Resident Rotation Yearly Schedule Template - PDF

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					            UNIVERSITY OF CINCINNATI GENERAL SURGERY RESIDENCY
                            GOALS AND OBJECTIVES


Rotation:     University Hospital Transplant Surgery Service

Year:         PGY 1


Patient Care
      Goal - Residents must be able to provide patient care that is compassionate,
appropriate, and effective for the treatment of end-stage renal, pancreas and liver
disease, the transplant recipient, vascular access and hepatobiliary surgical disease.
Residents are expected to:

        Competencies –
        1. assess patients with end-stage renal, pancreas and liver disease,
           hepatobiliary disease and solid abdominal organ transplant recipients
        2. manage patients with end-stage renal, pancreas and liver disease,
           hepatobiliary disease and solid abdominal organ transplant recipients
        3. treat patients with end-stage renal, pancreas and liver disease, hepatobiliary
           disease and solid abdominal organ transplant recipients

        Objectives –
        1. Assist in the diagnosis, preoperative evaluation of pretransplant and
           transplant patients
               a. End-stage renal disease (ESRD)
               b. Diabetes Mellitus
               c. End-stage liver disease (ESLD)
               d. Renal Transplant
               e. Pancreas Transplant
               f. Liver Transplant
               g. Vascular Access
               h. Hepatobiliary Disease

        2. Demonstrate competency in performing procedures and patient care
           appropriate for a 1st year General Surgery resident
              a. Patient management
                      i. Perform reliable and competent history and physicals on
                         complex patients
                     ii. Manage inpatient floor post-transplant and hepatobiliary
                         patients
                    iii. Manage
              b. Vascular access
                      i. Placement of tunneled hemodialysis catheter
                             1. Femoral vein

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                                         Amit D Tevar
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                            2. Internal jugular vein
                    ii. Placement of temporary hemodialysis catheter
                            1. Femoral vein
                            2. Internal jugular vein
                   iii. Placement longterm hemodialysis access
                            1. Arteriovenous graft
                            2. Arteriovenous fistula creation
              c. Hepatobiliary
                     i. Laparoscopic exploration
                    ii. Intraoperative ultrasound examination of the liver
                   iii. Liver biopsy
                   iv. Cholecystectomy (open)
                    v. Cholecystectomy (laparoscopic)


Medical Knowledge
      Goal - Residents must demonstrate knowledge of established and evolving
pathophysiologic, clinical and epidemiologic sciences, as well as the application of this
knowledge to patient care. Residents are expected to:

       Competencies –
       1. Understand the physiology and pathophysiology of end stage renal, pancreas
          and liver disease
       2. Understand the indications, contraindications and candidate listing process
          and UNOS guidelines and postoperative managment for renal, pancreas and
          liver transplant
       3. Understand the mechanism of action, efficacy, indications, risk and benefits of
          immunosuppressive therapy
       4. Understand the physiology and rationale behind modalities of short-term and
          long-term hemodialysis access for the end stage renal patient
       5. Understand the anatomy, pathophysiology of the benign and malignant liver
          disease

       Objectives –
       1. End-stage renal disease and Renal Transplantation
             a. Define ESRD and indications for HD
             b. Calculate glomerular filtration rate
             c. Understand UNOS guidelines for renal transplantation and renal organ
                allocation
             d. Understand the postoperative fluid management of the live and
                cadaveric donor renal transplant
             e. Understand mechanism of common induction and maintenance
                immunosuppressive therapy in renal transplant
             f. Understand classification system of rejection and treatment modalities
             g. Interpret and understand limitations of common post-transplant renal
                imaging modalities

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                  i. Ultrasound
                 ii. Renal scan
        h. Identify indications for renal biopsy
2.   Pancreas Transplant
        a. Understand the indications and rationale for pancreas transplant for
            DM Type I
        b. List UNOS guidelines for pancreas transplantation and whole organ
            pancreas allocation
        c. Understand the evaluation for pancreas transplant candidates
        d. Understand the postoperative care of pancreas transplant recipient
        e. Understand mechanism of common induction and maintenance
            immunosuppressive therapy in pancreas transplant
3.   Liver Transplant
        a. Understand the pathophysiology of chronic liver disease
        b. List details of classification systems of liver failure and HCC
                  i. Child’s Pugh Turcotte
                 ii. MELD
                iii. Milan Criteria
               iv. UCSF Criteria
        c. List UNOS guidelines for liver transplantation and whole organ liver
            allocation
        d. Understand mechanism of common induction and maintenance
            immunosuppressive therapy in liver transplant
        e. Understand clinical management while awaiting liver transplant
        f. Understand immediate postoperative care
        g. Be able to appropriately investigate elevated LFT’s post transplant
        h. Be able to evaluate liver ultrasound results
4.   Vascular Access Surgery
        a. List the indications for hemodialysis
        b. Understand the risk, benefits and longterm outcomes of various
            modalities of longterm dialysis access
                  i. Peritoneal catheter
                 ii. Tunneled catheter placement
                iii. AV graft insertion
               iv. AV fistula creation
        c. Understand the pathophysiology of venous intimal hyperplasia
        d. Demonstrate understanding of noninvasive vascular test to deterine
            appropriate selection of longterm hemodialysis access
        e. Understand the modalities, indications and longterm outcomes of AV
            access salvage procedures
                  i. Revision
                 ii. Angioplasty
                iii. Stent placement
5.   Hepatobiliary Surgery
        a. Understand the segmental anatomy of the liver
        b. List benign lesions, diagnostic workup and treatment options

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                        i. Cyst
                       ii. Abscess
                      iii. Hemangioma
                      iv. Adenoma
                       v. Focal Nodular Hyperplasia
             c.   Understand diagnostic workup and treatment modalities for malignant
                  liver lesions
                        i. HCC
                       ii. Metastatic colorectal adenocarcinoma
                      iii. Carcinoid
                      iv. Cholangiocarcinoma
             d.   Understand diagnostic workup and treatment modalities for cirrhosis
                  and portal hypertension
                        i. Ascites
                       ii. Esophageal varices
                      iii. Encephalopathy
                      iv. Hepatorenal syndrome
             e.   Demonstrate understanding of local regional therapy vs liver
                  transplantation for HCC in the cirrhotic patient
             f.   Be able to interpret commonly utilized imaging studies:
                        i. CT biphasic
                       ii. Ultrasound
                      iii. HIDA scan
                      iv. ERC
             g.   Understand diagnostic evaluation and treatment modalities for
                  iatragenic bile duct injury

Practice-Based Learning and Improvement
      Goal- The resident will investigate and evaluate their care of patients, appraise
and assimilate scientific evidence, and to continuously improve patient care based on
constant self-evaluation and life long learning. Residents are expected to develop skills
and habits to be able to:

      Competencies-
      1. Use information technology to optimize learning
      2. Participate in the education of patients, families, students, residents and other
         health professionals.

      Objectives-
      1. Perform electronic database searches of the medical literature
      2. Present a 15 min talk and patient presentation during HB Clinic


Systems Based Practice



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       Goal- Residents must demonstrate an awareness of and responsiveness to the
larger context and system of health care, as well as the ability to call effectively on other
resources in the system to provide optimal health care. Residents are expected to:

       Competencies-
       1. Participate in identifying systems errors and in implementing potential system
solutions.

       Objectives-
       1. Participate in weekly Transplant Morbidity and Mortality Conference
       2. Participate in weekly Kidney/Pancreas Selection Conference and collaborate
          with team members to improve overall management of the service

Professionalism
      Goal- Residents must demonstrate a commitment to carrying out professional
responsibilities and an adherence to ethical principles. Residents are expected to
demonstrate:

       Competencies-
       1. Compassion, integrity, and respect for others
       2. Responsiveness to patient needs that supersedes self-interest.

       Objectives-
       1. No negative reports concerning the resident from staff, patients, or
          Attendings.
       2. Attendance and participation with Daily 6NW Patient Staff Meeting
       3. Professional attire during Kidney/Pancreas/Liver Transplant and HB Clinic.

Interpersonal and Communication Skills
        Goal- Residents must demonstrate interpersonal and communication skills that
result in the effective exchange of information and teaming with patients, their families,
and professional associates. Residents are expected to:

       Competencies-
       1. Communicate effectively with physicians, other health professionals, and
health related agencies.

       Objectives-
       1. Demonstrate ability to present a patient on rounds and formulate a
          preliminary treatment plan.
       2. Demonstrate ability to evaluate and present a clinic outpatient consult with a
          treatment plan


Teaching Methods


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      1. Daily Attending Rounds- A specific Attending is designated for the Service
         each weekday. The Rounding Surgeon sees all of the patients with the
         resident team.
      2. Transplant Lecture Series
            a. Wednesday 12:00 pm
      3. Wednesday Outpatient Clinic. This is a nonoperative day and residents will
         be expected to fully participate in education and patient care in
            a. HB clinic
            b. Kidney/Pancreas Evaluation Clinic
            c. Renal/Access Surgery Clinic
      4. Kidney/Pancreas Transplant Selection Meeting
            a. Thursday 1:00 pm
      5. Liver Selection Meeting
            a. Tuesday 12:00 pm
      6. Liver Transplant Evaluation Clinic
            a. Monday 8:00 am
      7. Transplant Grand Rounds
            a. Tuesday 4:00 pm
      8. Direct teaching in the operating room and during patient care.

Assessment Methods (Residents)
     1. Verbal feedback during daily rounds
     2. Verbal feedback during weekly meeting with Amit Tevar, MD
     3. Written feedback by fellow at conclusion of rotation
     4. Written self-evaluation at conclusion of rotation
     5. Written formal evaluation by faculty at conclusion of rotation

Assessment Methods (Program Evaluation)
     1. Written feedback instrument at completion of rotation
     2. Written evaluation of faculty by resident at completion of rotation
     3. Performance on ABSITE examination (yearly)

Level of Supervision
        The Transplant Surgery Senior Fellow will supervise junior residents and medical
students. The nighttime and weekend Attending call schedule is available to all in the
Divisional office. An attending surgeon is available in-house 24 hours daily as needed
for discussion, consultation, and patient care.

Educational Resources
     Transplantation of the Liver 2nd Ed, Busuttil
     Transplantation, Ginns
     Handbook of Kidney Transplantation 4th Ed, Danovitch
     Vascular Surgery, Rutherford, 6th Edition
     Surgery of the Liver, Biliary Tract and Pancreas, Blumgart



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