PGY 5
| Knowledge Objectives |
- Knowledge of regulatory agencies including state licensing authority, state and local public health rules and regulations, and regulatory agencies such as HCFA, PRO, JCAHO, NCQA.
- Knowledge of basic practice management principles such as budgeting, record keeping, medical records, and the recruitment, hiring, supervision and management of staff.
- In-depth knowledge of methods of Evidence-Based Medicine to the analysis of medical literature.
- Knowledge and ability to apply scientific principles to clinical decision-making.
- In-depth knowledge of principles of research design.
- Ability to present papers at local and national meetings.
- Discuss the clinical and economic rationale for blood component transfusion therapy, including:
- Role of acute limited normovolemic hemodilution
- Role of autologous blood donation and use
- Use of cell-saver
- Alternatives to the use of blood products in Jehovah's witnesses
- NIH consensus recommendations for use of blood products
- Wound healing in the elderly.
- Role of High-PEEP, Pressure-controlled ventilation, Prolonged Inspiratory Time Ventilation, Airway Pressure Release Ventilation, High Frequency Jet Ventilators, Oscillators and ECMO in ARDS.
- Indications and use of CAVH, CVVH, CVVHD, CAVHD with and without renal replacement.
- Triaging of critically ill patients to the intensive care unit.
- Understanding the role of new technology in the intensive care unit.
- Discuss the pathophysiology, clinical presentation, work-up, and management of:
- Solitary thyroid nodule
- Thyrotoxicosis
- Primary, secondary, and tertiary hyperparathyroidism
- Insulinoma/glucagonoma/vipoma
- Gastrinoma
- Gastrointestinal carcinoid tumors
- Discuss the preoperative preparation/management of:
- Thyrotoxicosis
- Pheochromocytoma
- Hyperaldosteronism
- Carcinoid crisis
- Adrenal insufficiency crisis
- Knowledge of the surgical approach to:
- The left and right adrenal glands
- The head of the pancreas
- The body and tail of the pancreas<
- The inferior and superior parathyroids glands
- The retrosternal goiter
- Understanding the role of the following in the management of endocrine surgery:
- Localizing modalities (metaiodobenzylguanine [MIBG], sestamibi, selective venous sampling, intraoperative tumor localization, rapid parathyroid hormone [PTH] assay)
- Diagnostic assays (sensitive TSH, C-peptide, FNAB)
- Knowledge of anesthetic management during endocrine surgery, including:
- Airway management during head and neck surgery
- Cardiovascular manipulations during thyroid and pheochromocytoma surgery
- Outline the appropriate surgical management of disorders of the pancreas (chronic pancreatitis, pancreatic pseudocysts, cystoadenomas, adenocarcinomas, ampullary carcinomas)including the technical details and options for:
- Pancreaticoduodenectomy
- Distal pancreatectomy
- Total pancreatectomy
- Longitudinal pancreaticoduodenostomy (Puestow procedure)
- Subtotal pancreatectomy
- Cystogastrostomy, cystoduodenostomy, cystojejunostomy
- Detailed knowledge of the anatomy of the liver and biliary tract
- Detail the appropriate surgical management of any selected disorder of the liver or biliary tract, including:
- Hepatocellular carcinoma
- Cholangiocarcinoma of extrahepatic ducts
- Hepatoma in the cirrhotic liver
- Hemangioblastoma
- Sclerosing cholangitis
- All form of cirrhosis
- Benign and malignant biliary strictures
- Choledochal cysts
- Knowledge of the physiologic and organic manifestations of vascular disease, such as:
- Renovascular hypertension
- Portal hypertension
- Renal failure
- Describe the operative exposure of the major vessels, including:
- Aortic arch
- Proximal right and left subclavian
- Carotid artery
- Descending thoracic aorta
- Suprarenal aorta
- Infrarenal aorta
- Femoral artery
- Popliteal artery above and below the knee
- Anterior, posterior tibial and peroneal arteries
- Knowledge of basic principles of endovascular repair of abdominal aortic aneurysms.
- Knowledge of factors for decision making in vascular surgery:
- Risk/reward ratio
- Preoperative cardiac assessment
- Morbidity and mortality probability
- Outline the management of graft infections.
- Knowledge of complications of major vascular procedures.
- Knowledge of the management of concomitant intraabdominal pathology found at the time of AAA repair, such as:
- Cholelithiasis
- Colon cancer
- Renal tumors
- Understanding issues associated with preservation of pelvic circulation through reperfusion of one of the hypogastric, significance of previous colectomy, and indications for re-implantation of inferior mesenteric artery during AAA repair.
- Issues associated with the management of renovascular and mesenteric occlusive disease, or suprarenal extension of aneurysm during repair of AAA.
- Knowledge of the management of carotid disease in the elderly with respect to:
- Natural history, if untreated
- Effect of life expectancy and gender on the benefits of CEA in asymptomatic patients
- Causes of stroke during CEA
- Understanding the etiology of recurrent carotid artery stenosis
- Role of carotid artery stenting
- Understand the principles of selection of bypass conduits such as:
- In situ saphenous vein
- Reversed saphenous vein
- Transposed saphenous vein
- Prosthetic grafts
- Prosthetic grafts
- Lesser saphenous vein
- Arm veins
- Prosthetic grafts with vein cuff
| Skill Objectives |
- Direct all surgical management of patients in the ICU, including taking care for admission and discharge.
- Communicate effectively and compassionately with families (supporting their emotional needs) with respect to issues concerning life-sustaining measures of the critically ill patients and withdrawal of therapy understanding their values system.
- Be an effective surgical team leader with good time management and organizational skills.
- Be able to teach effectively medical students and residents.
- Participate in departmental meetings, prepare evaluations of junior residents, and serve on at least two hospital committees (GME, Quality Assurance, Surgical Education, OR, or Tissue Committee).
- Supervise a junior resident through the following:
- Appendectomy
- Uncomplicated laparoscopic cholecystectomy
- Simple hernia repair (inguinal and umbilical)
- Omentopexy of a perforated duodenal ulcer
- Uncomplicated right hemicolectomy
- Uncomplicated small bowel resection
- Exploratory laparotomy and lysis of adhesions.
- Coordinate the overall care of patients with complex pancreatic disease, including initial evaluation, appropriate diagnostic work-up, and operative management of:
- Pancreatic abscess and infected pancreatic necrosis
- Cystoadenomas
- Periampullary carcinomas
- Endocrine tumors of the pancreas
- Perform complex pancreatic procedures such as:
- Whipple resection
- Total and subtotal pancreatectomy
- Drainage of pancreatic abscess and necrosectomy
- Local resection of ampullary tumors
- Exploration for islet cell tumors
- Coordinate the overall care of the patient with hepatobiliary disease, including:
- Initial evaluation
- Appropriate diagnostic studies
- Indicated consultations
- Appropriate diagnostic studies
- Operative management
- Perform complex hepatobiliary procedures and procedures on the extrahepatic biliary system, including:
- Anatomic liver resection
- Portosystemic shunts (portocaval, mesocaval, splenorenal central and distal)
- Resection cholangiocarcinomas
- Choledochal cysts
- Benign biliary strictures
- Assist on liver transplant
- Assist on hepatoportoenterostomy
- Obtain vascular control of the aorta:
- In the left chest
- At the hiatus
- Above the renal arteries
- Below the renal arteries
- Obtain vascular control of the inferior vena cava above and below the renal veins and in the pericardium.
- Expose and control the superior mesenteric artery for embolectomy and bypass.
- Perform under supervision carotid endarterectomy
- Perform under supervision AAA repair.
- Perform under supervision extra-anatomic bypass such as:
- Axillo-axillary bypass
- Axillo-bifemoral bypass
- Manage prosthetic graft infections, including:
- Diagnosis
- Selection of alternate route of revascularization
- Selection of appropriate graft material
- Timing
- Manage complications of major vascular procedures such as:
- Carotid endarterectomy
- Aortic reconstruction
- Lower extremity revascularization