G_O.VASCULAR. PGY5

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					Stanford Vascular Surgery: R5                                                                    Wednesday, February 23, 2011



                         Stanford University General Surgery Residency Program
                             Vascular Surgery Goals and Objectives for Residents: R-5
                                       Rotation Director: Jason T. Lee, MD
Description
The Vascular Surgery rotation at the VA Palo Alto Health Care System and Stanford Hospital offers a broad experience in the care of
complex patients with vascular surgical diseases and processes.

Goals
The goal of the Vascular Surgery rotation is to help the chief residents:
  Develop knowledge and experience in the evaluation and management of inpatient and outpatient vascular surgical diseases.
  Refine procedural and operative skills commonly required in the care of these patients, including mastering the fundamentals of
     image-guided therapies
  Be the team leader for a busy vascular and endovascular surgical service.

Objectives
The Vascular Surgery R-5 rotation has the following objectives:

   Develop expertise in the management and guidance of inpatient surgical teams, interactions with professional colleagues, referring
    physicians and complementary specialties, and supervision and education of junior residents and medical students in a VA
    environment.
   Develop expertise with surgical exposures, instrumentation and techniques for complex and reoperative aortic, cerebrovascular,
    mesenteric and peripheral vascular reconstructive and revascularization procedures, using open, percutaneous and hybrid surgical
    techniques.
   Develop independent decision-making, operative management and team leadership skills for all facets of vascular disease and
    vascular practice management in a predominantly male gender patient environment.
   The resident gains knowledge of vascular care through discussion on rounds with the attending physician and also by independent
    reading. This knowledge base includes basic fluoroscopic imaging, guidewire management, diagnostic arteriography and
    venography, angiography suite and interventional device inventory management, and vascular access
   The resident gains operative skills through pre-operative reading and preparation and by direct intra-operative teaching from the
    Vascular Surgery Attendings.



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Stanford Vascular Surgery: R5                                                                     Wednesday, February 23, 2011




        Residents can expect frequent teaching from members of the team, both at the bedside and during formal and informal
sessions. Chief residents are also expected to act as senior leader on the team, and able to run the service with the junior residets,
interns, nurse practitioners, and medical students.
        Residents are evaluated in the 6 core competencies (Medical knowledge, Patient care, Interpersonal communication skills,
Professionalism, Practiced based learning and Systems based practice) using specific web-based evaluation forms. An outline of core
competencies with rotation objectives, instructional activities, and evaluations is below.

Specific goals and objectives for residents

GOALS                            R-5 OBJECTIVES                          INSTRUCTIONAL                  EVALUATION
Core Competencies                                                        ACTIVITIES
Knowledge:                       1. Attend vascular surgery clinic 1     Teaching by attending          Weekly feedback by
To acquire and apply             day/week, including evaluation of new faculty.                         fellow/chief resident/attending
knowledge of established         patients, assessment of operative and                                  and Rotation evaluation by
and evolving basic and           anesthetic risks, appropriate           Independent reading            each Vascular Surgery
applied clinical sciences that   consultation and referral indications,                                 attending
relate to the practice of        and performance, evaluation and         Weekly conferences             (https://stanford.medhub.com)
vascular surgery                 interpretation of non-invasive vascular
                                 laboratory testing procedures. Perform
                                 ultrasound guided interventions such
                                 as thrombin injection of femoral
                                 pseudoaneurysms, radiofrequency and
                                 laser venous ablation of superficial
                                 varicosities and perforating veins.
                                 Perform correlation studies with
                                 alternative imaging modalities for
                                 quality assurance. Develop familiarity
                                 and skill with the use and maintenance
                                 of contemporary vascular imaging




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Stanford Vascular Surgery: R5                                                                        Wednesday, February 23, 2011



                                equipment including full size and
                                portable duplex scanning instruments,
                                hand-held continuous wave Doppler
                                devices, plethysomgraphic equipment,
                                treadmill systems, STENTOR systems
                                for image archiving, etc.
                                3. To demonstrate an appropriate
                                knowledge of rescue techniques for
                                complications of interventional
                                procedures.

Patient Care:                   1. Serve as the team leader for the       Daily rounds with the            Weekly feedback by
To provide compassionate,       inpatient vascular services at            Vascular Surgery Team            fellow/chief resident/attending
appropriate, and effective      VAPAHCS. Supervise the                                                     and Rotation evaluation by
care to vascular patients.      management of the inpatient census,       Pre-operative and intra-         each Vascular Surgery
                                reporting requirements, team              operative teaching               attending
                                schedules, call coverage, operative                                        (https://stanford.medhub.com)
                                scheduling, patient evaluation
                                procedures, consultation requirements,
                                transfer mechanisms, and ensuring
                                close contact and updating of referring
                                physicians and professional
                                colleagues.
                                2. Perform chief level open and hybrid
                                (cases combining open and
                                endovascular techniques) vascular
                                surgical procedures as appropriate on
                                designated patients including all major
                                vascular reconstructions.




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Stanford Vascular Surgery: R5                                                                      Wednesday, February 23, 2011




GOALS                           R-5 OBJECTIVES                             INSTRUCTIONAL                 EVALUATION
Core Competencies                                                          ACTIVITIES
Effective Interpersonal         1. Instruct junior residents on basic      Daily rounds with the         Weekly feedback by
and Communication skills:       angiographic techniques in the             Vascular Surgery Team         fellow/chief resident/attending
Residents must                  outpatient angiographic facilities at                                    and Rotation evaluation by
communicate in a way that       VAPAHCS.                                   Weekly Vascular               each Vascular Surgery
leads to effective              2. Organize all teaching conferences       Conferences                   attending
information exchange of a       for junior residents and students at                                     (https://stanford.medhub.com)
vascular surgery care plan to   VAPAHCS.
patients, their families, and   3. Works effectively with team
professional associates.        members (attending, interns and NP)
                                to communicate care plan and discuss
                                with attendings
Practice based learning         1. Supervise and review all complete       Daily rounds with the      Weekly feedback by
and improvement:                directed histories and physical            Vascular Surgery Team      fellow/chief resident/attending
In order to improve patient     examinations on vascular surgery                                      and Rotation evaluation by
care practices, residents       clinic patients, review all                Weekly Vascular Conference each Vascular Surgery
must be able to critically      accompanying clinical and image-                                      attending
evaluate their own              based information regarding their                                     (https://stanford.medhub.com)
performance as well as          patients with junior residents, develop
appraise and incorporate        an independent management plan
clinical scientific evidence.   appropriate for each patient
                                2. Master all angiographic scenarios
                                on the Mentice Simulator including
                                iliac angioplasty/stenting, renal
                                angioplasty/stenting, and carotid
                                angioplasty/stenting.
                                3. Use information technology to
                                assimilate current medical literature as
                                it relates to patient care



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Stanford Vascular Surgery: R5                                                                       Wednesday, February 23, 2011



GOALS                             R-5 OBJECTIVES                            INSTRUCTIONAL                 EVALUATION
Core Competencies                                                           ACTIVITIES
Professionalism:                  1. Learn to manage complex patient        Daily rounds with the         Weekly feedback by
Residents must show a             problems specifically related to          Vascular Surgery Team         fellow/chief resident/attending
commitment to professional        relating information to families                                        and Rotation evaluation by
responsibilities, adherence       regarding unexpected outcomes in a        Weekly Teaching               each Vascular Surgery
to ethical principles, and        VA hospital. Learn to interact with a     Conferences                   attending
sensitivity to diversity.         relatively homogeneous patient                                          (https://stanford.medhub.com)
                                  population of mostly elderly males
                                  with significant vascular and cardiac
                                  comorbid factors.
                                  2. Learn to interact with multiple
                                  subspecialty groups in consultation as
                                  well as multi-disciplinary conferences
                                  3. Displays appropriate demeanor,
                                  even in adverse or stressful situations
                                  4. Acts with sensitivity and
                                  responsiveness to patient’s culture,
                                  age, gender, and disabilities

Systems-based Practice:           1. Demonstrate expertise with all basic Daily rounds with the           Weekly feedback by
A resident must be able to        and advanced interventional             Vascular Surgery Team           fellow/chief resident/attending
demonstrate an awareness of       procedures                                                              and Rotation evaluation by
and responsiveness to the         2. Understands how care for patients                                    each Vascular Surgery
system of health care and         and enables the hospital to deliver a                                   attending
the ability to effectively call   wide range of patient care.                                             (https://stanford.medhub.com)
on system resources to            3. Understands how care practice
provide optimal care.             affects staffing and health care costs




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