, compassion, integrity, and honesty in all interactions
                  with patients, families, and other health care providers.
                 Demonstrate personal responsibility for patient welfare.
                 Articulate ethical issues underlying clinical decisions made for at least once
                  complex case seen during this rotation.

Systems-Based Practice
G-Level Objectives
   All      Know when to call for help from attending physicians.
            Understand when, how, and why to request a consult from medical and
              surgical specialists, and how to use the information gained as a result.
            Provide timely and pertinent consultation when asked by Emergency Medicine
              physicians.
            Use the talents and skills of other health providers in the OR and ward.
            Diagnose any ―systems issues‖ associated with medical errors, complications,
              and ―near misses‖ that occurred during this rotation.


LEARNING RESOURCES FOR TRAINEES
SCORE Website Portal:

      Modules, chapters, videos, and radiographic images (STAT dx) pertinent to the core topics enumerated
       above
      Evidence-Based Reviews in Surgery
      MD Content Course on Health Care (economics, operations, legal/financial, leadership)

TACS Moodle Website

      See assignments and additional resources

The Trauma Professional’s Blog

      www.regionstraumapro.com

Regions Hospital Trauma Wiki

      www.regionstrauma.org/wiki




                                      ROTATION PLAN FOR 2011-12
                       REGIONS HOSPITAL, General Surgery Service

ROTATION NAME
TRAINING LEVELS ON SERVICE: PGY -5; PGY-4; PGY-2; PGY-1
SERVICE DIRECTOR: Seth Wolpert, M.D.
TEACHING FACULTY:
                                                      96
Victoria Elmer, M.D.
Todd Morris, M.D.

ROTATION’S WEEKLY EDUCATION SCHEDULE

    Monday            Tuesday at        Wednesday            Thursday             Friday
                        UMMC
                   6:30 G4+G5         Service             6:30 M + M
                   7:00 M+M           Teaching            12:00 SICU
                   7:45 Grand         Rounds (7:30am      Conf
                   Rounds             unless cases ,
                   8:30 Core          then after cases)
                   Curriculum
                   9:45-noon Skills
                   Lab

                   1:00pm Rotation
                   teaching hour
                   (Regions)



Activity                              Who is responsible?              When does this
                                                                       occur?
Orientation to the Rotation           Dr. Wolpert                      Moodle
Bedside Teaching Rounds               Assigned by Dr. Wolpert          Wed
Weekly Core Topic Teaching            Assigned by Dr. Wolpert          Tues
Mid-Rotation Review                   Drs. Wolpert, Morris, Elmer      Tues
End-of-Rotation Oral Exam             Drs. Wolpert, Morris, Elmer      Tues
End-of-Rotation Meeting w/            Drs Wolpert, Morris, Elmer       Tues at Mock Oral
Resident

ROTATION GOALS AND OBJECTIVES FOR MEDICAL KNOWLEDGE AND PATIENT CARE, BY CORE
TOPIC AND RESIDENT TRAINING LEVEL

Core Topic 1: Hernia: Open Inguinal Repair
Medical Knowledge
G-Level Objectives
PGY-1,2 Understand inguinal anatomy
          Understand hernia presentation
          Describe indications for hernia repair
          Understand alternatives to hernia repair
PGY-4,5 Demonstrate competence of the above points
          Understand different operative approaches to inguinal hernia
          Understand how to deal with complications of hernia

Patient Care
G-Level Technical / Procedural Skills                Care Plans
PGY-1,2 Understand how to perform hernia repair      Be able to diagnose inguinal hernia
                                                     Be able to understand how to advise
                                                     patients about treatment options

PGY-4,5    Be able to perform hernia repair and      As above
           demonstrate understanding of different
                                                     97
           approaches

Core Topic 2: Small Bowel Obstruction
Medical Knowledge
G-Level Objectives
PGY-1,2 Understand pathophysiology of SBO
          Be able to differentiate ileus from SBO
          Understand how to categorize SBO
          Describe etiologies of SBO
          Understand diagnostic algorithms
          Understand therapeutic objectives
PGY-4,5 As above




Patient Care
G-Level Technical / Procedural Skills                 Care Plans
PGY-1,2 Begin to understand concepts in lysis of      Understand patient presentation
           adhesions                                  Understand patient resuscitation
                                                      Begin to be understand treatment
                                                      decisions

PGY-4,5    Be proficient at lysis of adhesions        As above
           Be proficient at other therapies for SBO   Be able to formulate a treatment strategy
                                                      Be able to identify different SBO
                                                      presentations and the adjustments in
                                                      treatment

Core Topic 3: Breast: Cancer, Ductal Carcinoma In Situ
Medical Knowledge
G-Level Objectives
PGY-1,2 Understand pathology of benign breast disease
          Understand pathology of breast cancer
          Understand screening recommendations
          Understand risk factors for breast cancer
PGY-4,5 As above
          Understand breast cancer risk management strategies
          Understand the care of patients with advanced breast cancer

Patient Care
G-Level Technical / Procedural Skills                 Care Plans
PGY-1,2 Be proficient at breast bx                    Understand presentation of a breast
           Be proficient at lumpectomy                mass
           Be proficient at mastectomy                Understand evaluation and imaging of a
           Be proficient at sentinel node biopsy      breast mass
                                                      Formulate an understanding of
                                                      therapeutic options
PGY-4,5    As above                                   As above
           Be proficient at axillary dissection       Understand and be able to explain
           Be proficient at image guided breast       therapeutic options
           excision                                   Describe care for locally advanced
                                                      breast cancer
                                                      98
                                                      Understand adjuvant and neoadjuvant
                                                      options

Core Topic 4: Endocrine: Thyroid, Adrenal, and Parathyroid
Medical Knowledge
G-Level Objectives
PGY-1,2 Understanding of endocrine physiology
          Understanding of endocrine anatomy
          Understanding of endocrine pathophysiology
PGY-4,5 As above

Patient Care
G-Level Technical / Procedural Skills           Care Plans
PGY-1,2 Introduction to operative principles    Understanding of clinical (history,
                                                physical exam and lab) evaluation of
                                                adrenal and thyroid nodules
                                                Role of surgery in goiter
                                                Understanding of patient evaluation
                                                (history, physical exam and lab) of
                                                hyperparathyroidism
PGY-4,5 Become proficient at open and minimally As above
        invasive endocrine surgery.             Role of imaging in endocrine surgery
                                                Understanding of pre-op preparation and
                                                postoperative care in endocrine surgery
                                                Management of complications in
                                                endocrine surgery
ROTATION GOALS AND OBJECTIVES FOR PROBLEM-BASED LEARNING AND IMPROVEMENT,
INTERPERSONAL SKILLS AND COMMUNICATION, PROFESSIONALISM, AND SYSTEMS BASED
PRACTICE



Problem-Based Learning and Improvement
G-Level Objectives
PGY-1       Identify own learning needs or goals at the onset of the rotation.
through     Following a surgical procedure, debrief what went well, and what could have
PGY-5         been improved.
            Identify differences in incidence, prognosis, and outcomes of cancer treatment
              according to race and gender.
            Diagnose personal learning needs associated with any medical errors,
              complications, or ―near misses‖ that occurred during your watch.
            Use feedback gained from others, and the experience gained on this rotation,
              to formulate future learning goals and steps.

Interpersonal Skills and Communication
G-Level Objectives
PGY-1        Communicate patient information clearly to other health providers in written
through         notes and oral presentations.
PGY-5        Apply appropriate communication skills with patients and families (i.e. effective
                listening, awareness of nonverbal cues, and use of open-ended questions).
             Counsel and educate patients and families on their treatment options, their

                                                      99
                surgical outcomes and prognosis, and home care needs.
               Explain to medical students / junior residents the fundamentals of your job, as
                well as their jobs.

Professionalism
G-Level Objectives
PGY-1          Adhere to patient privacy and informed consent policies at all times.
through        Adhere to University behavior policies (e.g., sexual harassment, duty hours,
PGY-5           dress code) at all times.
               Demonstrate respect, compassion, integrity, and honesty in all interactions
                with patients, families, and other health care providers.
               Demonstrate personal responsibility for patient welfare.
               Articulate ethical issues underlying clinical decisions made for at least once
                complex case seen during this rotation.

Systems-Based Practice
G-Level Objectives
PGY-1        Know when to call for help from attending physicians.
through      Understand when, how, and why to request a consult from medical oncology
PGY-5           and radiation oncology, and how to use the information gained as a result.
             Provide timely and pertinent consultation when asked by medical or surgical
                colleagues.
             Use the talents and skills of other health providers in the OR and ward.
             Estimate the costs / benefits of cancer screening (mammography,
                colonoscopy), staging (CT, PET, etc.), and treatment.
             Consider patient characteristics (e.g., age, race and ethnicity, family support,
                socio-economic status, type of insurance) in evaluating treatment options and
                developing an appropriate care plan.
             Discuss the distinction between medically necessary care and over care, and
                its implications for our patients.
             Diagnose any ―systems issues‖ associated with medical errors,
                complications, and ―near misses‖ that occurred during this rotation.

LEARNING RESOURCES FOR TRAINEES
SCORE Website Portal:
    Modules, chapters, videos, and radiographic images (STAT dx) pertinent to the core topics enumerated
     above
    Evidence-Based Reviews in Surgery
    MD Content Course on Health Care (economics, operations, legal/financial, leadership)

REGIONS GENERAL SURGERY Moodle Website
   See assignments and additional resources




                                      ROTATION PLAN FOR 2011-12


                   REGIONS HOSPITAL, Vascular Surgery
                                         100
ROTATION NAME
TRAINING LEVELS ON SERVICE: 1 PGY-4 resident
SERVICE DIRECTOR: Gary Rosenthal, M.D.
TEACHING FACULTY:
Joel Barbato, M.D.
Lan Tan Nguyen, M.D.

ROTATION’S WEEKLY EDUCATION SCHEDULE

    Monday             Tuesday at         Wednesday               Thursday             Friday
                         UMMC
                    6:30 G4+G5          6:30 – 7:30
                    7:00 M+M            Vascular
                    7:45 Grand          conference
                    Rounds              Regions
                    8:30 Core
                    Curriculum
                    9:45-noon Skills
                    Lab



Activity                               Who is responsible?                When does this
                                                                          occur?
Orientation to the Rotation            Rosenthal                          First day of rotation
Bedside Teaching Rounds                Rosenthal, Nguyen, Barbato         daily
Weekly Core Topic Teaching             Rosenthal, Nguyen, Barbato         Thursdays
Mid-Rotation Review                    Rosenthal                          4th week
End-of-Rotation Oral Exam              Rosenthal, Nguyen, Barbato         Final week
End-of-Rotation Meeting w/             Rosenthal                          Final week
Resident


ROTATION GOALS AND OBJECTIVES FOR MEDICAL KNOWLEDGE AND PATIENT CARE, BY CORE
TOPIC AND RESIDENT TRAINING LEVEL

Core Topic 1: Open Elective and Ruptured Aortic Aneurysm
Medical Knowledge
G-Level Objectives
G4        For iliac aneurysm, understand:
           Epidemiology, risk of rupture
           Evaluation of operative risk, determination of suitability for open or endovascular
            repair
           Diagnosing ruptured aneurysm
           Appropriate testing for elective and ruptured aneurysm repair
           Morbidity and mortality of both open elective and ruptured aortic aneurysm

Patient Care
G-Level Technical / Procedural Skills                        Care Plans
G4        1. Know what is the appropriate field to prep      1. Pre-operative risk testing for
          2. Understand both the midline and lateral            elective aneurysm repair
             retroperitoneal approach to the aorta           2. Post-operative management of
                                                       101
          3. Dissection to obtain supra celiac and                   open elective and ruptured
             infra-renal aortic control                              aneurysm patient including fluid and
          4. Dissection for control of the iliac arteries            electrolyte management
          5. End-to-end and end-to-side suturing                  3. Recognize and manage
             techniques                                              postoperative complications,
          6. Choose appropriate graft material and                   including intestinal ischemia,
             size                                                    cardiac abnormalities, and
                                                                     incisional problems

Core Topic 2: Peripheral Artery Aneurysms and DVT
Medical Knowledge
G-Level Objectives
G4        Understand:
           Epidemiology of peripheral artery aneurysms and DVT
           Signs and symptoms of both urgent and non-urgent peripheral artery aneurysms
           Risk of coexisting peripheral aneurysms and abdominal aortic aneurysms
           Signs and symptoms of deep venous thrombosis, phlegmasia cerulea dolens,
            phlegmasia alba dolens, and superficial thrombophlebitis

Patient Care
G-Level Technical / Procedural Skills                             Care Plans
G4        1. Field preparation                                    1. Preoperative cardiac risk
          2. Perform medial and posterior approach to                assessment for aneurysm patients
             the popliteal artery                                 2. Understand post-operative incision
          3. Dissection of the common femoral artery                 care and appropriate long-term
          4. Harvesting greater saphenous vein for                   follow up including intermittent
             repair                                                  functional and ultrasound testing
          5. End-to-end and end-to-side vein to artery
             suturing techniques
          6. Perform both four compartment calf
             fasciotomies and thigh fasciotomies for
             phlegmasia
          7. Perform femoral vein thrombectomy
          8. Perform embolectomies in cases of
             complicated peripheral aneurysms with
             distal embolization

Core Topic 3: Dialysis Access and Mesenteric Ischemia
Medical Knowledge
G-Level Objectives
G4        Understand:
           The importance of rapid fistula or graft surgery to avoid central catheters
           Temporary dialysis options
           Multiple dialysis techniques and how to choose among them appropriately
           Complications of access and how to manage them
           How to make the diagnosis of both acute and chronic mesenteric ischemia and to
            conduct appropriate tests
           Preoperative cardiac risk evaluation
           How to determine the appropriate procedure in terms of percutaneous stenting or
            open surgical repair
           How to determine intra-operatively embolic disease reverse thrombotic disease

Patient Care

                                                            102
G-Level    Technical / Procedural Skills                    Care Plans
G4         Perform:                                         1. Evaluation of post-dialysis
           1. All aspects of radiocephalic,                    procedure patient in terms of
              brachiocephalic, and basilic transposition       determining maturity inability to use
              fistulas                                      2. Testing needed to assess failing
           2. Forearm and upper arm loop dialysis              dialysis access
              grafts                                        3. Manage the patient after
           3. Dialysis access revision; no help to             mesenteric bypass in terms of
              ligate a bleeding fistula                        ventilator management, and fluid
           4. Transabdominal and lateral                       and electrolyte balance
              thoracoabdominal retroperitoneal              4. Understand long-term follow up of a
              approach to the mesenteric portion of the        mesenteric bypass patient
              aorta
           5. Dissection of the celiac axis and superior
              mesenteric artery
           6. Antegrade and retrograde aorto
              mesenteric bypasses
           7. Superior mesenteric artery embolectomy
           8. Bowel resection related to ischemic
              events as well as performing a second
              look operation


Core Topic 4: Vascular Trauma
Medical Knowledge
G-Level Objectives
G4        Understand:
           Diagnosis and management of cervical, thoracic, abdominal, and extremity arterial
            injuries
           Repair techniques for arterial injuries and operative exposure
           Repair of the vena cava

Patient Care
G-Level Technical / Procedural Skills                  Care Plans
G4        1. Obtain proximal distal control of         1. Post-operative electrolyte and fluid
             extremity or intra-abdominal vessels         management
          2. Perform interposition vein grafting or    2. Perform post-operative
             bypass vein grafting                         revascularization assessment
          3. Perform completion angiography            3. Examine patient for compartment
          4. Perform four compartment lower               syndrome
             extremity fasciotomies                    4. Understand long-term follow up of
                                                          vascular repair

Core Topic 5: Endovascular AAA Repair
Medical Knowledge
G-Level Objectives
G4        Understand:
           Indication for AAA repair and requirements for endograft placement
           Complete femoral artery dissection
           Types of endoleaks and management

Patient Care
G-Level Technical / Procedural Skills                  Care Plans
G4        1. Perform bilateral femoral groin           1. Understand immediate postoperative
                                                      103
              dissections                                   care including incision management
           2. Perform retroperitoneal iliac artery          and determination of peripheral
              exposure                                      perfusion
           3. Perform arteriotomy repair                 2. Perform appropriate interval CT scan
                                                            follow up for determination of endoleak
                                                         3. Determine which endoleak will need
                                                            repair and how to perform this

Core Topic 6: Atherosclerotic Disease
Medical Knowledge
G-Level Objectives
G4        Understand:
           Diagnosis and management of claudication, rest pain, and tissue loss
           Which claudication patients need intervention
           That rest pain and tissue loss needs immediate revascularization
           The significance of foot and toe ulceration and how to evaluate ability to heal
           Revascularization options in terms of percutaneous angioplasty and stenting as
            well as arterial bypass surgery

Patient Care
G-Level Technical / Procedural Skills                   Care Plans
G4        1. Perform femoral popliteal and femoral      1. Understand immediate postoperative
             tibial bypass                                 management including electrolytes
          2. Complete dissection of the greater            and fluid, incisions, and evaluation of
             saphenous vein                                perfusion
          3. Complete dissection of the common          2. Perform appropriate interval follow up
             femoral, superficial femoral, popliteal,      with ultrasound and pressure
             and tibial vessel.                            measurements
          4. Perform vein to artery anastomoses
          5. Exposure of the pararenal and
             infrarenal aorta both transperitoneally
             and retroperitoneally
          6. Perform exposure of the iliac arteries
             both transperitoneal and
             retroperitoneal


ROTATION GOALS AND OBJECTIVES FOR PROBLEM-BASED LEARNING AND IMPROVEMENT,
INTERPERSONAL SKILLS AND COMMUNICATION, PROFESSIONALISM, AND SYSTEMS BASED
PRACTICE



Problem-Based Learning and Improvement
G-Level Objectives
G4         1. Analyze personal strengths and weakness and create methods to improve.
           2. Learn to accept constructive criticism.
           3. Apply scientific literature in patient management decision making.
           4. Critically review the literature using principles of biostatistics, study design, and
              epidemiology.
           5. Develop practice patterns using the concepts of ―best practice‖ and ―evidence-
              based medicine.‖

                                                        104
Interpersonal Skills and Communication
G-Level Objectives
G4          1. Function as surgical team leader.
            2. Teach ethical and appropriate patient relationships.
            3. Demonstrate effective listening skills, including observing nonverbal cues and
                using explanatory questioning.
            4. Demonstrate effective, complete, and legible note writing skills.
            5. Teach effective medical presentations.
            6. Assure effective and thorough patient hand-off/sign out.


Professionalism
G-Level Objectives
G4           1. Demonstrate respect, compassion, integrity and honesty.
             2. Demonstrate patient care that supersedes personal self-interest.
             3. Demonstrate personal responsibility for patient problems.
             4. Understand and utilize privacy policies, informed consent, business and
                medical ethics.
             5. Understand and follow institutional behavior policies (i.e. Sexual harassment,
                etc.).


Systems-Based Practice
G-Level Objectives
G4         1. Understand cost-effective health care delivery
           2. Organize and manage the surgical service
           a. Hospital and clinic patient care
           b. Resident and medical student teaching


LEARNING RESOURCES FOR TRAINEES
SCORE Website Portal:

      Modules, chapters, videos, and radiographic images (STAT dx) pertinent to the core topics enumerated
       above
      Evidence-Based Reviews in Surgery
      MD Content Course on Health Care (economics, operations, legal/financial, leadership)

Regions Vascular Moodle Website

      See assignments and additional resources




                                       ROTATION PLAN FOR 2011-12

                   REGIONS HOSPITAL, Surgical Intensive Care Unit

                                                      105
ROTATION NAME
TRAINING LEVELS ON SERVICE: PGY -1
SERVICE DIRECTOR: Bruce Bennett, M.D.
TEACHING FACULTY:
David Dries, M.D.
Gary Collins, M.D.
Cassandra Palmer, M.D.

ROTATION’S WEEKLY EDUCATION SCHEDULE
(List: required site or specialty-specific education conferences, scheduled weekly rotation teaching hour.)
     Monday              Tuesday at          Wednesday            Thursday            Friday
                           UMMC
                      6:30 G4+G5
                      7:00 M+M
                      7:45 Grand
                      Rounds
                      8:30 Core
                      Curriculum
                      9:45-noon Skills
                      Lab

Activity                               Who is responsible?              When does this
                                                                        occur?
Orientation to the Rotation
Bedside Teaching Rounds
Weekly Core Topic Teaching
Mid-Rotation Review
End-of-Rotation Oral Exam
End-of-Rotation Meeting w/
Resident



ROTATION GOALS AND OBJECTIVES FOR PROBLEM-BASED LEARNING AND IMPROVEMENT,
INTERPERSONAL SKILLS AND COMMUNICATION, PROFESSIONALISM, AND SYSTEMS BASED
PRACTICE

Problem-Based Learning and Improvement
G-Level Objectives
            Identify own learning needs or goals at the onset of the rotation.
            Following a surgical procedure, debrief what went well, and what could have
              been improved.
            Identify differences in incidence, prognosis, and outcomes of cancer treatment
              according to race and gender.
            Diagnose personal learning needs associated with any medical errors,
              complications, or ―near misses‖ that occurred during your watch.
            Use feedback gained from others, and the experience gained on this rotation,
              to formulate future learning goals and steps.


Interpersonal Skills and Communication
G-Level Objectives

                                                       106
               Communicate patient information clearly to other health providers in written
                notes and oral presentations.
               Apply appropriate communication skills with patients and families (i.e. effective
                listening, awareness of nonverbal cues, and use of open-ended questions).
               Counsel and educate patients and families on their treatment options, their
                surgical outcomes and prognosis, and home care needs.
               Explain to medical students / junior residents the fundamentals of your job, as
                well as their jobs.


Professionalism
G-Level Objectives
              Adhere to patient privacy and informed consent policies at all times.
              Adhere to University behavior policies (e.g., sexual harassment, duty hours,
                dress code) at all times.
              Demonstrate respect, compassion, integrity, and honesty in all interactions with
                patients, families, and other health care providers.
              Demonstrate personal responsibility for patient welfare.
                Articulate ethical issues underlying clinical decisions made for at least once
                complex case seen during this rotation.


Systems-Based Practice
G-Level Objectives
            Know when to call for help from attending physicians.
            Understand when, how, and why to request a consult from medical oncology
              and radiation oncology, and how to use the information gained as a result.
            Provide timely and pertinent consultation when asked by medical or surgical
              colleagues.
            Use the talents and skills of other health providers in the OR and ward.
            Estimate the costs / benefits of cancer screening (mammography,
              colonoscopy), staging (CT, PET, etc.), and treatment.
            Consider patient characteristics (e.g., age, race and ethnicity, family support,
              socio-economic status, type of insurance) in evaluating treatment options and
              developing an appropriate care plan.
            Discuss the distinction between medically necessary care and over care, and
              its implications for our patients.
              Diagnose any ―systems issues‖ associated with medical errors, complications,
              and ―near misses‖ that occurred during this rotation.


LEARNING RESOURCES FOR TRAINEES
SCORE Website Portal:
    Modules, chapters, videos, and radiographic images (STAT dx) pertinent to the core topics enumerated
     above
    Evidence-Based Reviews in Surgery
    MD Content Course on Health Care (economics, operations, legal/financial, leadership)

[Rotation Name] Moodle Website
                                                      107
      See assignments and additional resources

                                     SURGICAL CRITICAL CARE (SICU)
                                            Regions Hospital

                                      Patient Care
                  PGY-1                                           PGY-2
Manual Dexterity                               Manual Dexterity
Perform bedside procedures:                    Supervise and instruct bedside
   Central venous catheterization                  procedures.
   Pulmonary artery catheterization            Central venous catheterization
   Arterial line placement                         Pulmonary artery catheterization
   Endotracheal intubation                     Arterial line placement
Observe bedside procedures:                    Perform bedside procedures:
   Percutaneous gastrostomy,                   Endotracheal intubation
   tracheostomy, other minor procedures        Percutaneous gastrostomy,
                                                   tracheostomy, other minor
Care Plans                                         procedures
Understand Advanced Cardiac Life
     Support protocols.                        Care Plans
Identify and evaluate by history and           Identify and evaluate by history and
     physical examination.                          physical examination.
Formulate differential diagnoses for           Formulate differential diagnoses for ICU
     common ICU problems.                           problems.
Apply standard ventilator management and       Apply ventilator management in the
     weaning.                                       patient with acute lung injury.
Initiate treatment plan and management         Initiate treatment plan and management
     for:                                           for:
     Sepsis                                         Severe sepsis
     Hypoxemia                                      Multisystem organ dysfunction
     Hypotension                                    CNS dysfunction (e.g. intracranial
     Shock                                               bleed)
          Cardiogenic                               Acute GI bleed
          Distributive                              Hepatic failure
          Hypovolemic                               Myocardial ischemia
          Obstructive                          Understand appropriate utilization of:
     Renal failure                                  Vasoactive agents
     Respiratory failure                            Antibiotics and other antimicrobials
Gastrointestinal bleeding                           Paralytics and sedatives
Understand appropriate utilization of:         Understand therapy for treatment of
Antibiotics                                         disorders of coagulation including
Sedatives                                           nonheparin anticoagulants, and
Blood component therapy                             fibrinolytic therapy.
       Therapy for treatment of disorders of   Appropriately interpret and utilize
          coagulation including aspirin,            invasive hemodynamic data.
          heparins

SICU (Regions) cont.
                                  Medical Knowledge
                  PGY-1                                         PGY-2
Explain:                                       Explain:
   Pathophysiology of sepsis                     Pathophysiology of organ failure
   Principles of Antimicrobial therapy           (pulmonary, renal, GI, cardiac)
   Evaluation of fever in the                    Appropriate indications for radiographic
                                                       108
   immunosuppressed patient                     evaluation of critically-ill patients
   Introductory interpretation of               Appropriate interpretation of advanced
   radiographs                                  diagnostics (e.g. CT scans)
   Common surgical conditions leading to        Pathophysiology of nosocomial
   ICU admission                                infections in the critically-ill
   Interpretation of common laboratory          Principles of nutritional support
   tests (e.g. Arterial blood gasses,           including advanced nutritional
   electrolytes)                                monitoring techniques (e.g. respiratory
   Basic principles of nutritional support      quotient) and specialized issues
   Principles of resuscitation from shock       (refeeding syndrome, Rx of hepatic
   states                                       and renal failure) Common disorders
   Hormonal, biochemical, and metabolic         of coagulation in the ICU (e.g. deep
   response to tissue injury.                   venous thrombosis, thrombocytopenia)

                      Practice-Based Learning & Improvement
                  PGY-1                                       PGY-2
Demonstrate insight into contributing      Perform critical evaluation of
  factors associated with ICU and            complications of ICU care by
  surgical complications by participation    preparation and presentation of
  in monthly morbidity and mortality         complications at monthly ICU morbidity
  conference.                                and mortality conference.
Demonstrate commitment to personal         Continue commitment to personal lifelong
  lifelong learning by initiating directed   learning by initiating reading using
  reading regarding patient issues in the    advanced sources (e.g. source
  ICU.                                       literature) regarding patient issues in
                                             the ICU.

                           Interpersonal Communication Skills
                     PGY-1                                         PGY-2
Understand proper interaction skills with      Develop supervisory skills by providing
   regards to communication with other           oversight and supervision of junior
   services in care of complex, critically ill   members of the Surgical ICU team
   patients (in other words,                     (e.g. anesthesia and surgery residents,
   communication, communication,                 medical students).
   communication!) .                           Demonstrate facility with family
Develop tools for proper family                  communication skills, understanding
   communication skills, understanding           nuances of communication with
   nuances of communication with                 patient’s families in the setting of
   patient’s families in the setting of          critical illness. Demonstrate proper
   critical illness. Relate proper               techniques for communicating ―bad
   techniques for communicating ―bad             news‖ to patient’s family in the ICU.
   news‖ to patient’s family in the ICU.       Participate as appropriate in family care
Participate as an observer in family care        conferences.
   conferences.                                Demonstrate knowledge of current uses
Understand principles of effective               of medical documentation, including
   documentation as a tool for                   interactions with 3rd party payer
   communication.                                system.

SICU (Regions) cont.
                                    Professionalism
                    PGY-1                                       PGY-2
Explain principals of informed consent.       Understand nuances of withholding or
Discuss the issues of patient rights in the     withdrawing life support in the critically-
   setting of critical illness.                 ill patient.
                                                       109
Understand the process for implementation Relate the role of advanced directives in
   of DO NOT RESUSCITATE orders in            the critically-ill patient.
   the critically ill.                      Experience the effects of critical illness on
Demonstrate appropriate transfer of patient   families of different backgrounds (age,
   care to primary services caring for the    culture, etc.).
   critically-ill patient in transition to  Understand methods of coping with stress
   hospital care.                             of caring for critically ill (and dying)
                                              patients.

                                 System-Based Practice
                   PGY-1                                        PGY-2
Relate techniques for cost-effective,        Understand cost-effective health care
   appropriate perioperative evaluation.       delivery in the ICU.
Demonstrate principles of infection control Appropriate ability to utilize triage and
   (prevention of health care associated       bed-control to provide for critically ill
   and blood borne infections).                patients.
Demonstrate ability to provide ongoing       Relate the role (and cost) of ICU care in
   care of patients with chronic critical      the setting of the North American
   illness (e.g. appropriate transfer of       medical system.
   patients to chronic hospital, ventilator, Demonstrate knowledge of current uses
   and advanced nursing facilities).           of medical documentation, including
Understand the role of other services in       interactions with 3rd party payer
   proper care of complex, critically ill      system.
   patients.                                 Understand the role of other services in
                                               proper care of complex, critically ill
                                               patients.




                                        ROTATION PLAN FOR 2011-12
                        REGIONS HOSPITAL, Burn Service

ROTATION NAME
TRAINING LEVELS ON SERVICE: PGY -3; PGY-1
SERVICE DIRECTOR: William Mohr, M.D.
TEACHING FACULTY:
David Ahrenholz, M.D.
Frederick Endorf, M.D.
ROTATION’S WEEKLY EDUCATION SCHEDULE


     Monday           Tuesday at UMMC         Wednesday                Thursday             Friday
8:30 Burn team       6:30 G4+G5           Trauma conf (1)          6:30 Surgery            OR
rounds               7:00 M+M             Burn Roundtable          M&M                     teaching
1p Resident          7:45 Grand Rounds    (2)                      Trauma/ ICU conf
lecture              8:30 Core            Burn M&M (3)             (4)
                     Curriculum           2p Burn Pt care
                     9:45-noon Skills Lab conf
1. 3rd , 4th, & 5th WED each month at 7:30.

                                                       110
2. 1st WED each month at 11:30.
3. 3rd WED each month at 11:30.
4. 1st & 2nd THR each month at 7:30.


Activity                                          When does this
                                       Who is responsible?
                                                  occur?
Orientation to the Rotation   Mohr                First 1-2 days
Bedside Teaching Rounds       Attending on call   Monday 8:30, daily
Weekly Core Topic Teaching    Attending on call   Monday 1300, & prn
Mid-Rotation Review           Mohr                Middle week of rotation
End-of-Rotation Oral Exam     Mohr                Last week of rotation
End-of-Rotation Meeting w/    Mohr                Same time as Oral
Resident                                          Exam
ROTATION GOALS AND OBJECTIVES FOR MEDICAL KNOWLEDGE AND PATIENT CARE, BY CORE
TOPIC AND RESIDENT TRAINING LEVEL

Core Topic 1: Burn Resuscitation
Medical Knowledge
G-Level Objectives
PGY-1     Understand the pathophysiology of burn injury
          Describe what factors impact the volume of resuscitation
          Describe the benefits and detriments of different resuscitation strategies
               When to use colloids, blood, diuretics
          Understand the difference between pediatric and adult burn shock resuscitation
          Understand the principles of vascular access
          Describe the complications associated with massive resuscitation
PGY- 3    Understand the pathophysiology of burn injury
          Describe what factors impact the volume of resuscitation
          Describe the benefits and detriments of different resuscitation strategies
               When to use colloids, blood, diuretics
          Understand the difference between pediatric and adult burn shock resuscitation
          Understand the principles of vascular access
          Describe the complications associated with massive resuscitation
          Describe how different interventions impact on burn shock resuscitation

Patient Care
G-Level Technical / Procedural Skills                Care Plans
PGY-1      Perform central venous access             Identify/evaluate by history and exam
           Perform escharotomy                       Initiate resuscitation plan and
           Perform/interpreted bladder pressure      management:
           measurements                                    Adult < 20% BSA burn
                                                           Adult > 20% BSA burn
                                                           Child < 15% BSA burn
                                                           Child > 15% BSA burn
PGY-3      Perform central venous access             Identify/evaluate by history and exam
           Perform escharotomy                       Initiate resuscitation plan and
           Perform/interpreted bladder pressure      management:
           measurements                                    Adult < 20% BSA burn
           Blood use determination                         Adult > 20% BSA burn
                                                           Child < 15% BSA burn
                                                           Child > 15% BSA burn
                                                           Electrical injury

                                                    111
Core Topic 2: Skin Substitutes & Burn Dressings
Medical Knowledge
G-Level Objectives
PGY-1     Understand the structure and function of the skin
          Describe the consequences of loss of barrier function
          Differentiate between skin substitutes and dressings
               Categorize by synthetic, biologic or combination
               Categorize by temporary, permanent or combination
          List types of permanent skin substitutes
PGY-3     Understand the structure and function of the skin
          Describe the consequences of loss of barrier function
          Differentiate between skin substitutes and dressings
               Categorize by synthetic, biologic or combination
               Categorize by temporary, permanent or combination
          List types of permanent skin substitutes
          Understand the differences, utility and complications of topical wound management

Patient Care
G-Level Technical / Procedural Skills                   Care Plans
PGY-1      Assess the burn wound                        Identify/evaluate by history and exam
               Identify infection                      Initiate treatment plan and management:
               Identify conversion to full-                  Partial thickness burns
                  thickness                                   Full-thickness burns
               Identify side effects from                    Burns covered with artificial
                  dressings                                      dermis
           Perform/assist basic burn dressings                Burns covered with autograft
PGY-3      Assess the burn wound                        Identify/evaluate by history and exam
               Identify infection                      Initiate treatment plan and management:
               Identify conversion to full-                  Partial thickness burns
                  thickness                                   Full-thickness burns
               Identify side effects from                    Burns covered with artificial
                  dressings                                      dermis
           Perform/assist basic burn dressings                Burns covered with autograft
           Perform skin grafts utilizing artificial           Extended-wear dressings
           dermis
           Prepare artificial dermis for autografting

Core Topic 3: Electrical Injury
Medical Knowledge
G-Level Objectives
PGY-1     Understand the pathophysiology of electrical injuries
          Understand the potential for secondary traumatic injuries
          Describe the difference between low and high voltage and air injuries
          Describe how electrical burns differ from thermal injury
          Understand the principles of resuscitation for electrical injury
          Understand complications associated with electrical injury
               Physical
               Neurobehavioral
               Psychological
          Describe monitoring and diagnostic measures for electrical injuries
PGY-3     Understand the pathophysiology of electrical injuries

                                                        112
          Understand the potential for secondary traumatic injuries
          Describe the difference between low and high voltage and air injuries
          Describe how electrical burns differ from thermal injury
          Understand the principles of resuscitation for electrical injury
          Understand complications associated with electrical injury
              Physical
              Neurobehavioral
              Psychological
          Describe monitoring and diagnostic measures for electrical injuries
          Describe pain management for electrical injuries

Patient Care
G-Level Technical / Procedural Skills                Care Plans
PGY-1      Interpret monitoring for myoglobinuria    Identify/evaluate by history and exam
           Interpret compartment pressure            Initiate treatment plan and management:
           evaluation                                      Low-voltage injury
           Interpret cardiac monitoring/evaluation         High voltage injury
           Perform wound assessment on electrical    Initiate treatment plan for
           burns                                     rhabdomyolysis
PGY-3      Interpret monitoring for myoglobinuria    Identify/evaluate by history and exam
           Interpret compartment pressure            Initiate treatment plan and management:
           evaluation                                      Low-voltage injury
           Perform compartment pressure                    High voltage injury
           evaluation                                Initiate treatment plan for
           Perform fasciotomy                        rhabdomyolysis
           Interpret cardiac monitoring/evaluation   Initiate treatment plan for neuropathic
           Perform wound assessment on electrical    pain
           burns                                     Initiate treatment plan for PTSD
           Assess for neuropsychological             Initiate treatment for neuropsychological
           complications                             Sx

Core Topic 4: Chemical Injury
Medical Knowledge
G-Level Objectives
PGY-1     Understand the pathophysiology of chemical injuries
               The difference between acids and bases
          Describe the typical locations for chemical burns and the impact on care
          Identify specific agents of concern
          Describe initial treatment of chemical burns
          Understand potential complications from chemical injury treatment
PGY-3     Understand the pathophysiology of chemical injuries
               The difference between acids and bases
          Describe the typical locations for chemical burns and the impact on care
          Identify specific agents of concern
          Describe initial treatment of chemical burns
          Understand decision making or hospitalized vs. outpatient chemical burn care
          Understand potential complications from chemical injury treatment
          Understand critical care aspects of chemical injuries

Patient Care
G-Level Technical / Procedural Skills                Care Plans
PGY-1      Perform chemical burn assessment          Identify/evaluate by history and exam
           Perform adequate excision                 Initiate treatment plan and management:
                                                           Common acid and base burns
                                                     113
                                                          Hydrofluoric acid
                                                          Ocular burns
                                                          Chemical inhalation
                                                          Tar burns
PGY-3     Perform chemical burn assessment          Identify/evaluate by history and exam
          Determination of admit vs. home burn      Initiate treatment plan and management:
          care                                            Common acid and base burns
          Perform adequate excision                       Hydrofluoric acid
          Treat electrolyte imbalance with HF             Ocular burns
          burns                                           Chemical inhalation
          Manage hydrofluoric acid treatment plan         Tar burns
                                                    Care plan for outpatient chemical burns

Core Topic 5: Inhalation Injury
Medical Knowledge
G-Level Objectives
PGY-1     Understand the pathophysiology of smoke inhalation
               Toxic smoke compounds and Metabolic poisons (carbon monoxide, cyanide)
               Anatomic injuries (Oropharynx , tracheobronchial, lung parenchyma)
          Understand the diagnosis and treatment of smoke inhalation
          Understand the diagnosis and treatment of metabolic poisons
          Ventilatory management of inhalation injury
          Complications of inhalation injury
               In hospital complications
PGY-3     Understand the pathophysiology of smoke inhalation
               Toxic smoke compounds and Metabolic poisons (carbon monoxide, cyanide)
               Anatomic injuries (Oropharynx , tracheobronchial, lung parenchyma)
          Understand the diagnosis and treatment of smoke inhalation
          Understand the diagnosis and treatment of metabolic poisons
          Ventilatory management of inhalation injury
          Complications of inhalation injury
               In hospital complications
               Chronic pulmonary complications

Patient Care
G-Level Technical / Procedural Skills               Care Plans
PGY-1      Perform (chest) escharotomy              Identify/evaluate by history and exam
           Interpret bronchoscopy                   Initiate treatment plan and management:
                                                          Fluid resuscitation
                                                          Ventilator strategies
                                                          Diagnosis/treatment of
                                                             pneumonia
PGY-3     Perform (chest) escharotomy               Identify/evaluate by history and exam
          Interpret/Perform bronchoscopy            Initiate treatment plan and management:
          Manage ventilator for inhalation injury         Fluid resuscitation
                                                          Ventilator strategies
                                                          Diagnosis/treatment of
                                                             pneumonia
                                                          Diagnosis/treatment of ARDS

Core Topic 6: Necrotizing Soft-tissue Infection
Medical Knowledge
G-Level Objectives
                                                    114
PGY-1     Understand the pathophysiology of necrotizing soft tissue infection (NSTI)
          Demonstrate knowledge of diagnostic criteria
               Define infections based on level of involvement
          Identify primary surgical pathogens
               Streptococcus
               Staphylococcus
               Clostridium
               Mixed gram-negative
          Understand treatment modalities
PGY-3     Understand the pathophysiology of necrotizing soft tissue infection (NSTI)
          Identify primary surgical pathogens
               Streptococcus
               Staphylococcus
               Clostridium
               Mixed gram-negative
          Demonstrate knowledge of diagnostic criteria
               Define infections based on level of involvement
          Understand treatment modalities
          Differentiate from Staph Scalded Skin Syndrome and Purpura Fulminans

Patient Care
G-Level Technical / Procedural Skills                Care Plans
PGY-1      Perform appropriate diagnostic workup     Identify/evaluate by history and exam
           Perform radical excision of affected      Initiate treatment plan and management:
           tissue                                          Diagnostic workup
           Identify sepsis/severe sepsis                   Fluid resuscitation
           Perform definitive coverage of wounds
PGY-3      Perform appropriate diagnostic workup     Identify/evaluate by history and exam
           Perform radical excision of affected      Initiate treatment plan and management:
           tissue                                          Diagnostic workup
           Identify sepsis/severe sepsis                   Fluid resuscitation
           Manage associated sepsis/severe sepsis          Severe sepsis
           Determine timing of definitive coverage
           Perform definitive coverage of wounds

ROTATION GOALS AND OBJECTIVES FOR PROBLEM-BASED LEARNING AND IMPROVEMENT,
INTERPERSONAL SKILLS AND COMMUNICATION, PROFESSIONALISM, AND SYSTEMS BASED
PRACTICE



Problem-Based Learning and Improvement
G-Level Objectives
All         Identify own learning needs or goals at the onset of the rotation.
            Following a surgical procedure, debrief what went well, and what could have
              been improved.
            Identify differences in incidence, prognosis, and outcomes of cancer treatment
              according to race and gender.
            Diagnose personal learning needs associated with any medical errors,
              complications, or ―near misses‖ that occurred during your watch.
            Use feedback gained from others, and the experience gained on this rotation,
              to formulate future learning goals and steps.
                                                     115
Interpersonal Skills and Communication
G-Level Objectives
All          Communicate patient information clearly to other health providers in written
                notes and oral presentations.
             Apply appropriate communication skills with patients and families (i.e. effective
                listening, awareness of nonverbal cues, and use of open-ended questions).
             Counsel and educate patients and families on their treatment options, their
                surgical outcomes and prognosis, and home care needs.
             Explain to medical students / junior residents the fundamentals of your job, as
                well as their jobs.


Professionalism
G-Level Objectives
All           Adhere to patient privacy and informed consent policies at all times.
              Adhere to University behavior policies (e.g., sexual harassment, duty hours,
                dress code) at all times.
              Demonstrate respect, compassion, integrity, and honesty in all interactions with
                patients, families, and other health care providers.
              Demonstrate personal responsibility for patient welfare.
                Articulate ethical issues underlying clinical decisions made for at least once
                complex case seen during this rotation.

Systems-Based Practice
G-Level Objectives
All         Know when to call for help from attending physicians.
            Understand when, how, and why to request a consult from medical specialists,
              and how to use the information gained as a result.
            Provide timely and pertinent consultation when asked by emergency medical,
              medical or surgical colleagues.
            Use the talents and skills of other health providers in the OR and Burn Unit.
            Estimate the relative costs / benefits of different surgical and nonsurgical
              management of the disease processes cared for in the Burn Unit.
            Consider patient characteristics (e.g., age, race and ethnicity, family support,
              socio-economic status, type of insurance) in evaluating treatment options and
              developing an appropriate care plan.
            Discuss the distinction between medically necessary care and over care, and
              its implications for our patients.
              Diagnose any ―systems issues‖ associated with medical errors, complications,
              and ―near misses‖ that occurred during this rotation.

LEARNING RESOURCES FOR TRAINEES
Regions Burn Center:
    Burn Pearls available on the Burn Potpourri Internet
    The Burn Library
                 Total Burn Care. Herndon Ed.
                 Journal of Burn Care and Resuscitation
                 Burns
                                                     116
                  The Journal of Trauma
                  More than 200 books covering aspects of burn and trauma care
      Burn resuscitation flash cards

SCORE Website Portal:
   Modules, chapters, videos, and radiographic images (STAT dx) pertinent to the core topics enumerated
     above
   Evidence-Based Reviews in Surgery
   MD Content Course on Health Care (economics, operations, legal/financial, leadership)

REGIONS BURN Moodle Website
   See assignments and additional resources


                                             PLASTIC SURGERY
                                              Regions Hospital

                                      Patient Care
                                         PGY-1
Manual Dexterity & Care Plans
Be able to manage
       Wound care and debridement
       Advanced suture technique
       Ability to evaluate complex wounds
       Basic examination of the hand
       Apply splints or casts for common hand injuries
Perform operative procedures
Wound repair:
       Intermediate and complex
       Split-thickness skin graft
       Full-thickness skin graft
       Excision of skin tumors
       Drainage of hand infections
       Repair of fingertip injuries
Closed and open reduction of hand fractures

                                  Medical Knowledge
                                          PGY-1
Understand the principles of wound healing and wound care
Understand the principles of grafts and flaps
Understand the ―reconstructive ladder‖
Recognize common skin lesions
Understand the basic embryology underlying common congenital anomalies
Understand aesthetic surgery principles

                          Practice-Based Learning & Improvement
                                             PGY-1
Analyze personal strengths and weakness.
Accept constructive criticism.
Utilize scientific literature in patient management questions.
Apply principles of biostatistics, study design, and epidemiology to surgical problems.
Apply the concepts of ―best practice‖ and ―evidence-based medicine.‖
Utilize technology and medical informatics in patient management.

                                                       117
                          Interpersonal Communication Skills
                                            PGY-1
Create ethical and appropriate patient relationships.
Develop effective listening skills, including observing nonverbal cues and using
explanatory questioning.
Develop effective, complete, and legible note writing skills.
Learn to give effective medical presentations to other providers, on rounds, at
institutional conferences, and at local/national meetings.

Plastics (Region) cont.
                                    Professionalism
                                          PGY-1
Demonstrate respect, compassion, integrity and honesty.
Demonstrate patient care that supersedes personal self-interest.
Demonstrate personal responsibility for patient problems.
Understand and utilize privacy policies, informed consent, business and medical ethics.
Understand and follow institutional behavior policies (i.e. Sexual harassment, duty
hours, dress code, etc.).

                                System-Based Practice
                                         PGY-1
Understand how patient care affects other health care providers.
Learn role of consultant.
Understand the continuity between clinic and hospital based care.
Understand the role the community hospital, and private practice in the healthcare
system.
Practice cost-effective and appropriate preoperative evaluation and postoperative
follow up.
Understand resource allocation issues.


                                     GENERAL/VASCULAR SURGERY
                                 Minneapolis Veterans Affairs Medical Center

                                      Patient Care
                  PGY-1&2                                         PGY-5
Manual Dexterity                              Manual Dexterity
Understand wound care                         Conduct all general surgery procedures
    Opening of infected surgical wounds          with appropriate direction and
    Wet to dry dressing                          assistance, including complex,
Perform simple suture technique                  multistep procedures.
Perform bedside procedures                            Abdominoperineal resection
    Central venous catheterization                    Whipple
    Fine-needle aspiration of superficial             Total thyroidectomy
    lesions                                           Modified radical mastectomy
Develop operative skills:
Incision and drainage of subcutaneous and Care Plans
    perirectal abscess                        Identify and evaluate by history and
Excision of simple skin and subcutaneous         physical examination
    lesions                                   Formulate differential diagnoses
Incisional biopsy                             Initiate treatment plan and management
Surgical breast biopsy                           Intraabdominal catastrophe
Surgical lymph node biopsy                       Ischemic bowel
Open inguinal herniorrhaphy                      Perforated diverticulitis
                                                      118
Simple hemorrhoid procedures                     Perforated ulcer disease
Lower extremity amputation                       Massive gastrointestinal bleeding
Varicose vein surgery                            Postoperative complications
                                                      Necrotizing infection
Care Plans                                            Anastomotic leak
Understand Advanced Cardiac Life                      Hemorrhage
Support protocols                              Manual Dexterity & Care Plans
Identification and evaluation by history and   Perform complex vascular surgical
         physical examination                  procedures
Formulation of differential diagnoses            Carotid endarterectomy
Initiation of treatment plan and                 Repair of aortic aneurysm
         management                              Aortic reconstruction for occlusive
         Acute abdomen                           disease
         Soft-tissue infections                  Femoral distal bypass
                 Cellulitis                      Extra-anatomic reconstruction
                 Necrotizing soft-tissue       Distal lower extremity bypass
                 infections
         Wound infections
         Acute leg pain
         Acute respiratory distress
         Acute chest pain
          Extremity swelling
Manual Dexterity & Care Plans
Perform a focused history and physical for
     the vascular system, including Doppler
     &
      ankle brachial index
Manage wounds-wet to dry dressings
Perform wound debridement
Place central venous lines
     Femoral
     Jugular
     Subclavian
Care for an ischemic limb
Apply an Unna boot
Amputate digits

Gen/Vasc SX (VAMC) cont.
                                  Medical Knowledge
                  PGY-1&2                                      PGY-5
Understand principles of wound healing       Understand primary surgical literature
Understand normal acid-base balance, and       beyond that in textbooks and review
   fluid, electrolyte, and nutritional         articles
   parameters                                Understand the natural history of
Provide treatment of fluid, electrolyte, and   medically treated or untreated
   nutritional abnormalities                   Vascular disease
   Gastric outlet obstruction                  Carotid artery stenosis
   Acute renal failure                         Abdominal aortic aneurysm
   Acute and chronic diarrhea                  Lower extremity arterial occlusive
   Bowel obstruction                               disease
   Cancer cachexia                           Summarize principles for preoperative
Identify and manage hematologic                assessment and postoperative care of
abnormalities                                  patients undergoing major vascular
   Anemia                                      surgical procedures

                                                       119
   Coagulopathy                                Describe the indications for
   Platelet disorders                             Balloon angioplasty
Understand principles of microbiology and         Arterial stent placement
   their clinical applications                    Inferior cava filter placement
Describe arterial and venous anatomy           Describe the indications for operative
Understand risk factors of atherosclerosis     intervention
Understand risk factors, signs, and               Claudication
   symptoms of chronic venous                     Critical limb ischemia
   insufficiency                                  Abdominal aortic aneurysm
Understand signs and symptoms of acute            Transient ischemic attack and stroke
   and chronic arterial disease                   Asymptomatic carotid stenosis
Make differential diagnosis of a swollen          Varicose veins
   extremity                                      Venous stasis ulcer
Make differential diagnosis of foot ulcer      Renal and visceral artery stenosis
Understand signs and symptoms of
   lymphedema



Gen/Vasc SX (VAMC) cont.
                          Interpersonal Communication Skills
                  PGY-1&2                                         PGY-5
Create ethical and appropriate patient        Create ethical and appropriate patient
    relationships.                               relationships.
Develop effective listening skills, including Develop effective listening skills, including
    observing nonverbal cues and using           observing nonverbal cues and using
    explanatory questioning.                     explanatory questioning.
Develop effective, complete, and legible      Develop effective, complete, and legible
    note writing skills.                         note writing skills.
Learn to give effective medical               Learn to give effective medical
    presentations to other providers, on         presentations to other providers, on
    rounds, at institutional conferences,        rounds, at institutional conferences,
    and at local/national meetings.              and at local/national meetings.
Effective and thorough patient hand-          Effective and thorough patient hand-
    off/sign out.                                off/sign out.

                                    Professionalism
                 PGY-1&2                                       PGY-5
Demonstrate respect, compassion,             Demonstrate respect, compassion,
   integrity and honesty.                      integrity and honesty.
Demonstrate patient care that supersedes Demonstrate patient care that supersedes
   personal self-interest.                     personal self-interest.
Demonstrate personal responsibility for      Demonstrate personal responsibility for
   patient problems.                           patient problems.
Understand and utilize privacy policies,     Understand and utilize privacy policies,
   informed consent, business and              informed consent, business and
   medical ethics.                             medical ethics.
Understand and follow institutional          Understand and follow institutional
   behavior policies (i.e. Sexual              behavior policies (i.e. Sexual
   harassment, duty hours, dress code,         harassment, duty hours, dress code,
   etc.).                                      etc.).




                                                        120
                               System-Based Practice.
                 PGY-1&2                                      PGY-5
Understand how patient care affects other   Understand how patient care affects other
   health care providers.                     health care providers.
Understand the continuity between clinic    Learn role of consultant.
   and hospital based care.                 Understand the continuity between clinic
Understand the role of the Veterans Affairs   and hospital based care.
   Medical Center in the healthcare         Understand the role of the Veterans
   system.                                    Affairs Medical Center in the healthcare
Practice cost-effective and appropriate       system.
   preoperative evaluation and              Practice cost-effective and appropriate
   postoperative follow up.                   preoperative evaluation and
Understand resource allocation issues.        postoperative follow up.
                                            Understand resource allocation issues.

                                             CHEST SURGERY
                                 Minneapolis Veterans Affairs Medical Center

                                      Patient Care
                                         PGY-1
Manual Dexterity & Care Plans
Perform endotracheal intubation
Perform tube thoracostomy—placement and removal
Perform central venous access
Perform thoracentesis
Perform bronchoscopy
Perform pericardiocentesis
Perform saphenous vein harvest

                                  Medical Knowledge
                                        PGY-1
Understand anatomy of the chest
Interpret chest x-ray
Understand indications for Computerized Axial Tomography scan of the chest
Understand bronchoscopic anatomy
Understand signs and symptoms of benign and malignant tumors:
     Lung tumors
     Esophageal tumors
Understand indications for heart catheterization
Understand physiology of cardiopulmonary bypass
Manage heart failure
Apply intraaortic balloon pump and ventricular assist devices
                          Practice-Based Learning & Improvement
                                             PGY-1
Analyze personal strengths and weakness.
Accept constructive criticism.
Utilize scientific literature in patient management questions.
Apply principles of biostatistics, study design, and epidemiology to surgical problems.
Apply the concepts of ―best practice‖ and ―evidence-based medicine.‖
Utilize technology and medical informatics in patient management.

                        Interpersonal Communication Skills
                                         PGY-1
Create ethical and appropriate patient relationships.
                                                       121
Develop effective listening skills, including observing nonverbal cues and using
explanatory questioning.
Develop effective, complete, and legible note writing skills.
Learn to give effective medical presentations to other providers, on rounds, at
institutional conferences, and at local/national meetings.

                                    Professionalism
                                          PGY-1
Demonstrate respect, compassion, integrity and honesty.
Demonstrate patient care that supersedes personal self-interest.
Demonstrate personal responsibility for patient problems.
Understand and utilize privacy policies, informed consent, business and medical ethics.
Understand and follow institutional behavior policies (i.e. Sexual harassment, duty
hours, dress code, etc.).


                                System-Based Practice
                                         PGY-1
Understand how patient care affects other health care providers.
Learn role of consultant.
Understand the continuity between clinic and hospital based care.
Understand the role the community hospital, and private practice in the healthcare
system.
Practice cost-effective and appropriate preoperative evaluation and postoperative
follow up.
Understand resource allocation issues.



                                        SURGICAL CRITICAL CARE
                                  Minneapolis Veterans Affairs Medical Center

                                      Patient Care

                    PGY-1                                         PGY-2
Manual Dexterity                               Manual Dexterity
Perform bedside procedures                     Supervise and instruct bedside
   Central venous catheterization                procedures:
   Pulmonary artery catheterization              Central venous catheterization
   Arterial line placement                       Pulmonary artery catheterization
   Endotracheal intubation                       Arterial line placement
   Observe bedside procedures:                 Perform bedside procedures:
   Percutaneous gastrostomy,                      Endotracheal intubation
   tracheostomy, other minor procedures           Percutaneous gastrostomy,
                                                     tracheostomy, other minor
Care Plans                                           procedures
Understand Advanced Cardiac Life
   Support protocols.                           Care Plans
Identification and evaluation by history and   Identify and evaluate by history and
   physical examination.                          physical examination.
Formulation of differential diagnoses for      Formulate differential diagnoses for ICU
   common ICU problems.                           problems.
Standard ventilator management and             Ventilator management in the patient with
   weaning.                                       acute lung injury.
                                                       122
Initiation of treatment plan and             Initiation of treatment plan and
     management for:                             management for:
     Sepsis                                      Severe sepsis
     Hypoxemia                                   Multisystem organ dysfunction
     Hypotension                                 CNS dysfunction (e.g. intracranial
     Shock                                            bleed)
     Cardiogenic                                 Acute GI bleed
     Distributive                                Hepatic failure
     Hypovolemic                                 Myocardial ischemia
     Obstructive
     Renal failure                           Understand appropriate utilization of:
     Respiratory failure                       Vasoactive agents
Gastrointestinal bleeding                      Antibiotics and other antimicrobials
Understand appropriate utilization of:          Paralytics and sedatives
Antibiotics                                  Therapy for treatment of disorders of
Sedatives                                      coagulation including nonheparin
Blood component therapy                        anticoagulants, and fibrinolytic therapy.
     Therapy for treatment of disorders of   Appropriately interpret and utilize invasive
         coagulation including aspirin,        hemodynamic data.
         heparins

ICU (VAMC) cont.


                                  Medical Knowledge
                  PGY-1                                       PGY-2
Demonstrate knowledge of:                   Demonstrate knowledge of:
  Pathophysiology of sepsis                   Pathophysiology of organ failure
  Principles of Antimicrobial therapy            (pulmonary, renal, GI, cardiac)
  Evaluation of fever in the                  Appropriate indications for radiographic
      immunosuppressed patient                   evaluation of critically-ill patients
      Introductory interpretation of          Appropriate interpretation of advanced
      radiographs                                diagnostics (e.g. CT scans)
  Common surgical conditions leading to       Pathophysiology of nosocomial
      ICU admission                              infections in the critically-ill
  Interpretation of common laboratory         Principles of nutritional support
      tests (e.g. Arterial blood gasses,         including advanced nutritional
      electrolytes)                              monitoring techniques (e.g.
  Basic principles of nutritional support        respiratory quotient) and
  Principles of resuscitation from shock         specialized issues (refeeding
      states                                     syndrome, Rx of hepatic and renal
  Hormonal, biochemical, and metabolic           failure) Common disorders of
      response to tissue injury.                 coagulation in the ICU (e.g. deep
                                                 venous thrombosis,
                                                 thrombocytopenia)




                                                      123
                      Practice-Based Learning & Improvement
                  PGY-1                                       PGY-2
Demonstrate insight into contributing      Perform critical evaluation of
  factors associated with ICU and            complications of ICU care by
  surgical complications by participation    preparation and presentation of
  in monthly morbidity and mortality         complications at monthly ICU morbidity
  conference.                                and mortality conference.
Demonstrate commitment to personal         Continue commitment to personal lifelong
  lifelong learning by initiating directed   learning by initiating reading using
  reading regarding patient issues in the    advanced sources (e.g. source
  ICU.                                       literature) regarding patient issues in
                                             the ICU.

                           Interpersonal Communication Skills
                     PGY-1                                         PGY-2
Understand proper interaction skills with      Develop supervisory skills by providing
   regards to communication with other           oversight and supervision of junior
   services in care of complex, critically ill   members of the Surgical ICU team
   patients (in other words,                     (e.g. anesthesia and surgery residents,
   communication, communication,                 medical students).
   communication!) .                           Demonstrate facility with family
Develop tools for proper family                  communication skills, understanding
   communication skills, understanding           nuances of communication with
   nuances of communication with                 patient’s families in the setting of
   patient’s families in the setting of          critical illness. Demonstrate proper
   critical illness. Relate proper               techniques for communicating ―bad
   techniques for communicating ―bad             news‖ to patient’s family in the ICU.
   news‖ to patient’s family in the ICU.       Participate as appropriate in family care
Participate as an observer in family care        conferences.
   conferences.                                Demonstrate knowledge of current uses
Understand principles of effective               of medical documentation, including
   documentation as a tool for                   interactions with 3rd party payer
   communication.                                system.


ICU (VAMC) cont.
                                   Professionalism

                       PGY-1                                       PGY-2
Demonstrate knowledge of principals of        Understand nuances of withholding or
   informed consent.                            withdrawing life support in the critically-
Discuss the issues of patient rights in the     ill patient.
   setting of critical illness.               Relate the role of advanced directives in
Understand the process for implementation       the critically-ill patient.
   of DO NOT RESUSCITATE orders in            Experience the effects of critical illness on
   the critically ill.                          families of different backgrounds (age,
Demonstrate appropriate transfer of patient     culture, etc.).
   care to primary services caring for the    Understand methods of coping with stress
   critically-ill patient in transition to      of caring for critically ill (and dying)
   hospital care.                               patients.

                                System-Based Practice
                 PGY-1                                     PGY-2
Relate techniques for cost-effective,      Understand cost-effective health care
                                                       124
   appropriate perioperative evaluation.         delivery in the ICU.
Demonstrate principles of infection control    Appropriate ability to utilize triage and
   (prevention of health care associated         bed-control to provide for critically ill
   and blood borne infections).                  patients.
Demonstrate ability to provide ongoing         Relate the role (and cost) of ICU care in
   care of patients with chronic critical        the setting of the Veteran’s Affairs
   illness (e.g. appropriate transfer of         Medical Center.
   patients to chronic hospital, ventilator,   Demonstrate knowledge of current uses
   and advanced nursing facilities).             of medical documentation, including
Understand the role of other services in         interactions with 3rd party payer
   proper care of complex, critically ill        system.
   patients.                                   Understand the role of other services in
                                                 proper care of complex, critically ill
                                                 patients.




                                        ROTATION PLAN FOR 2011-12

                    METHODIST HOSPITAL (Park Nicollet Medical Center)
ROTATION NAME
TRAINING LEVELS ON SERVICE: 3 PGY-4; 1 PGY-3; Medical Students
SERVICE DIRECTOR: M. Mark Melin M.D.
TEACHING FACULTY:
George Belzer, M.D.
Mary Colbert, M.D.
Joel Friedman, M.D.
Brian Grubbs, M.D.
Keith Heaton, M.D.
Tom Jones, M.D.
Jeffrey Mendeloff, M.D.
Kevin Ose, M.D.
Michael Schueppert, M.D.
Charles Svendsen, M.D.
Paul Vietzan, M.D.
Robert Wetherille, M.D.
David Willis, M.D.

ROTATION’S WEEKLY EDUCATION SCHEDULE

    Monday             Tuesday at          Wednesday             Thursday               Friday
                         UMMC
7:00 – 8:00 am      6:30 G4+G5           6:30-7:00 am         6:30-7:00 am        6:30-7:30 am
Colorectal          7:00 M+M             Ethics / Journal     Vascular            M+M Conference
Conference          7:45 Grand           Club (once-twice     Conference          Gen/Vascular
(once a month)      Rounds               a month) with        (once a month)
                    8:30 Core            G3, G4, med
                    Curriculum           students
                    9:45-noon Skills
                    Lab
                                                        125
Activity                               Who is responsible?             When does this
                                                                       occur?
Orientation to the Rotation            Mark Melin, MD                  Start of rotation
Bedside Teaching Rounds                Monthly M+M Leader              1-2 Fridays per month
Weekly Core Topic Teaching             All staff                       Weekly
Mid-Rotation Review                    All staff                       Weekly
End-of-Rotation Oral Exam              M+M Leader                      Every Friday after M+M
End-of-Rotation Meeting w/             Mark Melin, MD                  End of rotation
Resident


ROTATION GOALS AND OBJECTIVES FOR MEDICAL KNOWLEDGE AND PATIENT CARE, BY CORE
TOPIC AND RESIDENT TRAINING LEVEL

The rotation at Methodist Hospital consists of three PGY-4 residents and one PGY-3 resident. The PGY-3 and
4 residents are treated equally during the course of their rotation at Methodist with respect to peri-operative
responsibilities and surgical case involvement.

Core Topic 1: Benign Gall Bladder
Medical Knowledge
G-Level Objectives
PGY-3     All residents should:
and        Understand biliary colic and its management, how it differs from common duct
PGY-4          stones
           Know how to interpret labs
           Recognize and describe abnormal anatomy
           Know how to manage post-op complications

Patient Care
G-Level Technical / Procedural Skill                   Care Plans:
PGY-3      All residents should be able to:            All residents should be able to:
and        1. Execute adequate preoperative            1. Manage postoperative complications
PGY-4           patient preparation.                      such as retained common bile duct
           2. Recognize and act on indications for        stone, biliary leak, cholangitis.
                intra-operative common bile duct
                study, laparoscopic versus open.
           3. Understand abnormal biliary duct
                anatomy and variations.
           4. Recognize and act on indications for
                conversion to open procedure.




Core Topic 2: C. Difficile Infection
Medical Knowledge
G-Level Objectives:
PGY-3     All residents should understand:
and        The epidemiology of C. Diff infections
PGY-4      Differential diagnosis
           ―Benign‖ versus ―malignant‖
                                                      126
              Forms of C. Difficile infection and differentiation from toxic megacolon
              Indications for surgical management versus persistent medical management

Patient Care
G-Level Technical / Procedural Skills:                  Care Plans:
PGY-3      All residents should be able to recognize    All residents should be able to:
and        and act on:                                  1. Manage postoperative complications
PGY-4      1. Indications for surgical management            such as sepsis syndrome,
                of C-Difficile infection, toxic              malnutrition.
                megacolon.                              2. Recognize and act on indications and
           2. Options for preoperative GI                    timing for reestablishment of
                preparation.                                 gastrointestinal continuity.
           3. Assessment of nutritional status.
           4. Intra-operative technical aspects of
                managing toxic megacolon.
           5. Options for primary anastomosis
                versus creation of colostomy, versus
                diverting loop ileostomy.

Core Topic 3: Colitis
Medical Knowledge
G-Level Objectives:
PGY-3     All residents should know:
and        Defining types of colitis
PGY-4      Differential diagnosis
           Options for medical management.

Patient Care
G-Level Technical / Procedural Skills:                  Care Plans:
PGY-3      All residents should be able to:             All residents should be able to:
and        1. Execute preoperative                      1. Manage postoperative complications
PGY-4           gastrointestinal/colon preparation.          such as anastomotic leak, sepsis
           2. Understand and initiate rapid                  syndrome,
                recovery protocols.                     2. Initiate and commence medical
           3. Perform technique of colectomy and             management of colitis.
                options for pouch reconstruction.
           4. Describe options for pouch
                reconstruction and determine clinical
                indications for each type of pouch
                reconstruction option.


Core Topic 4: Crohn’s Disease
Medical Knowledge
G-Level Objectives:
PGY-3     All residents should know:
and        Differentiation of Crohn’s disease versus ulcerative colitis
PGY-4      Other colon pathology differential diagnosis
           Indications for medical therapy versus surgical management


Patient Care
G-Level Technical / Procedural Skills:                  Care Plans:

                                                        127
PGY-3      All residents should be able to:            All residents should be able to:
and        1. Execute preoperative                     1. Manage postoperative complications
PGY-4           gastrointestinal/colon preparation.         such as anastomotic leak, sepsis
           2. Understand, describe, assist, and             syndrome
                perform the technical skills and       2. Provide postoperative medical
                anastomotic principles for small            management of Crohn’s disease.
                intestine/colon resection, technique
                and option for stricturoplasty.


Core Topic 5: Large Bowel Obstruction
Medical Knowledge
G-Level Objectives:
PGY-3     All residents should know:
and        Differential diagnosis of causes of large bowel obstruction
PGY-4      Options for medical management, including the role of colonic stents
           Options for diagnostic evaluations.

Patient Care
G-Level Technical / Procedural Skills:                 Care Plans:
PGY-3      All residents should be able to:            All residents should be able to:
and        1. Execute preoperative                     1. Recognize and act on postoperative
PGY-4           gastrointestinal/colon preparations.        anastomotic leaks.
           2. Describe and perform the                 2. Manage sepsis syndrome.
                construction of a primary              3. Manage persistent postoperative
                anastomosis versus diversion                ileus.
                procedures.                            4. Manage nutritional needs.
           3. Understand, describe and perform
                the appropriate creation of stoma
                placement.
           4. Describe bowel preparation options.



Core Topic 6: Colorectal Cancer
Medical Knowledge
G-Level Objectives:

PGY-3      All residents should know:
and         Preoperative evaluation
PGY-4       Radiographic evaluation for performance of accurate colorectal cancer staging
            Indications for preoperative chemotherapy/radiation therapy
            Indications for non-operative management of colorectal cancer

Patient Care
G-Level Technical / Procedural Skill:                  Care Plans
PGY-3      All residents should be able to:            All residents should be able to:
and        1. Execute gastrointestinal/colon           1. Recognize and act on post-operative
PGY-4           preoperative preparations.                  anastomotic leaks
           2. Understand, describe, and perform        2. Manage sepsis syndrome.
                management of colorectal cancer        3. Recognize and act on indications for
                procedural options, including               restoration of colonic continuity.
                assisting in the performance of AP
                resection.
                                                       128
           3. Understand, describe and determine
              the arterial anatomy and implications
              for intra-operative resection.

Core Topic 7: Diverticulitis
Medical Knowledge
G-Level Objectives:
PGY-3     All residents should know:
and        Medical assessment and management of diverticulitis
PGY-4      Observation versus selective percutaneous drain placement, versus surgery
           Indications of medical failure
           Indications for surgical management of diverticulitis

Patient Care
G-Level Technical / Procedural Skills:                   Care Plans:

PGY-3      All residents should be able to:              All residents should be able to:
and        1. Execute preoperative                       1. Recognize anastomotic leak, sepsis
PGY-4           gastrointestinal/colon preparation.           syndrome.
           2. Execute intra-operative techniques:        2. Manage stomas.
                two-handed dissection, finding           3. Recognize and act on indications for
                appropriate retroperitoneal planes for        restoration of intestinal continuity.
                dissection.
           3. Understand, describe and address
                techniques that allow avoidance of
                potential intra-operative
                complications of ureteral trauma, and
                vein trauma.

Core Topic 8: Parathyroid
Medical Knowledge
G-Level Objectives:

PGY-3      All residents should:
and         Understand accurate medical evaluation, diagnosis of parathyroid pathology
PGY-4       Understand indicated preoperative laboratory evaluation
            Describe differential diagnosis for causes of hypercalcemia
            Describe localization studies
            Describe radiologic studies for preoperative evaluation
            Describe acute medical treatment of malignant hypercalcemia

Patient Care
G-Level Technical / Procedural Skills:                   Care Plans
PGY-3      All residents should be able to:              1. Describe and initiate management of
and        1. Describe, demonstrate and initiate            postoperative complications including
PGY-4           the surgical approach of parathyroid        hypocalcemia, recurrent nerve injury,
                exploration versus focused surgical         and neck hematoma.
                resection.
           2. Describe and demonstrate the
                location of ―missing‖ parathyroid
                glands.
           3. Describe and demonstrate
                hyperplasia versus adenoma

                                                         129
               management.

Core Topic 9: Acute Limb Ischemia
Medical Knowledge
G-Level Objectives:

PGY-3      All residents should be able to:
and         Describe clinical presentation, risk factors for development of acute limb
PGY-4           ischemia.
            Know important aspects of clinical history, radiologic options for evaluation
                versus immediate surgical management

Patient Care
G-Level Technical / Procedural Skills                   Care Plans:
PGY-3      All residents should be able to:             All residents should be able to:
and        1. Describe, demonstrate, and initiate       1. Describe and initiate postoperative
PGY-4           field preparation for performance of         limb ischemia management,
                technique of embolectomy.                    identification of potential
           2. Describe and demonstrate technique             compartment syndrome if fasciotomy
                of intraoperative angiography.               not performed intraoperatively,
           3. Describe indications for performance           management of postoperative
                of four compartment fasciotomy and           wounds, indication for
                initiate performance of four                 anticoagulation.
                compartment fasciotomy.                 2. Describe and initiate management of
                                                             cardiac complications and renal
                                                             complications.
Core Topic 10: Chronic Limb Ischemia
Medical Knowledge
G-Level Objectives:
PGY-3     All residents should be able to:
and       1. Define clinical presentation, associated clinical risk factors, and the important
PGY-4          aspects of medical history
          2. Differentiate chronic limb ischemia from acute limb ischemia
          3. Describe indications for radiographic evaluations.

Patient Care
G-Level Technical / Procedural Skills:                  Care Plans:
PGY-3      All residents should be able to:             All residents should be able to:
and        1. Describe and initiate adequate field      1. Initiate and manage perioperative
PGY-4           preparation.                                 cardiac and renal complications.
           2. Describe options for surgical             2. Initiate and manage postoperative
                reconstruction of chronic limb               wound complications.
                ischemia and demonstrate                3. Identify and appropriately manage
                appropriate interpretation of                and execute recognition of bypass
                angiogram preoperatively.                    graft complications.
           3. Describe and demonstrate types of         4. Evaluate and initiate short-term and
                vascular conduits utilized.                  long-term follow-up plans for vascular
           4. Describe and initiate appropriate              bypass grafts.
                preoperative vein mapping.

Core Topic 11: Venous Insufficiency
Medical Knowledge
G-Level Objectives:
PGY-3     All residents should be able to:
                                                       130
              Define clinical presentation, clinical risk factors for development of venous
               insufficiency
              Explain medical versus surgical treatments options of venous insufficiency
              Define management of wounds in patients with venous insufficiency and identify
               associated peripheral arterial disease

Patient Care
G-Level Technical / Procedural Skills:                  Care Plans:
PGY-3      All residents should be able to:             All residents should be able to:
and        1. Define, outline and evaluate surgical     1. Describe, initiate and execute
PGY-4           options for management of                    postoperative care plans for varicose
                superficial venous insufficiency.            vein surgical patients.
           2. Describe the technique of saphenous       2. Describe and initiate management
                vein stripping.                              and appropriate evaluation of
           3. Describe ablation of the saphenous             postoperative deep venous
                vein using radiofrequency ablation or        thromboses and pulmonary emboli.
                laser therapy.                          3. Initiate and manage patients with
           4. Describe and demonstrate technique             venous hypertensive ulcerations.
                of varicose vein avulsion (ambulatory
                phlebectomy).
           5. Describe and initiate management of
                perforating vein management in
                patients with venous ulcerations.


Core Topic 12: Carotid
Medical Knowledge
G-Level Objectives:

PGY-3      All residents should be able to:
and         Describe surgical indications for asymptomatic patients
PGY-4       Describe surgical versus medical management for asymptomatic patients
            Describe surgical versus nonsurgical management options for symptomatic
                patients
            Describe indications for carotid artery stent placement
            Describe options for radiographic evaluation of carotid artery stenosis
            Describe preoperative assessment of cardiac status

Patient Care
G-Level Technical / Procedural Skills:                  Care Plans:

PGY-3      All residents should be able to:              All residents should be able to:
and        1. Describe and initiate field               1. Describe, initiate and manage
PGY-4           preparation.                                 postoperative complications of
           2. Describe and initiate surgical                 carotid endarterectomy including
                technique and exposure for carotid           transient ischemic attack,
                artery endarterectomy.                       cerebrovascular accident, myocardial
           3. Describe and assist in options for             infarction, neck hematoma,
                intraoperative cerebral protection           compromised airway.
                including EEG utilization, blood
                pressure management, indications
                for shunt utilization.


                                                        131
Core Topic 13: Thoracic Outlet
Medical Knowledge
G-Level Objectives:
PGY-3      Define clinical presentation of neurogenic versus venous (Paget-Schroetter),
and          versus arterial
PGY-4      Describe medical management
           Describe indications for surgical management
           Describe management of subclavian venous thrombosis associated with effort
             thrombosis
           Describe preoperative evaluation of neurogenic thoracic outlet
           Describe options for radiographic evaluation of thoracic outlet syndrome.

Patient Care
G-Level Technical / Procedural Skills:                   Care Plans:
PGY-3      1. Describe and initiate field                1. Describe and initiate management of
and           preparation.                                  postoperative complications including
PGY-4      2. Describe and assist in surgical               hematoma, neurogenic
              options for management of thoracic            complications, arteriocclusive
              outlet syndrome, including                    complications.
              transaxillary first rib resection versus   2. Describe, initiate and management of
              anterior approach to first rib                postoperative physical therapy
              resection.
           3. Describe and determine the
              indications for vein patch angioplasty
              in patients with a history of venous
              thoracic outlet syndrome.


ROTATION GOALS AND OBJECTIVES FOR PROBLEM-BASED LEARNING AND IMPROVEMENT,
INTERPERSONAL SKILLS AND COMMUNICATION, PROFESSIONALISM, AND SYSTEMS BASED
PRACTICE



Problem-Based Learning and Improvement
G-Level Objectives
PGY-3       Identify own learning needs or goals at the onset of the rotation.
and         Following a surgical procedure, debrief what went well, and what could have
PGY-4         been improved.
            Identify differences in incidence, prognosis, and outcomes of cancer treatment
              according to race and gender.
            Diagnose personal learning needs associated with any medical errors,
              complications, or ―near misses‖ that occurred during your watch.
            Use feedback gained from others, and the experience gained on this rotation,
              to formulate future learning goals and steps.

Interpersonal Skills and Communication
G-Level Objectives
PGY-3        Communicate patient information clearly to other health providers in written
and             notes and oral presentations.
PGY-4        Apply appropriate communication skills with patients and families (i.e. effective

                                                         132
                listening, awareness of nonverbal cues, and use of open-ended questions).
               Counsel and educate patients and families on their treatment options, their
                surgical outcomes and prognosis, and home care needs.
               Explain to medical students / junior residents the fundamentals of your job, as
                well as their jobs.

Professionalism
G-Level Objectives
PGY-3         Adhere to patient privacy and informed consent policies at all times.
and           Adhere to University behavior policies (e.g., sexual harassment, duty hours,
PGY-4           dress code) at all times.
              Demonstrate respect, compassion, integrity, and honesty in all interactions with
                patients, families, and other health care providers.
              Demonstrate personal responsibility for patient welfare.
                Articulate ethical issues underlying clinical decisions made for at least once
                complex case seen during this rotation.

Systems-Based Practice
G-Level Objectives
PGY-3       Know when to call for help from attending physicians.
and         Understand when, how, and why to request a consult from medical oncology
PGY-4         and radiation oncology, and how to use the information gained as a result.
            Provide timely and pertinent consultation when asked by medical or surgical
              colleagues.
            Use the talents and skills of other health providers in the OR and ward.
            Estimate the costs / benefits of cancer screening (mammography,
              colonoscopy), staging (CT, PET, etc.), and treatment.
            Consider patient characteristics (e.g., age, race and ethnicity, family support,
              socio-economic status, type of insurance) in evaluating treatment options and
              developing an appropriate care plan.
            Discuss the distinction between medically necessary care and over care, and
              its implications for our patients.
              Diagnose any ―systems issues‖ associated with medical errors, complications,
              and ―near misses‖ that occurred during this rotation.

LEARNING RESOURCES FOR TRAINEES
SCORE Website Portal:

      Modules, chapters, videos, and radiographic images (STAT dx) pertinent to the core topics enumerated
       above
      Evidence-Based Reviews in Surgery
      MD Content Course on Health Care (economics, operations, legal/financial, leadership)

METHODIST HOSPITAL Moodle Website

      See assignments and additional resources




                                                     133
                                       ROTATION PLAN FOR 2011-12

                   NORTH MEMORIAL MEDICAL CENTER

ROTATION NAME
TRAINING LEVELS ON SERVICE: PGY-1
SERVICE DIRECTOR: Alan Beal M.D.
TEACHING FACULTY:
Mark Ahrendt, M.D.
Dana Carlson, M.D.
Sandra Engwall, M.D.
Isaac Felemovicius, M.D.
Eric Irwin, M.D.

ROTATION’S WEEKLY EDUCATION SCHEDULE

    Monday            Tuesday at         Wednesday              Thursday            Friday
                        UMMC
3:45 pm            6:30 G4+G5          3:45 pm               7:00 am: Trauma    3:45 pm
Attending Walk     7:00 M+M            Attending Walk        M+M, Trauma        Attending Walk
Rounds (On Call    7:45 Grand          Rounds (On Call       Journal Club;      Rounds (On Call
trauma surgeon)    Rounds              trauma surgeon)       Surgery Topics     trauma surgeon)
                   8:30 Core                                 conference
                   Curriculum                                (Trauma
                   9:45-noon Skills                          Attending Staff)
                   Lab



Activity                               Who is responsible?              When does this
                                                                        occur?
Orientation to the Rotation            Susan Adler / Alan Beal, MD      First day of rotation
Bedside Teaching Rounds                Core Trauma Surgeons             See above schedule
Weekly Core Topic Teaching             Core Trauma Surgeons             Thursday am, or at
                                                                        afternoon Walk Rounds
Mid-Rotation Review                    Alan Beal, MD                    Variable
End-of-Rotation Oral Exam              Alan Beal, MD                    Last Thursday of
                                                                        rotation
End-of-Rotation Meeting w/             Alan Beal, MD                    Last week of rotation
Resident

ROTATION GOALS AND OBJECTIVES FOR MEDICAL KNOWLEDGE AND PATIENT CARE, BY CORE
TOPIC AND RESIDENT TRAINING LEVEL

Core Topic 1: Appendicitis
Medical Knowledge
G-Level Objectives
PGY-1     Understand natural history, common presentation, current concepts of imaging, use
          of open vs. laparoscopic techniques, and antibiotic choices for acute appendicitis in
                                                       134
           both adults and children.

Patient Care
G-Level Technical / Procedural Skills                  Care Plans
PGY-1      Gradual increase in operative technical     Gain comfort and experience with post-
           responsibility with both open and           operative plans and management of both
           laparoscopic appendectomy.                  complicated and uncomplicated
                                                       appendicitis

Core Topic 2: Biliary Disease
Medical Knowledge
G-Level Objectives
PGY-1     Understand various presentations of symptomatic gallstone disease, its natural
          history, surgical indications, and use of imaging techniques. Begin to appreciate the
          variable biliary anatomy. Become familiar with both laparoscopic and open
          cholecystectomy techniques, their indications, as well as various techniques to
          remove choledocholithiasis. Discuss the presentation and basic management of bile
          duct injuries. Characterize the presentation and management of acalculous
          cholecystitis.

Patient Care
G-Level Technical / Procedural Skills                  Care Plans
PGY-1      Gradual increase in operative technical     Gain comfort and experience with
           responsibility with laparoscopic            postoperative plans and management of
           cholecystectomy and cholangiography.        both complication and uncomplicated
                                                       biliary disease.

Core Topic 3: Bowel Obstruction
Medical Knowledge
G-Level Objectives
PGY-1     Understand the epidemiology, clinical manifestations, and diagnostic techniques for
          bowel obstruction, as well as surgical indications.

Patient Care (Bowel Obstruction)
G-Level Technical / Procedural Skills                  Care Plans
PGY-1      Assist in laparotomy and lysis of           Gain comfort and experience in non-
           adhesions for small bowel obstruction.      operative and pre-operative
                                                       management of those with acute bowel
                                                       obstruction, as well as post-operative
                                                       management after laparotomy.

Core Topic 4: Abdominal Wall Hernias
Medical Knowledge
G-Level Objectives
PGY-1     Understand the natural history of inguinal and ventral/incisional hernias and be able
          to discuss the surgical indications for each, including non-operative management.
          Compare and discuss advantages and disadvantages of open vs. laparoscopic
          techniques for both inguinal and incisional hernias.

Patient Care
G-Level Technical / Procedural Skills                  Care Plans
PGY-1      Gradual increase in operative technical     Be knowledgeable of indications and
           responsibility for both open and            risks of open and laparoscopic
           laparoscopic hernia repairs for both        techniques for informative discussions
                                                      135
           inguinal and incisional hernias.            with patients pre-operatively and post-
                                                       operatively.

Core Topic 5: Central Venous Catheters
Medical Knowledge
G-Level Objectives
PGY-1     Be familiar with different approaches to placement of central venous lines,
          indications for such catheters, and a variety of complications, both acute and sub-
          acute. Acquire knowledge of the definition of catheter-related blood stream infection,
          diagnostic criteria, basic treatment regimens, and preventative measures.

Patient Care
G-Level Technical / Procedural Skills                    Care Plans
PGY-1      Acquire experience under attending staff Become familiar with the technique of full
           guidance in placement of several types        barrier draping and ongoing local
           of central venous catheters.                  catheter care after insertion.
Core Topic 6: Sepsis
Medical Knowledge
G-Level Objectives
PGY-1      Know the definitions of sepsis, severe sepsis, and septic shock. Be familiar with the
           Surviving Sepsis Campaign and international guidelines for management of severe
           sepsis, as well as landmark studies of early goal-directed therapy. Be able to
           choose appropriate first-line antibiotic choices for patients with sepsis.

Patient Care
G-Level Technical / Procedural Skills                  Care Plans
PGY-1      NA                                          Be familiar with institutional order sets for
                                                       the treatment of severe sepsis.

Core Topic 7: Solid Organ Injury (Liver and Spleen)
Medical Knowledge
G-Level Objectives
PGY-1     Obtain knowledge in the diagnosis of blunt injuries to liver, spleen, kidney, and
          pancreas in both adults and children. Be familiar with the American College of
          Surgeons CT staging of blunt solid organ injury scales. Know the indications for
          surgical intervention in these injuries. Become familiar with the indications for
          angioembolization as a form of treatment in blunt solid organ injuries. Become more
          comfortable in CT evaluation of blunt solid organ injuries.

Patient Care
G-Level Technical / Procedural Skills                  Care Plans
PGY-1      Assist in a trauma exploratory              Be familiar with institutional order sets for
           laparotomy.                                 the non-operative treatment of blunt
                                                       splenic and hepatic injuries.

Core Topic 8: Fluid Resuscitation and Massive Transfusion
Medical Knowledge
G-Level Objectives
PGY-1     Become familiar with the key areas of fluid resuscitation in the trauma patient in both
          adults and children and discuss the endpoints/goals for fluid resuscitation. Discuss
          the indications for blood transfusion in the surgical and/or trauma patient. Be familiar
          with the term, ―damage control resuscitation,‖ and ―massive blood transfusion
          protocol,‖ and discuss the types of patients where these techniques might be used.
          Is there a role for the use of Factor VII?
                                                       136
Patient Care
G-Level Technical / Procedural Skills                 Care Plans
PGY-1      NA                                         Discuss the intricacies of developing an
                                                      institutional massive transfusion protocol.

ROTATION GOALS AND OBJECTIVES FOR PROBLEM-BASED LEARNING AND IMPROVEMENT,
INTERPERSONAL SKILLS AND COMMUNICATION, PROFESSIONALISM, AND SYSTEMS BASED
PRACTICE


Problem-Based Learning and Improvement
G-Level Objectives
PGY-1       Identify own learning needs or goals at the onset of the rotation.
            Following a surgical procedure, debrief what went well, and what could have
              been improved.
            Identify differences in incidence, prognosis, and outcomes of cancer treatment
              according to race and gender.
            Diagnose personal learning needs associated with any medical errors,
              complications, or ―near misses‖ that occurred during your watch.
            Use feedback gained from others, and the experience gained on this rotation,
              to formulate future learning goals and steps.

Interpersonal Skills and Communication
G-Level Objectives
PGY-1        Communicate patient information clearly to other health providers in written
                notes and oral presentations.
             Apply appropriate communication skills with patients and families (i.e. effective
                listening, awareness of nonverbal cues, and use of open-ended questions).
             Counsel and educate patients and families on their treatment options, their
                surgical outcomes and prognosis, and home care needs.
             Explain to medical students / junior residents the fundamentals of your job, as
                well as their jobs.

Professionalism
G-Level Objectives
PGY-1         Adhere to patient privacy and informed consent policies at all times.
              Adhere to University behavior policies (e.g., sexual harassment, duty hours,
                dress code) at all times.
              Demonstrate respect, compassion, integrity, and honesty in all interactions with
                patients, families, and other health care providers.
              Demonstrate personal responsibility for patient welfare.
                Articulate ethical issues underlying clinical decisions made for at least once
                complex case seen during this rotation.


Systems-Based Practice
G-Level Objectives
PGY-1       Know when to call for help from attending physicians.

                                                     137
                Understand when, how, and why to request a consult from medical oncology
                 and radiation oncology, and how to use the information gained as a result.
                Provide timely and pertinent consultation when asked by medical or surgical
                 colleagues.
                Use the talents and skills of other health providers in the OR and ward.
                Estimate the costs / benefits of cancer screening (mammography,
                 colonoscopy), staging (CT, PET, etc.), and treatment.
                Consider patient characteristics (e.g., age, race and ethnicity, family support,
                 socio-economic status, type of insurance) in evaluating treatment options and
                 developing an appropriate care plan.
                Discuss the distinction between medically necessary care and over care, and
                 its implications for our patients.
                 Diagnose any ―systems issues‖ associated with medical errors, complications,
                 and ―near misses‖ that occurred during this rotation.

LEARNING RESOURCES FOR TRAINEES
SCORE Website Portal:

      Modules, chapters, videos, and radiographic images (STAT dx) pertinent to the core topics enumerated
       above
      Evidence-Based Reviews in Surgery
      MD Content Course on Health Care (economics, operations, legal/financial, leadership)

NORTH MEMORIAL Moodle Website

      See assignments and additional resources



Teaching Medical Students

Residents are an essential part of the teaching of medical students. It is critical that any resident who
supervises or teaches medical students must be familiar with the educational objectives of the course or
clerkship and be prepared for their roles in teaching and evaluation. Therefore, we’ve included in this manual
the clerkship objectives for Surgery as well as the overall Educational Program Objectives.

Surgery – SURG 7500

Goals and Objectives

This course provides the medical students an opportunity to learn various responsibilities of a PGY-1 Surgery
resident. At the completion of the rotation it is expected that the student will have achieved competence in the
following subject areas:

      mastery of 12 assigned core topics in general surgery
      initial history and physical examination of the patient
      orderly, systematic diagnosis of surgical diseases
      suitable pre-operative preparation of the surgical patient
      function of the O.R. and the surgeon's role
      operative procedures used in treatment of surgical diseases
      perioperative patient care
      how to interpret surgical literature
                                                       138
       interpersonal behavior with surgical patients


Educational Program Objectives
University of Minnesota Medical School

Graduates of the University of Minnesota Medical School should be able to:

                                                 OUTCOME MEASURES                          ACGME ESSENTIAL
   OBJECTIVE                                                                               COMPETENCY
   1.    Demonstrate mastery of key                     USMLE Steps 1 and 2                Medical Knowledge
      concepts and principles in the basic              Year 1 and 2 course
      sciences and clinical disciplines that                 performance, based on
      are the basis of current and future                    standardized examinations
      medical practice.                                 Clinical rotation performance
                                                        Feedback from residency
                                                        directors
   2.       Demonstrate mastery of key                  USMLE Steps 1 and 2                Medical Knowledge
        concepts and principles of other                Course performance (esp. in
        sciences and humanities that apply to           Physician and Society,
        current and future medical practice,            Nutrition, and Human Behavior
        including epidemiology, biostatistics,          at TC campus; Medical
        healthcare delivery and finance,                Sociology, Medical
        ethics, human behavior, nutrition,              Epidemiology and biometrics,
        preventive medicine, and the cultural           Family Medicine I, Medical
        contexts of medical care.                       Ethics, Human Behavioral
                                                        Development and Problems,
                                                        and Psycho-Social-Spiritual
                                                        Aspects of Life-Threatening
                                                        Illness at DU campus)
                                                        Clinical rotation performance
                                                        Feedback from residency
                                                        directors
   3.       Competently gather and present in           Yr. 2 OSCE                         Patient Care;
        oral and written form relevant patient          Physician and Patient (PAP)        Interpersonal and
        information through the performance             course performance at TC           Communication Skills
        of a complete history and physical              campus, assessed by tutors
        examination.                                    using global rating forms and
                                                        observed practical exams
                                                        Course performance at DU
                                                        campus in Applied Anatomy,
                                                        Clinical Rounds & Clerkship
                                                        (CR & C), Clinical Pathology
                                                        Conference, and Integrated
                                                        Clinical Medicine
                                                        Clinical rotation performance
   4.      Competently establish a doctor-              Yr. 2 OSCE and Primary Care        Patient Care;
        patient relationship that facilitates           Clerkship (PCC) OSCE               Interpersonal and
        patients’ abilities to effectively              PAP course performance at          Communication Skills
        contribute to the decision making and           TC campus, assessed by
        management of their own health                  tutors using global rating forms
        maintenance and disease treatment.              and observed practical exams
                                                        Preceptorship and CR & C
                                                        course performance at DU
                                                          139
                                              campus
                                              Clinical rotation performance
5.     Competently diagnose and               PCC OSCE                           Medical Knowledge;
   manage common medical problems in          Clinical rotation performance      Patient Care
   patients.
6.     Assist in the diagnosis and            Clinical rotation performance      Medical Knowledge;
   management of uncommon medical             Documented achievement of          Patient Care;
   problems; and, through knowing the         procedural skills in the           Practice-Based
   limits of her/his own knowledge,           Competencies Required for          Learning and
   adequately determine the need for          Graduation                         Improvement
   referral.
7.     Begin to individualize care through    Clinical rotation performance      Patient Care; Medical
   integration of knowledge from the          Feedback from residency            Knowledge;
   basic sciences, clinical disciplines,      directors                          Interpersonal and
   evidence-based medicine, and                                                  Communication
   population-based medicine with                                                Skills;
   specific information about the patient                                        Professionalism
   and patient’s life situation.
8.     Demonstrate competence                 Yr. 2 and PCC OSCE                 Practice-Based
   practicing in ambulatory and hospital      PAP course performance at          Learning and
   settings, effectively working with other   TC campus, assessed by             Improvement;
   health professionals in a team             tutors using global rating forms   Systems-Based
   approach toward                            and observed practical exams       Practice
                                              Physician and Society (PAS)
     integrative care.
                                              course performance at TC
                                              campus
                                              Preceptorship, CR & C, and
                                              Introduction to Rural Primary
                                              Care Medicine course
                                              performance at DU campus
                                              Clinical rotation performance
9.     Demonstrate basic understanding        PAS course performance at          Practice-Based
   of health systems and how physicians       TC campus                          Learning and
   can work effectively in health care        Medical Sociology and CR & C       Improvement;
   organizations, including:                  course performance at DU           Systems-Based
         Use of electronic communication      campus                             Practice
        and database management for           Clinical rotation performance,
        patient care.                         especially the PCC
         Quality assessment and               Feedback from residency
        improvement.                          directors
         Cost-effectiveness of health         Feedback from local health
        interventions.                        plans
         Assessment of patient
        satisfaction.
         Identification and alleviation of
        medical errors.
10. Competently evaluate and manage           Critical reading exercises in      Patient Care; Medical
   medical information.                       PAS and other courses at TC        Knowledge; Practice-
                                              campus                             Based Learning and
                                              Clinical Pathology Conference      Improvement;
                                              performance and exercises in       Systems-Based
                                              Problem Based Learning             Practice
                                              Cases at DU campus
                                              Year 2 Health disparities
                                                140
                                                    project
                                                    PCC EBM project
   11.     Uphold and demonstrate in                PAS course performance at        Professionalism
         action/practice basic precepts of the      TC campus
         medical profession: altruism, respect,     Preceptorship and Cr & C
         compassion, honesty, integrity and         course performance at DU
         confidentiality.                           campus
                                                    Clinical rotation performance
                                                    Participation in honor code and
                                                    student peer assessment
                                                    program
                                                    Participation in anatomy
                                                    memorial
                                                    Participation in volunteer
                                                    service activities
   12.   Exhibit the beginning of a pattern of      PBL cases at DU campus           Professionalism
      continuous learning and self-care             Yr. 2 Health disparities project
      through self-directed learning and            Clinical rotation performance
      systematic reflection on their                Participation in research
      experiences.
   13. Demonstrate a basic understanding            Course performance in all          Patient Care; Medical
      of the healthcare needs of society and        years                              Knowledge; Practice-
      a commitment to contribute to society         Introduction to Rural Primary      Based Learning and
      both in the medical field and in the          Care Medicine course project       Improvement;
      broader contexts of society needs.            at DU campus                       Professionalism;
                                                    Involvement of students in         Systems-Based
                                                    international study                Practice
                                                    Enrollment in RPAP, RCAM,
                                                    and UCAM
                                                    Yr. 2 Health disparities project
                                                    Feedback from residency
                                                    directors
                                                    Participation in volunteer
                                                    service activities

These objectives are written to reflect the qualities and competencies expected of our graduates. Each
objective specifies the expected competency level to be attained by our students, the outcome measures used
to evaluate attainment of the objective, and the essential qualities and competencies of a physician (as defined
by the six ACGME Essential Competencies) addressed by the objective. The Accreditation Council for
Graduate Medical Education (ACGME) has formulated essential competencies felt to be necessary for
physicians practicing in the current health care climate. They are:



                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
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              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 health care and the ability to effectively call
           on system resources to provide optimal patient care

The objectives for the undergraduate curriculum can be grouped as follows:

       Objectives 1-3: Knowledge and skills addressed principally in the first two (preclinical) curricular years;
       Objectives 4-9: Knowledge and skills addressed principally in the second two (clinical) curricular years;
       Objectives 10-13: Knowledge, attitudes, and skills addressed throughout the curriculum.

The objectives, which relate to the ACGME essential competencies, are designed to be modified for use also
by the graduate (GME) programs at the University of Minnesota Medical School. Residency programs can
modify the competency level stated in the objectives and the outcome measures to reflect their own programs,
while maintaining the overall integration of basic learning objectives across undergraduate and graduate
medical education.

One of the primary outcome measures for the objectives is clinical rotation performance. To expand on
this; clinical rotation performance is assessed by attending physicians and residents using a Web-based
global rating form, evaluating the following knowledge, competencies, skills, and attitudes:
                 Medical knowledge and the ability to apply knowledge in clinical situations
                 Competency in patient care including communication and relationships with patients/families
                 Skills in data gathering from the history, physical examination, clinical and academic sources,
            and diagnostic tests
                 Assessment and prioritization of problems
                 Management of problems, including knowledge of patient data and progress
                 Appropriate decision making
                 Communication in written and oral reports
                 Professionalism, including: patient care and management in teams (work habits),
            independent learning, personal characteristics, and commitment to medicine
                 Specific procedural skills (see report outlining Competencies Required for Graduation)
Ratified by Education Council 2/18/03

American Board of Surgery-Requirements for Certification in Surgery

Please see the following URL for the complete resource on this topic:
http://home.absurgery.org/xfer/BookletofInfo-Surgery.pdf

ACGME Program Requirements for Residency Education in Surgery
Please see the following URL for the complete resource on this topic:
http://www.acgme.org/acWebsite/RRC_440/440_prIndex.asp

ACGME Surgical Operative Log Program

Tracking Your Operative Experience on the ACGME Surgical Operative Log Program
The Accreditation Council for Graduate Medical Education (ACGME), requires that the following groups of
residents use their system, the ACGME General Surgery, Resident Case Log System, for tracking your
operative experience:

Categorical General Surgery Residents
Urology Residents
Non-designated Preliminary Residents


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Per the ACGME ―The resident experience log is an Internet based case log system utilizing CPT codes or ICD-
9-CM codes (ICD-9) to track resident experience. The Residency Review Committees have indexed these
codes into categories for evaluation. Any valid CPT or ICD-9 code can be entered in the application but only
those codes the RRC has selected will be evaluated for experience. This application was designed to allow
residents to enter procedures on a regular basis at their convenience. Entry can be done from any PC
connected to the Internet. The site is secured by encryption certificate obtained through the VeriSign
Corporation.‖

Your operative log will be monitored by the Program Director, Dr. Maddaus, and the Surgical Education
Council and it is reviewed with you at your biannual evaluation meetings.

Getting Started on the Resident Case Log System
Using your Internet-browser, go to the ACGME homepage at www.acgme.org. From the left column select--
Data Collection Systems, Resident Case Log System, Login.
Your User ID and Password is your X500 for both, an example is:
User ID-johns756
Password-johns756

If you would like to change your password click on the Change Password box on the log in page.
Please refer to the Data Entry Manual in the Help section for additional information. Please call me, 612-625-
6483, or email me if I can provide you with any additional information or if you have any problems with this
system.
Note some recent changes to operative log requirements:
Requirement for Endoscopy Numbers
Laparoscopy
Basic: 60 total cases
Cholecystectomy
Appendectomy
Advanced: 25 total cases
Lap, Gastrostomy and Feeding Jejunoscopy
Lap, Inguinal and Incisional Herniorrhaphy
Bariatric Laparoscopy
Lap, Anti-reflux Procedure
Lap, Enterolysis
Lap, Small and Large Bowel
Lap, Renal and Adrenal surgery
Lap, Donor Nephrectomy
Lap, Splenectomy
Endoscopy: 85 total
Upper endoscopy, including percutaneous endoscopic gastrostomy: 35 procedures
Colonoscopy: 50 procedures

Requirement to Pediatric Numbers
Pediatric Appendectomy6
Pediatric Hernia 8
Total Pediatric cases 20

You must be familiar with the ACGME operative log requirements located at
http://www.acgme.org/acWebsite/RRC_440/440_info.asp

Credit roles for Surgery Residents

Only one resident may take credit as surgeon for each operation and only for one procedure in a multi-
procedure operation. On same patient/same day/same operation a senior resident may take credit as surgeon
while another resident takes credit as a First Assistant, or a senior resident may take credit as a Teaching
                                                     143
Assistant while a more junior resident takes credit as a surgeon SC = Surgeon Chief Year (only cases credited
as surgeon during 12 months of Chief Year)
J = Surgeon Junior Years (all cases credited as surgeon prior to Chief Year) TA = Teaching Assistant (more
senior resident working with junior resident who takes credit as surgeon) FA = First Assistant (any instance in
which a resident assists at an operation with another surgeon---an attending or more senior resident---
responsible for the operation)

Critical Care Cases
Select the patients who best represent all the essential aspects of intensive care unit management. Each
resident is to develop a Critical Care Index Case (CCIC) log of at least 20 patients who best represent the full
breadth of critical care management. At least two out of the seven categories listed below should be
applicable to each chosen patient. The completed CCIC log should include experience, with at least one
patient, in all seven of the following essential categories.
You must enter such cases in the SOL system and on the log at both the SC & SJ level. Please make sure
you have entered cases for all areas, do not miss 99199-multible organ trauma no operation required.

Must report Critical Care experience for all areas as both SC and SJ, and 1 pt with all options
Multi Organ Trauma-No Operation Required
Must report both SJ & SC experience with Sentinel Lymph Node Biopsy SLN Breast code # 38525B

You must meet or exceed all Defined Category Numbers

Surgery Research Resident Manual
Please see the following URL for the complete resource on this topic:
http://www.surgery.umn.edu/prod/groups/med/@pub/@med/@surg/documents/asset/med_asset_241168.pdf

Residency Management Suite

To use Residency Management Suite:
You will need to use an IBM compatible computer.
   1. To access RMS, open your Internet browser to access RMS.
        Website: www.new-innov.com/login.htm
         Institution’s login: mmcgme
         Username: user specific
   2. Password: user specific
      **If you do not remember your username and/or password, contact the Surgical Education Office,
     Michelle Lunden directly at 612-626-2590 or the Surgical Administrative Center RMS coordinator, at 612-
     626-4959.
   3. It is highly recommended to bookmark this page. By doing that, you will not have to enter mmcgme
       every time.
   4. Once in the system, you will see a menu on the top of the screen for your options. Under Main choose
       Duty Hours. Once to the Duty Hours main page there will be a bold header saying Logging Hours.
       Click on the My Duty Hour link under that. On this screen you will see 4 Data Entry Views to choose
       from. PLEASE NOTE: You can choose whatever method you want; however, it has been found that
       the Graphical entry screen is the best for your specific specialty. Because of this, only directions on
       Graphical and Vacation/Leave are outlined below.

           A. Graphical
               The screen that RMS defaults to is the graphical data entry screen. Pick the day to log hours
               off the calendar then click the continue button. From this screen you will see the full week
               around the day you picked. Choose the appropriate Assignment Definition from the drop
               down box and fill in duty hours by color coding the daily hours. You can fill in multiple days
               and multiple assignments all on one screen. Click on save when done. You can also edit in
               bulk here if changes need to be made to past assignments. This will be used most often to
               log hours after they have happened.
                                                      144
           D. Vacation/Leave
                This screen allows you to pick the correct Time Away designation to track vacation and leave.
                Make sure you have the correct Assignment Definition chosen and then simply click on the first
                day of vacation in the first calendar and the last day of vacation in the second calendar. There
                are five different Vacation/Leave Assignment Definitions.
                        1. Time Away-Does NOT Extend Training-Short
                                This Assignment Definition should be chosen if you will be gone for 14 days or
                        less.
                        2. Time Away-Does NOT Extend Training-Short-Education
                                This Assignment Definition should be chosen for approved Academic Leave time.
                        3. Time Away-Does NOT Extend Training-Short-Holiday
                                This Assignment Definition should be chosen for approved Holiday Leave time.
5.      Once hours have been logged on the system, it is important to make sure no conflicts and that all hours
are approved. To do this scroll over My Duty Hours and click on Approve My Hours. You can also click on
the blue Approve Existing Hours link on the main Duty Hour page. After picking the appropriate date range
the only hour that will show up are hours either not approved or in conflict (these will be marked with an
asterisk). To clear up conflicts either edit the entries or mark the incorrect one with Did Not Work. Make sure
to approve all hours worked with Approve Selected Entries.
6.      Make sure to logout of the system until you are ready to log more hours.


Resident Duty Hours in the Learning and Working Environment

Duty Hour Policy, GME: http://www.med.umn.edu/gme/residents/instpolicyman/genpolprocdutyhrpol/home.html

Residency Management Suite (RMS) Updating and Approving Assignments and Hours in Duty Hour Module of
RMS, GME
http://www.med.umn.edu/gme/residents/instpolicyman/genpolprocrms/home.html

Principles
The program must be committed to and be responsible for promoting patient safety and resident well-being
and to providing a supportive educational environment.
The learning objectives of the program must not be compromised by excessive reliance on residents to fulfill
service obligations.
Didactic and clinical education must have priority in the allotment of residents’ time and energy.
Duty hour assignments must recognize that faculty and residents collectively have responsibility for the safety
and welfare of patients.

Fatigue
Cab vouchers available for any trainee who feels or is deemed by another that they are too impaired to drive
safely home. Click here for the Cab Voucher policies for UMMC-FV and HCMC.
Faculty and residents must be educated to recognize the signs of fatigue and sleep deprivation and must adopt
and apply policies to prevent and counteract its potential negative effects on patient care and learning.

Duty Hours (the terms in this section are defined in the ACGME Glossary)
Duty hours are defined as all clinical and academic activities related to the program; i.e., patient care (both
inpatient and outpatient), administrative duties relative to patient care, the provision for transfer of patient care,
time spent in-house during call activities, and scheduled activities, such as conferences. Duty hours do not
include reading and preparation time spent away from the duty site.
Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house
call activities.
Residents must be provided with one day in seven free from all educational and clinical responsibilities,
averaged over a four-week period, inclusive of call.
                                                         145
Adequate time for rest and personal activities must be provided. This should consist of a 10-hour time period
provided between all daily duty periods and after in-house call.

Reporting Duty Hour Violations, GME
In accordance with the Institution Duty Hour Monitoring Policy trainees concerned about continuous duty hour
violations by their program can contact the Designated Institution Official or send a confidential email to
gmedhv@umn.edu

Supervision of Residents

Supervision Policy, GME
http://www.med.umn.edu/gme/residents/instpolicyman/genpolprocsupervision/home.html

University of Minnesota Department of Surgery
Resident Supervision Policies and Procedures
Effective July 1, 2011
Policy Overview
This document summarizes the University of Minnesota Department of Surgery (DOS) policies and procedures
regarding resident supervision. These policies are designed to be 100% compliant with the 2011 ACGME
Program Requirements. It is mandatory that all residents and faculty understand and uphold these policies at
all times.
Levels of Supervision
      Direct Supervision: supervising physician is physically present during the procedure/encounter.
      Indirect Supervision: supervising physician is available by phone, text, or pager to be able to provide
        Direct Supervision
      Oversight: supervising physician reviews the procedure/encounter at a later time and provides
        feedback after care is delivered.

Principles of Supervision of All Residents (PGY-1 to PGY-5)
All residents are supervised by an identifiable, credentialed, and privileged attending surgeon faculty who is
ultimately responsible for that patient's care. This information is readily available to residents, faculty
members, and other health care professionals at each hospital. Additionally, every patient is apprised of who
this attending is upon admission to the hospital. Typically, this information is available to the patient with
complete information about the care team at the facility (resident, fellow, faculty, nurse, etc.) This also clarifies
the roles of each member of the care team for the patient. Attending call schedules are available through the
hospital operators. Additionally, most sites have attending call schedules available on line. Direct Supervision
is provided in the operating room for all residents when performing cases at our training institutions.

Guidelines for Specific Circumstances and Events
The University of Minnesota Physicians faculty practice has established guidelines for when attending
physicians are to be notified about patient care issues. While not all-inclusive, residents are also expected to
contact attending staff for other issues as needed. Each resident is provided a card listing the guidelines to
attach to his/her identification badge as a reminder. Additionally, the UMMC SICU rotation has a similar card
as noted below. Residents are required to notify attending staff specifically for the following indications.
University of Minnesota Physicians Surgery Attending Physician Notification Guidelines
     Admission to the hospital
     Transfer to ICU or higher level of care
     Unanticipated intubation or ventilator support
     Development of new significant neurological changes (e.g. CVA, seizure, new onset of paralysis, acute
        decline in level of consciousness)
     Development of new significant cardiac changes (e.g. CODE, serious arrhythmia, PE, hemodynamic
        instability)
     Development of major wound complications (e.g. dehiscence or evisceration)
                                                         146
      Medication or treatment errors requiring clinical intervention (e.g. invasive procedures, increased
       monitoring, new medications except Narcan)
      Unanticipated blood transfusion without prior attending knowledge or instruction (before or after
       operation)
      Development of any clinical problem requiring an invasive procedure or operation
      Patient, family, or clinical staff request for attending notification
      Death

UMMC SICU Rotation ―When to Call the Attending‖ Card
    Any new admission
    Pulmonary Issues
    Hypoxia
         o No response to FIO2 > 60%
         o Any new intubation
    High airway pressures
    Respiratory arrest
    Cardiovascular arrest
    New symptoms or evidence of myocardial ischemia or worsening of chronic angina
    Evidence of left ventricular failure or fluid overload not responsive to a first attempt at diuresis
    Hypotension
         o Refractory to fluid administration (how much is your judgment)
         o Need to start a pressor
    Need to place a pulmonary artery catheter for volume (preload) or cardiac pump (contractility) status
    Dysrhythmias
         o Sinus tachycardia unresponsive to fluids
         o Bradycardia
         o Tachydysrhythmias (atrial fibrillation, flutter, etc.)
    Escalation of antihypertensive therapy (i.e. starting a drip)
    Significant decline in renal function including oliguria unresponsive to fluid resuscitation, or rise in
      BUN or creatinine
    Significant change in neurological status or new seizure activity
    Any death (unless planned comfort care)
    Other Issues
    Inability to resuscitate
    Any time you are uncertain or need help
    Major change in course
    Remember Airway, Breathing, Circulation (i.e. stabilize the patient)
    Formulate a plan before you call
    Use other resources (residents/interns) in the hospital if needed
    Additional thoughts
         o It is better to be aware of a problem than discover it during rounds
         o More minds working a problem consider more solutions
    Attending staff are with you and want to help


We recognize that starting this academic year, particular levels of residents require more strict attention and
accountability for activities within our hospital systems, especially as this pertains to procedural skills. We are
                                                        147
keenly aware of this and in fact, in a proactive way, have been functionally utilizing our SimPORTAL curriculum
with this exact paradigm in mind for several years. This year, we have formally introduced a supervision policy
as it relates to the new requirements in this area.


PGY-1: Indirect Supervision
PGY-1 residents may be indirectly supervised for the following. Supervision will be by senior members of the
resident teams, fellows, or attending faculty. Direct supervision may be appropriate depending on the
resident's level of proficiency. The basic competencies that are addressed below are introduced in a
structured way as part of our PGY-1 bootcamp experience. Taken together, supervision occurs during daily
rounds and other reporting structures currently in place:
    1. Patient Management Competencies
            a. evaluation and management of a patient admitted to hospital, including initial history and
                physical examination, formulation of a plan of therapy, and necessary orders for therapy and
                tests
            b. pre-operative evaluation and management, including history and physical examination,
                formulation of a plan of therapy, and specification of necessary tests
            c. evaluation and management of post-operative patients, including the conduct of monitoring, and
                orders for medications, testing, and other treatments
            d. transfer of patients between hospital units or hospitals
            e. discharge of patients from the hospital
            f. interpretation of laboratory results
    2. Procedural Competencies
            a. performance of basic venous access procedures, including establishing intravenous access
            b. placement and removal of nasogastric tubes and Foley catheters
            c. arterial puncture for blood gases

PGY-1: Direct Supervision

Until competency is demonstrated, PGY-1 residents require direct supervision for the following. In each
situation below, PGY- 1 residents know to alert more senior residents (or attendings) who are expected to
supervise patient care and who’s role on the care teams is to provide care in these situation. For example,
patients with hypotension, oliguria, cardiac arrhythmias, etc. are cared for in the intensive care units. The ICU
teams are led by PGY-2 residents or above.
    1. Patient Management Competencies
            a. initial evaluation and management of patients in the urgent or emergent situation, including
               urgent consultations, trauma, and emergency department consultations (ATLS required)
            b. evaluation and management of post-operative complications, including hypotension,
               hypertension, oliguria, anuria, cardiac arrhythmias, hypoxemia, change in respiratory rate,
               change in neurologic status, and compartment syndromes
            c. evaluation and management of critcially-ill patients, either immediately post- operatively or in the
               intensive care unit, including the conduct of monitoring, and orders for medications, testing, and
               other treatments
            d. management of patients in cardiac or respiratory arrest (ACLS required)
    2. Procedural Competencies
            a. carry-out of advanced vascular access procedures, including central venous catheterization,
               temporary dialysis access, and arterial cannulation
            b. repair of surgical incisions of the skin and soft tissues
            c. repair of skin and soft tissue lacerations
            d. excision of lesions of the skin and subcutaneous tissues
            e. tube thoracostomy
            f. paracentesis
            g. endotracheal intubation
                                                       148
           h. bedside debridement

Methods for Determining Progression from Direct to Indirect Supervision
    PGY-1 Orientation Bootcamp and Simulation Skills Pre-Test
    PGY-1 Simulation Skills Post-Test
    PGY-1 Onsite Faculty Evaluation
    Competency Passport: Residents will carry a booklet (Passport) that contains the competencies
      where documentation is required prior to being able to perform the procedure with indirect supervision.

The Accreditation Council for Graduate Medical Education (ACGME), through the Residency Review
Committee for Surgery (RRC), requires that ―programs must set guidelines for circumstances and events in
which residents must communicate with appropriate supervising faculty members…‖ and that programs ―must
define those physician tasks for which residents must be supervised directly until they have demonstrated
competence as defined by the program director, and must maintain records of such demonstration of
competence.‖
The Surgical Education Council approved a revised supervision policy, and a method of documenting resident
competency for 24 basic patient care tasks. We are using what we call a ―Passport‖ approach to
documentation. For now, this means a little booklet that each resident carries in his or her coat pocket.

Surgery Resident Supervision and Procedure PASSPORT

Patient Management Tasks
     Emergent or urgent general surgery consultation, including ED evaluation
     Trauma patient evaluation
     Post-op complications: hypotension
     Post-op complications: hypertension
     Post-op complications: respiratory dysfunction (hypoxemia, change in respiratory rate)
     Post-op complications: change in neurologic status
     Post-op complications: CODE Blue
     Renal dysfunction (loguria or anuria)
     Cardiac arrhythmia
     Compartment syndrome
     ICU management: initial evaluation and treatment of a critically ill patient

Patient Management Procedures
     Central venous catheterization
     Arterial line placement
     Pulmonary artery (Swan Ganz) catheterization
     Surgical incision closure: skin
     Surgical incision closure: fascia
     Laceration repair: simple
     Laceration repair: complex (flap, V shaped, stellate, etc.)
     Excision of a skin lesion
     Chest tube placement
     Paracentesis
     Endotracheal intubation
     Bedside debridement of necrotic wound
     Incision and drainage of simple cutaneous abscess




                                                      149
On-Call Schedules
On-call schedules are located on AMION at http://amion.com
If you are on-call the night before you begin a new rotation you must inform the education office that will be
creating your call schedule, so that you are not placed on call back to back.
Resident days off, during which they are free of all responsibilities, should be built into the specific call
schedules for each site. Thus, each resident will know specifically which days they are to have off, without
exception. This allows us to formalize days off for each resident and it also permits us to track compliance with
this RRC requirement.
Clearly some flexibility is required because of the demanding and variable nature of the surgical services. The
RRC recognizes this and that is why it is stated that residents have 1 day out of 7 free, on average. Therefore,
this policy should not be construed as a mandatory weekly day off, but one that provides on average, 1 day out
of 7 free.

University of Minnesota Department of Surgery Transition of Care Guidelines


Rationale:
Consistent with the Vision of the University of Minnesota Department of Surgery, we are driven to deliver
clinical excellence, compassionate patient care, and education of surgical leaders. In order to provide optimal,
safe care for our patients and an appropriate training environment for surgical residents, the process of
transitions of care must be addressed in a formal and standardized manner. We are faced with a growing
body of literature on safety in patient sign-outs, along with mandates for standardization from regulating bodies
(ACGME, JCAHO). Further, the 2011 duty-hour requirements have led to restructuring of PGY-1 call coverage,
resulting in more frequent transitions of care, oftentimes between two individuals who are not part of the
patients’ regular care team. The effective execution of transitions of care is of substantial importance.


Objective:
The overall objective of this proposal is to develop a standardized process of handing off care of patients on
inpatient services covered by residents of the University of Minnesota Department of Surgery. This proposal
should be evidence-based with an emphasis on patient safety, should meet ACGME and JCAHO requirements
for standardization of the sign-out process, should take into account the unique cultural as well as systems-
based issues of the residency program and hospital services involved, and should provide absolute clarity to
residents and other members of the health-care team as to what information should be transmitted verbally
and in writing as well as the details of the process by which this should be accomplished.


Specific Goals:
   Develop a set of expected behaviors surrounding the sign-out process for all inpatient surgical services
    covered by our resident body, to be followed by all trainees as well as mid-level providers involved in the
    handoff of such patients
   Establish a list of required data points which must be present on all written sign-out lists
   Establish a list of required pieces of information that must take place as part of the verbal exchange in
    handing off patients as well as upon resumption of care by the primary service
   Provide recommendations for additional suggested behaviors which are highly encouraged to be a part of
    the sign-out process
Proposed Guidelines (See Appendix A on page 151 for Concise Overview of Sign-out Guidelines)


Behaviors:
                                                        150
   Sign-out must be an active process, including a written and verbal component, 100% of the time. Face-to-
    face discussions are strongly encouraged, with reasonable exceptions. One such example includes the
    circumstance in which the resident receiving sign-out is scrubbed into an operation; in this case, the
    individual signing out should bring the list to the operating room with a clear plan for verbal telephone
    communication. Lists should never be left on patient wards, resident workrooms, etc. It is the
    responsibility of the individual signing out to bring the list to the covering resident. These expectations
    should be maintained regardless of whether the individual signing out is a PGY-1 resident, an upper-level
    resident, or a PA/NP. Triggers for absolute face-to-face sign-outs include, but are not limited to: patient
    instability, complex patients requiring detailed collaborative review of data, and large services with a
    number of ongoing issues. In these circumstances, a face-to-face encounter must occur, even if it requires
    breaking scrub.
   Sufficient time allotment for the sign-out process is a significant predictor adequacy of information
    exchange. Individual discretion is highly encouraged, with some variability anticipated based on the status
    and size of the service list. It is expected that individuals on either the receiving or providing end of the
    information will actively participate until both parties feel comfortable that the pertinent points have been
    appropriately addressed.
   Prioritization should be given to the sickest patients, including threshold and plans for escalation of care. In
    circumstances where it will provide the best continuity of care for sick patients, the two parties are
    encouraged to review patient data, imaging, and/or exam findings together. Examples may include co-
    examining a patient receiving serial abdominal exams, demonstrating the expected Doppler findings on a
    patient with concerning graft patency, etc.
   The ―chain of command‖ must clearly be identified, along with provision of pertinent contact numbers.
   Junior and Chief residents are highly encouraged to provide lateral communication to their peers at the
    same level of training regarding sick or unstable patients, so that the entire coverage team is aware and on
    board with plans.
   The primary service should provide communication to all patients during afternoon/evening rounds
    regarding nighttime coverage. Patients should be told who is on call and assured that the on-call team will
    be familiar with their cases and active issues.
   Poor prioritization of numerous signed-out tasks can be a cause for unsafe patient care. PGY-1 residents
    covering multiple services with a number of ―to-do‖ items are encouraged to review their prioritization plans
    with the junior resident in-house. It is expected that the junior resident will readily assist the PGY-1
    resident in this developing such prioritization plans when needed or requested.
   Each morning, it is expected that the primary team will contact the post-call individual to ask about any
    overnight events by 7 am. This exchange is expected to be verbal and can occur via the telephone. The
    post-call individual is also highly encouraged to proactively alert the primary service of any major events
    overnight; however, it is remains the responsibility of the primary team to contact the post-call individual
    every day.
   Chief residents are encouraged to help PGY-1 residents in identifying additional service-dependent
    components that may be useful as part of the sign-out.
   All residents are encouraged to provide feedback regarding the sign-out process to the Administrative
    Residents. The guidelines and expectations for sign-out can and will be adjusted based on feedback from
    the resident body and the continuously changing needs of the systems in which we care for patients.




Required elements of the written sign-out list:


                                                        151
The written sign-out list for all services covered by surgical residents must include all of the following elements.
The structure, format, and software used may have some flexibility at the discretion of the specific service;
however, standardized templates for each rotation site are currently underway.
      Patient name
      Patient MRN
      Patient sex/age
      Patient location
      Attending surgeon
      Diagnosis
      Operative procedure(s) and date(s)
      Focused PMH
           o Examples of key elements: diabetes, CAD, dialysis dependence, etc.
      Focused medications
           o Antibiotics and what they are being treated for
           o Anticoagulants
           o Beta blockers
           o Diuretics
           o Any other meds that may affect management of acute issues overnight
      Tubes/drains/lines
      Active issues/complications
           o Active issues should be listed on the written sign-out and individually discussed in terms of
               status and overall plan for each issue during the verbal exchange.
           o Surgical patients are presumed to be full code in the perioperative period; thus, it will be
               expected that if a patient has DNR/DNI status, comfort care, etc., this will be noted as an active
               issue
      Things to do, including pending labs and studies and who should be informed of result and when, and if
       they want to know results even if they are normal
      Chain of command for patients on the service (Is the service covered by the chief on call, or by a
       fellow? If a fellow, which fellow? Are all attendings covering their own patients, or is one attending on
       call for everybody? Contact numbers for attendings must be on the list.)
      Identification of the member of the primary team who will be receiving sign-out and rounding on the
       service the following morning, particularly on weekends/holidays
      Any additional service-dependent pieces of information (such as immunosuppression for transplant
       patients, EF for cardiac patients, etc.)


Required elements of the verbal exchange:
      A description of each patient, tailored to the acuity of the individual patient’s status
      Identification of active problems for each patient, along with current management and ongoing plan for
       each of those active problems. Note that these items should be present on the written list as well as
       addressed during the verbal exchange.
      Identification of any pending studies or tests
      Identification of any pertinent social issues relating to patient and family communication
      Review of tasks that are being signed out



                                                        152
        Information pertaining to any planned admissions to the service or patients who are expected to visit
         the emergency room, known plans for such patients, and who should be called after the patient has
         been seen/admitted


Ongoing plans for development, improvement, and education regarding these Guidelines:
        To develop a standardized written format for the sign-out list at each hospital/rotation site
        To receive feedback from the resident body regarding the sign-out process and to revisit and revise the
         established guidelines as needed
        To study the impact of the new sign-out procedure upon resident comfort, clarity of expectations, and
         perceptions of patient safety, for the purposes of systematic improvement as well as scholarly activity
        To educate incoming PGY-1 residents regarding the sign out procedure, through involvement in the
         orientation sessions


Members of the 2011 Communications Committee:
Mara Antonoff, Elizabeth Berdan, Christopher Holley, Varia Kirchner, and Tara Krosch


References used in creating these guidelines:1-3


1.       Gakhar B, Spencer AL. Using Direct Observation, Formal Evaluation, and an Interactive Curriculum to
         Improve the Sign-Out Practices of Internal Medicine Interns. Academic Medicine. Jul 1
         2010;85(7):1182-1188.

2.       Kemp CD, Bath JM, Berger J, et al. The top 10 list for a safe and effective sign-out. Arch Surg. Oct 1
         2008;143(10):1008-1010.

3.       Clark CJ, Sindell SL, Koehler RP. Template for success: using a resident-designed sign-out template in
         the handover of patient care. J Surg Educ. Jan 1 2011;68(1):52-57.




Appendix A: Concise Overview of Sign-out Components

              Written Sign-out List                               Verbal Exchange
        Name                                             Describe each patient
        MRN
                                                          Identify active problems, with current
        Sex/Age                                           management and ongoing plan for
                                                           each problem
        Location
        Attending                                        Pending studies/tests
        Dx                                               Review tasks being signed out
        Operation(s) & date(s)                           Planned admissions
        Focused PMH                                      Expected communications up chain of
        Focused meds                                      command


                                                        153
      Tubes/drains/lines
      Active issues
      Things to do
      Chain of command



Regions PGY-1 Call System to begin 11/14/11

Current Dilemmas:
    16-hour work rule requires days off both pre- and post-call
    Pre- and post-call days off result in time away from service, causing fragmented rotational experience
       for PGY-1 residents
    PGY-1 time away negatively impacts team dynamics, continuity of care, and work flow for other team
       members

Goals:
    To minimize fragmented nature of PGY-1 rotational experience
    To provide residents and faculty with a re-formatted call schedule in which PGY-1 residents will have
       predictable days away due to pre/post-call circumstances
    To optimize continuity of care for patients
    To maximize educational experience for PGY-1 residents on service

Proposed format:
    Modified version of UMMC block schedule, in which PGY-1 residents take all of their night call for the
      month in a consecutive block, thereby resulting in 5 days of night call, with one pre-call day off at the
      beginning and one post-call day at the end. This results in the same number of nighttime calls, with
      approximately half as many days away from the hospital.
    SICU PGY-1 resident to cover day call Q Saturday, without any nighttime shifts.
    Blocks will be continuous, including all nights but Saturday night; Saturday nights will be divided up
      separately. Friday and Sunday nights are incorporated into the blocks, because Friday night call
      requires Friday day-time off, and Sunday night call requires Monday day-time call.
    Note that blocks cannot be longer than 5 consecutive nights—this is mandated by the ACGME.
    Monday-Thursday call hours: 5 pm – 6 am. Post call individual may stay up to 16 hours for post call
      activities. This individual should have a 10 hour break between shifts, and at least 8 hours is a must.
    Friday call hours: 5pm to 7 am
    Saturday call hours: 7 am to 7 pm, and 7 pm to 7 am
    Sunday call hours: 7 am to 7 pm, and 7 pm to 6 am

Call Schedule Procedure 2011-2012

UMMC:
The 3rd year on Surg Onc will make both the Junior and Intern schedules. Both of these schedules should be
sent to the 3 UMMC Chiefs for review, and approval from the Surg Onc chief will be required prior to sending
the tentative schedule to Varia and Mara via email.

For intern night float at the U, the intent from the onset was to have an individual do all of their weeknight nigh
float shifts in a SINGLE block for the month rather than fragmented over several weeks. So, for example, with
6 interns, if you take the Saturday day, Saturday night, and Sunday day shifts out of the picture, which leaves
about 27 night float shifts for the month. Divided among 6 interns, that gives each person about 4-5 night float
shifts. So the first person is on Sun, Mon, Tues, and Wed nights. The next person is on Thurs, Fri, Sun, and
Mon. The next person is on Tues, Wed, Thurs, and Friday. The next person is on Sun, Mon, Tue, Wed, and
                                                        154
Thurs. Etc. The Saturday day shifts, Saturday night shifts, and Sunday day shifts are then distributed
equitably. If one person ends up with 4 nights and another ends up with 5, this will be taken into consideration
with regard to the distribution of the weekend day shifts. However, all attempts need to be made to do this in a
fair manner.

Also, the Surg Onc chief and junior must alternate weekends in order to allow appropriate weekend service
coverage.

(UMMC Peds is an exception--the senior on Peds will make the call schedules for the individuals on this
service.)

Regions:
The 3rd year on Burn will make the Junior and Intern call schedules. These should be sent to the Chiefs on
General Surgery and TACS, with approval from the TACS chief required prior to sending the tentative schedule
to Varia and Mara via email.

VA:
The VA Chief will make both the Junior and Intern call schedules, and then send it to Varia for publication.

Methodist:
The fourth-years will continue to delegate one senior resident for each period to make the call schedule. A
tentative schedule should be approved by the other fourth-years prior to sending to Varia for publication.

Deadlines/Timing:
The tentative schedule must be sent to Varia (kirc0079@umn.edu) and Mara (antonoff@umn.edu) by the 1st
of the month, one month prior, at the absolute latest. (For example, the July schedule MUST be sent to Varia
NO LATER than June 1.) After posting of the schedule, requests for changes/switches, regardless of the
reason, should be sent to one of the Administrative Residents (Jenny or Mara). After the 15th of the month, no
requests will be taken for any changes or switches, with exceptions made only for significant unexpected
events (interviews, funerals, etc.).

Moonlighting Policy, GME
http://www.med.umn.edu/gme/residents/instpolicyman/genpolprocmoonlighting/home.html


General Surgery Resident Rotation Dates for 2011-2012
PGY-1
June 20, 2011 through June 18, 2012
6/20/11-7/24/11       5wks
7/25/11-8/21/11       4wks
8/22/11-9/18/11       4wks
9/19/11-10/16/11      4 wks.
10/17/11-11/13/11     4 wks.
11/14/11-12/18/11     4 wks.
12/19/11-1/16/12      4 wks.
1/1712-2/20/12        4 wks.
2/21/12-3/25/12       4 wks.
3/26/12-4/22/12       4 wks.

                                                       155
4/23/12-5/20/12      4 wks.
5/21/12-6/18/12 at 8:00 am 4wks


VA/UMMC Orthopedic Rotation Dates
6/20/11-8/7/11            12/19/11- 2/5/12
8/8/11-9/18/11            2/6/12 – 3/25/12
9/19/11-10/30/11          3/26/12 - 5/6/12
10/31/11-12/18/11         5/7/12 - 6/18/12

PGY-2
July 1, 2011 through June 30, 2012
7/01/11-8/14/11      6 weeks         2 days
8/15/11-9/25/11      6 weeks
9/26/11-11/13/11     7 weeks
11/14/11-1/01/12     7 weeks
1/02/12-2/12/12      6 weeks
2/13/12-3/25/12      6 weeks
3/26/12-5/13/12      7 weeks
5/14/12-6/30/12      6 weeks      6 days
PGY-3
July 1, 2011 through June 30, 2012
7/01/11-8/28/11      8 weeks      2 days
8/29/11-10/30/11     9 weeks
10/31/11-01/01/12    9 weeks
01/02/12-03/04/12    9 weeks
03/05/12-05/06/12    9 weeks
05/07/12-06/30/12    7 weeks      5 days
PGY- 4
June 19, 2011 through June 14, 2012
Long                                          Short
6/19/11-12/18/11                              6/19/11-8/21/11     9 weeks
25 weeks                                      8/22/11-10/23/11    9 weeks
12/19/11-6/14/12                              10/24/11-12/18/11   8 weeks
26 weeks    3 days                            12/19/11-2/19/12    9 weeks
                                              2/20/12-4/22/12     9 weeks
                                              4/23/12-6/14/12     7 weeks   4 days
PGY- 5
                                                       156
June 19, 2011 through June 15, 2012
6/19/11-8/21/11       9 weeks
8/22/11-10/23/11      9 weeks
10/24/11-12/18/11     8 weeks
12/19/11-2/19/12      9 weeks
2/20/12-4/22/12       9 weeks
4/23/12-6/15/12       7 weeks        5 days


3/29/2011




ABSITE Performance Standards Department of Surgery Policy


Starting in 2008-09 and the 2009 ABSITE, the Department is enforcing a new policy regarding performance.
This policy is as follows:

      Scoring below the 30th percentile (Total Test Score) on the ABSITE for the first time places a resident at
       risk for academic probation. The at-risk status is removed if the resident’s subsequent year’s
       performance exceeds the 30th percentile.

      Scoring two times in a row below the 30th percentile results in automatic academic probation. The
       probationary status is removed from the resident’s file if the subsequent year’s performance exceeds
       the 30th percentile.

      Scoring below the 30th percentile for a second time in three or more years, after one or more years of
       improved performance, places the resident back in the at-risk status for academic probation.

      Scoring three times below the 30th percentile (either sequentially or intermittently), despite attempts at
       remediation, and in combination with poor performance in other areas, places a resident at risk for
       dismissal from the program. The ABSITE score will never constitute the sole criterion for promotion
       decisions or dismissal, however it has been shown to be a valid predictor of performance on the written
       ABS board exam, and as such will be taken very seriously in determining satisfactory progress towards
       graduation.

      Residents at-risk for academic probation, and those on probation due to their performance on the
       ABSITE, are required to participate in remediation as directed by the Department.

      Residents who are at risk or on academic probation during any year they are scheduled for the
       research lab will have their moonlighting privileges significantly reduced or removed. Privileges will be
       regained if performance on the subsequent year’s ABSITE exceeds the 30th percentile.




Communication Policy

                                                      157
1.     All general announcements and information will be disseminated via email.
2.     Residents/Fellows are required to maintain an active email address and access it at least weekly.
3.     Resident/Fellows may use a personal email address in lieu of their University X.500 address but must
       forward their University address to their personal address.


Grand Rounds Compliance
1. Attendance at Grand Rounds is monitored and each resident must attend Grand Rounds and Core
Curriculum.
2. Promotion to the next year of training is predicated upon documented attendance at ≥ 70 percent of Grand
Rounds sessions during the academic year.
3. Attendance at Grand Rounds is mandatory for all General Surgery Residents at all training sites, including
those participating in research endeavors, as it is critical for their training. The only exceptions are those
residents who are on call the evening prior at non-UMMC sites, any trainees involved in emergent patient care,
and residents on vacation.

Dress Code Policy
All Department of Surgery Residents and Fellows will comply with the University of Minnesota, Medical School,
Graduate Medical Education Committee Dress Code Policy listed below.
In addition, all Department of Surgery Residents and Fellows will dress appropriately such that while attending
conferences and when participating in all training activities shirts/ties and business attire are worn. Post call
residents must be neatly groomed and clean.

Dress Code Policy
Please see the following URL for the complete resource on this topic:
http://www.med.umn.edu/gme/residents/instpolicyman/genpolprocdresscode/home.html


UMMC On Call Rooms
University of Minnesota Medical Center has 18 on-call rooms located on the 4th floor of the Mayo building. All
rooms have punch code security access which is changed daily and contain a desk, TV, clock radio, and air
conditioning, with a security monitor on duty from 2:00 pm-8:00 am. On-call Residents, on-call Medical
Students, on-call fellows, on-call attending physicians and certain on-call hospital staff are eligible to check-in
to a call room. Check-in can only occur during the designated check-in hours of 2:30 pm until 7:00 am. To
check-in, go to the check-in desk located in the Resident Lounge (Mayo C-496). The check-in desk is staffed
by a security monitor during set hours 7 days/week and will require you to present your hospital ID badge. The
security monitor will assign you a room and give you the access code along with the locker room and lounge
access codes. All individuals must be out of their rooms by 8:00 am. Housekeeping will come to begin
cleaning by 7:00 am. If you wish to sleep until 8:00 am, make sure your DO NOT DISTURB sign is indicated
on your door. No room is checked out to the same service two days in a row. Belongings left in room past
noon will be removed and kept in a security locker. Belongings can be picked up any time after 2:30 pm from
the security monitor.

UMMC General Surgery Resident/Fellow Workroom

The Department of Surgery Resident Workroom is located in 174 & 175 Mayo. The room has punch code
security access, which can be obtained from the Surgical Education Office, and is accessible to surgery
residents 24 hours a day. The room contains a computer and printer with and Internet access. The room also
has built in desks, a phone, and reference textbooks.

UMMC Resident Lounge

The Resident Lounge at the University of Minnesota Medical Center is located in Room 6-501 in Unit J and is
available 24 hours per day for residents from all specialties. The room is accessible by punch code access,
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which is changed weekly, or by open door when security monitor is on duty. TV/VCR, computers, and phones
with access to the main hospital are available. There is also a partially stocked kitchen with refrigerator,
coffee/tea makers, microwave, and toaster.

Support Services
Please refer to the Institution Manual for different services that are offered to Residents and Fellows,
http://www.med.umn.edu/gme/residents/instpolicyman/home.html


Laboratory/Pathology/Radiology Services
Laboratory, pathology, and radiology services are readily available through University of Minnesota Medical
Center. Below is the contact information and location of each of these medical services:

UMMC Diagnostic Laboratories
Mayo Medical Building, Room D-293
420 Delaware Street SE, MMC 198
Minneapolis, MN 55455
Tel: 612-273-7838
Fax: 612-273-0183

Pathology
Pathology Department (also, Pathology Surgical, May Room 422, MMC 76)
Mayo Medical Building, Room C-477
420 Delaware Street SE, MMC 609
Minneapolis, MN 55455
Tel: 612-273-5920
Fax: 612-273-1142

Radiology
Radiology Department (also, Reading Rooms, Registration)
Harvard at East River Road (UH), Room 2-300 (all divisions: MMC 292)
Minneapolis, MN 55455
Tel: 612-273-5690
Fax: 612-273-8954

Interventional CV Radiology, UH-2-300
Tel: 612-273-4220
Fax: 612-273-7500
Radiology Engineering, UH 2-493
Tel: 612-273-6801
Fax: 612-273-6887

Radiology Film Desk Hospital, UH 2-403
Tel: 612-273-5777
Fax: 612-273-7515


Medical Records
Patient records can be accessed either via the UMP Electronic Medical Records (EMR) system as far back as
January 1, 2002, or by calling University of Minnesota Medical Center’s (UMMC) Health Information
Management (HIM) offices at 612-626-3535.
For official medical record retrieval, patients are to contact the UMMC’s HIM offices at:
University of Minnesota Medical Center
                                                       159
ATTN: Release of Information
420 Delaware Street SE, MMC 601
Minneapolis, MN 55455
Tel: 612-626-3535
Fax: 612-273-2345

Security/Safety University of Minnesota Medcial Center
The Security Monitor Program (SMP) is a branch of the University of Minnesota Police Department. SMP
offers a walking/biking escort service to and from campus locations and nearby adjacent neighborhoods. This
service is available completely free to students, staff, faculty, and visitors to the University of Minnesota – Twin
Cities campus. To request an escort from a trained student security monitor, please call 624-WALK shortly
before your desired departure time and walk safe.
Fairview University Medical Center also employes security officers who are on duty 24 hours a day to respond
to emergencies and to escort persons to and from the parking facilities. A security officer is available after 2:20
PM Monday- Friday, you may calltheur offuce at 612-273-4544. If you wish to take the shuttle it runs 7 00 AM-
2:20 PM, Monday Friday every 20 minutes.

Monitoring of Resident Well-Being

Available to all residents is the Resident Assistance Program (RAP). In order to monitor resident stress,
including mental or emotional conditions inhibiting performance or learning, and drug or alcohol related
dysfunction, the University of Minnesota Medical School has contracted with an agency called Sand Creek to
provide services for you or anyone in your family.
Sand Creek’s counselors have particular expertise in dealing with the unique needs of individuals in their
residency training programs. In contacting them, you will receive help in determining the problem, what should
be done, and how to go about it.
Your privacy is a primary concern. That is why an outside firm provides your RAP services. Your counselor
will keep everything strictly confidential. Nothing is disclosed to your faculty or to others without your written
consent.
The RAP services cost you nothing for the initial assessment. Depending on your needs, you may be referred
to outside sources of help. If so, you will receive assistance in finding an appropriate, affordable resource.
Your health insurance does provide portions of coverage for personal counseling, psychiatric care, chemical
dependency and drug treatment.
Whether you have an emergency on your hands or you simply need someone to help you sort things out, there
is help. A counselor will quickly respond to your call. When the Sand Creek’s office is closed, an answering
service will take your call and relay your message. In an emergency, a counselor will contact you immediately.
You may discuss your concerns with a counselor at the Sand Creek Office or a counselor will meet you at your
hospital. The RAP is designed to be flexible and to accommodate your busy schedule.
       Sand Creek
       www.sandcreekeap.com
       610 North Main Street, Suite 200, Stillwater, MN 55082
       Tel: 651-430-3383




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Section 6 Department of Surgery Contacts

Surgical Education Office   Fax: 612-625-4411 Location: 11-145 A-F PWB
Michael A. Maddaus, MD      612-624-9461    madda001@umn.edu          Surgery Program Director
Jeffrey G. Chipman, MD      612-625-7129    chipm001@umn.edu          Surgery Associate Program Director
Jonathan D’Cunha, MD        612-624-9461    dcunh001@umn.edu          Surgery Associate Program Director
Robert D. Acton, MD         612-626-4214    acton002@umn.edu          Surgery Medical Student Director
Connie Schmitz, Ph.D.       612-624-1722    schmi002@umn.edu          Dir of Educational Research & Devel
Niea Johnson                612-626-2590    floyd003@umn.edu          Medical Student Coordinator
Gina Deveney                612-625-3141    deveneyg@umn.edu          Surgery Education Program Coordinator
Cathy Larson                612-625-6483    larso051@umn.edu          General Surgery Residency Coordinator
Michelle Lunden             612-626-2590    lund0538@umn.edu          Resident Education Assistant

Surgery Chairman’s Office Fax: 612-626-0654                           Location: 11-132 PWB
Selwyn Vickers, MD        612-626-1999    vickers@umn.edu             Jay Phillips Professor and Chairman
Bonnie Boucher            612-625-2478    boucher@umn.edu             Executive Administrator

Surgery-Admin Center Contact                Fax: 612-626-0654         Location: 11-132 PWB
Toni Leeth               612-625-1174       leeth002@umn.edu          Surgery Dept. Administrator

Surgery Research                            Location: 11-135 PWB
Lisa Rogers                 612-626-3843    roger031@umn.edu          Research Coordinator

Deputy Chairman’s Office Fax: 612-625-3660 Location: 11-168 PWB
David Rothenberger, MD   612-626-6122    rothe002@umn.edu             Professor and Deputy Chairman
Ann Lavallee             612-626-6122    laval022@umn.edu             Executive Office and Admin




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