PLASTIC SURGERY CURRICULUM by liuqingzhan

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									PLASTIC SURGERY
  CURRICULUM
Table of Contents
Basic Science and Surgery in General .............................page 3
1.     Anesthesia ...............................................................page 5
2.     Burn Surgery ...........................................................page 12
3.     Cardiothoracic ........................................................page 19
4.     Critical Care ............................................................page 27
5.     Emergency Medicine ..............................................page 35
6.     General Surgery ......................................................page 43
       a. Surgical oncology...............................................page 44
       b. Gastrointestinal surgery .....................................page 45
       c. Breast surgery ....................................................page 47
       d. Minimally invasive surgery ...............................page 48
       e. Endocrine surgery ..............................................page 49
7.     Neurosurgery...........................................................page 57
8.     Oral and Maxillofacial Surgery ..............................page 64
9.     Orthopedic Surgery .................................................page 72
10. Otorhinolaryngology ...............................................page 79
11. Pediatric Surgery.....................................................page 87
12. Thoracic Surgery.....................................................page 94
13. Transplant Surgery ..................................................page 103
14. Trauma Surgery ......................................................page 112
15. Vascular Surgery.....................................................page 119
       Plastic Surgery…………………………………….page 128
16. General Principles of Plastic Surgery .....................page 130
17. Plastic Surgery of the Integument ...........................page 153
18. Plastic Surgery of the Head and Neck ....................page 165
19. Plastic Surgery of Hand and Upper Extremity .......page 178
20. Plastic Surgery of the Trunk ...................................page 191
21. Plastic Surgery of the Lower Extremity..................page 202
22. Aesthetic Plastic Surgery ........................................page 211




                                                                                           2
PLASTIC SURGERY
  CURRICULUM

 Basic Science and
 Surgery in General




                      3
Purpose:   The plastic surgery curriculum (goals and objectives) is provided to
           residents and attendings for education and assessment. The curriculum
           not only is an educational tool, but a guide for assessment. Residents
           should utilize the curriculum to direct independent study and self
           assessment. Attendings should utilize the curriculum to direct resident
           teaching and assessment. The curriculum is the tie between education and
           assessment.



Note:      The plastic surgery curriculum is broken down into 7 major sections of
           plastic surgery. Each of the 7 sections is in-turn broken down according to
           the 6 General Competencies

           A.   Medical Knowledge
           B.   Patient Care
           C.   Practice Bases Learning and Improvement
           D.   Interpersonal and Communication Skills
           E.   System Based Practice
           F.   Professionalism




                                                                                    4
ANESTHESIOLOGY




                 5
A.     Medical Knowledge


Goal: The resident will achieve a detailed knowledge of the techniques and practice of
anesthesia.

       Objectives:

       1.     Discuss the preoperative anesthesia evaluation, including the identification
              of risk factors (i.e. chronic lung disease, cervical spine disorder) that is
              critical to the formulation of a safe anesthetic plan.

       2.     Discuss the appropriate use of regional vs. general anesthesia for a given
              patient and given procedure.

       3.     Discuss the indications and contraindications of basic anesthesia
              pharmacology

       4.     Outline the appropriate NPO guidelines for adult and pediatric patients.

       5.     List the indications for and relative contra-indications against regional
              anesthesia.

       6.     Describe the common postoperative pain management modalities
              including epidural anesthesia.

       7.     Discuss the pathophysiology, diagnosis, and management of pain
              syndromes.




                                                                                         6
B.    Patient Care

Goal: The resident will provide patient care that is compassionate, appropriate, and
effective for the treatment of surgical problems.

      Objectives

      1.     Participate in the induction, administration, and emergence of general
             anesthesia.

      2.     Participate in the administration of regional anesthesia, including:

             a.      spinal anesthesia
             b.      epidural anesthesia
             c.      regional blocks

      3.     Perform intraoperative monitoring of patients under anesthesia.

      4.     Manage the complications of general and regional anesthesia.

      5.     Perform effective airway management skills, including:

             a.      mask ventilation
             b.      endotracheal intubation
             c.      laryngeal mask airway
             d.      oral and nasal airways

      6.     Become certified in CPR and ACLS.

      7.     Maintain an airway in an anesthetized, spontaneously ventilating healthy
             patient.

      8.     Perform laryngoscopy and oral intubation in anesthetized patients.

      9.     Set-up and check all necessary anesthesia equipment for a surgical
             procedure.

      10.    Perform arterial catheterization.

      11.    Perform central venous catheterization.

      12.    Perform upper extremity and lower extremity regional anesthesia.

      13.    Participate in the post anesthesia care unit management of patients
             including ventilatory support, pain management, blood pressure control,
             fluid management, monitoring and appropriate time of discharge.



                                                                                    7
C.     Practice Based Learning and Improvement


Goal: The resident will investigate and evaluate his or her own patient care practices,
appraise and assimilate scientific evidence, and improve patient care practices.

       Objectives
       1.     Uses information technology to prepare for cases, bringing to the OR the
              knowledge of current modalities of care and the scientific evidence for
              that care.

       2.     Routinely analyzes the effectiveness of own practices in caring for surgery
              patients.

       3.     Improves own practices in the care of patients by integrating appropriately
              gathered data and feedback.

       4.     Educates medical students and other healthcare professionals in the
              practices of surgery.

       5.     Functions independently with graduated advancement and appropriate
              faculty supervision.

       6.     Uses library sources to perform research and perform literature searches.

       7.     Understands the principles of clinical research and the application of
              biostatistics.




                                                                                          8
D.     Interpersonal and Communication Skills


Goal: The resident will demonstrate interpersonal and communication skills that result
in effective information exchange and teaming with patients, their families, and
professional associates.

       Objectives

       1.   Educates patients and families in post anesthesia care.

       2.     Demonstrates compassion for patients and families.

       3.     Provides adequate counseling and informed consent to patients.

       4.     Listens to patients and their families.

       5.     Assimilates data and information provided by other members of the health
              care team.

       6.     Charts and records accurate information.




                                                                                    9
E.     System Based Practice


Goal: The resident will 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 care that is of optimal value.

       Objectives

       1.      Coordinates all aspects of the post anesthetic care for patients.

       2.      Demonstrates knowledge of cost-effective anesthetic care.

       3.      Advocates for patients within the health care system.

       4.      Refers patients to the appropriate practitioners and agencies.

       5.      Facilitates the timely discharge of same day surgery patients

       6.      Works with primary care physicians, and other consultants such as
               cardiologists, toward the safe administration of anesthesia.




                                                                                         10
F.     Professionalism


Goal: The resident will demonstrate a commitment to carrying out professional
responsibilities, adherence to ethical principles, and sensitivity to a diverse patient
population.

       Objectives

       1.     Develops a sensitivity of the unique stresses placed on families under care
              for surgical diagnoses.

       2.     Exhibits an unselfish regard for the welfare of surgical patients.

       3.     Demonstrates firm adherence to a code of moral and ethical values.

       4.     Is respectful to patients and their families especially in times of stress to
              the family unit.

       5.     Respects and appropriately integrates other members of the health care
              team.

       6.     Provides appropriately prompt hand consultations when requested.

       7.     Demonstrates sensitivity to the individual patient’s profession, life goals,
              and cultural background as they apply to health care.

       8.     Is reliable, punctual, and accountable for own actions in the OR and clinic.

       9.     Understands the concepts of autonomy, beneficence, nonmaleficence,
              justice, and respect for life.

       10.   Maintains patient confidentiality.




                                                                                        11
BURN SURGERY




               12
A.     Medical Knowledge


Goal: The resident will achieve a detailed knowledge of the evaluation and management
of burn patients.

       Objectives:

       1.     Discuss the techniques of resuscitation of major burns.

       2.     Recite the criteria for superficial and deep partial thickness, as well as full-
              thickness classification of burns.

       3.     Discuss the three zones of a burn wound.

       4.     Discuss the properties of split thickness vs. full thickness skin grafts, as
              meshed and sheet grafts.

       5.     Discuss the treatment of inhalation injuries.

       6.     Describe the resuscitation and management of electrical burns.

       7.     Describe the indications of fasciotomies and escharotomies.

       8.     List the details regarding the use of skin substitutes, biological dressings,
              and xenografts in the treatment of the burn patient.

       9.     Discuss the reconstruction for burn contractures.

       10.    Recite the use of pressure garments and silicone therapy in the prevention
              of abnormal scars.

       11.    Describe the pathology and management of thermal, chemical, and
              electrical injury and inhalation injury and relationship to mortality,
              morbidity, and course of patient recovery.

       12.    Outline the principles of burn shock, immunologic alteration, and
              bacteriologic pathology of the burn wound.

       13.    Discuss the epidemiology, prevention,             and    socioeconomic      and
              psychological impact of burns.

       14.    Recite the physiologic response to thermal, chemical, and electrical burn
              injuries, including the micro and macro disruption of normal skin anatomy
              and physiology.




                                                                                           13
B.     Patient Care

Goal: The resident will provide patient care that is compassionate, appropriate, and
effective for the treatment of burn patients.

       Objectives

       1.     Evaluate the appearance of the burn wound in relation to its depth,
              bacteriologic condition, healing potential, and requirement for
              intervention.

       2.     Perform burn wound debridement and preparation for skin grafting.

       3.     Perform split thickness skin grafts.

       4.     Perform full thickness skin grafts.

       5.     Utilize skin substitutes, biological dressings, and xenografts in the
              treatment of burn wounds.

       6.     Utilize splinting and pressure garments to minimize scar formation and
              post burn contractures.

       7.     Perform the surgical treatment of post-burn contractures with releases, z-
              plasties, and grafting.

       8.     Participate in the acute resuscitation and care of the burned patient.

       9.     Treat patients who are victims of electrical burns.

       10.    Perform escharotomies and fasciotomies when indicated.




                                                                                       14
C.     Practice Based Learning and Improvement


Goal: The resident will investigate and evaluate his or her own patient care practices,
appraise and assimilate scientific evidence, and improve patient care practices.

       Objectives
       1.     Uses information technology to prepare for surgical cases, bringing to the
              OR the knowledge of current modalities of care and the scientific evidence
              for that care.

       2.     Routinely analyzes the effectiveness of own practices in caring for burn
              patients.

       3.     Improves own practices in the care of burn patients by integrating
              appropriately gathered data and feedback.

       4.     Educates medical students and other healthcare professionals in the
              practices of burn surgery and reconstruction.

       5.     Functions independently with graduated advancement and appropriate
              faculty supervision.

       6.   Uses library sources to perform research and perform literature searches.

       7.   Understands the principles of clinical research and the application of
            biostatistics.




                                                                                        15
D.     Interpersonal and Communication Skills


Goal: The resident will demonstrate interpersonal and communication skills that result
in effective information exchange and teaming with patients, their families, and
professional associates.

       Objectives

       1.     Educates patients and families in post operative and rehabilitative
              strategies for burn patients.

       2.     Demonstrates compassion for patients and families afflicted with trauma.

       3.     Provides adequate counseling and informed consent to patients.

       4.     Listens to patients and their families.

       5.     Assimilates data and information provided by other members of the health
              care team.

       6.     Charts and records accurate information.




                                                                                     16
E.     System Based Practice


Goal: The resident will 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 care that is of optimal value.

       Objectives

       1.      Coordinates all aspects of the rehabilitation of the burn surgery patient.

       2.      Direct the rehabilitation of burn surgery patients by partnering with the
               following:

               a.      Physical Therapy
               b.      Occupational Therapy
               c.      PRM physicians
               d.      social workers
               e.      nutritionalists

       3.      Demonstrates knowledge of cost-effective burn surgery care.

       4.      Advocates for burn surgery patients within the health care system.

       5.      Refers orthopedic patients to the appropriate practitioners and agencies.

       6.      Facilitates the timely discharge of burn surgery patients

       7.      Works with paramedical professionals in the prehospital care of trauma
               patients.




                                                                                            17
F.     Professionalism


Goal: The resident will demonstrate a commitment to carrying out professional
responsibilities, adherence to ethical principles, and sensitivity to a diverse patient
population.

       Objectives

       1.     Develops a sensitivity of the unique stresses placed on families under care
              for burn injuries.

       2.     Exhibits an unselfish regard for the welfare of burn surgery patients.

       3.     Demonstrates firm adherence to a code of moral and ethical values.

       4.     Is respectful to burn patients and their families especially in times of
              trauma and stress to the family unit.

       5.     Respects and appropriately integrates other members of the burn surgery
              team.

       6.     Provides appropriately prompt consultations when requested.

       7.     Demonstrates sensitivity to the individual patient’s profession, life goals,
              and cultural background as they apply to burn care.

       8.     Is reliable, punctual, and accountable for own actions in the OR and clinic.

       9.     Understands the concepts of autonomy, beneficence, nonmaleficence,
              justice, and respect for life.

       10.    Maintains patient confidentiality.




                                                                                       18
CARDIOTHORACIC SURGERY




                         19
A.     Medical Knowledge


Goal: The resident will achieve a detailed knowledge of the evaluation and treatment of
a variety of disease processes. The resident will be exposed to patients with both medical
and surgical emergencies and will become comfortable with the initial evaluation and
stabilization of patients.

       Objectives:

       1.     Discuss the basic pathophysiology of cardiothoracic and pulmonary
              disease entities.

       2.     Discuss the indications and contraindications for cardiac surgery.

       3.     Discuss the diagnosis and treatment of patients undergoing significant
              cardiovascular events, including:

              a.       myocardial infarction
              b.       arrhythmias
              c.       unstable angina
              d.       cardiogenic shock
              e.      cerebrovascular accidents
              f.      transient ischemic attacks

       4.     Discuss the physiology and methodology of cardiopulmonary bypass.

       5.     Discuss the physiology and methodology of ECMO

       6.     Discuss the circumstances in which cardiothoracic surgery can be
              performed off of cardiopulmonary bypass.

       7.     Recite the basic details of commonly performed cardiac operations, such
              as:

              a.      coronary artery bypass grafting
              b.      valve replacement
              c.      thoracic aneurysm repair
              d.      cardiothoracic transplant

       8.     Discuss the basic understanding of pacemakers and defibrillating devices.

       9.     Discuss the pathophysiology and treatment of cardiogenic shock.

       10.    Recite the indications for and contraindications for cardiothoracic
              transplantation.



                                                                                       20
11.   Discuss the details of immunotherapy for cardiothoracic transplant
      surgery.

12.   Discuss the diagnosis and treatment of acute and chronic rejection of heart
      and lung transplants.

13.   Recite the details about the process of organ donation.

14.   Participate in the care of patients including management of arrhythmias
      and the anticoagulation of cardiac patients.




                                                                              21
B.     Patient Care

Goal: The resident will provide patient care that is compassionate, appropriate, and
effective for the treatment of cardiothoracic problems.

       Objectives

       1.     Preoperatively evaluate and prepare cardiothoracic patients for surgery.

       2.     Interprets laboratory and diagnostic tests.

       3.     Care for patients with post-operative dysrhythmias.

       4.     Become certified in ACLS

       5.     Interprets electrocardiograms

       6.     Care for patients with post-operative hemodynamic problems.

       7.     Participate in the diagnosis and care of post-operative cardiac
              complications.




                                                                                         22
C.     Practice Based Learning and Improvement


Goal: The resident will investigate and evaluate his or her own patient care practices,
appraise and assimilate scientific evidence, and improve patient care practices.

       Objectives
       1.     Uses information technology to prepare for cases, using in the OR the
              knowledge of current modalities of care and the scientific evidence for
              that care.

       2.     Routinely analyzes the effectiveness of own practices in caring for
              patients.

       3.     Improves own practices in the care of patients by integrating appropriately
              gathered data and feedback.

       4.     Educates medical students and other healthcare professionals in the
              practices of cardiothoracic medicine.

       5.     Functions independently with graduated advancement and appropriate
              faculty supervision.

       6.     Uses library sources to perform research and perform literature searches.

       7.     Understands the principles of clinical research and the application of
              biostatistics.




                                                                                      23
D.     Interpersonal and Communication Skills


Goal: The resident will demonstrate interpersonal and communication skills that result
in effective information exchange and teaming with patients, their families, and
professional associates.

       Objectives

       1.   Educates patients and families in follow-up strategies and rehabilitation for
              cardiothoracic surgery patients.

       2.     Demonstrates compassion for patients          and   families     undergoing
              cardiothoracic surgery and transplantation.

       3.     Provides adequate counseling and informed consent to patients.

       4.     Listens to patients and their families.

       5.     Assimilates data and information provided by other members of the
              cardiothoracic health care team.

       6.     Charts and records accurate information.




                                                                                      24
E.     System Based Practice


Goal: The resident will 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 care that is of optimal value.

       Objectives

       1.      Coordinates all aspects of the preoperative and postoperative care and
               rehabilitation of cardiothoracic surgery patients.

       2.      Create a cost-effective, focused work-up of diagnostic testing.

       3.      Advocates for cardiac patients within the health care system.

       4.      Refers cardiothoracic patients to the appropriate practitioners and
               agencies.

       5.      Facilitates the timely discharge of cardiothoracic surgery patients

        6.     Learn to coordinate the admission of patients and communicate with
               primary care physicians, inpatient house staff, and consultants.




                                                                                         25
F.     Professionalism


Goal: The resident will demonstrate a commitment to carrying out professional
responsibilities, adherence to ethical principles, and sensitivity to a diverse patient
population.

       Objectives

       1.     Develops a sensitivity of the unique stresses placed on families under care
              for cardiothoracic surgery .

       2.     Exhibits an unselfish regard for the welfare of cardiac surgery patients.

       3.     Demonstrates firm adherence to a code of moral and ethical values.

       4.     Is respectful to patients and their families especially in times of stress to
              the family unit.

       5.     Respects and appropriately integrates other members of the cardiac health
              care team.

       6.     Provides appropriately prompt hand consultations when requested.

       7.     Demonstrates sensitivity to the individual patient’s profession, life goals,
              and cultural background as they apply to surgery.

       8.     Is reliable, punctual, and accountable for own actions in the OR and clinic.

       9.     Understands the concepts of autonomy, beneficence, nonmaleficence,
              justice, and respect for life.

       10.    Maintains patient confidentiality.




                                                                                          26
CRITICAL CARE MEDICINE




                         27
A.     Medical Knowledge


Goal: The resident will achieve a detailed knowledge of the techniques and practice of
critical care medicine.

       Objectives:

       1.     Discuss the fundamental concepts of critically ill patient care.

       2.     Describe the physiological parameters of critical illness.

       3.     Interpret physiologic patient data.

       4.     Provide a differential diagnosis, develop diagnostic strategies, and
              evaluate therapeutic interventions.

       5.     Discuss the collaborative practice style of ICU care setting.

       6.     List the physiology, pathophysiology, and treatment of the various kinds
              of shock, including:

              a.     hypovolemic
              b.      cardiogenic
              c.      septic
              d.     distributive
              e.     obstructive

       7.     Discuss the common cardiopulmonary pathophysiology encountered in the
              ICU, including:

                     a.      myocardial infarction and cardiac dysrhythmias
                     b.       ARDS
                     c.      pulmonary embolism
                     d.       pneumonia
                     e.      acute pericardial disease

       8.     Discuss the common renal pathophysiology encountered in the ICU,
              including:

              a.     acute and chronic renal failure
              b.     volume, osmolality, electrolyte derangements
              c.     acid-base disorders
              d.     hemodialysis and peritoneal dialysis




                                                                                   28
9.    Discuss the common infectious pathophysiology encountered in the ICU,
      including:

      a.     antimicrobial agents
      b.     infection control
      c.     severe infections
      d.     sepsis and septic shock
      e.     immunocompromised hosts
      f.     hospital acquired and opportunistic infections

10.   List the common medications used in the ICU setting and their:

      a.     pharmacokinetics
      b.     dynamics
      c.      metabolisms
      d.     toxicity
      e.     excretion




                                                                        29
B.     Patient Care

Goal: The resident will gain experience patient care that is compassionate, appropriate,
and effective for the treatment of critically ill surgical patients.

       Objectives

       1.     Demonstrate proficiency in ICU procedures, including:

              a.      awake and urgent intubations
              b.      central venous access
              c.      pulmonary artery catheter placement
              d.      arterial catheter placement

       2.     Manage mechanical ventilation, including:

              a.      pressure ventilation
              b.       volume ventilation
              c.       cPAP
              d.      PEEP
              e.      intermittent mandatory ventilation

       3.     Participate in the monitoring, bioengineering, and biostatistics in the ICU,
              including:

              a.      prognostic indices and severity codes
              b.      invasive cardiac monitoring
              c.      noninvasive cardiac monitoring (EKG, echo)
              d.      brain monitoring (ICP, CPP)
              e.      respiratory monitoring
              f.      metabolic monitoring (O2 consumption, CO2 production)

       4.     Engage in the ethical and legal aspects of critical care medicine.

       5.     Participate in the resuscitation of patients from shock.

       6.     Perform post operative care for surgical patients.




                                                                                       30
C.     Practice Based Learning and Improvement


Goal: The resident will investigate and evaluate his or her own patient care practices,
appraise and assimilate scientific evidence, and improve patient care practices.

       Objectives
       1.     Uses information technology to prepare for cases, bringing to the ICU the
              knowledge of current modalities of care and the scientific evidence for
              that care.

       2.     Routinely analyzes the effectiveness of own practices in caring for ICU
              patients.

       3.     Improves own practices in the care of patients by integrating appropriately
              gathered data and feedback.

       4.     Educates medical students and other healthcare professionals in the
              practices of critical care medicine.

       5.     Functions independently with graduated advancement and appropriate
              faculty supervision.

       6.    Uses library sources to perform research and perform literature searches.

       7.     Understands the principles of clinical research and the application of
              biostatistics.




                                                                                         31
D.     Interpersonal and Communication Skills


Goal: The resident will demonstrate interpersonal and communication skills that result
in effective information exchange and teaming with patients, their families, and
professional associates.

       Objectives

       1.   Educates patients and families in critical care medicine.

       2.     Demonstrates compassion for patients and families.

       3.     Provides adequate counseling and informed consent to patients.

       4.     Listens to patients and their families.

       5.     Assimilates data and information provided by other members of the health
              care team.

       6.     Charts and records accurate information.




                                                                                   32
E.     System Based Practice


Goal: The resident will 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 care that is of optimal value.

       Objectives

       1.      Coordinates the care of patients in the ICU who are critically ill.

       2.      Demonstrates knowledge of cost-effective critical care medicine.

       3.      Advocates for patients within the health care system.

       4.      Refers patients to the appropriate practitioners and agencies.

       5.    Facilitates the timely discharge and/or placement of critical care patients.




                                                                                            33
F.     Professionalism


Goal: The resident will demonstrate a commitment to carrying out professional
responsibilities, adherence to ethical principles, and sensitivity to a diverse patient
population.

       Objectives

       1.     Develops a sensitivity of the unique stresses placed on families with
              members in the ICU.

       2.     Exhibits an unselfish regard for the welfare of ICU patients.

       3.     Demonstrates firm adherence to a code of moral and ethical values.

       4.     Is respectful to patients and their families especially in times of stress to
              the family unit.

       5.     Respects and appropriately integrates other members of the health care
              team.

       6.     Provides appropriately prompt hand consultations when requested.

       7.     Demonstrates sensitivity to the individual patient’s profession, life goals,
              and cultural background as they apply to health care.

       8.     Is reliable, punctual, and accountable for own actions in the ICU.

       9.     Understands the concepts of autonomy, beneficence, nonmaleficence,
              justice, and respect for life.

       10.    Maintains patient confidentiality.

       11.    Discuss the ethical issues confronted in the ICU, and summarize the
              approach to complex issues, particularly in the withdrawal of life support.




                                                                                        34
EMERGENCY MEDICINE




                     35
A.     Medical Knowledge


Goal: The resident will achieve a detailed knowledge of the evaluation and treatment of
a variety of urgent disease processes. The resident will be exposed to patients with both
medical and surgical emergencies and will become comfortable with the initial evaluation
and stabilization of patients.

       Objectives:

       1.     Discuss the basic pathophysiology of emergency disease entities.

       2.     Discuss the factors determining whether a patient can be discharged or
              needs to be admitted to the hospital.

       3.     Discuss the diagnosis and treatment of patients undergoing significant
              cardiovascular events, including:

              a.      myocardial infarction
              b.      arrhythmias
              c.      unstable angina
              d.      cardiogenic shock
              e.      cerebrovascular accidents
              f.      transient ischemic attacks

       4.   Discuss the diagnosis and treatment of patients with abdominal pain

       5.   Discuss the diagnosis and treatment of patients with acute airway
            emergencies, including:

              a.      asthma
              b.      COPD
              c.      upper airway exacerbation
              d.      pneumonic processes

       6.    Discuss the diagnosis and treatment of patients with diabetic emergencies,
            including:

              a.      diabetic ketoacidosis
              b.      hyperosmolar hyperglycemia
              c.      insulin therapy
              d.      hypoglycemia




                                                                                      36
7.    Discuss the diagnosis and treatment of patients with ENT emergencies,
      including:

       a.     epistaxis
       b.     acute pharyngitis
       c.     sinusitis
       d.     otitis media and externa
       e.     foreign bodies in the ears, nose, and throat

8.    Discuss the diagnosis and treatment of patients with GU emergencies,
      including:

       a.     UTIs
       b.     renal colic
       c.     STDs

9.    Recite the dosages, indications, and contraindications of medications
      used in emergency medicine, including:

       a.     resuscitation medications
       b.     analgesics
       c.     sedatives
       d.     antibiotics

10.   Discuss the pathophysiology and treatment of various kinds of shock:
      including: hemorrhagic, cardiogenic, neurogenic, septic




                                                                        37
B.     Patient Care

Goal: The resident will provide patient care that is compassionate, appropriate, and
effective for the treatment of trauma problems.

       Objectives

       1.     Evaluate patients in an efficient fashion and create a focused list of
              differential diagnoses.

       2.     Interprets laboratory and diagnostic tests.

       3.     Develop technical skills performed in the Emergency Department
              including:

              a.      suturing
              b.      central venous access
              c.      airway management
              d.      pain management
              e.      basic orthopaedic procedures – splinting, casting
              f.      phlebotomy
              g.      endotracheal intubation
              h.      thoracostomy
              i.      NGT and Foley cath insertion

       4.     Become certified in ACLS

       5.     Interpret electrocardiograms

       6.     Become certified in ATLS




                                                                                 38
C.     Practice Based Learning and Improvement


Goal: The resident will investigate and evaluate his or her own patient care practices,
appraise and assimilate scientific evidence, and improve patient care practices.

       Objectives

       1.     Uses information technology to prepare for cases, using in the ED the
              knowledge of current modalities of care and the scientific evidence for
              that care.

       2.     Routinely analyzes the effectiveness of own practices in caring for
              emergency patients.

       3.     Improves own practices in the care of emergency patients by integrating
              appropriately gathered data and feedback.

       4.     Educates medical students and other healthcare professionals in the
              practices of emergency medicine.

       5.     Functions independently with graduated advancement and appropriate
              faculty supervision.

       6.    Uses library sources to perform research and perform literature searches.

       7.     Understands the principles of clinical research and the application of
              biostatistics.




                                                                                         39
D.     Interpersonal and Communication Skills


Goal: The resident will demonstrate interpersonal and communication skills that result
in effective information exchange and teaming with patients, their families, and
professional associates.

       Objectives

       1.   Educates patients and families in follow-up strategies for emergency patients.

       2.      Demonstrates compassion for patients and families in the ED.

       3.      Provides adequate counseling and informed consent to patients.

       4.      Listens to patients and their families.

       5.      Assimilates data and information provided by other members of the health
               care team.

       6.      Charts and records accurate information.




                                                                                        40
E.     System Based Practice


Goal: The resident will 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 care that is of optimal value.

       Objectives

       1.      Coordinates all aspects of the emergency care of patients.

       2.      Create a cost-effective, focused work-up of diagnostic testing.

       3.      Advocates for trauma patients within the health care system.

       4.      Refers trauma patients to the appropriate practitioners and agencies.

       5.      Facilitates the timely discharge of emergency patients

       6.      Works with paramedical professionals in the prehospital care of trauma
               patients.

       7.      Learn to coordinate the admission of patients and communicate with
               primary care physicians, inpatient house staff, and consultants.




                                                                                         41
F.     Professionalism


Goal: The resident will demonstrate a commitment to carrying out professional
responsibilities, adherence to ethical principles, and sensitivity to a diverse patient
population.

       Objectives

       1.     Develops a sensitivity of the unique stresses placed on families under care
              for emergency injuries.

       2.     Exhibits an unselfish regard for the welfare of emergency patients.

       3.     Demonstrates firm adherence to a code of moral and ethical values.

       4.     Is respectful to patients and their families especially in times of trauma
              and stress to the family unit.

       5.     Respects and appropriately integrates other members of the health team.

       6.     Provides appropriately prompt hand consultations when requested.

       7.     Demonstrates sensitivity to the individual patient’s profession, life goals,
              and cultural background as they apply to emergency medicine.

       8.     Is reliable, punctual, and accountable for own actions in the ED and clinic.

       9.     Understands the concepts of autonomy, beneficence, nonmaleficence,
              justice, and respect for life.

       10.   Maintains patient confidentiality.




                                                                                        42
GENERAL SURGERY




                  43
A.     Medical Knowledge

I. Surgical Oncology

Goal: The resident will achieve a detailed knowledge of the evaluation and management
of surgical oncology patients.

       Objectives:

       1.     Discuss the basic pathophysiology of the mechanisms involved in
              malignant transformation, tumor growth, and metastases formation .

       2.     Discuss the treatment of malignant melanoma, including:

              a.     staging of malignant melanoma
              b.     indications for operative management of melanoma and the
                     selection of appropriate surgical procedures.
              c.     adjuvant treatment regimens and indication for their use in patients
                     with melanoma
              d.     treatment of advanced melanoma

       3.     Recite the natural history and biologic behavior of specific tumor types,
              including:

              a.     breast cancer
              b.     colorectal cancer
              c.     upper GI malignancies
              d.     melanoma
              e.     sarcoma

       4.     Recite the details of the management of wound care in the surgical
              oncology patient.

       5.     Discuss the details of the use/dosing of chemotherapy in surgical oncology
              patients.




                                                                                      44
II. Gastrointestinal Surgery

Goal: The resident will achieve a detailed knowledge of the evaluation and management
of the general GI surgical patient.

       1.     Discuss the evaluation, diagnosis, and management of the acute abdomen.

       2.     Discuss the evaluation, diagnosis, and surgical management of the
              stomach and duodenum, including:

              a.     benign stomach tumors
              b.     gastritis and upper GI bleeds
              c.     malignancies of the stomach and duodenum
              d.     morbid obesity

       3.     Discuss the evaluation, diagnosis, and surgical management of the small
              intestines, including:

              a.     intestinal obstruction
              b.     regional enteritis/Crohn’s Disease
              c.     Meckel’s diverticulum
              d.     carcinoid tumors
              e.     appendicitis
              f.     morbid obesity

       4.     Discuss the evaluation, diagnosis, and surgical management of the colon,
              including:

              a.     diverticulitis
              b.     benign and malignant neoplasms of the large intestine.
              c.     ulcerative colitis
              d.     constipation
              e.     benign and malignant neoplasms of the rectum
               f.     perirectal abscess
              g.     pilonidal disease
              h.     hemorrhoids
              i.     anal fissures
              j.     Crohn’s disease
              k.     intestinal ischemia
              l.     inflammatory bowel disease




                                                                                   45
5.   Discuss the evaluation, diagnosis, and surgical management of the
     pancreato-biliary system, including:

     a.     acute cholecystitis
     b.     chronic cholecystitis and cholelithiasis
     c.    cholangitis
     d.    gallstone ileus and fistula
     e.    gallbladder carcinoma
     f.    acute and chronic pancreatitis, pseudocyst
     g.    pancreatic neoplasms
     h.    endocrine tumors
     i.    hepatocellular carcinoma
     j.    metastases of the liver




                                                                   46
III. Breast Surgery

Goal: The resident will achieve a detailed knowledge of the evaluation and management
of the breast patient.

       1.     Discuss the evaluation, diagnosis, and surgical care of the breast mass.

       2.     Describe the evaluation of non-palpable breast abnormalities

       3.     Discuss the appropriate use of mammography, ultrasound, fine needle
              aspiration, and stereotactic biopsies

       4.     Discuss the preoperative staging of breast cancer.

       5.     Recite the use of preoperative chemotherapy and radiation therapy for
              breast cancer.

       6.     Describe the indication for operative management of breast disease, and
              selection of appropriate surgical procedures.

       7.     Discuss the adjuvant treatment regimens and indications for their use in
              breast cancer.

       8.     Describe the treatment of advanced breast cancer.

       9.     Recite the screening for breast cancer.

       10.    Discuss the genetic predisposition to breast cancer and prophylactic
              mastectomy.




                                                                                         47
IV. Minimal Access Surgery

Goal: The resident will achieve a detailed knowledge and understanding of minimally
access surgery.

      1.     Discuss the advantages and disadvantages of minimally invasive surgery.

      2.     Recite the physiologic effects of pneumoperitoneum, including:

             a.     acidosis
             b.     cardiovascular changes
             c.     urine output
             d.     pulmonary
             e..    air embolism
             f.     deep venous thrombosis

      3.     Discuss the basic equipment necessary for a laparoscopic equipment.

      4.     Discuss the suitability of minimally invasive surgery for various disease
             processes.




                                                                                   48
IV. Endocrine Surgery

Goal: The resident will achieve a detailed knowledge of the evaluation and management
of the endocrine surgery patient.

       1.     Discuss the evaluation, diagnosis, and management of surgical endocrine
              disease, including:

              a.     hot and cold thyroid nodules
              b.     adrenal masses and pheochromocytomas
              c.     primary, secondary, and tertiary hyperparathyroidism
              d.     pancreatic islet tumors
              e.     inherited endocrine tumor syndromes
              f.     thyroid malignancies
              g.     substernal goiters

       2.     Describe the care of patients with postoperative hypocalcemia




                                                                                  49
B.     Patient Care


Goal: The resident will provide patient care that is compassionate, appropriate, and
effective for the treatment of cardiothoracic problems.

       Objectives

       1.     Preoperatively evaluate the fitness of a patient for surgery, including
              cardiac screening, nutritional status, etc.

       2.     Interprets laboratory and diagnostic tests.

       3.     Gradually acquire the basic operative skills, including:

              a.      incision of tissues
              b.      suturing techniques
              c.      knot tying
              d.      gentle handling of tissues
              e.      wound closure
              f.      dressings

       4.     Postoperatively manage and care for surgical patients.

       5.     Participate, with graduated independence, in basic general surgery
              procedures with, including:

              a.      placement of central venous catheters
              b.      proctoscopies
              c.      lymph node biopsies
              d.      G and J-tube insertions
              e.      drainage of abcesses
              f.      fistulotomies and sphincterotomies
              g.      hernia repairs
              h.      tracheostomies

       6.     Participates, with graduated surgical independence, in general surgery
              procedures, including:

              a.      bowel resections
              b.      lysis of adhesions
              c.      formation of stomas
              d.      splenectomies
              e.      cholecystectomies
              f.      gastric resections
              g.      pancreatic resections



                                                                                  50
      h.     liver resections and biliary reconstructions

7.    Care for ICU patients with post-operative hemodynamic problems.

8.    Participate in the diagnosis and care of patients with post-operative
      complications in general surgery.

9.    Participate in preoperative preparation for surgery including bowel preps,
      antibiotic prophylaxis, DVT prophylaxis, fluid therapy, dietary
      management, etc.

10.   Perform bedside procedures with graduated surgical independence,
      including:

      a.     wound care
      b.     drain care
      c.     feeding tube placement and care
      d.     placement and care of central lines
      e.     pleural catheters
      f.     nasogastric tubes
      g.     foley catheters

11.   Prepare and position patients for minimally invasive surgery.

12.   Manage intraoperative and postoperative complications of minimally
      invasive surgery.

13.   Participate in minimally invasive surgery, mastering techniques,
      including:

      a.     maneuvering an angled laparoscope
      b.     intracorporeal knot-tying
      c.     closing port sites
      d.     endoscopic stapling
      e.     harmonic scalpel use
      f.     placement of endoscopic loop
      g.     bimanual dexterity

14.   Participate with graduated surgical independence in endocrine surgery,
      including:

      a.     thyroid lobectomies
      b.     thyroidectomies
      c.     parathyroid adenoma
      d.     open and laparoscopic adrenalectomy




                                                                             51
15.   Participate with graduated surgical independence in breast cancer surgery,
      including:

      a.     segmental mastectomy
      b.     simple or modified radical mastectomy
      c.     axillary dissection
      d.     sentinel node mapping and sampling
      e.     reconstruction after mastectomy

16.   Participate with graduated surgical independence in the treatment of
      malignant melanoma, including:

      a.     evaluation of suspicious skin lesions
      b.     wide local excision
      c.     sentinel node mapping
      d.     regional lymph node dissections
      e. treatment of advanced melanoma (isolated limb perfusion)

17.   Participate in design and implementation of compassionate care for
      terminally ill patients




                                                                             52
C.     Practice Based Learning and Improvement


Goal: The resident will investigate and evaluate his or her own patient care practices,
appraise and assimilate scientific evidence, and improve patient care practices.

       Objectives
       1.     Uses information technology to prepare for cases, using in the OR the
              knowledge of current modalities of care and the scientific evidence for
              that care.

       2.     Routinely analyzes the effectiveness of own practices in caring for
              surgery patients.

       3.     Improves own practices in the care of patients by integrating appropriately
              gathered data and feedback.

       4.     Educates medical students and other healthcare professionals in the
              practices of general surgery.

       5.     Functions independently with graduated advancement and appropriate
              faculty supervision.

       6.    Uses library sources to perform research and perform literature searches.

       7.     Understands the principles of clinical research and the application of
              biostatistics.




                                                                                         53
D.     Interpersonal and Communication Skills


Goal: The resident will demonstrate interpersonal and communication skills that result
in effective information exchange and teaming with patients, their families, and
professional associates.

       Objectives

        1.   Educates patients and families in follow-up strategies and rehabilitation for
              general surgery patients.

        2.    Demonstrates compassion for surgical oncology patients and families.

        3.    Provides adequate counseling and informed consent to patients.

        4.    Listens to patients and their families.

        5.    Assimilates data and information provided by other members of the
              general surgery health care team.

        6.    Charts and records accurate information.




                                                                                       54
E.     System Based Practice


Goal: The resident will 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 care that is of optimal value.

       Objectives

       1.      Coordinates all aspects of the preoperative and postoperative care and
               rehabilitation surgical oncology patients.

       2.    Create a cost-effective, focused work-up of diagnostic testing.

       3.    Advocates for surgical patients within the health care system.

       4.    Refers surgical patients to the appropriate practitioners and agencies.

       5.    Facilitates the timely discharge and/or placement of surgery patients.

        6.     Learn to coordinate the admission of patients and communicate with
               primary care physicians, inpatient house staff, and consultants.

       7.      Discuss the scientific basis and regulations governing clinical trials and
               their    importance in defining appropriate cancer therapy.

       8.      Coordinates the total care of the surgical oncology patient by partnering
               with other members of the oncology team, including:

               a.      medical oncologists
               b.      radiation oncologists
               c.      social workers
               d.      pastoral care
               e.      hospice
               f.      cancer researchers

       9.    Participate in tumor board and surgical oncology conferences.




                                                                                            55
F.     Professionalism


Goal: The resident will demonstrate a commitment to carrying out professional
responsibilities, adherence to ethical principles, and sensitivity to a diverse patient
population.

       Objectives

       1.     Develops a sensitivity of the unique stresses placed on families under care
              for general surgery .

       2.     Exhibits an unselfish regard for the welfare of general surgery patients.

       3.     Demonstrates firm adherence to a code of moral and ethical values.

       4.     Is respectful to patients and their families especially in times of stress to
              the family unit.

       5.     Respects and appropriately integrates other members of the general
              surgery health care team.

       6.     Provides appropriately prompt consultations when requested.

       7.     Demonstrates sensitivity to the individual patient’s profession, life goals,
              and cultural background as they apply to surgery.

       8.     Is reliable, punctual, and accountable for own actions in the OR and clinic.

       9.     Understands the concepts of autonomy, beneficence, nonmaleficence,
              justice, and respect for life.

       10.   Maintains patient confidentiality.




                                                                                          56
NEUROSURGERY




               57
A.     Medical Knowledge


Goal: The resident will achieve a detailed knowledge of the evaluation and management
of neurosurgical patients.

       Objectives:

       1.     Discuss the signs of severe head injury and herniation syndromes.

       2.     Discuss the signs of spinal cord injury.

       3.     List the signs of cerebral ischemia and intracranial hypertension, and
              discuss it’s management as it pertains to neurosurgical emergencies.

       4.     Describe a basic understanding of the use of CT and MRI as well as
              angiography in the work-up of patients with neurological diseases.

       5.     Discuss the indications for operative carotid endarterectomy.

       6.     Recite the details of a brain death examination.

       7.     Recite the protocol for clearance of the spine in the multiply injured
              patient.

       8.     List the protocol for appropriate patient immobilization in the patient with
              a suspected spinal injury.

       9.     Discuss the use of common neurophysiologic and laboratory tests to
              develop a synthesized treatment plan for neurosurgical patients.

       10.    Recite the indications for lumbar puncture and cerebrospinal fluid
              sampling.

       11.    Discuss the etiology and management of subarachnoid hemorrhage,
              cerebral ischemia, cerebral edema, raised intracranial pressure,
              hydrocephalus, and degenerative spine disease.

       12.    Discuss the broad spectrum of the severity of injuries to the head and
              spine and the basic principles of early management.




                                                                                       58
B.     Patient Care

Goal: The resident will provide patient care that is compassionate, appropriate, and
effective for the treatment of neurosurgical care.

       Objectives

       1.     Perform a neurological examination on patients suffering from
              neurosurgical diseases, such as:

              a.      head trauma
              b.      spine trauma
              c.      cerebrovascular disease
              d.      intracerebral hemorrhage
              e.      radiculopathy
              f.      back pain
              g.      hydrocephalus

       2.     Participate in the management of increased intracranial pressure in
              patients with head injury, tumor, stroke, and hydrocephalus.

       3.     With graduated surgical independence, place an intracranial pressure
              monitor.

       4.     With graduated surgical independence, place bur holes or assist in
              performing a craniotomy for the evacuation of hematoma.

       5.     Manage soft tissue injuries of the scalp, head, or spine.

       6.     Assist in elective operative procedures in neurosurgery.

       7.     Participate in the in-hospital and emergency management of neurosurgical
              patients.

       8.     Develop the clinical skills, and become proficient at conducting a
              neurologic examination.

       9.     Become proficient at taking pertinent clinical histories from neurosurgical
              patients.

       10.    Participate in the creation of scalp, spine incisions, proper flap
              construction, wound care, and opening/closing principles.




                                                                                      59
C.     Practice Based Learning and Improvement


Goal: The resident will investigate and evaluate his or her own patient care practices,
appraise and assimilate scientific evidence, and improve patient care practices.

       Objectives
       1.     Uses information technology to prepare for surgical cases, bringing to the
              OR the knowledge of current modalities of care and the scientific evidence
              for that care.

       2.     Routinely analyzes the effectiveness of own practices in caring for
              neurosurgery patients.

       3.     Improves own practices in the care of neurosurgery patients by integrating
              appropriately gathered data and feedback.

       4.     Educates medical students and other healthcare professionals in the
              practices of neurosurgery.

       5.     Functions independently with graduated advancement and appropriate
              faculty supervision.

       6.     Uses library sources to perform research and perform literature searches.

       7      Understands the principles of clinical research and the application of
              biostatistics.




                                                                                      60
D.     Interpersonal and Communication Skills


Goal: The resident will demonstrate interpersonal and communication skills that result
in effective information exchange and teaming with patients, their families, and
professional associates.

       Objectives

       1.     Educates patients and families in post operative and rehabilitative
              strategies for trauma patients.

       2.     Demonstrates compassion for patients and families afflicted with trauma.

       3.     Provides adequate counseling and informed consent to patients.

       4.     Listens to patients and their families.

       5.     Assimilates data and information provided by other members of the health
              care team.

       6.     Charts and records accurate information.




                                                                                     61
E.     System Based Practice


Goal: The resident will 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 care that is of optimal value.

       Objectives

       1.      Coordinates all aspects of the rehabilitation of the trauma patient.

       2.      Direct the rehabilitation of patients following trauma by partnering with
               the following:

               a.      Physical Therapy
               b.      Occupational Therapy
               c.      PRM physicians
               d.      social workers
               e.      nutritionalists

       3.      Demonstrates knowledge of cost-effective trauma care.

       4.      Advocates for trauma patients within the health care system.

       5.      Refers trauma patients to the appropriate practitioners and agencies.

       6.      Facilitates the timely discharge of trauma patients

       7.      Works with paramedical professionals in the prehospital care of trauma
               patients.




                                                                                           62
F.     Professionalism

Goal: The resident will demonstrate a commitment to carrying out professional
responsibilities, adherence to ethical principles, and sensitivity to a diverse patient
population.

       Objectives

       1.     Develops a sensitivity of the unique stresses placed on families under care
              for traumatic injuries.

       2.     Exhibits an unselfish regard for the welfare of trauma patients.

       3.     Demonstrates firm adherence to a code of moral and ethical values.

       4.     Is respectful to hand patients and their families especially in times of
              trauma and stress to the family unit.

       5.     Respects and appropriately integrates other members of the trauma team.

       6.     Provides appropriately prompt hand consultations when requested.

       7.     Demonstrates sensitivity to the individual patient’s profession, life goals,
              and cultural background as they apply to trauma care.

       8.     Is reliable, punctual, and accountable for own actions in the OR and hand
              clinic.

       9.     Understands the concepts of autonomy, beneficence, nonmaleficence,
              justice, and respect for life.

       10.   Maintains patient confidentiality.




                                                                                       63
ORAL AND MAXILLOFACIAL
       SURGERY




                         64
A.     Medical Knowledge


Goal: The resident will achieve a detailed knowledge of the techniques and practice of
oral and maxillofacial surgery.

       Objectives:

       1.     Discuss the embryology of the head and neck.

       2.     Recite the tenets of growth of the craniofacial skeleton.

       3.     Draw the anatomy of the head and neck with particular concern to the
              jaws and craniofacial skeleton.

       4.     Discuss the principles of odontogenesis

       5.     Recite the principles of and infiltration techniques of local anesthesia used
              in the head and neck.

       6.     List the principles of bone fixation and bony healing.

       7.     Discuss the general evaluation of the facial trauma patient.

       8.     Recite the techniques of the treatment of facial fractures, including:

              a.      frontal sinus fractures
              b.      orbital fractures
              c.      nasal fractures
              d.      NOE fractures
              e.      midface and maxillary fractures
              f.      mandibular fractures
              g.      management of teeth in fractures

       9.     Discuss the unique treatment of pediatric facial fractures.

       10.    Describe the cephalometric analysis of maxillofacial surgery patients.

       11.    Discuss the common diagnoses in maxillofacial surgery and their
              management, including:

              a.      retrogenia
              b.       mandibular excess and deficiency
              c.      vertical maxillary excess
              d.      maxillary deficiency


                                                                                         65
12.   Discuss the different kinds of occlusion, including:

      a.     overjet
      b.      overbite
      c.     Angle classification
      d.     crossbites

13,   Discuss the use of distraction osteogenesis in maxillofacial surgery.

14.   Discuss maxillofacial surgery in the cleft patient.

15.   Describe the acquired diseases of the TMJ and their management.

16.   Describe the use of dento-facial prosthetics.




                                                                              66
B.     Patient Care

Goal: The resident will provide patient care that is compassionate, appropriate, and
effective for the treatment of surgical problems.

       Objectives

       1.     Perform the various local anesthetic facial blocks for procedures done in
              oral and maxillofacial surgery.

       2.     Perform with graduated surgical independence bony fixation of the
              craniofacial skeleton.

       3.     Perform the head and neck exam in the facial trauma patient.

       4.     Perform the facial evaluation for orthognathic surgery patients.

       5.     Participate in the cephalometric analysis, prediction tracing, and
              preoperative surgical planning of maxillofacial surgery patients.

       6.     Perform a face-bow transfer.

       7.     Participate in preoperative model surgery.

       8.     Participate in common maxillofacial surgical procedures, including:

              a.      facial fractures
              b.      genioplasties
              c.      sagittal split mandibular osteotomies
              d.      maxillary LeFort I osteotomies
              e.      bimaxillary osteotomies

       9.     Participate in the creation and application of dental splints in maxillofacial
              surgery.




                                                                                          67
C.     Practice Based Learning and Improvement


Goal: The resident will investigate and evaluate his or her own patient care practices,
appraise and assimilate scientific evidence, and improve patient care practices.

       Objectives
       1.      Uses information technology to prepare for cases, bringing to the OR the
               knowledge of current modalities of care and the scientific evidence for
               that care.

       2.      Routinely analyzes the effectiveness of own practices in caring for surgery
               patients.

       3.      Improves own practices in the care of patients by integrating appropriately
               gathered data and feedback.

       4.      Educates medical students and other healthcare professionals in the
               practices of oral and maxillofacial surgery.

       5.      Functions independently with graduated advancement and appropriate
               faculty supervision.

       6.      Uses library sources to perform research and perform literature searches.

       7.      Understands the principles of clinical research and the application off
               biostatistics.




                                                                                          68
D.     Interpersonal and Communication Skills


Goal: The resident will demonstrate interpersonal and communication skills that result
in effective information exchange and teaming with patients, their families, and
professional associates.

       Objectives

         1.   Educates patients and families in post oral and maxillofacial surgery care.

         2.   Demonstrates compassion for patients and families.

         3.   Provides adequate counseling and informed consent to patients.

         4.   Listens to patients and their families.

         5.   Assimilates data and information provided by other members of the health
              care team.

         6.   Charts and records accurate information.




                                                                                        69
E.     System Based Practice


Goal: The resident will 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 care that is of optimal value.

       Objectives

       1.    Coordinates all aspects of the oral and maxillofacial surgery care for
              patients.

       2..     Demonstrates knowledge of cost-effective oral and maxillofacial surgery
               care.

       3.     Advocates for patients within the health care system.

       4.     Refers patients to the appropriate practitioners and agencies.

       5.    Facilitates the timely discharge of same day surgery patients

       6.      Works with primary care physicians, and other consultants such as
               cardiologists, toward the safe administration of anesthesia.




                                                                                         70
F.     Professionalism


Goal: The resident will demonstrate a commitment to carrying out professional
responsibilities, adherence to ethical principles, and sensitivity to a diverse patient
population.

       Objectives

       1.      Develops a sensitivity of the unique stresses placed on families under care
               for surgical diagnoses.

       2.      Exhibits an unselfish regard for the welfare of surgical patients.

       3.      Demonstrates firm adherence to a code of moral and ethical values.

       4.      Is respectful to patients and their families especially in times of stress to
               the family unit.

       5.      Respects and appropriately integrates other members of the health care
               team.

       6.      Provides appropriately prompt consultations when requested.

       7.      Demonstrates sensitivity to the individual patient’s profession, life goals,
               and cultural background as they apply to health care.

       8.      Is reliable, punctual, and accountable for own actions in the OR and clinic.

       9.    Understands the concepts of autonomy, beneficence, nonmaleficence,
               justice, and respect for life.

       10.     Maintains patient confidentiality.




                                                                                               71
ORTHOPEDIC SURGERY




                     72
A.     Medical Knowledge


Goal: The resident will achieve a detailed knowledge of the evaluation and management
of orthopedic patients.

       Objectives:

       1.     Discuss the basic science component of fracture and soft tissue injury and
              healing.

       2.     Discuss the concepts of internal fixation and its influences on fracture
              healing.

       3.     List the classification and terminology of open and closed fractures.

       4.     Discuss the acute management of open and closed fractures.

       5.     Recite the criteria for the diagnosis of compartment syndrome.

       6.     Discuss the soft tissue management in open fractures.

       7.     Discuss the diagnosis and management of malunions, nonunions, and
              osteomyelitis.




                                                                                      73
B.     Patient Care

Goal: The resident will provide patient care that is compassionate, appropriate, and
effective for the treatment of orthopedic care.

       Objectives

       1.     Participate in the management of skeletal trauma.

       2.     Learn and participate in splinting and casting techniques.

       3.     Diagnose and treat compartment syndrome.

       4.     Participate with graduated surgical independence in the open reduction
              and internal fixation of fractures.

       5.     Participate with graduated surgical independence in the closed reduction
              and external fixation of fractures.

       6.     Participate in the care of acute hand injuries.




                                                                                   74
C.     Practice Based Learning and Improvement


Goal: The resident will investigate and evaluate his or her own patient care practices,
appraise and assimilate scientific evidence, and improve patient care practices.

       Objectives
       1.     Uses information technology to prepare for surgical cases, bringing to the
              OR the knowledge of current modalities of care and the scientific evidence
              for that care.

       2.     Routinely analyzes the effectiveness of own practices in caring for
              orthopedic patients.

       3.     Improves own practices in the care of orthopedic patients by integrating
              appropriately gathered data and feedback.

       4.     Educates medical students and other healthcare professionals in the
              practices of orthopedic surgery.

       5.     Functions independently with graduated advancement and appropriate
              faculty supervision.

       6.    Uses library sources to perform research and perform literature searches.

       7.     Understands the principles of clinical research and the application of
              biostatistics.




                                                                                         75
D.     Interpersonal and Communication Skills


Goal: The resident will demonstrate interpersonal and communication skills that result
in effective information exchange and teaming with patients, their families, and
professional associates.

       Objectives

       1.     Educates patients and families in post operative and rehabilitative
              strategies for trauma patients.

       2.     Demonstrates compassion for patients and families afflicted with trauma.

       3.     Provides adequate counseling and informed consent to patients.

       4.     Listens to patients and their families.

       5.     Assimilates data and information provided by other members of the health
              care team.

       6.     Charts and records accurate information.




                                                                                     76
E.     System Based Practice


Goal: The resident will 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 care that is of optimal value.

       Objectives

       1.   Coordinates all aspects of the rehabilitation of the orthopedic surgery patient.

       2.      Direct the rehabilitation of orthopedic surgery patients by partnering with
               the following:

               a.      Physical Therapy
               b.      Occupational Therapy
               c.      PRM physicians
               d.      social workers
               e.      nutritionalists

       3.      Demonstrates knowledge of cost-effective orthopedic care.

       4.      Advocates for orthopedic surgery patients within the health care system.

       5.      Refers orthopedic patients to the appropriate practitioners and agencies.

       6.      Facilitates the timely discharge of orthopedic surgery patients

       7.      Works with paramedical professionals in the prehospital care of trauma
               patients.




                                                                                           77
F.     Professionalism


Goal: The resident will demonstrate a commitment to carrying out professional
responsibilities, adherence to ethical principles, and sensitivity to a diverse patient
population.

       Objectives

       1.     Develops a sensitivity of the unique stresses placed on families under care
              for traumatic orthopedic injuries.

       2.     Exhibits an unselfish regard for the welfare of orthopedic surgery patients.

       3.     Demonstrates firm adherence to a code of moral and ethical values.

       4.     Is respectful to hand patients and their families especially in times of
              trauma and stress to the family unit.

       5.     Respects and appropriately integrates other members of the orthopedic
              surgery team.

       6.     Provides appropriately prompt consultations when requested.

       7.     Demonstrates sensitivity to the individual patient’s profession, life goals,
              and cultural background as they apply to orthopedic care.

       8.     Is reliable, punctual, and accountable for own actions in the OR and clinic.

       9.     Understands the concepts of autonomy, beneficence, nonmaleficence,
              justice, and respect for life.

       10.   Maintains patient confidentiality.




                                                                                       78
OTORHINOLARYNGOLOGY




                      79
A.     Medical Knowledge


Goal: The resident will achieve a detailed knowledge of the evaluation and treatment of
a variety of disease processes. The resident will be exposed to patients with both medical
and surgical emergencies and will become comfortable with the initial evaluation and
stabilization of patients.

       Objectives:

       1.   Discuss the diagnosis and treatment of patients with ENT emergencies,
              including:

               a.     epistaxis
               b.     acute pharyngitis
               c.     sinusitis
               d.     otitis media and externa
               e.     foreign bodies in the ears, nose, and throat
               f.     acute epiglottis
               g.     airway obstruction

       2.      Draw the anatomy of the head and neck with attention to the upper
               aerodigestive tract.

       3.      Discuss the physiology of the upper aerodigestive tract.

       4.      Discuss the management of various infections of the head and neck and
               the associated complications.

       5.      Recite the methods of evaluating the head and neck including endoscopic
               procedures.

       6.      Discuss the pathogenesis and common presentations of head and neck
               malignancies.

       7.      List the staging systems for head and neck malignancies.

       8.      Discuss the techniques of evaluation and treatment of metastatic
               carcinoma in the neck.

       9.      Discuss the adjuvant therapeutic treatment available for treatment of
               patients with head and neck malignancies.




                                                                                       80
     10.   Discuss the options for head and neck reconstruction after extirpative
           surgery.

     11.   List the common nonmalignant and malignant diseases of the parotid
           gland and their treatment.

     12.   Discuss the common disease entities affecting the facial nerve, including
           Bell’s palsy.

     13.   Describe the static and dynamic reconstructive procedures for facial nerve
           reanimation.

     14.   Discuss the physiology of the nose, with attention to the nasal cycle,
           internal nasal valve physiology, and the effect of anatomy on air flow.

     15.   Discuss the anatomic relationship of the facial nerve with attention to the
           facial planes.

     16.   Discuss the branches of the external carotid artery and their courses.

     17.   Discuss the courses and relationships of the cranial nerves.




B.   Patient Care



                                                                                    81
Goal: The resident will provide patient care that is compassionate, appropriate, and
effective for the treatment of head and neck problems.

       Objectives

       1.     Perform a comprehensive head and neck examination including
              endoscopy.

       2.     Treat patients with Bell’s palsy.

       3.     Participate in extirpative surgery of head and neck malignancies including
              neck dissections.

       4.     Participate in head and neck reconstructive surgery following extirpative
              cancer resections.

       5.     Participate in static and dynamic facial nerve reconstructions.

       6.     Participate in tracheostomy procedures.

       7.     Participate in the treatment of airway obstruction.

       8.     Manage the postoperative care of patients undergoing head and neck
              extirpative and reconstructive surgery.

       9.     Become comfortable with nasal exams using a nasal speculum.

       10.    Manage patients with epistaxis, and become comfortable with nasal
              packing.




                                                                                     82
C.     Practice Based Learning and Improvement


Goal: The resident will investigate and evaluate his or her own patient care practices,
appraise and assimilate scientific evidence, and improve patient care practices.

       Objectives
       1.     Uses information technology to prepare for cases, using in the OR the
              knowledge of current modalities of care and the scientific evidence for
              that care.

       2.     Routinely analyzes the effectiveness of own practices in caring for head
              and neck surgery patients.

       3.     Improves own practices in the care of patients by integrating appropriately
              gathered data and feedback.

       4.     Educates medical students and other healthcare professionals in the
              practices of head and neck surgery.

       5.     Functions independently with graduated advancement and appropriate
              faculty supervision.

       6.     Uses library sources to perform research and perform literature searches.

       7.     Understands the principles of clinical research and the application of
              biostatistics.




                                                                                       83
D.     Interpersonal and Communication Skills


Goal: The resident will demonstrate interpersonal and communication skills that result
in effective information exchange and teaming with patients, their families, and
professional associates.

       Objectives

       1.     Educates patients and families in follow-up strategies and rehabilitation
              for head and neck surgery patients.

       2.     Demonstrates compassion for patients and families undergoing head and
              neck surgery.

       3.     Provides adequate counseling and informed consent to patients.

       4.     Listens to patients and their families.

       5.     Assimilates data and information provided by other members of the head
              and neck cancer team.

       6.     Charts and records accurate information.

       7.     Educates patients and families of skin damage, cancerous and pre-
              cancerous lesions.




                                                                                    84
E.     System Based Practice


Goal: The resident will 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 care that is of optimal value.

       Objectives

       1.      Coordinates all aspects of the preoperative and postoperative care and
               rehabilitation of head and neck surgery patients.

       2.      Create a cost-effective, focused work-up of diagnostic testing.

       3.      Advocates for head and neck cancer patients within the health care system.

       4.      Refers head and neck patients to the appropriate practitioners and
               agencies.

       5.      Facilitates the timely discharge and/or placement of head and neck surgery
               patients

       6.      Learn to coordinate the admission of patients and communicate with
               primary care physicians, inpatient house staff, and consultants.

       7.      Direct the total care of head and neck patients by partnering with the
               following:

             a.        cancer surgeons
             b.        reconstructive surgeons
             c.        radiation oncologists
             d.        medical oncologists
             e.        nutritionalists
             f.        social workers




                                                                                         85
F.     Professionalism


Goal: The resident will demonstrate a commitment to carrying out professional
responsibilities, adherence to ethical principles, and sensitivity to a diverse patient
population.

       Objectives

       1.     Develops a sensitivity of the unique stresses placed on families under care
              for head and neck surgery .

       2.     Exhibits an unselfish regard for the welfare of head and neck surgery
              patients.

       3.     Demonstrates firm adherence to a code of moral and ethical values.

       4.     Is respectful to patients and their families especially in times of stress to
              the family unit.

       5.     Respects and appropriately integrates other members of the head and neck
              surgery health care team.

       6.     Provides appropriately prompt head and neck consultations when
              requested.

       7.     Demonstrates sensitivity to the individual patient’s profession, life goals,
              and cultural background as they apply to surgery.

       8.     Is reliable, punctual, and accountable for own actions in the OR and clinic.

       9.     Understands the concepts of autonomy, beneficence, nonmaleficence,
              justice, and respect for life.

       10.   Maintains patient confidentiality.




                                                                                        86
PEDIATRIC SURGERY




                    87
A.     Medical Knowledge

Goal: The resident will achieve a detailed knowledge of the pathophysiology of
pediatric surgical diseases and will develop the skills needed to treat the pediatric surgery
patient.

       Objectives:

       1.      Discuss the embryology, physiology pathophysiology, presentation,
               diagnosis, and management of the major pediatric surgical diseases,
               including (but not limited to):

               a.      appendicitis
               b.      congenital diaphragmatic hernia
               c.      gastroesophageal reflux
               d.      Hirschsprung’s disease
               e.      imperforate anus
               f.      intussusception
               g.      pyloric stenosis
               h.      tracheo-esophogeal fistula
               i.      malrotations with midgut volvulus
               j.      pediatric tumors
                               i. neuroblastoma
                               ii. Wilms tumor
                               iii. Teratomas
               k.      abdominal wall defects
                           i. gastroschisis
                           ii. omphalocele

       2.      List the principles of the resuscitation and care of the multiply injured
               child.

       3.      Describe the unique details in the management of hospitalized children,
               including:

             a.        fluid and electrolyte
             b.        nutritional therapies
             c.        pain control
             d.        antimicrobials
             e.        thermoregulation

       4.    Discuss the diagnosis and management of congenital outpatient pediatric
             diagnoses such as:

             a.        inguinal hernias
             b.        undescended testes


                                                                                          88
c.   thyroglossal duct cysts
d.   branchial cleft cysts
     e. hygromas




                               89
B.     Patient Care

Goal: The resident will provide patient care that is compassionate, appropriate, and
effective for the treatment of pediatric surgery problems.

       Objectives:

       1.     Evaluates children with pediatric surgical diagnoses, performing the
              physical exams and initial assessment.

       2.     Participate in the resuscitation and management of the multiply injured
              child.

       3.     Become familiar with the management of critically ill neonates.

       4.     Participate in the outpatient management of children with complex
              surgical conditions.

       5.     Participate in the surgical management of children with pediatric surgical
              diagnoses.

       6.     Treat pediatric patients postoperatively, managing their care, including:

              a.      pain control
              b.      fluid and electrolyte balance
              c.      wound care
              d.      antibiotic therapy




                                                                                          90
C.     Practice Based Learning and Improvement


Goal: The resident will investigate and evaluate his or her own patient care practices,
appraise and assimilate scientific evidence, and improve patient care practices.

       Objectives
       1.     Uses information technology to prepare for surgical cases, bringing to the
              OR the knowledge of current modalities of care and the scientific evidence
              for that care.

       2.     Routinely analyzes the effectiveness of own practices in caring for
              pediatric surgery patients.

       3.     Improves own practices in the care of pediatric surgery patients by
              integrating appropriately gathered data and feedback.

       4.     Educates medical students and other healthcare professionals in the
              practices of pediatric surgery.

       5.     Functions independently with graduated advancement and appropriate
              faculty supervision.

       6.     Uses library sources to perform research and perform literature searches.

       7.     Understands the principles of clinical research and the application of
              biostatistics.




                                                                                      91
D.     Interpersonal and Communication Skills


Goal: The resident will demonstrate interpersonal and communication skills that result
in effective information exchange and teaming with patients, their families, and
professional associates.

       Objectives

       1.     Educates patients and families in post operative and rehabilitative
              strategies for pediatric surgery patients.

       2.     Demonstrates compassion for patients and families afflicted with trauma.

       3.     Provides adequate counseling and informed consent to patients.

       4.     Listens to patients and their families.

       5.     Assimilates data and information provided by other members of the health
              care team.

       6.     Charts and records accurate information.




                                                                                     92
E.     System Based Practice


Goal: The resident will 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 care that is of optimal value.

       Objectives

       1.      Coordinates all aspects of the rehabilitation of the pediatric surgery
               patient.

       2.      Direct the rehabilitation of pediatric surgery patients by partnering with
               the following:

               a.      Physical Therapy
               b.      Occupational Therapy
               c.      PRM physicians
               d.      social workers
               e.      nutritionalists

       3.      Demonstrates knowledge of cost-effective pediatric surgery care.

       4.      Advocates for pediatric surgery patients within the health care system.

       5.      Refers pediatric patients to the appropriate practitioners and agencies.

       6.      Facilitates the timely discharge of pediatric surgery patients

       7.      Works with paramedical professionals in the prehospital care of trauma
               patients.




                                                                                            93
F.     Professionalism


Goal: The resident will demonstrate a commitment to carrying out professional
responsibilities, adherence to ethical principles, and sensitivity to a diverse patient
population.

       Objectives

       1.     Develops a sensitivity of the unique stresses placed on families under care
              for pediatric injuries.

       2.     Exhibits an unselfish regard for the welfare of pediatric surgery patients.

       3.     Demonstrates firm adherence to a code of moral and ethical values.

       4.     Is respectful to pediatric patients and their families especially in times of
              trauma and stress to the family unit.

       5.     Respects and appropriately integrates other members of the pediatric
              surgery team.

       6.     Provides appropriately prompt pediatric surgical consultations when
              requested.

       7.     Demonstrates sensitivity to the individual patient’s profession, life goals,
              and cultural background as they apply to surgery.

       8.     Is reliable, punctual, and accountable for own actions in the OR and clinic.

       9.     Understands the concepts of autonomy, beneficence, nonmaleficence,
              justice, and respect for life.

       10.   Maintains patient confidentiality.




                                                                                        94
THORACIC SURGERY




                   95
A.     Medical Knowledge


Goal: The resident will achieve a detailed knowledge of the evaluation and treatment of
a variety of disease processes. The resident will be exposed to patients with both medical
and surgical emergencies and will become comfortable with the initial evaluation and
stabilization of patients.

       Objectives:

       1.      Discuss the basic pathophysiology of thoracic and pulmonary disease
               entities.

       2.      Discuss the indications and contraindications for thoracic surgery.

       3.      Discuss the diagnosis and treatment of patients undergoing significant
               thoracic diagnoses, including:

               a.     pulmonary malignancies
               b.     esophageal malignancies
               c.     refractory esophageal reflux
               d.     empyemas
               e.      pleural effusions
                f.    emphysema

       7.      Recite the basic details of commonly performed thoracic operations, such
               as:

               a.     pulmonary resections
               b      lung transplantation
               c.     Nissen Fundoplications
               d.     esophageal resection
               e.     thymoma

       8.      Discuss the basic understanding of pacemakers and defibrillating devices.

       9.      Recite the indications for and contraindications for pulmonary
               transplantation.

       10.     Discuss the details of immunotherapy for thoracic transplant surgery.

       11.     Discuss the diagnosis and treatment of acute and chronic rejection of lung
               transplants.




                                                                                       96
12.   Recite the details about the process of organ donation.

13.   Discuss the intricacies of mechanical pulmonary ventilation.

14.   Discuss and interpret esophageal manometry, pH studies, spirometry, and
      measurement of diffusing capacity.

15.   Recite the staging of esophageal and lung malignancies.

16.   Discuss the role and benefits of minimally invasive approach to:

             a.   Nissen Fundoplications
             b.   Esophagectomies
             c.   Lung biopsies
             d.   Lung resections




                                                                          97
B.     Patient Care

Goal: The resident will provide patient care that is compassionate, appropriate, and
effective for the treatment of cardiothoracic problems.

       Objectives

       1.     Preoperatively evaluate and prepare thoracic patients for surgery.

       2.     Interprets laboratory and diagnostic tests.

       3.     Care for patients with post-operative dysrhythmias.

       4.     Become certified in ACLS

       5.     Interprets electrocardiograms

       6.     Care for patients with post-operative hemodynamic problems.

       7.      Participate in the diagnosis and care of post-operative complications in
              thoracic surgery.

       8.     Participate in the operative therapy of acquired diseases of the lungs and
              mediastinum including the use of traditional operative therapy and
              endoscopic therapy, including:

              a.      thoracotomies
              b.       thoracostomies
              c.      thoracoscopic and laparoscopic procedures
              d.      bronchoscopies
              e.      esophagoscopies

       9.     Interpret chest xrays and CT scans of thoracic diagnoses.

       10.    Performs with graduated independent surgical experience the following
              thoracic surgery procedures:

              a.      thoracentesis
              b.      insertion of pleural drainage catheters
              c.      placement of chest tubes
              d.      bronchoscopy
              e.      esophagoscopy




                                                                                     98
C.     Practice Based Learning and Improvement


Goal: The resident will investigate and evaluate his or her own patient care practices,
appraise and assimilate scientific evidence, and improve patient care practices.

       Objectives
       1.     Uses information technology to prepare for cases, using in the OR the
              knowledge of current modalities of care and the scientific evidence for
              that care.

       2.     Routinely analyzes the effectiveness of own practices in caring for
              thoracic surgery patients.

       3.     Improves own practices in the care of patients by integrating appropriately
              gathered data and feedback.

       4.     Educates medical students and other healthcare professionals in the
              practices of thoracic surgery.

       5.     Functions independently with graduated advancement and appropriate
              faculty supervision.

       6.     Uses library sources to perform research and perform literature searches.

       7.     Understands the principles of clinical research and the application of
              biostatistics.




                                                                                       99
D.     Interpersonal and Communication Skills


Goal: The resident will demonstrate interpersonal and communication skills that result
in effective information exchange and teaming with patients, their families, and
professional associates.

       Objectives

       1.     Educates patients and families in follow-up strategies and rehabilitation
              for thoracic surgery patients.

       2.     Demonstrates compassion for patients and families undergoing thoracic
              surgery and transplantation.

       3.     Provides adequate counseling and informed consent to patients.

       4.     Listens to patients and their families.

       5.     Assimilates data and information provided by other members of the
              thoracic health care team.

       6.     Charts and records accurate information.




                                                                                   100
E.     System Based Practice


Goal: The resident will 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 care that is of optimal value.

       Objectives

       1.      Coordinates all aspects of the preoperative and postoperative care and
               rehabilitation of thoracic surgery patients.

       2.      Create a cost-effective, focused work-up of diagnostic testing.

       3.      Advocates for cardiac patients within the health care system.

       4.      Refers thoracic patients to the appropriate practitioners and agencies.

       5.      Facilitates the timely discharge of thoracic surgery patients

        6.     Learn to coordinate the admission of patients and communicate with
               primary care physicians, inpatient house staff, and consultants.




                                                                                         101
F.     Professionalism


Goal: The resident will demonstrate a commitment to carrying out professional
responsibilities, adherence to ethical principles, and sensitivity to a diverse patient
population.

       Objectives

       1.     Develops a sensitivity of the unique stresses placed on families under care
              for thoracic surgery .

       2.     Exhibits an unselfish regard for the welfare of thoracic surgery patients.

       3.     Demonstrates firm adherence to a code of moral and ethical values.

       4.     Is respectful to patients and their families especially in times of stress to
              the family unit.

       5.     Respects and appropriately integrates other members of the thoracic health
              care team.

       6.     Provides appropriately prompt hand consultations when requested.

       7.     Demonstrates sensitivity to the individual patient’s profession, life goals,
              and cultural background as they apply to surgery.

       8.     Is reliable, punctual, and accountable for own actions in the OR and clinic.

       9.     Understands the concepts of autonomy, beneficence, nonmaleficence,
              justice, and respect for life.

       10.   Maintains patient confidentiality.




                                                                                       102
TRANSPLANT SURGERY




                     103
A.     Medical Knowledge


Goal: The resident will achieve a detailed knowledge of the evaluation and treatment of
a variety of disease processes. The resident will be exposed to patients with both medical
and surgical emergencies and will become comfortable with the initial evaluation and
stabilization of patients.

       Objectives:

       1.      Discuss the basic pathophysiology of end-stage liver and kidney failure.

       2.      Discuss the indications and contraindications for transplant surgery.

       3.      Discuss the diagnosis and treatment of patients undergoing significant
               transplant surgeries, including:

               a.     kidney
               b.     liver
               c.     pancreas
               d.     cardiac
               e.     lung
               f.     small bowel

       7.      Recite the details of the management of wound care in the
               immunocompromised patient.

       8.      Discuss the details of the use/dosing of immunosuppressive therapy in
               transplant surgery, including:

               a.     steroids
               b.     purine analogs and inhibitors (azathioprine, mycophenolate)
               c.     anti-lymphocyte preparations (OKT3, Thymoglobulin)
               d.     anti-T helper cell drugs (cyclosporine, tacrolimus)

       9       Discuss the diagnosis and treatment of acute and chronic rejection in
               transplant patients.

       10.     Recite the details about the process of organ donation.

       11.     Describe the general medical care of the immunosuppressed transplant
               patient.




                                                                                        104
14.   Discuss the alterations in physiology and the pathophysiology of end-stage
      kidney and liver failure.

15.   Discuss the effect of immunosuppression on tumor development and skin
      tumor presentation.

16.   Understand the effect of immunosuppression on wound healing.

16.   Discuss issues in transplant immunobiology, including:

      a.     major histocompatibility complex (MHC)
      b.     Human Leucocyte Antigens (HLA)
      c.     panel reactive antibody (PRA)
      d.     donor specific crossmatches
      e.     graft rejection and timing following transplantation (hyperacute,
             acute cellular, chronic)
      f.     differential diagnosis for rejection




                                                                             105
B.     Patient Care

Goal: The resident will provide patient care that is compassionate, appropriate, and
effective for the treatment of cardiothoracic problems.

       Objectives

       1.     Preoperatively evaluate and manage patients with end-stage liver and
              kidney disease.

       2.     Interprets laboratory and diagnostic tests.

       3.     Postoperatively manage and care for transplant patients.

       4.     Participate in the placement of vascular access for the treatment of end-
              stage renal failure and plasmapheresis, including:

              a.      vascular shunts
              b.      peritoneal dialysis catheters
              c.      Cimino Fistulas
              d.      vascular access procedures

       5.     Participates with graduated surgical independence in transplant surgery,
              including:

              a.      kidney transplants
              b.      liver transplants
              c.      living related organ donation
              d.      pancreas transplants
              c.      cardiac transplants
              d.      lung transplants
              e.      small bowel transplants
              f.      organ harvesting
              g.      hepatobiliary procedures
              h.      portosystemic shunts, liver resections

       6.     Care for patients with post-operative hemodynamic problems.

       7.     Participate in the diagnosis and care of patients with post-operative
              complications in transplant surgery, including:

              a.      delayed graft function
              b.      infectious complications
              c.      transplant dysfunction and rejection
              d.      immunosuppressive drug toxicity



                                                                                       106
8.    Participate in the general medical care of immunosuppressed transplant
      recipients.

9.    Participates in the preoperative assessment, preparation for surgery,
      postoperative inpatient and outpatient care of transplant patients.

10.   Participate in the treatment of liver failure complications, including:

      a.     acute variceal hemorrhage
      b.     hepatic encephalopathy
      c.     refractory ascites
      d.     hepatorenal syndrome
      e.     spontaneous bacterial peritonitis
       f.    alterations in drug excretion




                                                                                107
C.     Practice Based Learning and Improvement


Goal: The resident will investigate and evaluate his or her own patient care practices,
appraise and assimilate scientific evidence, and improve patient care practices.

       Objectives
       1.      Uses information technology to prepare for cases, using in the OR the
               knowledge of current modalities of care and the scientific evidence for
               that care.

       2.      Routinely analyzes the effectiveness of own practices in caring for
               transplant surgery patients.

       3.      Improves own practices in the care of patients by integrating appropriately
               gathered data and feedback.

       4.      Educates medical students and other healthcare professionals in the
               practices of transplant surgery.

       5.      Functions independently with graduated advancement and appropriate
               faculty supervision.

       6.      Uses library sources to perform research and perform literature searches.

       7.      Understands the principles of clinical research and the application of
               biostatistics.




                                                                                          108
D.     Interpersonal and Communication Skills


Goal: The resident will demonstrate interpersonal and communication skills that result
in effective information exchange and teaming with patients, their families, and
professional associates.

       Objectives

       1.     Educates patients and families in follow-up strategies and rehabilitation
              for transplant surgery patients.

       2.     Demonstrates compassion for patients and families undergoing
              transplantation.

       3.     Provides adequate counseling and informed consent to patients.

       4.     Listens to patients and their families.

       5.     Assimilates data and information provided by other members of the
              transplant team.

       6.     Charts and records accurate information.

       7.     Educates patients and families of transplantation of skin damage,
              cancerous and pre-cancerous lesions caused by immunosuppressant
              therapy.




                                                                                      109
E.     System Based Practice


Goal: The resident will 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 care that is of optimal value.

       Objectives

       1.      Coordinates all aspects of the preoperative and postoperative care and
               rehabilitation of transplant surgery patients.

       2.      Create a cost-effective, focused work-up of diagnostic testing.

       3.      Advocates for transplant patients within the health care system.

       4.      Refers transplant patients to the appropriate practitioners and agencies.

       5.      Facilitates the timely discharge of transplant surgery patients

        6.     Learn to coordinate the admission of patients and communicate with
               primary care physicians, inpatient house staff, and consultants.

       7.      Direct the total care of transplant patients by partnering with the
               following:

             a.        Transplant surgeons
             b.        Immunologists
             c.        Nutitionalists
             d.        Social Workers
             e.        Nephrologists
             f.        Hepatologists




                                                                                        110
F.     Professionalism


Goal: The resident will demonstrate a commitment to carrying out professional
responsibilities, adherence to ethical principles, and sensitivity to a diverse patient
population.

       Objectives

       1.      Develops a sensitivity of the unique stresses placed on families under care
               for transplant surgery .

       2.      Exhibits an unselfish regard for the welfare of transplant surgery patients.

       3.      Demonstrates firm adherence to a code of moral and ethical values.

       4.      Is respectful to patients and their families especially in times of stress to
               the family unit.

       5.      Respects and appropriately integrates other members of the transplant
               surgery health care team.

       6.      Provides appropriately prompt hand consultations when requested.

       7.      Demonstrates sensitivity to the individual patient’s profession, life goals,
               and cultural background as they apply to surgery.

       8.      Is reliable, punctual, and accountable for own actions in the OR and clinic.

       9.      Understands the concepts of autonomy, beneficence, nonmaleficence,
               justice, and respect for life.

       10.     Maintains patient confidentiality.




                                                                                           111
TRAUMA SURGERY




                 112
A.     Medical Knowledge


Goal: The resident will achieve a detailed knowledge of the pathophysiology of blunt
and penetrating trauma and will develop the skills needed to treat the trauma patient .

       Objectives:

       1.     Describe the mechanisms of injury of blunt and penetrating injury.

       2.     Recite the steps of the primary, secondary, and tertiary surgery.

       3.     Discuss the diagnosis and treatment of thoracic injuries, including:

              a.     Flail chest
              b.     Cardiac tamponade and contusion
              c.     Open and tension pneumothorax
              d.     Airway obstruction
              e.     Aortic transection
              f.     Diaphragmatic tear
              g.     Esophageal tear
              h.     Rib fracture

       4.     Discuss the diagnosis and treatment of abdominal injuries, including:

              a.     splenic injury
              b.     hepatic injury
              c.     bowel injury
              d.     gastric injury
              e.     pancreatic injury
              f.     renal and bladder injury

       5.     Discuss the diagnosis and treatment of central nervous system injury:

              a.     brain injury
              b.     spinal cord injury

       6.     Discuss the diagnosis and treatment of orthopaedic injuries.

       7.      Recites the steps in the treatment of hemorrhagic shock.

       8.     Recite the indications for and complications of blood product transfusion.




                                                                                      113
B.     Patient Care

Goal: The resident will provide patient care that is compassionate, appropriate, and
effective for the treatment of trauma problems.

       Objectives

       1.     Perform a primary, secondary, and tertiary survey for a trauma patient.

       2.     Function as the Team Leader in the resuscitation phase of trauma patient
              care.

       3.     Perform the emergency treatment for flail chest, cardiac tamponade,
              pneumothorax, and airway obstruction

       4.     Participate in the operative treatment of thoracic and abdominal trauma.

       5.     Perform a complete CNS evaluation of the trauma patient and assign GCS
              scores.

       6.     Perform thoracostomy and thoracotomy on appropriate trauma patients

       7.     Perform a diagnostic peritoneal lavage.

       8.     Participate in exploratory laparotomies for trauma patients.

       9.     Treat patients with cardiac tamponade and perform pericardial centesis
              and pericardial windows.

       10.    Participates in the evaluation, resusciatation, and initial and definitive
              treatment of trauma patients.

       11.   Become ATLS certified.




                                                                                        114
C.     Practice Based Learning and Improvement


Goal: The resident will investigate and evaluate his or her own patient care practices,
appraise and assimilate scientific evidence, and improve patient care practices.

       Objectives
       1.     Uses information technology to prepare for surgical cases, bringing to the
              OR the knowledge of current modalities of care and the scientific evidence
              for that care.

       2.     Routinely analyzes the effectiveness of own practices in caring for trauma
              patients.

       3.     Improves own practices in the care of trauma patients by integrating
              appropriately gathered data and feedback.

       4.     Educates medical students and other healthcare professionals in the
              practices of trauma surgery.

       5.     Functions independently with graduated advancement and appropriate
              faculty supervision.

       6.     Uses library sources to perform research and perform literature searches.

       7.     Understands the principles of clinical research and the application of
              biostatistics.




                                                                                     115
D.     Interpersonal and Communication Skills


Goal: The resident will demonstrate interpersonal and communication skills that result
in effective information exchange and teaming with patients, their families, and
professional associates.

       Objectives

       1.     Educates patients and families in post operative and rehabilitative
              strategies for trauma patients.

       2.     Demonstrates compassion for patients and families afflicted with trauma.

       3.     Provides adequate counseling and informed consent to patients.

       4.     Listens to patients and their families.

       5.     Assimilates data and information provided by other members of the health
              care team.

       6.     Charts and records accurate information.




                                                                                    116
E.     System Based Practice


Goal: The resident will 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 care that is of optimal value.

       Objectives

       1.      Coordinates all aspects of the rehabilitation of the trauma patient.

       2.      Direct the rehabilitation of patients following trauma by partnering with
               the following:

               a.      Physical Therapy
               b.      Occupational Therapy
               c.      PRM physicians
               d.      social workers
               e.      nutritionalists

       3.      Demonstrates knowledge of cost-effective trauma care.

       4.      Advocates for trauma patients within the health care system.

       5.      Refers trauma patients to the appropriate practitioners and agencies.

       6.      Facilitates the timely discharge of trauma patients

       7.      Works with paramedical professionals in the prehospital care of trauma
               patients.




                                                                                        117
F.     Professionalism


Goal: The resident will demonstrate a commitment to carrying out professional
responsibilities, adherence to ethical principles, and sensitivity to a diverse patient
population.

       Objectives

       1.     Develops a sensitivity of the unique stresses placed on families under care
              for traumatic injuries.

       2.     Exhibits an unselfish regard for the welfare of trauma patients.

       3.     Demonstrates firm adherence to a code of moral and ethical values.

       4.     Is respectful to hand patients and their families especially in times of
              trauma and stress to the family unit.

       5.     Respects and appropriately integrates other members of the trauma team.

       6.     Provides appropriately prompt hand consultations when requested.

       7.     Demonstrates sensitivity to the individual patient’s profession, life goals,
              and cultural background as they apply to trauma care.

       8.     Is reliable, punctual, and accountable for own actions in the OR and hand
              clinic.

       9.     Understands the concepts of autonomy, beneficenece, nonmaleficence,
              justice, and respect for life.

       10.   Maintains patient confidentiality.




                                                                                      118
VASCULAR SURGERY




                   119
A.    Medical Knowledge


Goal: The resident will achieve a detailed knowledge of vascular disease and will
develop the skills needed to treat the vascular surgery patient .

      Objectives:

      1.     Discuss the etiology, evaluation, and management of aneurysmal disease.

      2.     Discuss the etiology, evaluation, and management of arterial and venous
             occlusive disease, including:

             a.     extremity
             b.     carotid
             c.     visceral
             d.     renal

      3.     Discus the etiology, evaluation, and management of renal artery occlusive
             disease.

      4.     Discuss the etiology, evaluation, and management of embolic and stenotic
             arterial disease.

      5.     Discuss the etiology, evaluation, and management of Thoracic outlet
             syndrome, innominate, subclavian arterial disease.

      6.     Discuss the etiology, evaluation, and management of lower extremity
             diabetic foot disease, chronic venous insufficiency, deep venous
             thrombosis, and lymphedema.

      7.     Describe the       diagnosis   and   management   of   vascular   surgery
             complications.

      8.     Discuss the diagnosis and management of vascular trauma.

      9.     Recites the various invasive and non-invasive techniques used to diagnose
             vascular disease, including:

             a.      hemodynamic assessment
             b.     duplex evaluation
             c.     arteriography
             d.     CT
             e.     MRI/MRA/MRV
             f.     pulse volume recordings
             g.     transcutaneous oxygen



                                                                                  120
10.   Discuss the diagnosis and management of coagulation disorders,
      including:

      a.     bleeding disorders
      b.     heparin associated thrombocytopenia
      c.     hypercoagulable states

11.   Discuss the pathophysiology and management of non-atherosclerotic
      vascular diseases, including:

      a.     systemic vasculitides
      b.     giant cell arteritis
      c.     Takayasu’s disease
      d.     radiation induced arterial disease
      e.     arterial infections
      f.     adventitial cystic disease
      g.     Buerger’s Disease
      h.     Marfan’s syndrome
      i.     Ehler-Danlos syndrome
      j.     homocystinuria

12.   Discuss the indications and use of common medications utilized in
      vascular surgery, including:

      a.     low molecular weight heparin
      b.     antiplatelet agents
      c.     anti thrombolytic therapy

13.   Recite the indications for thrombolysis, surgical endarterectomy, vascular
      bypass, or endovascular repair of vascular lesions.

14.   Draw the appropriate surgical incisions and techniques for vascular
      exposure.




                                                                            121
B.     Patient Care

Goal: The resident will provide patient care that is compassionate, appropriate, and
effective for the treatment of vascular surgery problems.

       Objectives

       1.     Participates in the pre and postoperative care of the vascular surgery
              patient.

       2.     Participates, with graduated surgical independence, in simple and
              associated vascular surgical procedures, including:

              a.      amputations
              b.      vascular access procedures
              c.      vascular shunts
              d.      closure of surgical wounds and incisions

       3.     Participates, with graduated surgical independence, in vascular bypass
              surgeries, including:

              a.      femoral-popliteal bypass
              b.      femoral-femoral bypass
              c.      femoral-tibial bypass
              d.      aorto-femoral bypass

       4.     Participate, with graduated surgical independence, in major vascular
              surgery, including:

              a.      carotid endarterectomies
              b.      abdominal aortic aneurysms
              c.      endovascular procedures
              d.      aneurysmal disease procedures
              e.      central and extremity arterial occlusive disease
              f.      renal artery occlusive disease
              g.      visceral ischemia

       5.     Care for patients who are post amputation, and treat phantom pain
              syndromes.

       6.     Evaluate and diagnose patients with vascular surgery diagnoses.

       7.     Develop a working knowledge of and interpret vascular lab studies and
              imaging studies.




                                                                                122
8.   Learn the commonly performed techniques for arterial and venous
     anastomoses.




                                                                123
C.     Practice Based Learning and Improvement


Goal: The resident will investigate and evaluate his or her own patient care practices,
appraise and assimilate scientific evidence, and improve patient care practices.

       Objectives
       1.     Uses information technology to prepare for surgical cases, bringing to the
              OR the knowledge of current modalities of care and the scientific evidence
              for that care.

       2.     Routinely analyzes the effectiveness of own practices in caring for
              vascular surgery patients.

       3.     Improves own practices in the care of vascular surgery patients by
              integrating appropriately gathered data and feedback.

       4.     Educates medical students and other healthcare professionals in the
              practices of vascular surgery.

       5.     Functions independently with graduated advancement and appropriate
              faculty supervision.

       6.     Uses library sources to perform research and perform literature searches.

       7.     Understands the principles of clinical research and the application of
              biostatistics.




                                                                                     124
D.     Interpersonal and Communication Skills


Goal: The resident will demonstrate interpersonal and communication skills that result
in effective information exchange and teaming with patients, their families, and
professional associates.

       Objectives

       1.     Educates patients and families in post operative and rehabilitative
              strategies for vascular surgery patients.

       2.     Demonstrates compassion for patients and families afflicted by vascular
              disease.

       3.     Provides adequate counseling and informed consent to patients.

       4.     Listens to patients and their families.

       5.     Assimilates data and information provided by other members of the health
              care team.

       6.     Charts and records accurate information.




                                                                                  125
E.     System Based Practice


Goal: The resident will 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 care that is of optimal value.

       Objectives

       1.      Coordinates all aspects of the rehabilitation of the vascular surgery patient.

       2.      Direct the rehabilitation of patients following vascular surgery by
               partnering with the following:

               a.      Physical Therapy
               b.      Occupational Therapy
               c.      PRM physicians
               d.      social workers
               e.      nutritionalists

       3.      Demonstrates knowledge of cost-effective vascular surgery care.

       4.      Advocates for patients within the health care system.

       5.      Refers patients to the appropriate practitioners and agencies.

       6.      Facilitates the timely discharge and/or placement of vascular surgery
               patients




                                                                                         126
F.     Professionalism


Goal: The resident will demonstrate a commitment to carrying out professional
responsibilities, adherence to ethical principles, and sensitivity to a diverse patient
population.

       Objectives

       1.     Develops a sensitivity of the unique stresses placed on families under care
              for vascular surgery.

       2.     Exhibits an unselfish regard for the welfare of surgery patients.

       3.     Demonstrates firm adherence to a code of moral and ethical values.

       4.     Is respectful to hand patients and their families especially in times of
              trauma and stress to the family unit.

       5.     Respects and appropriately integrates other members of the vascular
              surgery team.

       6.     Provides appropriately prompt hand consultations when requested.

       7.     Demonstrates sensitivity to the individual patient’s profession, life goals,
              and cultural background as they apply to vascular surgery.

       8.     Is reliable, punctual, and accountable for own actions in the OR and clinic.

       9.     Understands the concepts of autonomy, beneficence, nonmaleficence,
              justice, and respect for life.

       10.   Maintains patient confidentiality.




                                                                                      127
PLASTIC SURGERY
  CURRICULUM




                  128
Purpose:   The plastic surgery curriculum (goals and objectives) is provided to
           residents and attendings for education and assessment. The curriculum
           not only is an educational tool, but a guide for assessment. Residents
           should utilize the curriculum to direct independent study and self
           assessment. Attendings should utilize the curriculum to direct resident
           teaching and assessment. The curriculum is the tie between education and
           assessment.



Note:      The plastic surgery curriculum is broken down into 7 major sections of
           plastic surgery. Each of the 7 sections is in-turn broken down according to
           the 6 General Competencies

           A.   Medical Knowledge
           B.   Patient Care
           C.   Practice Bases Learning and Improvement
           D.   Interpersonal and Communication Skills
           E.   System Based Practice
           F.   Professionalism




                                                                                  129
          CORE OF
KNOWLEDGE/GENERAL PLASTIC
  SURGICAL PRINCIPLES AND
        TECHNIQUES




                       130
A.     Medical Knowledge

I:     Wound Repair: Principles and Applications

Goal: The resident will demonstrate knowledge of the physiology and biochemistry of
wound healing and manage complex wounds using a variety of techniques to achieve
normal healing and maximum aesthetic benefit.

       Objectives:

       1.     Recite the physiology and biochemistry of normal healing.

       2.     Discuss the physiology and biochemistry of abnormal wound healing
              including hypertrophic scars and keloids.

       3.     Discuss common agents and processes which result in abnormal healing.

       4.     Identify the pharmacologic agents and other nonsurgical methods for
              treatment of abnormal healing.

       5.     Describe the management of dressings, splints and other techniques
              utilized in wound management.

       6.     Explain the differences in the healing of cortical and cancellous,
              membranous and endochondral bone.

       7.     Draw and plan techniques of scar revision (such as Z-plasty and W-
              plasty).

       8.     Describe the various lines of the skin (such as relaxed skin tension) and
              their importance in placement of incisions for maximum aesthetic result.

       9.     Discuss the role of nutrition in the wound healing process and the standard
              methods for diagnosis and treatment of nutritional deficiencies.

       10.    Discriminate the pathologic processes involved in keloid formation and
              the methods available to treat keloids.

       11.    Understand the differences in suture materials and indications for the use
              of different materials.

       12.    Discuss the basic science of healing, including the anatomy, physiology,
              biochemistry, microbiology, immunology, wound healing for:

              a.     skin and soft tissue
              b.     tendon



                                                                                      131
      c.     bone (different types)
      d.     nerve
      e.     cartilage.

13.   Discuss abnormal wound healing, including:

      a.     delayed healing – physiology and treatment
      b.     excessive healing (hypertrophic scars and keloids).




                                                                   132
II:    Flaps and Grafts

Goal: The resident will demonstrate knowledge of the physiology and flaps and grafts,
will be familiar with surgery in all types of flaps and grafts, and will utilize these
effectively in the full spectrum of plastic surgical practice.

       Objectives:

       1.     Discuss the terminology of flap movement including advancement flap,
              rotation flap, transposition of flap, etc.

       2.     Recite the terminology of flap vascular supply including random flap,
              island flap, free flap, etc.

       3.     Identify the variations in flap anatomy including cutaneous flap,
              fasciocutaneous flap, musculocutaneous flap, etc.

       4.     Explain the physiology of normal flaps, ischemic flaps, and the "delay"
              phenomenon.

       5.     Discuss the pathophysiology and microbiology of acute, intermediate, and
              secondary wounds, and the impact this has for the timing and techniques
              of wound closure surgery; be thoroughly familiar with the factors
              influencing the choice of flap versus graft for wound closure.

       6.     Explain in detail the specific physiology of split and full thickness skin
              grafts, dermal grafts, cartilage grafts, bone grafts, tendon grafts, nerve
              grafts, fascial grafts, and composite grafts.

       7.     Explain the differences in first degree and second degree wound
              contraction versus contracture.

       8.     Explain the concept of dermatomes and angiosomes and their implications
              on wounds and flaps.

       9.     Discern the principles and applications of special grafting techniques
              including dermabrasion and over-grafting, the crane principle, xenografts,
              skin matrix and synthetic or chemically manipulated materials.

       10.    Recite the Mathes Classification of muscle flaps.

       11.    Discuss the technological, pharmacological, and physiological monitoring
              techniques including fluorescence, capillary refill, thermal monitoring,
              laser flow probes, oxygen saturation, pH monitoring, etc.




                                                                                           133
III:   Microsurgery

Goal: The resident will demonstrate knowledge of the principles of microsurgery, and
master basic microsurgery techniques including microneural repair and microvascular
anastomosis.

       Objectives:

       1.     Explain the use of the operating microscope and the technical aspects of
              microvascular anastomosis (artery and vein) and microneural repair.

       2.     Discern the indications for, the contraindications to, and the techniques for
              accomplishing replantation of amputated parts. Recognize the techniques
              of monitoring the success of replantation.

       3.     Discuss the varying types of blood supply to discrete units of tissue
              (including arterialized flap, musculocutaneous flap, fasciocutaneous flap).

       4.     List the terms and types of free tissue flaps – skin, skin/muscle,
              skin/muscle/bone, skin/tendon, muscle alone.

       5.     List in detail the anatomy for harvesting the most common flaps, including
              latissimus dorsi, rectus abdominis, radial forearm.

       6.     Discern the indications for harvesting various flaps and matching donor
              sites to specific recipient site needs.

       7.     Discuss radiologic techniques for evaluation of both donor and recipient
              sites.

       8.     Discuss the mechanisms and consequences of the no-reflow phenomenon;
              knows how to treat a failing flap.

       9.     Discuss the technologic, pharmacologic and physiologic principles of
              postoperative monitoring of free flaps.

       10.    Recite the basic physiology of nerve injury (axontomesis, neurotomesis,
              neuropraxia, Wallerian degeneration) and of nerve healing.

       11.    Draw the intraneural anatomy and anatomic relationships of structures of
              the major peripheral nerves.

       12.    Explain the principles of repair of nerve injury including need for nerve
              grafting, the anatomy of nerve graft donor sites, and the physiology,
              timing and techniques of primary, delayed primary and late nerve repair.




                                                                                       134
13.   Discuss the principles and techniques of hematologic manipulation of
      abnormal vascular flow characteristics.

14.   Discuss the technical aspects of microsurgery including:

      a.     microscopes – principles, usage
      b.     sutures – types, indications\
      c.     microvascular coupling devices
      d.     suturing techniques.

15.   Discuss the use of electrophysiologic tools in the evaluation of nerve
      injury (EMG, NCS).




                                                                               135
IV:    Implants/Biomaterials

Goal: The resident will demonstrate knowledge of both biology and physiology of
various implant materials including bone, cartilage, and alloplasts.

       Objectives:

       1.     Identify the local wound factors which influence bone graft survival.

       2.     Discuss the biologic differences between vascularized and non-
              vascularized bone grafts.

       3.     Recite the influence of perichondrial and scoring on the warping of
              cartilage grafts.

       4.     Discuss the various types of breast implants and the factors involved in
              implant choice including surface content characteristics; be aware of the
              issues regarding silicone and be able to discuss these with a patient.

       5.     Discern the effects of breast implant surface characteristics on formation
              of capsular contracture.

       6.     Discuss the various injectable materials for subcutaneous filling and the
              principles of their use.

       7.     Discuss the processes of bone repair: incorporation, osteoconduction and
              osteoinduction.

       8.     Discuss the difference in incorporation between cortical and cancellous
              bone grafts and membranous and endochondral autografts.

       9.     Explain the immunology of bone and cartilage transplantation.

       10.    List the chemistry and biocompatibility of the commonly implanted
              biomaterials including silicone, methyl methacrylate, hydroxyapatite,
              tricalcium phosphate and proplast.

       11.    Describe the factors involved in the choice of implant materials for
              varying reconstructive problems.

       12.    Discuss the chemistry and biocompatibility of commonly injected
              materials including: collagen (bovine and human), fat, and others.




                                                                                      136
V:     Special Techniques

Goal: The resident will demonstrate knowledge of the principles of a variety of special
techniques in plastic surgery, including: liposuction, tissue expansion, laser treatments
and dermabrasion, and utilize the techniques effectively in appropriate clinical scenarios.

       Objectives:

       1.      Discuss the basic principles, the common techniques and the
               instrumentation of suction lipectomy including tumescence, standard and
               ultrasonic liposuction.

       2.      Recite the indications and for contraindications to suction lipectomy, and
               be familiar with the principles of patient assessment; recognize the
               limitations of liposuction.

       3.      Explain the preoperative, intraoperative and postoperative management of
               the patient undergoing suction lipectomy; be familiar with the
               complications of liposuction and their management.

       4.      Discuss the physiologic principles of tissue expansion.

       5.      Discriminate the various techniques for tissue expansion and be familiar
               with the differing expansion devices.

       6.      Discuss the principles of management of patients undergoing tissue
               expansion; recognize and treat the complications of tissue expansion.

       7.      Discuss the physiologic and pathologic principles of dermabrasion,
               chemical peel and laser resurfacing; recognize the differences between the
               techniques and the indications for choice between the techniques.

       8.      Recite the principles of pre- and postoperative management of patients
               undergoing facial resurfacing; recognize the complications of the
               technique and its management.

       9.      Explain the pharmacologic aspects and the techniques of chemical peel.

       10.     Discriminate the biophysical properties of commonly used lasers, and
               choose different lasers for different types of problems.

       11.     Discuss the indications for and contraindications to laser treatments and
               techniques of laser use, and the various complications of laser therapy and
               their treatment.




                                                                                        137
VI:    Medicolegal and Psychiatric Aspects of Plastic Surgery

Goal: The resident will demonstrate a clear understanding of medicolegal and
psychiatric aspects of plastic surgery practice, regularly obtain informed consent from
patients, and perform a basic psychological evaluation when appropriate.

       Objectives:

       1.      Discuss the medical and legal perspectives of the contractual agreement
               between a physician and his/her patient.

       2.      Discern the concepts of informed consent and implied guarantee.

       3.      Discuss the role of the medical record as a legal document.

       4.      Discern the impact physical deformity can have on patients and their
               families.

       5.      Discuss techniques to explore the motivations of patients seeking cosmetic
               surgery, and how to distinguish acceptable, unacceptable, and pathological
               motivations.

       6.      Recite the legal and ethical ways to sever the physician/patient
               relationship.

       7.      Discuss the various types of malpractice insurance.

       8.      Discuss the basic principles of risk management.

       9.      List the psychiatric and psychological treatment options for patients with
               physical deformities and their families.

       10.     Discuss the strategies to effectively treat the dissatisfied patient/family.




                                                                                          138
VII:   Anesthesia and Critical Care

Goal: The resident will demonstrate the indications, principles, techniques and
complications of local, regional, and general anesthesia, will be thoroughly familiar with
the principles and techniques of critical care and management of the critically ill burn,
trauma, and postoperative patients.

       Objectives:

       1.      Discuss common agents for local anesthesia (esters and amides), and
               regional anesthesia and general anesthesia (intravenous agents, inhalation
               agents, muscle relaxants, antiemetics, etc).

       2.      Identify the principles and the techniques for administration of local
               anesthesia.

       3.      Recite the pharmacology and safe utilization of agents used in "conscious
               sedation", including narcotics and benzodiazepines.

       4.      Recite the emergency care of burn and trauma patients including
               diagnostic techniques and management principles.

       5.      Recite the principles and techniques for regional anesthesia, particularly:

               a.     digital block
               b.     wrist block
               c.     brachial block
               d.     bier block
               e.     ankle block

       6.      Discuss the principles of spinal and epidural anesthesia.

       7.      Discuss the principles and techniques for general anesthesia utilizing
               different anesthetic techniques.

       8.      Discuss the use of common agents for local anesthesia (esters and amides)
               including:

               a.     mode of action
               b.     duration of action
               c.     dosage and toxicity
               d.     side effects
               e.     antidotes.




                                                                                        139
9.   Discuss the general principles and techniques for general anesthesia,
     including:

     a.     patient monitoring
     b.     airway management
     c.     preoperative mediations
     d.     intravenous agents
     e.     inhalation agents
     f.     muscle relaxants
     g      antiemetics.




                                                                             140
VIII: Transplantation/Immunology

Goal: The resident will demonstrate knowledge of the basic principles of immunology
and tissue transplantation techniques for treatment of common plastic surgical problems.

       Objectives:

       1.     Discuss the physiology of skin graft take and the immunology of allograft
              rejection.

       2.     Recite the basic immune response including antibody recognition of
              foreign antigens, first set rejection, and second set rejection.

       3.     List the cellular response to foreign tissue or material including the role of
              lymphocytes, macrophages, and T-cells.

       4.     Discern the actions of and proper usage of pharmacologic agents to alter
              the immune response, including cyclosporine, immuran, steroids, and
              monoclonal antibodies.

       5.     Discuss the role of immunology in host responses to tumor, including
              lymphocytic infiltration of melanoma, basal cell carcinoma, and squamous
              cell carcinoma.

       6.     Describe the role of immunology in response to foreign materials and
              regional or systemic reactions, e.g., "silicone synovitis," capsular
              contractures.

       7.     Describe the difference between skin transplantation and the
              transplantation of solid organs.

       8.     Discuss current information regarding human immunodeficiency virus and
              diseases.

       9.     Discuss the immunologic aspects of plastic surgery, including:

              a.      autoimmune disease
              b.      immunology of skin transplantation
              c.      interrelationship of transplantation and microsurgery.




                                                                                        141
IX:    Pharmacology/Therapeutics

Goal: The resident will demonstrate knowledge of the pharmacology of drugs used in
plastic surgical practice including antibiotics, anti-inflammatory agents, analgesics, and
effectively utilize such drugs in a wide variety of settings.

       Objectives:

       1.      List the common pathogens producing infections of the skin, head and
               neck structures, breast and hand.

       2.      List the special pathogens related to infections caused by human and
               animal bites and infections.

       3.      Discuss the indications and proper antibiotics and antimicrobials for
               treatment of the problems noted in #1 and #2 above.

       4.      List the principles of use (including dosage and complications) of common
               analgesics (oral and parenteral).

       5.      Discuss the pharmacology and clinical use of steroids in plastic surgery
               patients (including scar treatment, hand problems, steroid-dependent
               patients).

       6.      Discuss the pharmacology of the major types of antibiotics and the
               indications for their use.

       7.      Discuss the commonly used anti-inflammatory agents including dosage
               and mechanism of action.

       8.      Discuss the pharmacology, complications and clinical use of common
               chemotherapeutic agents for treatment of skin and head and neck
               malignancies.

       9.      Discuss the principles of management of extravasation injuries involving
               chemotherapeutic agents and other drugs.

       10.     Discuss the bacteriology of wounds, including:
               a       skin infection
               b.      breast infections
               c.      surgical wound infections
               d.      hand infections
               e.      special problems
                       1. animal bites
                       2. human bites
                       3. farm injuries.


                                                                                        142
X:     Patient Management/Office Management

Goal: The resident will demonstrate knowledge of patient evaluation, ICD-9 and CPT
terminology, and office operating room management.

       Objectives:

       1.     Explain how to interview and evaluate the patient, especially a surgery
              candidate.

       2.     Demonstrate the coding of diagnoses by the ICD-9 system.

       3.     Demonstrate coding of procedures by the CPT system.

       4.     Discuss ethical principles as they relate to billing and coding.

       5.     Demonstrate how to take and catalogue standardized medical photographs.

       6.     Discuss the principles of risk management.

       7.     Recite the basic principles of how to equip and organize an office
              operating room to comply with AAAAPSF standards.

       8.     Discuss the functioning of an outpatient operating facility, including:

              a.     equipment
              b.     laboratory evaluation
              c.     patient records
              d.     patient monitoring
              e.     AAAAPSF standards
              g      risk management.




                                                                                        143
B.     Patient Care

Goal: The resident will provide patient care that is compassionate, appropriate, and
effective.

       Objectives:

       1.     Participate in the care and treatment of scars and keloids, including:

              a.      surgical techniques (Z-plasty, W-plasty, etc)
              b.      nonsurgical techniques
              c.      camouflage techniques.

       2.     Evaluate patients and their nutritional status as related to wound healing,
              including:

              a.      diagnosis of deficiency
              b.      treatment of deficiency

       3.     Participate in planning surgical incisions, with respect to:

              a.      selection in relation to skin lines
              b.      techniques for closure
              c.      suture materials – types and uses.

       4.     Participate in wound management, including:

              a.      debridement
              b.      use of splints, dressings, casts, topics agents
              c.      use of biologic substitutes.

       5.     Treat complex wound problems such as dehiscence, delayed healing of
              complex traumatic wounds.

       6.     Evaluate patients with scar problems and revise scars to achieve functional
              and aesthetic benefit.

       7.     Perform surgical and pharmacologic treatment of hypertrophic scars and
              keloids.

       8.     Utilize splints, casts, dressings, topical agents, etc., to optimize healing.

       9.     Place incisions for elective surgery in such a way as to achieve the greatest
              aesthetic benefit.

       10.    Utilize biologic and artificial skin substitutes in wound management.



                                                                                          144
11.   Participate in the surgery of grafts and flaps including: skin, dermis,
      cartilage, bone, tendon, muscle, fascia, combined tissue; specifically:

      a.     grafting techniques
      b.     instruments for harvesting grafts
      c.     graft preservation techniques
      d.     donor site management
      e.     recipient site management
      f.     special techniques
      g.     xenografts

12.   Perform operations incorporating the full spectrum of flaps and grafts
      including skin grafts, local flaps, fascial and musculocutaneous flaps, free
      tissue transfers, bone grafts, composite grafts, etc.

13.   Treat patients who have complications of flaps and grafts including skin
      graft loss, flap necrosis, wound dehiscence, wound infection, etc.

14.   Participate in the use of the operating microscope; perform microvascular
      anastomosis and microneural repair in the laboratory and operating room.

15.   Participate, with graduated independent experience, in surgical procedures
      for free tissue transfer; harvest flaps and manage donor sites; when
      competent, perform vascular anastomosis for free tissue transfer.

16.   Diagnose and treat a variety of nerve injuries, using microsurgery and
      nerve grafts where appropriate.

17.   Conduct preoperative evaluation and postoperative management of
      patients undergoing free tissue transfer.

18.   Manage long-term aspects, including donor site problems, of patients who
      have undergone free tissue transfers.

19.   Participate, with graduated independent experience, in surgical procedures
      for replantation of amputated parts, perform vascular anastomosis and
      nerve repairs during replantation procedures.

20.   Conduct preoperative evaluation and postoperative management of
      patients undergoing replantation of amputated parts and revascularization
      procedures.

21.   Manage long-term aspects, including rehabilitation, of patients who have
      undergone replantation and revascularization procedures.




                                                                                145
22.   Prepare methyl methacrylate prostheses.

23.   Perform surgical procedures using solid implant materials including:

      a.     cranioplasty
      b.     silicone implantation to breasts, orbital floor, malar area, chin or
             joints
      c.     bone substitution for small defects, such as orthognathic
             advancements
      d.     non-vascularized bone grafts for a variety of defects:
      e.     vascularized bone grafts.

24.   Perform soft tissue augmentation using injectable material.

25.   Achieve certification in laser use.

26.   Evaluate and treat patients with localized lipodystrophy, using suction
      lipectomy techniques.

27.   Participate in the evaluation and treatment of patients with a wide variety
      of congenital and acquired defects using tissue expansion techniques.

28.   Evaluate and treat patients using dermabrasion and/or chemical peel.

29.   Evaluate and treat patients with problems amenable to laser therapy.

30.   Participate in obtaining informed consent from patients; effectively
      documenting that agreement.

31.   Evaluate patients for aesthetic surgery from a physical and psychological
      perspective.

32.   Contribute effectively and accurately to the medical record of both
      inpatients and outpatients.

33.   Treat patients with physical deformities and explore the psychological
      aspects of their care.

34.   Participate in the management of problem patients, including angry
      patients, dissatisfied patients, “doctor shoppers”, “drug seekers”, etc.

35.   Participate in the management of critically ill patients in the surgical
      intensive care unit.

36.   Participate in the critical care management/emergency management of
      burn and trauma patients, including:


                                                                                 146
      a.     initial care
      b.     diagnosis
      c.     preparation for the operating room
      d.     postoperative care.

37.   Participate in the management of ICU patient, including:

      a.     monitoring
      b.     respiratory management
      c.     cardiovascular management
      d.     fluid management
      e      management of infection and sepsis
      f.     management of nutrition.

38.   Participate in the care of surgical patients with complications including:

      a.     respiratory failure
      b.     cardiovascular problems (arrhythmia, DVT, PE)
      c.     sepsis
      d.     bleeding
      e.     hematoma.

39.   Participate in the management of patients with autoimmune and collagen
      vascular diseases such as lupus erythematosus.

40.   Identify patients who are at risk for malignancy because of their
      immunosuppressed condition and provides screening and education to
      these patients.

41.   Identify and treat patients whose condition warrants allografting (e.g.,
      large body surface burn).

42.   Perform pre- and postoperative management of immunosuppressed
      patients undergoing plastic surgical procedures.

43.   Diagnose and treat patients with surgical wound infections.

44.   Evaluate and treat patients with infections of the head and neck, breast,
      skin and hand.

45.   Prescribe analgesics for postoperative care and for pain management.

46.   Prescribe anti-inflammatory agents for appropriate cases.

47.   Utilize steroids for treatment of a variety of plastic surgical problems and
      in the postoperative care of steroid-dependent patients.


                                                                                  147
48.   Participate in the management of patients undergoing chemotherapy for
      head and neck and/or skin malignancies.

49.   Manage patients with localized extravasation injuries.

50.   Participate in outpatient management including both a clinic experience in
      which the resident has independent responsibility and an observation of
      faculty managing private patients including initial consultation and
      management of complications.

51.   Code diagnoses by the ICD-9 system.

52.   Code procedures by the CPT system.

53.   Photograph his/her own patients with a standardized format.

54.   Attend risk management seminar or studies risk management techniques
      and discuss principles with faculty; apply these principles in daily practice
      of plastic surgery.




                                                                               148
C.     Practice Based Learning and Improvement

Goal: The resident will investigate and evaluate his or her own patient care practices,
appraise and assimilate scientific evidence, and improved patient care practices.

       Objectives:

       1.      Use information technology to prepare for surgical cases, bringing to the
               OR the knowledge of current modalities of care for patients and the
               scientific evidence for that care.

       2.      Routinely analyzes the effectiveness of own practices in caring for
               patients.

       3.      Improve own practices in the care of patients by integrating appropriately
               gathered data and feedback.

       4.      Educate medical students and other healthcare professional in the practices
               of surgical patients.

       5.      Function independently with graduated advancement and appropriate
               faculty supervision in the evaluation and treatment of patients.




                                                                                          149
D.     Interpersonal and Communication Skills

Goal: The resident will demonstrate interpersonal and communication skills that result
in effective information exchange and teaming with patients, their families, and
professional associates.

       Objectives:

       1.     Educate patients and families in pre- and post-operative care of surgical
              patients.

       2.     Demonstrate compassion for patients and families with traumatic and
              acquired anomalies.

       3.     Provide adequate counseling and informed consent to patients.

       4.     Listen to patients and their families.

       5.     Assimilate data and information provided by other members of the health
              care team.

       6.     Effectively obtain truly informed consent from patients.

       7.     Effectively explore the motives of patients seeking cosmetic surgery.




                                                                                      150
E.     System Based Practice

Goal: The resident will 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 care that is of optimal value.

       Objectives:

       1.      Function within the organization of specialty clinics including the
               coordination of all special services in the evaluation of patients.

       2.      Participate in tumor-board conference.

       3.      Participates in multidisciplinary planning and treatment for patients with
               complex diagnoses.

       4.      Direct the overall care of patients with complicated wounds by partnering
               with the following:

               a.      nutritionalists
               b.      wound care specialists
               c.      occupational therapists

       5.      Demonstrate knowledge of cost-effective surgical care.

       6.      Advocate for patients within the health care and insurance system.




                                                                                        151
F.     Professionalism

Goal: The resident will demonstrate a commitment to carrying out professional
responsibilities, adherence to ethical principles, and sensitivity to a diverse patient
population.

       Objectives:

       1.      Develop a sensitivity of the unique stress placed on families under care for
               surgery.

       2.      Exhibit an unselfish regard for the welfare of patients.

       3.      Demonstrate firm adherence to a code of moral and ethical values.

       4.      Be respectful to patients and their families especially in times of trauma
               and stress to the family unit.

       5.      Respect and appropriately integrate other members of the healthcare team.

       6.      Provide appropriately prompt consultations when requested.

       7.      Demonstrate sensitivity to the individual patient’s profession, life goals,
               and cultural background as they apply to their surgical diagnosis.

       8.      Be reliable, punctual, and accountable for own actions in the OR and
               clinic.

       9.      Accurately and honestly council patients regarding risks and
               complications of breast implant surgery.

       10.     Effectively deal with dissatisfied patients.

       11.     Understand the physician/patient relationship.

       12.     Professionally and ethically perform CPT coding.

       13.     Understand the benefits and functionality of multidisciplinary health care
               teams.

       14.     Refer patients to the appropriate practitioners and agencies.

       15.     Facilitate the timely discharge of patients.




                                                                                          152
PLASTIC SURGERY OF THE
     INTEGUMENT




                         153
A.     Medical Knowledge

I:     Anatomy/Physiology/Embryology

Goal: The resident will demonstrate knowledge of the histology, function, and
development of the skin.

       Objectives:
       1.    Discuss the structure and functions of the epidermis.

       2.     Discuss the structure and functions of the dermis.

       3.     Discuss the structure and functions of the skin appendages.

       4.     Discuss the structure and function of subcutaneous tissue and fascial
              layers.

       5.     Recite the embryologic origin of the skin and at which gestational age
              components of the skin appear.

       6.     Describe the differentiation of the stratum germinativum into surface
              appendages, and the differentiation of the dermis.

       7.     Describe the structure and function of the nails.

       8.     Discuss the components of dermis including: fibroblasts, collegen, elastin,
              ground substance.

       9. Discuss the structure and function of the skin appendages including:

              a.      hairs
              b.      eccrine glands (sweat glands)
              c.      apocrine glands (axilla, anal-genital region, external ear, eyelid,
                      breast)
              d.      sebaceous glands
              e.      neural end organs.

       10. Discuss the reaction of skin to the following:

              a.      heat
              b.      cold
              c.      mechanical trauma
              d.      microbial trauma
              e.      UV light trauma
              f.      pharmacologic agents.
              g.      smoking



                                                                                        154
II:      Benign and Malignant Skin Lesions

Goal: The resident will demonstrate knowledge of benign and malignant lesions,
recognize the morphologic and histologic features of the more common lesions, and
effectively manage small and large skin tumors using a variety of treatment methods.

      Objectives:

         1.     List the clinical presentation of benign and malignant skin lesions and
                generalized skin disorders.

         2.     Discuss the natural history of both treated and untreated benign and
                malignant cutaneous lesions and generalized skin disorders.

         3.     Recite the histologic grading and clinical staging systems used for
                malignant and premalignant skin tumors.

         4.     Discuss other treatment modalities including, but not limited to: excisional
                therapy, Moh’s micrographic surgery, cryotherapy, laser therapy, and
                chemotherapy.

         5.     Discuss the histologic characteristics of benign and malignant cutaneous
                lesions.

         6.     Discuss the pathology, biologic behavior, and treatment of the following:

                a.     benign epithelial and adnexal tumors (nevi, papillomas, keratinous
                       cysts)
                b.     benign mesodermal tumors (hemangioma, vascular malformations)
                c.     malignant cutaneous tumors, epithelial and mesodermal (basal cell
                       carcinomas, squamous cell carcinoma, malignant melanoma,
                       sarcomas)
                d.     premalignant skin tumors.




                                                                                          155
III:   Burns and Trauma

Goal: The resident will demonstrate knowledge of the pathophysiology of burns,
principles of burn resuscitations, and the techniques of burn wound repair and
reconstruction.

       Objectives:

       1.     Recite the normal skin anatomy and circulation and how it is impaired by
              thermal injury.

       2.     Understand the pathophysiologic changes which occur with thermal injury
              and specific changes which occur in the zones of coagulation, stasis, and
              hyperemia.

       3. Utilize the Rule of Nines and more detailed body surface area charts, to
              compare the relative difference in body surface area in children and adults.

       4. Recite the parameters which define major, moderate, and minor burns.

       5. Discuss the various factors, in addition to body surface area, which impact the
             prognosis of a patient with a thermal injury.

       6. Explain the pathophysiology and treatment of inhalation injury and carbon
             monoxide poisoning.

       7. Explain the principles and techniques of fluid resuscitation, using isotonic and
             hypertonic solutions, and the principles of monitoring fluid status in acute
             burn patients.

       8. Describe the pathophysiologic changes unique to chemical burns, specifically
             acid burns, alkali burns, chemotherapy extravasations and hydrofluoric
             acid burns.

       9. Describe the injuries and sequelae associated with electrical injuries, such as
             cardiac dysrhythmias, central nervous system damage, intra-abdominal
             and vascular injury, cataracts, etc.

       10. Discuss the anatomy and physiology pertinent to the excisional treatment of
              burns and treatment by split thickness skin grafting.

       11. Describe the principles pertinent to burn reconstruction, including the
              aesthetic units of the face, tissue expansion, hair transplantation, splinting,
              etc.




                                                                                         156
12. Discuss the pharmacology and utilization of topical antibacterials and
       analgesics in the treatment of burns.

13.    Discuss the pathophysiology of acute and chronic radiation injury.

14.    Recite the pathophysiology of frostbite and its natural history.

15.    Discuss the principles of nutritional management of the burn patient.




                                                                               157
IV:    Congenital, Aesthetic and Functional Problems

Goal: The resident will demonstrate knowledge of the common congenital disorders and
disease processes of the skin, as well as the pathophysiology of aging.
       Objectives:

       1.     Explain the basic physiology of the aging process of the skin.

       2.     Describe the basic physiologic processes of sun exposure and its effect on
              the skin.

       3.     Discern the role of lasers in the management of various skin conditions.

       4.     Describe common inflammatory disorders of the skin such as cellulitis,
              lymphangitis, hidradenitis suppurativa, necrotizing fasciitis, and its
              medical and surgical treatment.

       5.     Discuss common generalized dermatologic diseases such as: scleroderma,
              dermatomyositis, lupus erythematosis.

       6.     Discuss the common congenital disorders of the skin, such as: xeroderma
              pigmentosa, Ehlers Danlos syndrome, basal cell nevus syndrome, etc.

       7.     Recite the basic principles of medical management and surgical treatment
              of common congenital disorders of the skin.

       8.     Explain the surgical aspects of treatment of patients with skin disorders
              such as scleroderma and lupus erythematosis.




                                                                                       158
B.     Patient Care

Goal: The resident will provide patient care that is compassionate, appropriate, and
effective for the treatment of disorders of the Integument.

       Objectives:

       1.     Evaluate both simple and complex cutaneous lesions, and proceed with
              diagnostic steps necessary to secure a definitive diagnosis.

       2.     Formulate definitive treatment plan for particular skin lesions by choosing
              a surgical or nonsurgical treatment modality (based on size, anatomical
              location, and physical condition of the patient).


       3.     Participate in diagnostic studies of the skin, including incisional and
              excisional biopsy, needle biopsy, and punch biopsy.

       4.     Participate in extirpative surgery for a variety of benign and malignant
              skin lesions and associated locoregional disease, choosing the optimal
              treatment for the particular region to be treated.

       5.     Participate in complex procedures (including skin grafts, local or distant
              flaps, or free tissue transfer) for the reconstruction of surgical wounds
              resulting from skin tumor extirpation.

       6.     Evaluate patients with minor, moderate, and major burns of chemical and
              thermal origin.

       7.     Manage outpatient burns operatively and non-operatively.

       8.     Participate, with graduated surgical independence, in the treatment of
              acute burns including escharotomies, fasciotomies, excision, grafting, etc.

       9.     Manage patients with burns of the hand including the operative and
              postoperative therapy and late reconstructive surgery.

       10.    Manage inpatients with major burns including resuscitation, nutrition,
              inhalation injury, and rehabilitation.

       11.    Evaluate and treat patients with acute and chronic radiation injuries.

       12.    Manage patients with chemical burns including intravenous infusion
              injuries.




                                                                                         159
13.   Perform reconstructive surgery on burn patients including functional and
      aesthetic procedures.

14.   Manage patients with frostbite injuries.

15.   Perform, with graduated surgical experience, laser treatments for
      conditions of the skin including:

      a.   vascular lesions
      b.   pigmented lesions
      c.   unwanted hair
      d.   skin resurfacing.

16.   Participate in surgery on patients with congenital skin disorders.

17.   Utilize pharmacologic agents for treatment of aging skin

18.   Recommend pharmacologic agents for prevention of sun exposure,
      instruct patients in their use and in general principles of skin protection
      from the sun.

19.   Evaluate and treat patients with bacterial, viral and fungal infections such
      a cellulitis, lymphangitis, necrotizing fascitis, and gas gangrene.

20.   Perform surgical extirpation and reconstruction for hidradenitis
      suppurativa.

21.   Participate in the surgical care of patients with generalized dermatological
      conditions such as scleroderma and lupus erythematosis.

22.   Formulate a definitive treatment plan for regional or distant sites of
      malignant cutaneous metastasis.




                                                                                    160
C.     Practice Based Learning and Improvement

Goal: The resident will investigate and evaluate his or her own patient care practices,
appraise and assimilate scientific evidence, and improve patient care practices.

       Objectives:

       1.      Use information technology to prepare for surgical cases, bringing to the
               OR the knowledge of current modalities of care and the scientific evidence
               for that care.

       2.      Routinely analyze the effectiveness of own practices in caring for patients
               with diagnoses involving the skin.

       3.      Improve own practices in the care of patients by integrating appropriately
               gathered data and feedback.

       4.      Educate medical students and other healthcare professionals in the practice
               of skin care and prevention of skin cancer.

       5.      Function independently with graduated advancement and appropriate
               faculty supervision.




                                                                                          161
D.     Interpersonal and Communication Skills

Goal: The resident will demonstrate interpersonal and communication skills that result
in effective information exchange and teaming with patients, their families, and
professional associates.

       Objectives:

       1.     Educate patients and families in the strategies to prevent skin cancer.

       2.     Demonstrate compassion for patients and families with burns.

       3.     Provide adequate counseling and informed consent to patients.

       4.     Listen to patients and their families.

       5.     Assimilate data and information provided by all members of the burn
              team.

       6.     Chart and record accurate information.

       7.     Be able to explain in a comprehensible but simplified manner to patients
              the nature of skin cancer, its extent, treatment options and long term
              results.




                                                                                        162
E.      System Based Practice

Goal: The resident will 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 care that is of optimal value.

     Objectives:

        1.     Coordinate all aspects of burn rehabilitation, including splinting, pressure
               garment use, physical therapy, occupational therapy, and social work.

        2.     Direct the rehabilitation of the burn patient by partnering with the
               following:

               a.      Physical Therapy
               b.      Occupational Therapy
               c.      prosthetic and orthotics specialists.

        3.     Demonstrate knowledge of cost-effective burn care.

        4.     Advocate for burn patients within the health care system.

        5.     Refer burn patients to the appropriate practitioners and agencies.

        6.     Facilitate the timely discharge of skin cancer patients.

        7.     Coordinate care of skin cancer patients with primary care providers,
               general dermatologists, and Moh’s surgeons.




                                                                                        163
F.     Professionalism

Goal: The resident will demonstrate a commitment to carrying out professional
responsibilities, adherence to ethical principles, and sensitivity to a diverse patient
population.

       Objectives:

       1.      Develop a sensitivity of the unique stress placed on families under care for
               burn injuries.

       2.      Exhibit and unselfish regard for the welfare of burn patients.

       3.      Demonstrate firm adherence to a code of moral and ethical values.

       4.      Be respectful to burn patients and their families, especially in times of
               trauma and stress to the family unit.

       5.      Respect and appropriately integrate other members of the burn care team.

       6.      Provide appropriately prompt skin care consultations when requested.

       7.      Demonstrate sensitivity to the individual patient’s profession, life goals,
               and cultural background as they apply to burn reconstruction.

       8.      Be reliable, punctual, and accountable for own actions in the OR and
               clinic.




                                                                                           164
PLASTIC SURGERY OF THE HEAD
          AND NECK




                         165
A.     Medical Knowledge

I:     Anatomy/Physiology/Embryology

Goal: The resident will achieve detailed knowledge of the anatomy, physiology,
embryology of the head and neck, and will apply this knowledge to the medical
management of disorders and processes in this anatomic area.

       Objectives:

       1.     Describe the anatomy of the skull including sutures, foramina, and cranial
              nerves.

       2.     Identify the anatomy of the facial bones.

       3.     Identify the anatomy of the eye including normal dimensions, bony
              structures, eyelids, extraocular muscles, innervation, vascular supply, and
              lacrimal apparatus.

       4.     Identify the anatomy of the ear including common measurements,
              relationships to other structures, and the vascular and sensory supply.

       5.     Draw the anatomy of the nose and septum including bones, nerves and
              vascular supply.

       6.     Recite the anatomy of the oropharynx including muscular structures and
              contiguous neurovascular structures.

       7.     Recite the physiology of the oropharynx including palatal function,
              speech, and swallowing.

       8.     Explain the general principles of embryology of the head and neck, with
              special reference to the development of the facial structures and the
              occurrence of congenital anomalies such as cleft lip and palate.

       9.     Recite the basic anatomy of the dental structures and the TMJ.




                                                                                        166
II:    Congenital Disorders

Goal: The resident will achieve familiarity with the anatomy, embryology and principles
of treatment of congenital disorders of the head and neck.

       Objectives:

       1.     Demonstrate intimate knowledge of the common congenital disorders of
              the head and neck including cleft lip and palate, craniofacial syndromes,
              vascular malformations, and auricular abnormalities

       2.     Discuss the etiology, genetics, embryology and anatomy of congenital
              disorders of the head and neck.

       3.     Be familiar with growth and development of the craniofacial skeleton and
              its affect on anomalies and their treatment

       4.     Be able to recite the diagnostic criteria and discus the evaluation and
              treatment for congenital anomalies such as:

              a.     craniosynostosis
              b.     hemifacial microsomia
              c.     rare craniofacial clefting
              d.     orbital hypertelorism
              e.     Pierre-Robin sequence
              f.     craniofacial tumors
              g.     choanal atresia
              h.     nasal anomalies
              i.     ear anomalies (prominent ear, microtia)
              j.     vascular anomalies
              k.     branchial cleft cysts
              l.     thyroglossal duct cysts
              m.     lymphatic anomalies

       5.     Discuss the cephalometric landmarks and analysis in the presurgical
              planning of patients with congenital head and neck anomalies.




                                                                                        167
III:   Benign and Malignant Tumors

Goal: The resident will obtain knowledge of benign and malignant tumors of the head
and neck, understand the biologic basis of treatment options for these lesions, and
perform complete management of such lesions including diagnosis, surgery and
nonsurgical therapy.

       Objectives:

       1.     Recognize the clinical presentation of squamous cell carcinoma of the
              head and neck.

       2.     Recite the lymphatic drainage pattern of the head and neck structures and
              the relationship to the management of malignant tumors.

       3.     Recite the methods for diagnosis and the options for treatment of
              squamous cell carcinomas of the head and neck.

       4.     Recite the TNM staging system for tumors of the head and neck; know the
              features and biologic behavior of these lesions.

       5.     Describe the general principles and techniques of adjuvant therapy such as
              radiation therapy and chemotherapy for head and neck malignancies.

       6.     Discuss the indications for an d the role of neck dissection in the treatment
              of head and neck malignancies.

       7.     Recite the process of long-term follow-up for patients with head and neck
              malignancies.

       8.     Recite the diagnosis of and principles of care for:

              a.     rhinophyma
              b.     eyelid and lacrimal neoplasms
              c.     infections of the head and neck
              d.     disease of nasal cavity and paranasal sinuses

       9.     Discuss the differential diagnosis of hemangiomas and vascular
              malformations.

       10.    Discuss the treatment options, including steroid therapy, laser therapy, and
              surgery for hemangiomas and vascular malformations of the head and
              neck.




                                                                                       168
IV:    Trauma

Goal: The resident will be familiar with the mechanisms of traumatic head and neck
injuries, understand the diagnostic techniques and therapeutic options for such problems,
and perform complete management of traumatic injuries of the head and neck.

       Objectives:

       1.      Describe the priorities involved in treating patients with head and neck
               injuries.

       2.      Describe the mechanical and structural properties of the facial skeleton as
               they relate to fracture patterns in facial trauma.

       3.      Describe the concepts of primary bone healing, malunion, nonunion and
               osteomyelitis.

       4.      Discuss the advantages and disadvantages of various techniques of
               treatment of facial fractures including:

               a.     nonoperative treatment
               b.     closed reduction
               c.     mandibulomxillary fixation
               d.     open reduction with and without fixations
               e.     intraoral splints
               f.     external fixation
               g.     bone grafting.

       5.      Describe the treatment of facial fracture complications including:

               a.     secondary deformities
               b.     infections and osteomyelitis
               c.     malocclusion
               d.     nonunions
               e.     malunions.

       6.      Describe the neuroanatomy, cranial nerve anatomy and soft tissue
               anatomy pertinent to facial fractures.

       7.      Recite the treatment of soft tissue injuries of the had and face including:

               a.     parotid gland and duct
               b.     facial nerve
               c.     lacrimal apparatus.




                                                                                          169
8.   Describe the evaluation and treatment of secondary deformities of facial
     fracture including:

     a.     malocclusion
     b.     enophthalmos
     c.     frontal sinus mucoceles
     d.     facial nerve paralysis
     e.     soft tissue contractures.

9.   Discuss the principles of care and the surgical steps in the treatment of the
     following facial fractures:

     a.     frontal sinus
     b.     naso-orbital ethmoid
     c.     orbital
     d.     zygomatic
     e.     nasal
     f.     maxillary
     g.     mandibular
     h.     pan-facial.




                                                                              170
B.     Patient Care

Goal: The resident will provide patient care that is compassionate, appropriate, and
effective for the treatment of hand and neck problems.


       Objectives:

       1.     Obtain cephalometric measurements and analyze cephalometric data in the
              presurgical planning.

       2.     Perform a comprehensive head and neck exam followed by facial form
              analysis.

       3.     Utilize radiographic and special diagnostic studies to evaluate head and
              neck anomalies.

       4.     Formulate a definitive short- and long-term treatment plan for common
              congenital disorders, choosing the most appropriate surgical or
              nonsurgical modality.

       5.     Draw the reconstruction of a cleft lip and palate.

       6.     Diagnose and develop a treatment plan for velopharyngeal incompetence.

       7.     Coordinate nonsurgical treatment of congenital head and neck disorders.

       8.     Participate in the Cleft-Craniofacial Team’s multidisciplinary evaluation
              and treatment planning for congenital disorders of the head and neck.

       9.     Provide perioperative care and participate in surgical treatment of patients
              with craniofacial anomalies.

       10.    Utilize diagnostic techniques for head and neck tumors including
              radiographic methods (e.g., sialogram, MRI scan, etc) and fine needle
              aspiration.

       11.    Perform fine needed aspirate biopsies.

       12.    Recite the steps in the surgical treatment of:

              a.      oropharyngeal tumors
              b.      salivary gland tumors
              c.      neck dissections




                                                                                       171
      d.     tumors of bony and dental origin.

13.   Participate in the extirpative surgery for oropharyngeal tumors, including
      performing neck dissection.

14.   Evaluate and treats patients with head and neck tumors of a vascular
      origin.

15.   Perform an orderly and systematic physical examination of the patient
      with facial trauma.

16.   Interpret radiographic diagnostic studies including panorex films,
      cephalograms, CT/3D CT scans, MR imaging, and angiography with
      respect to the head and neck trauma patient.

17.   Perform the staged management of devastating open facial injuries
      including wound care, debridement and reconstruction.

18.   Perform surgical procedures of facial fracture management including:

      a.     maxillary
      b.     mandibular
      c.     orbital
      d.     frontal sinus
      e.     zygomatic
      f.     zygomatic arch
      g.     nasal
      h.     panfacial.

19.   Perform all surgical techniques of access to the craniofacial skeleton.

20.   Perform a comprehensive examination of the facial nerve.

21.   Perform acute repair of soft tissue facial trauma.

22.   Perform secondary scar revision from facial trauma.

23.   Perform primary facial nerve repair, and associated procedures (i.e. global
      weight, static, and dynamic reconstruction) for the patient with facial
      paralysis.

24.   Perform systemic therapy and local injection of steroids for treatment of
      facial hemangiomas.

25.   Perform laser treatment for vascular malformations.




                                                                                172
C.     Practice Based Learning and Improvement

Goal: The resident will investigate and evaluate his or her own patient care practices,
appraise and assimilate scientific evidence, and improved patient care practices.

       Objectives:

       1.      Use information technology to prepare for surgical cases, bringing to the
               OR the knowledge of current modalities of care for patients with head and
               neck diagnoses and the scientific evidence for that care.

       2.      Routinely analyzes the effectiveness of own practices in caring for head
               and neck patients.

       3.      Improve own practices in the care of head and neck patients by integrating
               appropriately gathered data and feedback.

       4.      Educate medical students and other healthcare professional in the practices
               of head and neck surgery.

       5.      Function independently with graduated advancement and appropriate
               faculty supervision in the evaluation and treatment of patients with head
               and neck diagnoses.

       6.      Participate in, and appreciate the value of outcome studies as they apply to
               diagnoses of the head and neck.




                                                                                          173
D.     Interpersonal and Communication Skills

Goal: The resident will demonstrate interpersonal and communication skills that result
in effective information exchange and teaming with patients, their families, and
professional associates.

       Objectives:

       1.     Educate patients and families in pre- and post-operative care of head and
              neck patients.

       2.     Demonstrate compassion for patients and families with congenital and
              acquired anomalies of the head and neck.

       3.     Provide adequate counseling and informed consent to patients.

       4.     Listen to patients and their families.

       5.     Assimilate data and information provided by the craniofacial team and
              other members of the health care team, in the care of patients with
              congenital head and neck anomalies.

       6.     Assimilate date and information provided by the head and neck team and
              tumor board in the care of patients with congenital head and neck cancer.




                                                                                      174
E.     System Based Practice

Goal: The resident will 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 care that is of optimal value.

       Objectives:

       1.      Function within the organization of specialty clinics (Cleft Palate Center,
               Craniofacial Clinic) including the coordination of all special services in
               the evaluation of children with these anomalies.

       2.      Be able to coordinate the nonsurgical treatment of patients with congenital
               anomalies among contributing specialties (prosthetics, orthodontics,
               speech therapy).

       3.      Understand the value of and function within a team approach to treat
               patients with head and neck malignancies

       4.      Participate in tumor-board conference.

       5.      Participates in multidisciplinary planning and treatment for patients with
               head and neck malignancies.

       6.      Coordinate all aspects of head and neck rehabilitation, including physical
               therapy, sensory reeducation, and maxillofacial prosthetics.

       7.      Direct the rehabilitation of head and neck patients by partnering with the
               following:

               a.      physical therapy
               b.      occupational therapy
               c.      prosthetic and orthotics specialists
               d.      ENT cancer services
               e.      Speech and swallow specialists.

       8.      Demonstrate knowledge of cost-effective head and neck reconstruction.

       9.      Advocate for congenital craniofacial patients within the health care and
               insurance system.

       10.     Understand the benefits and functionality of multidisciplinary craniofacial
               teams.




                                                                                        175
11.   Refer craniofacial patients to the appropriate practitioners and agencies.

12.   Appreciate the functioning of the multispecialty fetal diagnosis and
      treatment committees and the potential role prenatal diagnosis plays in the
      family unit.

13.   Facilitate the timely discharge of head and neck patients.

14.   Partner with pediatricians in the combined care of infants undergoing
      systemic steroid therapy for head and neck hemangiomas.




                                                                               176
F.     Professionalism

Goal: The resident will demonstrate a commitment to carrying out professional
responsibilities, adherence to ethical principles, and sensitivity to a diverse patient
population.

       Objectives:

       1.      Develop a sensitivity of the unique stress placed on families under care for
               congenital craniofacial anomalies.

       2.      Exhibit an unselfish regard for the welfare of head and neck patients.

       3.      Demonstrate firm adherence to a code of moral and ethical values.

       4.      Be respectful to head and neck patients and their families especially in
               times of trauma and stress to the family unit.

       5.      Respect and appropriately integrate other members of the craniofacial
               team.

       6.      Provide appropriately prompt consultations when requested.

       7.      Demonstrate sensitivity to the individual patient’s profession, life goals,
               and cultural background as they apply to head and neck diagnoses of
               trauma, malignancy, and congenital anomalies.

       8.      Be reliable, punctual, and accountable for own actions in the OR and
               clinic.




                                                                                          177
 PLASTIC SURGERY OF THE
HAND AND UPPER EXTREMITY




                       178
A.     Medical Knowledge


I:     Anatomy/Physiology/Embryology

Goal: The resident will achieve a detailed knowledge of the anatomy, physiology, and
embryology of the upper extremity and will utilize this knowledge in the complete
management of the hand, arm, and brachial plexus.

       Objectives:

       1.     Describe in detail the anatomy and physiology of the muscles, tendons,
              ligaments, and bones of the hand and upper extremity.

       2.     Identify in detail the anatomy of the vascular tree of the upper extremity
              including relationships to the surrounding structures.

       3.     Identify in detail the anatomy of the major nerves and their branchings in
              the upper extremity including relationships to surrounding structures.

       4.     Draw the anatomy of the brachial plexus.

       5.     Demonstrate the detailed radiographic anatomy of the bony structures of
              the upper extremity.

       6.     Utilizes the radiologic techniques, including plain films, CT scan,
              angiography and MRI of the upper extremities.

       7.     Discriminate the principles of electrical evaluation and recite knowledge
              of the techniques of electrical examination of the upper extremities
              including conduction studies and EMG evaluation.

       8.     Recite the principles of upper extremity biomechanics.




                                                                                    179
II:   Congenital Disorders

Goal:     The resident will achieve familiarity with the spectrum of congenital
abnormalities of the upper extremity and perform comprehensive diagnostic evaluation
and surgical management of such problems.

      Objectives:

      1.     Recite the classification system for congenital hand anomalies including:

             a.      failure of part formation
             b.      failure of differentiation
             c.      duplication
             d.      overgrowth
             e.      undergrowth
             f.      congenital bands
             g.      generalized musculoskeletal anomalies

      2.     Describe the embryologic development and the physiologic theories which
             explain the etiology of hand anomalies.

      3.     Recite the operations including timing and techniques used in the surgical
             management of hand anomalies.




                                                                                    180
III.   Benign and Malignant Tumors

Goal: The resident will understand the principles of diagnosis and treatment of extremity
tumors and undertake comprehensive management of a wide variety of such lesions.

       Objectives:

       1.     Describes the principles and techniques of management of upper extremity
              tumors.

       2.     Describe the etiologic factors, epidemiology, and modalities of treatment
              for tumors of the upper extremities.

       3.     Describe the clinical manifestations of both soft and hard tissue tumors of
              the upper extremities.

       4.     Describe the reconstructive principles and techniques for restoration of
              form and function after surgical resections.

       5.     Recite the indications and use of adjunctive therapy (i.e. radiation therapy
              and chemotherapy) in the management of and the prognosis for upper
              extremity tumors.

       6.     Describe the principles and techniques of management for upper extremity
              tumors, including reconstruction after surgical extirpation, for:

              a.      vascular tumors
              b.      nerve tumors
              c.      benign deep soft tissue tumors
              d.      malignant deep soft tissue tumors
              e.      primary bone tumors

       7.     Rationalize the utilization of radiotherapy, medical oncology, hand
              therapy, occupational therapy, and prosthetics where appropriate for
              patients with upper extremity tumors.




                                                                                      181
IV:    Trauma

Goal: The resident will understand the principles of diagnosis and treatment of extremity
trauma, and perform comprehensive management of acute injuries and other trauma-
related problems of the hand and arm.

       Objectives:

       1.     Recite the principles and applications of diagnostic techniques for the
              evaluation of hand and upper extremity trauma.

       2.     Describe the techniques for operative management of traumatic injuries of
              the upper extremity, their indications and contraindications, and their
              possible complications and the treatment thereof.

       3.     Explain the indications for, contraindications to, and techniques in
              nonoperative management of traumatic injuries of the hand and upper
              extremity.

       4.     Describe the options for soft tissue coverage of upper extremities
              including:

              a.      skin grafts
              b.      local flaps
              c.      free tissue transfer




                                                                                     182
V. Functional Problems of the Upper Extremities

Goal: The resident will achieve familiarity with aesthetic and functional problems of
the hand and arm, understand the principles of rehabilitation of the upper extremity
and the management including comprehensive rehabilitation of the upper extremity.

   Objectives:

   1.      List the surgical and nonsurgical treatment of nerve compression and
           entrapment syndromes of the upper extremity.

   2.      Draw the pathologic anatomy and physiology of upper extremity
           contractures and Dupuytren’s disease.

   3.      Recite the basic pathophysiology of rheumatoid and nonspecific arthritis
           of the upper extremity.

   4.      Describe with the pharmacological therapy of rheumatoid arthritis.

   5.      Demonstrate the surgical treatment of rheumatoid arthritis, timing of
           therapeutic treatment and interactions with medical therapy.

   6.      Describe the common circulatory disorders of the upper extremity
           including, but not limited to: arterial thromboses, aneurysms, embolic
           disorders, arteriovenous fistulae, vasospastic disease and scleroderma.

   7.      Describe the diagnosis and treatment of common pain syndromes
           including sympathetic dystrophy.

   8.      Recite the management of upper extremity lymphedema.




                                                                                 183
VI.    Reconstruction

Goal: The resident will understand the principles and techniques of upper extremity
reconstruction and apply these to a variety of developmental, traumatic and acquired
problems.

       Objectives:

       1.     Recite the diagnostic techniques for evaluation of function including EMG
              and conduction studies, arteriography, CT scan, and MRI evaluation.

       2.     Recite the use of tendon transfers.




                                                                                   184
B.     Patient Care

Goal: The resident will provide patient care that is compassionate, appropriate, and
effective for the treatment of hand problems.

       Objectives

       1.      Perform the clinical techniques for physical examination of the hand and
               upper extremity.

       2.      Perform the surgical techniques         used   to   treat   congenital   and
               developmental hand anomalies.

       3.      Perform postoperative care of patients with congenital and developmental
               anomalies of the upper extremity.

       4.      Apply casts and splints for the preoperative and postoperative care of hand
               patients.

       5.      Utilizes the diagnostic techniques for upper extremity tumors.

       6.      Demonstrate the techniques of management of extremity tumors.

       7.      Performs the procedures for the acute management and participates in the
               post-operative rehabilitation of traumatic injuries of the upper extremity
               including:

             a.        fractures and dislocations
             b.        nerve injury including brachial plexus
             c.        major amputation and avulsions
             d.        joint injury
             e.        tendon extensor and flexor injury of the hand
             f.        muscle and tendon injury of the arm
             g.        nail bed injuries
             h.        infections
             i.        fingertip and other minor injuries

       8.      Perform the surgical treatment options for contractures.

       9.      Perform treatment for tenosynovitis and tendon rupture.

       10.     Describe the indications for and perform the techniques of tendon
               reconstruction including tendon grafting – sources, methods, indications




                                                                                        185
11.   Perform the management of nerve injuries including primary, delayed
      primary and secondary repair.

12.   Perform the techniques for reconstruction of the amputated thumb
      including lengthening, pollicization, free toe to thumb, and free wrap-
      around techniques.

13.   Perform the technical methods of soft tissue coverage including skin
      grafts, local flaps, distant flaps, and transfers.




                                                                         186
C.     Practice Based Learning and Improvement


Goal: The resident will investigate and evaluate his or her own patient care practices,
appraise and assimilate scientific evidence, and improve patient care practices.

       Objectives
       1.     Uses information technology to prepare for surgical cases, bringing to the
              OR the knowledge of current modalities of care and the scientific evidence
              for that care.

       2.     Routinely analyzes the effectiveness of own practices in caring for hand
              patients.

       3.     Improves own practices in the care of hand patients by integrating
              appropriately gathered data and feedback.

       4.     Educates medical students and other healthcare professionals in the
              practices of hand surgery.

       5.     Functions independently with graduated advancement and appropriate
              faculty supervision.




                                                                                    187
D.     Interpersonal and Communication Skills


Goal: The resident will demonstrate interpersonal and communication skills that result
in effective information exchange and teaming with patients, their families, and
professional associates.

       Objectives

       1.     Educates patients and families in post operative strategies for hand
              therapy.

       2.     Demonstrates compassion for patients and families with traumatic and
              congenital hand deformities.

       3.     Provides adequate counseling and informed consent to patients.

       4.     Listens to patients and their families.

       5.     Assimilates data and information provided by hand therapists and other
              members of the health care team.

       6.     Charts and records accurate information.




                                                                                  188
E.     System Based Practice


Goal: The resident will 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 care that is of optimal value.

       Objectives

       1.      Coordinates all aspects of hand and upper extremity rehabilitation,
               including splinting, prosthesis use, physical therapy, and sensory re-
               education.

       3.      Direct the rehabilitation of upper extremities following trauma by
               partnering with the following:

               a.      Physical Therapy
               b.      Occupational Therapy
               c.      prosthetic and orthotic specialists

       3.      Demonstrates knowledge of cost-effective hand care.

       4.      Advocates for hand patients within the health care system.

       5.      Understands the basics of the Worker’s Compensation.

       6.      Refers hand patients to the appropriate practitioners and agencies.

       7.      Facilitates the timely discharge of hand patients.




                                                                                        189
F.     Professionalism


Goal: The resident will demonstrate a commitment to carrying out professional
responsibilities, adherence to ethical principles, and sensitivity to a diverse patient
population.

       Objectives

       1.     Develops a sensitivity of the unique stresses placed on families under care
              for congenital anomalies of the hand.

       2.     Exhibits an unselfish regard for the welfare of hand patients.

       3.     Demonstrates firm adherence to a code of moral and ethical values.

       4.     Is respectful to hand patients and their families especially in times of
              trauma and stress to the family unit.

       5.     Respects and appropriately integrates other members of the hand care
              team.

       6.     Provides appropriately prompt hand consultations when requested.

       7.     Demonstrates sensitivity to the individual patient’s profession, life goals,
              and cultural background as they apply to hand surgery.

       8.     Is reliable, punctual, and accountable for own actions in the OR and hand
              clinic.




                                                                                      190
PLASTIC SURGERY OF THE
         TRUNK




                         191
A.     Medical Knowledge

I:     Anatomy/Physiology/Embryology

Goal: The resident will demonstrate knowledge of the anatomy, physiology, and
embryology of the trunk and breast, and apply this knowledge to the comprehensive
management of a variety of problems in these anatomic areas.

       Objectives:

       1.     Draw the musculature, blood supply, lymphatic drainage and innervation
              of the trunk, abdominal wall, and breast.

       2.     Discuss the embryonic development of the trunk, abdominal wall, and
              breast.

       3.     Recite the knowledge of the glandular structure and function, as well as
              understand hormonal influence on breast development and function.

       4.     Discuss the differences in breast structures and function in adolescence,
              reproductive years, pregnancy, lactation and menopause.

       5.     Discuss the structure and function of the male, as well as female genitalia.

       6.     Draw the anatomy of the breasts, including:

              a.     location on the chest wall
              b.     underlying structures
              c.     glandular structure: lobes, lobules, alveoli/histology
              d.     the nipple and its ducts
              e.     variations in anatomy: polymastia, polycythemia
              f.     vasculature, innervation and lymphatic drainage.

       7.     Discuss the anatomy of the trunk, anterior and posterior abdominal wall,
              including:

              a.     muscles forming the abdominal wall
              b.     deep and superficial fascia of the abdominal wall
              c.     anatomy of trunk muscles as related to flaps for reconstructive
                     purposes
              d.     fat distribution
              e.     innervation, blood supply, and lymphatic drainage.
              f.     skin and its elastic quality
              g.     the male and female escutcheon




                                                                                       192
II:    Congenital Disorders

Goal: The resident will demonstrate knowledge of congenital disorders of the trunk,
breast, and abdomen, and perform complete plastic surgical management of these
problems.

       Objectives:

       1.     Discuss the normal male and female breast growth and development and
              understand the general physiologic principles of disease in which breast
              abnormalities may be but one manifestation.

       2.     Discuss the physiologic consequences of developmental chest wall
              deformities.

       3.     Recite the surgical aspects of treatment of patients with developmental
              chest wall deformities such as pectus carinatum and pectus carivatum.

       4.     Discusses the basic principles and techniques of the surgical treatment of
              common developmental breast anomalies including amastia, Poland’s
              syndrome, asymmetry, ectopic mammary tissue, virginal hypertrophy and
              gynecomastia.

       5.     Discuss the knowledge of the common deformities of the posterior trunk.

       6.     Discuss the reconstructive surgery of posterior trunk lesions, including
              meningomyelocele, sacrococcygeal teratomas, etc., and recognize the
              benefit of a team approach to these problems.

       7.     Recite the embryology and developmental anatomy of congenital
              abdominal deformities such as gastrocscesis, prune belly and omphalocele.

       8.     Discuss the reconstructive surgical management of congenital abdominal
              deformities such as gastroscesis, prune belly, and omphalocele.




                                                                                         193
III:   Benign and Malignant Tumors

Goal: The resident will demonstrate knowledge of the biologic behavior, histology,
physiology and management principles of benign and malignant processes of the breast,
and carry out comprehensive medical and surgical management of such problems.

       Objectives:

       1.     Describe the biologic behavior, histologic characteristics, and clinical
              manifestation of malignancies of the breast.

       2.     Discuss the plastic surgical options for management of breast
              reconstruction after mastectomy for carcinoma and the principles of long-
              term follow-up patients with breast carcinoma.

       3.     Discuss the diagnostic techniques and treatment methods (surgical and
              nonsurgical) for management of premalignant disease and other processes
              of the breast.

       4.     Discuss the implications of genetic predisposition to breast cancer and the
              options of prophylactic mastectomy.

       5.     Describe the etiology of gynecomastia and be familiar with the surgical
              options for treatment.

       6.     Discuss the various treatment protocols (including surgery, radiation, and
              chemotherapy plus combinations) for management of carcinoma of the
              breast including sentinel node survey.

       7.     Discuss the complete treatment of malignancy of the breast including:

              a.     pathology and biologic behavior
              b.     diagnostic techniques
              c.     principles of primary treatment
              d.     techniques of primary treatment
              e.     secondary treatment
              f.     management of the opposite breast after mastectomy.




                                                                                         194
IV:    Trauma and Reconstruction

Goal: The resident will demonstrate knowledge of management of problems of the
breast and trunk, and carry out surgical management including reconstruction for such
disorders.

       Objectives:

       1.     Recite the basic principles of medical and surgical management of
              common acute traumatic trunk and breast injuries including sternal
              infections.

       2.     Recite the etiology and nonsurgical management of pressure sore ulcers
              (including preventative measures).

       3.     Recite a detailed knowledge of surgical aspects of pressure sore
              reconstruction.

       4.     Discuss the surgical aspect of breast reconstruction and the rationale for
              choices between different methods.

       5.     Discuss the use of prosthetic devices for breast reconstruction, including
              implants, tissue expanders, and external prosthesis.




                                                                                        195
B.     Patient Care

Goal: The resident will provide patient care that is compassionate, appropriate, and
effective for the treatment of reconstructive surgery.


       Objectives:

       1.     Perform reconstructive surgery on the trunk, breast, and abdomen with
              increasing independence and surgical responsibility.

       2.     Participate in treatment of patients with malignancy of the trunk, thorax
              and abdominal wall.

       3.     Participate in the surgical management of thoracic and abdominal wall
              reconstruction with graduated independence, including:

              a.      reconstruction following sternal dehiscence and/or infection
              b.      reconstruction after tumor resection utilizing flaps and grafts
              c.      reconstruction of radiation injury of the thorax and trunk
              d.      abdominal wall fascial reconstruction
              e.      abdominal wound dehiscences and hernias utilizing prosthetic
                      material, grafts, separation of parts.

       4.     Participate in surgical and nonsurgical management of pressure sores
              including:

              a.      etiology and staging
              b.      prevention
              c.      nonsurgical considerations and management including patient
                      compliance
              d.      pressure sore surgery utilizing local flaps, muscle and
                      myocutaneous flaps, and distant flaps
              e.      complications of surgery
              f.      rehabilitation.


       5.     Participate in the surgical care of common developmental breast
              anomalies, with graduated surgical independence, including amastia,
              Poland’s syndrome, asymmetry, ectopic mammary tissue, virginal
              hypertrophy, and gynecomastia.




                                                                                        196
6.    Participate in the full spectrum of reconstructive surgery after breast
      carcinoma, including procedures on the opposite breast; participate in
      long-term treatment and follow-up of these patients.

7.    Evaluate and treat patients with premalignant diseases of the breast,
      including prophylactic mastectomy in selected patients.

8.    Evaluate and surgically treat patients with gynecomastia.

9.    Participate in breast reconstruction following mastectomy, including:

      a.     tissue expanders
      b.     implants
      c.     flaps
      d.     nipple reconstruction
      e.     other procedures including tattooing
      f.     management of contralateral breast.

10.   Participate in the evaluation and treatment of patients with post surgical
      breast deformities.

11.   Participate in the evaluation of patients with developmental breast
      abnormalities and perform diagnostic studies; interact with appropriate
      consultants in allied areas.

12.   Perform perioperative care and surgery on patients with developmental
      and acquired breast abnormalities, including breast hypertrophy,
      asymmetry, tubular deformity, and Poland’s syndrome.

13.   Critically analyze patients with developmental chest wall deformities for
      aesthetic and functional reconstruction.

14.   Participate in reconstructive surgery on patients with developmental chest
      deformities.

15.   Participate in the surgical care of posterior trunk lesions, including
      meningomyelocele, sacrococcygeal teratomas, etc.

16.   Evaluate and participate in the multispecialty surgical evaluation of
      patients with congenital deformities of the posterior trunk.

17.   Participate in the reconstruction of posterior trunk congenital defects.

18.   Participate in the surgical care of congenital abdominal wall deformities
      such as gastroscesis, prune belly, and omphalocele.




                                                                                 197
            19.     Participate in the evaluation and surgical planning (in concert with other
                    surgical specialists) of congenital abdominal wall deformities.



C.   Practice Based Learning and Improvement

     Goal: The resident will investigate and evaluate his or her own patient care practices,
     appraise and assimilate scientific evidence, and improve patient care practices.

        Objectives:

            1.      Use information technology to prepare for surgical cases, bringing to the
                    OR the knowledge of current modalities of care and the scientific evidence
                    for that care.

            2.      Routinely analyze the effectiveness of own practices in caring for patient
                    with abdominal wall and trunk plastic surgical diagnoses.

            3.      Improve own practices in the care of patient by integrating appropriately
                    gathered data and feedback.

            4.      Educate medical students and other healthcare professionals in the practice
                    of reconstructive surgery.

            5.      Function independently with graduated advancement and appropriate
                    faculty supervision.

            6.      Participate in and appreciate the value of outcome studies as they apply to
                    abdominal wall and trunk plastic surgical reconstruction.




                                                                                               198
D.     Interpersonal and Communication Skills

Goal: The resident will demonstrate interpersonal and communication skills that result
in effective information exchange and teaming with patients, their families, and
professional associates.

       Objectives:

       1.     Educate patients and families in post-operative strategies for
              reconstructive surgery.

       2.     Demonstrate compassion for patients and their families affected by breast
              cancer.

       3.     Provide adequate counseling and informed consent to patients.

       4.     Listen to patients and their families.

       5.     Assimilate data and information provided by general surgeons and other
              members of the breast care team.

       6.     Chart and record accurate information.

       7.     Demonstrate appreciation of the psychosocial aspects of breast surgery,
              breast deformity, and post mastectomy reconstruction.




                                                                                    199
E.     System Based Practice

Goal: The resident will demonstrate an awareness of and responsiveness to the larger
context and system of health care and ability to effectively call on system resources to
provide care that is of optimal value.

       Objectives:

       1.      Direct the rehabilitation of pressure sore patients following surgery by
               partnering with the following:

               a.     physical therapy
               b.     occupational therapy
               c.     prosthetic and orthotics specialists
               d.     spina bifida clinic
               e.     physical medicine and rehabilitation specialists.

       2.      Demonstrate knowledge of cost-effective breast reconstruction and other
               breast surgery.

       3.      Advocate for breast cancer patients within the health care system.

       4.      Refer breast cancer patients to the appropriate practitioners and agencies.

       5.      Facilitate the timely discharge of patients undergoing reconstructive
               plastic surgery.

       6.      Participate in all aspects of breast cancer care, partnering with general
               surgeons, radiation oncologists, and other breast care team members in the
               complete care of the breast cancer patient.




                                                                                           200
F.     Professionalism

Goal: The resident will demonstrate a commitment to carrying out professional
responsibilities, adherence to ethical principles, and sensitivity to a diverse patient
population.

       Objectives:

       1.    Develop a sensitivity of the unique stress placed on families under care for
             breast cancer.

       2.      Exhibit and unselfish regard for the welfare of reconstructive patients.

       4.      Demonstrate firm adherence to a code of moral and ethical values.

       5.      Be respectful to breast cancer patients and their families, especially in
               times of stress to the family unit.

       6.      Respect and appropriate integrate other members of the breast care team.

       7.      Provide appropriately prompt reconstructive plastic surgery consultations
               when requested.

       8.      Demonstrate sensitivity to the individual patient’s profession, life goals,
               and cultural background as they apply to reconstructive plastic surgery.

       9.      Be reliable, punctual and accountable for own actions in the OR and
               outpatient clinic.




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PLASTIC SURGERY OF THE
  LOWER EXTREMITY




                         202
A.     Medical Knowledge

I:     Anatomy/Physiology/Embryology

Goal: The resident will obtain comprehensive knowledge of the anatomy, physiology,
and embryology of the lower extremities, and use this information in the management of
a variety of surgical problems of the leg.

       Objectives:

       1.     Draw the vascular, neural and osseous anatomy of the lower extremity.

       2.     Describe the muscular and vascular anatomy of specific flaps including
              fascia lata, vastus lateralis, rectus femoris, sartorius, and gracilis flaps.

       3.     Describe the boundaries of and vascular anatomy of specific cutaneous
              flaps including the lateral thigh, medial thigh, posterior thigh and groin
              flaps.

       4.     Draw the venous anatomy of the leg including the sapheneous vein.

       5.     Describe the muscular, cutaneous, and vascular anatomy of the
              gastrocnemius, soleus, and tibialis muscle flaps.

       6.     Explain the concept of fasciocutaneous flaps and be able to design them
              on the distal lower extremity.

       7.     Describe the cutaneous margins and vascular anatomy of foot flaps such
              as medical plantar, lateral plantar, V-Y plantar, and dorsalis pedis-based
              flaps.

       8.     Describe the neuroanatomy of and boundaries of sensate flaps in the lower
              extremity.

       9.     Explain the physiology of arterial insufficiency, venous hypertension, and
              diabetes as they pertain to the lower extremity.

       10.    Draw the detailed anatomy of the popliteal artery and its branches.

       11.    Describe the normal plantar arch and the fundamentals of normal foot
              vasculature.

       12.    Discriminate the advantages and disadvantages of the various levels of
              lower extremity amputation.




                                                                                           203
13.   Recite the basic lower extremity embryology, abnormal development and
      its sequelae.

14.   Describe the anatomy as applied to specific lower extremity flaps
      including:

      a.     skin flaps
      b.     muscle and skin-muscle flaps
      c.     fascial and fasciocutaneous flaps
      d.     sensate flaps
      e.     flaps which include bone

15.   Describe the biomechanics of the lower extremity including:

      a.     function of specific muscles and muscle groups
      b.     gait
      c.     functional consequences of use of specific muscles as flaps




                                                                           204
II:    Trauma/Reconstruction of the Lower Extremity

Goal: The resident will obtain the principles of management of trauma related problems
of the lower extremity and carry out surgical management in the reconstruction of such
problems.

       Objectives:

       1.     Recite the indications for and timing of closure of soft tissue defects of the
              lower extremity.

       2.     Describe coverage techniques (including skin grafts, flaps, distant flaps,
              musculocutaneous flaps, and free flaps) for soft tissue closure of the lower
              extremity.

       3.     Describe the management of infectious processes (including
              osteomyelitis) related to traumatic injuries of the lower extremity.

       4.     Describe the pathophysiology of and techniques for nonoperative and
              operative management of traumatic, ischemic, venous stasis, hypertensive
              and infectious ulcers.

       5.     Recite the etiology and treatment of lymphedema (including non operative
              measures).

       6.     Recite the basis for classification of tibial fractures and the treatment
              modification appropriate for injuries of varying severity.

       7.     Understand the orthopedic management of long-bone injuries including
              internal and external fixation, leg lengthening, and standard techniques for
              replacement of bone defects.

       8.     Recite the common congenital deformities of the lower extremity
              (including constriction defects and syndactyly) and their management.

       9.     Describe the indications of and techniques for replantation or
              revascularization of lower extremity devascularizing or amputative
              injuries.

       10.    Recite the principles and techniques of aesthetic contouring of the lower
              extremity (including excisional and liposuction techniques).




                                                                                          205
B.     Patient Care

Goal: The resident will provide patient care that is compassionate, appropriate, and
effective for the treatment of lower extremity diagnoses.


       Objectives:

       1.     Perform cadaver dissection of the lower extremity.

       2.     Apply anatomic and biomedical knowledge to the choice of procedures for
              lower extremity reconstruction.

       3.     Classify lower extremity tibial fractures.

       4.     Participate in the orthopedic management of lower extremity trauma.

       5.     Participate in the reconstruction of congenital deformities of the lower
              extremity.

       6.     Participate in the reconstruction of major vascular lesions or injuries of the
              lower extremity.

       7.     Perform reconstructions of major tendon or nerve injuries of the lower
              extremity.

       8.     Participate in the surgical and nonsurgical multidisciplinary care of left
              ulcers.

       9.     Evaluate and treat patients with lower extremity ulceration of different
              etiologic origins.

       10.    Undertake perioperative management and surgical treatment of patients
              with devascularizing injuries or conditions of the lower extremity.

       11.    Evaluate and treat patients with lymphedema of the lower extremity.

       12.    Perform aesthetic reconstruction and liposuction of the lower extremities.




                                                                                           206
C.     Practice Based Learning and Improvement

Goal: The resident will investigate and evaluate his or her own patient care practices,
appraise and assimilate scientific evidence, and improve patient care practices.

       Objectives:

       1.      Use information technology to prepare for surgical cases, bringing to the
               OR the knowledge of current modalities of care for patients with lower
               extremity diagnoses and the scientific evidence for that care.

       2.      Routinely analyze the effectiveness of own practices in caring for lower
               extremity patients.

       3.      Improve own practices in the care of lower extremity patients by
               integrating appropriately gathered data and feedback.

       4.      Educate medical students and other healthcare professionals in the
               practices of lower extremity reconstruction.

       5.      Function independently with graduated advancement and appropriate
               faculty supervision in the evaluation and treatment of patients with lower
               extremity diagnoses.




                                                                                          207
D.     Interpersonal and Communication Skills

Goal: The resident will demonstrate interpersonal and communication skills that result
in effective information exchange and teaming with patients, their families, and
professional associates.

       Objectives:

       1.     Educate patients and families in post-operative care of lower extremity
              diagnoses.

       2.     Demonstrate compassion for patients and families with congenital and
              acquired anomalies of the lower extremity.

       3.     Provide adequate counseling and informed consent to patients.

       4.     Listen to patients and their families.

       5.     Assimilate data and information provided by therapists and other members
              of the health care team.




                                                                                        208
E.     System Based Practice

Goal: The resident will 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 care that is of optimal value.

       Objectives:

       1.      Function within the organization of specialty clinics (diabetic clinic,
               venous stasis clinic, amputation clinic) including the coordination of all
               special services in the evaluation of lower extremity lesions.

       2.      Coordinate the nonsurgical treatment of patients with lower extremity
               lesions among contributing specialists (prosthetics, orthotics and wound
               care specialists).

       3.      Understand and function within a team approach to treat patients with
               lower extremity diagnoses.

       4.      Participate in multidisciplinary planning and treatment for patients with
               lower extremity amputations.

       5.      Direct the rehabilitation of lower extremity patients by partnering with the
               following:

               a.      physical therapy
               b.      occupational therapy
               c.      prosthetic and orthotics specialists

       6.      Demonstrate knowledge of cost-effective lower extremity reconstruction.




                                                                                        209
F.     Professionalism

Goal: The resident will demonstrate a commitment to carrying out professional
responsibilities, adherence to ethical principles, and sensitivity to a diverse patient
population.

       Objectives:

       1.    Develop a sensitivity of the unique stress placed on families under care for
             traumatic lower extremity injuries.

       2.    Exhibit and unselfish regard for the welfare of lower extremity patients.

       3.    Demonstrate firm adherence to a code of moral and ethical values.

       4.    Be respectful to patients and their families, especially in times of trauma and
             stress to the family unit.

       5.    Provide appropriately prompt consultations when requested.

       6.    Demonstrate sensitivity to the individual patient’s profession, life goals, and
             cultural background as they apply to lower extremities diagnoses.

       7.    Be reliable, punctual, and accountable for own actions in the OR and clinic.




                                                                                          210
AESTHETIC PLASTIC SURGERY




                            211
A.     Medical Knowledge


I.     Aesthetic Surgery of the Breast and Trunk

Goal: The resident will be thoroughly familiar with aesthetic surgery of the trunk and
breast, and undertake comprehensive surgical management of such diagnoses.

       Objectives:

       1.     Draw the normal anatomy of the breast and axillae.

       2.     Describe the pathologic anatomy and histology of the breast as it relates to
              mammary hyperplasia and hypoplasia.

       3.     Discuss the various surgical techniques for breast reduction, the
              indications for and contraindications to the procedures.

       4.     Discuss the complications of breast reduction, their prevention and
              management.

       5.     Describe the various surgical techniques for breast augmentation, the
              indications for an contraindications to the procedures.

       6.     Discuss the complications of augmentation mammoplasty, their prevention
              and management.

       7.     Discuss the different types of breast implants and the reasons for choosing
              a particular type for a particular problem.

       8.     Describe the basic techniques for mastopexy, the indications for and
              contraindications to these procedures.

       9.     Discuss the complications of mastopexy, their prevention and
              management.

       10.    Discuss techniques for treatment of aesthetic trunk deformity such as
              panniculectomy and abdominoplasty, the indications for them and
              contraindications to the procedures.

       11.    Discuss the complications of panniculectomies and abdominoplasties and
              their prevention and management.

       12.    Discuss the treatment options for congenital breast anomalies such as
              Pollands syndrome.




                                                                                      212
13.   Describe the techniques of suction lipectomy as applied to aesthetic
      deformities of the trunk, as well as anesthetic management for these
      procedures.

14.   Recite the principles of selection of mastopexy vs. augmentation
      mammoplasty.

15.   Recite the principles of selection of abdominoplasty vs. liposuction.

16.   Explain the basic principles and techniques for treating other aesthetic
      deformities of the breast and drunk such as inverted nipples, localized
      lipodystrophy, tubular breast deformity, etc.

17.   List the long-term consequences of augmentation mammoplasty such as
      capsular contraction and its treatment as well as methods for follow-up
      including special techniques for mammography.

18.   Discuss the post-obesity deformity and the options for body contouring
      surgery.




                                                                                 213
II.    Aesthetic Surgery of the Head and Neck

Goal: The resident will be familiar with aesthetic diagnoses of the head and neck and
understand the principles of surgical treatment of such problems.

       Objectives:

       1.     Discuss the concepts of beauty and aesthetic principles of the facial
              structures.

       2.     Identify the principles and techniques of aesthetic rhinoplasty as well as
              the differences in approach between primary and secondary rhinoplasty.

       3.     Recite the diagnostic and therapeutic techniques in the management of
              nasal airway obstruction.

       4.     Discuss the application of aesthetic principles to the cleft patient.

       5.     Explain the complications of rhinoplasty and septoplasty, their prevention
              and treatment.

       6.     Discuss the varying effects of aging and sun exposure on the facial
              structures.

       7.     Demonstrates the techniques of rhytidectomy, suction lipectomy,
              genioplasty, blepharoplasty, and other methods for treatment of the aging
              face.

       8.     Discuss the complications of facial aesthetic surgery, their prevention and
              treatment.

       9.     Draw the various aesthetic deformities of the ear and know the techniques
              of their correction.

       10.    Discuss the aesthetic and functional problems of the eyelid, including
              blepharochalasis and ptosis; knows the treatment for these diagnoses,
              complications and prevention.

       11.    Discuss the diagnostic methods and treatment options for the patient with
              facial palsy.

       12.    Describe the diagnostic principles and treatment techniques for alopecia
              pattern baldness including tissue expansion, scalp flaps, and hair
              transplantation.




                                                                                        214
13.   Discuss the principles and techniques of orthognathic surgery for the
      treatment of craniofacial skeletal dysharmony.

14.   Discuss the various ancillary techniques for management of the aging
      face, including chemical peel, Retin A, dermabrasion, collagen injection,
      laser resurfacing, injection of filling material, botulinum toxin,
      hydroxyapatite, hyaluronic acid, and skin care products.

15.   Discuss the use of lasers for the treatment of unwanted hair, tattoo
      removal, and facial resurfacing, include laser biophysics and safety.

16.   Discuss the various techniques used for face lifting, including the role of
      platysma, SMAS, subperiosteal, deep plan, composite, etc.

17.   Discuss the different types and appropriate uses of liposuction.




                                                                               215
B.      Patient Care

Goal:

        Objectives:

        1.    Perform complete assessment of patients presenting for facial plastic
              surgery.

        2.    Perform the following breast surgeries with graduated operative
              independence including:

              a.       reduction mammoplasty
              b.       augmentation mammoplasty
              c.       ptosis correction and mastopexy.

        3.    Perform the following surgeries including pre-operative markings with
              graduated operative independence, including:

              a.       suction lipectomy
              b.       panniculectomy
              c.       abdominoplasty
              d.       body lifts
              e.       brachioplasties
              f.       thigh lifts

        4.    Perform preoperative markings for reduction mammoplasty.

        5.    Perform a comprehensive (internal/external) nasal exam and participate in
              surgery of the nose including:

              a.       primary and secondary rhinoplasty
              b.       cleft lip nasal deformity
              c.       airway obstruction
              d.       septoplasty.

        6.    Participate in facial aesthetic surgery including:

              a.       rhytidectomy
              b.       brow lift
              c.       facial liposuction
              d.       blephanoplasty
              e.       gennioplasty
              f.       jaw disharmony




                                                                                      216
7.    Perform both open and endoscopic surgical therapy for patients with aging
      face including rhytidectomy and brow lift.

8.    Perform ancillary procedures for the aging face such as chemical peels,
      skin care, injection of fillers and botox, etc.

9.    Participate in the treatment of patients with facial nerve palsy including:

      a.     nerve grafts
      b.     placement of gold weights
      c.     suspensory static procedures
      d.     dynamic procedures
      e.     free tissue transfer.

10.   Evaluate the psychosocial status of the patient presenting for aesthetic
      plastic surgery and determine whether the patient is an appropriate
      candidate for surgery.




                                                                                 217
C.     Practice Based Learning and Improvement

Goal: The resident will investigate and evaluate his or her own patient care practices,
appraise and assimilate scientific evidence, and improve patient care practices.

       Objectives:

       1.      Uses information technology to prepare for surgical cases, bringing to the
               OR the knowledge of current modalities of care and the scientific evidence
               for that care.

       2.      Routinely analyzes the effectiveness of own practices in caring for
               aesthetic and breast patients.

       3.      Improve own practices in the care of aesthetic and breast patients by
               integrating appropriately gathered data and feedback.

       4.      Educate medical students and other healthcare professionals in the
               practices of aesthetic and breast surgery.

       5.      Function independently with graduated advancement and appropriate
               faculty supervision.

       6.      Continue to keep apprised of new techniques used in facial aesthetic
               surgery.




                                                                                          218
D.     Interpersonal and Communication Skills

Goal: The resident will demonstrate interpersonal and communication skills that result
in effective information exchange and teaming with patients, their families, and
professional associates.

       Objectives:

       1.     Educate patients and families in operative strategies for aesthetic surgery.

       2.     Provide adequate counseling and informed consent to patients.

       3.     Listen to patients and their families.

       4.     Chart and record accurate information.

       5.     Accurately assess patient’s expectations of aesthetic plastic surgery and
              honestly educate them on appropriate surgical intervention.




                                                                                       219
E.     System Based Practice

Goal: The resident will 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 care that is of optimal value.

       Objectives:

       1.      Demonstrate knowledge of cost-effective strategies for breast surgery.

       2.      Facilitate the timely discharge of aesthetic and breast patients.

       3.      Understand the state, local and specialty requirements for outpatient
               surgical centers utilized in the care of aesthetic surgery patients.




                                                                                        220
F.     Professionalism

Goal: The resident will demonstrate a commitment to carrying out professional
responsibilities, adherence to ethical principles and sensitivity to a diverse patient
population.

       Objectives:

       1.      Exhibit an unselfish regard for the welfare of patients presenting for
               cosmetic surgery.

       2.      Demonstrate firm adherence to a code of moral and ethical values.

       3.      Respect and appropriately integrate other member of the breast care team.

       4.      Demonstrate sensitivity to the individual patient’s profession, life goals,
               and cultural background as they apply to aesthetic and breast surgery.

       5.      Is reliable, punctual, and accountable for own actions in the OR and clinic.

       6.      Provide non-biased consultations for patients presenting for aesthetic
               surgery.

       7.      Understand the impact of psychological issues, such as body dysmorphic
               disorder and psychosocial stressors, in patients who present for cosmetic
               surgery.

       8.      Participate in the Chief Resident’s Aesthetic Clinic, adhering to strict
               ethical principles and professionalism specifically with respect to
               advertising, recruiting, educating and treating patients.

       9.      Appreciate the potential conflict of interest that exists in the practice of
               aesthetic plastic surgery with respect to patient’s surgical needs and
               expectations and the surgeon’s financial rewards.




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