Successfully Successfully Navigating the First Navigating the First Year of Surgical Year of Surgical Residency: Residency: Essentials for Essentials for Medical Students and Medical Students and PGY-1 Residents PGY-1 Residents
Mar 28, 2015
Successfully Successfully Navigating the First Navigating the First
Year of Surgical Year of Surgical Residency:Residency:
Essentials for Medical Essentials for Medical Students and PGY-1 Students and PGY-1
ResidentsResidents
Essentials for Surgical Essentials for Surgical Residents Entering PGY-1Residents Entering PGY-1
Surgical residents entering the first Surgical residents entering the first postgraduate year are expected to be postgraduate year are expected to be well grounded in the scientific basis of well grounded in the scientific basis of surgical diseases and disorders and surgical diseases and disorders and should be able to apply their should be able to apply their knowledge and skills to provide knowledge and skills to provide optimum patient care and ensure optimum patient care and ensure patient safety. patient safety.
Essentials for Surgical Essentials for Surgical Residents Entering PGY-1Residents Entering PGY-1
The essential areas of knowledge and The essential areas of knowledge and skills are listed here within the context skills are listed here within the context of the core competencies: of the core competencies:
►Medical Knowledge and Patient Care Medical Knowledge and Patient Care ►ProfessionalismProfessionalism► Interpersonal and Communication Skills Interpersonal and Communication Skills ►Practice-Based Learning and Practice-Based Learning and
Improvement, Improvement, ►Systems-Based Practice.Systems-Based Practice.
Essentials for Surgical Residents Entering PGY-Essentials for Surgical Residents Entering PGY-11
Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Clinical AssessmentClinical Assessment
and Perioperative Managementand Perioperative Management
Medical Knowledge and Patient Medical Knowledge and Patient CareCare
Effectively and efficiently perform a history and Effectively and efficiently perform a history and physical examination that is appropriate for age, physical examination that is appropriate for age, sex, and clinical problemsex, and clinical problem
Identify factors that increase perioperative riskIdentify factors that increase perioperative risk Diseases:Diseases:
►CardiacCardiac►EndocrineEndocrine►HepaticHepatic► InfectiousInfectious►PsychiatricPsychiatric►PulmonaryPulmonary►RenalRenal
Essentials for Surgical Residents Entering Essentials for Surgical Residents Entering PGY-1PGY-1
Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Essentials for Surgical Residents Entering Essentials for Surgical Residents Entering PGY-1PGY-1
Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Identify factors that increase perioperative riskIdentify factors that increase perioperative risk Conditions:Conditions:
►Extremes of AgeExtremes of Age► Immune suppressionImmune suppression►Metabolic disordersMetabolic disorders►PregnancyPregnancy►Substance AbuseSubstance Abuse
Develop appropriate differential diagnoses and Develop appropriate differential diagnoses and management plansmanagement plans
Write daily inpatient notes in an appropriate format, Write daily inpatient notes in an appropriate format, noting progress and changes in health statusnoting progress and changes in health status
Write concise clinic encounter notes in an Write concise clinic encounter notes in an appropriate formatappropriate format
Write routine ordersWrite routine orders►AdmissionAdmission►PreoperativePreoperative►PostoperativePostoperative
Essentials for Surgical Residents Entering PGY-Essentials for Surgical Residents Entering PGY-11
Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Maintain medical records in a legible, legally Maintain medical records in a legible, legally appropriate professional mannerappropriate professional manner
Consider the possibility of pregnancy in women of Consider the possibility of pregnancy in women of childbearing age and discuss the special needs and childbearing age and discuss the special needs and concerns of surgical patients who are pregnant or concerns of surgical patients who are pregnant or may be pregnantmay be pregnant
Discuss the impact of extremes of age on diagnosis Discuss the impact of extremes of age on diagnosis and management of the surgical patientand management of the surgical patient
Essentials for Surgical Residents Entering PGY-Essentials for Surgical Residents Entering PGY-11
Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Assessment of Basic Diagnostic Assessment of Basic Diagnostic Tests and RadiographsTests and Radiographs
Interpret normal and abnormal biochemical and Interpret normal and abnormal biochemical and hematologic laboratory test resultshematologic laboratory test results
Interpret a standard 12-lead electrocardiogram and Interpret a standard 12-lead electrocardiogram and identify common abnormalitiesidentify common abnormalities
Essentials for Surgical Residents Entering PGY-Essentials for Surgical Residents Entering PGY-11
Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Interpret normal and common abnormal findings in Interpret normal and common abnormal findings in radiographs of:radiographs of:
►AbdomenAbdomen►ChestChest►SkeletonSkeleton
Essentials for Surgical Residents Entering PGY-Essentials for Surgical Residents Entering PGY-11
Medical Knowledge and Patient CareMedical Knowledge and Patient Care
NutritionNutrition
Assess nutritional status Assess nutritional status
Describe nutritional requirements in health and Describe nutritional requirements in health and diseasedisease
Describe the risks, and benefits of enteral and Describe the risks, and benefits of enteral and parenteral nutritionparenteral nutrition
Essentials for Surgical Residents Entering PGY-Essentials for Surgical Residents Entering PGY-11
Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Airway Management and AnesthesiaAirway Management and Anesthesia
Obtain Advanced Cardiovascular Life Support Obtain Advanced Cardiovascular Life Support certification, including:certification, including:
►Assessing the adequacy of the airwayAssessing the adequacy of the airway►Obtaining oropharyngeal control of the airway and Obtaining oropharyngeal control of the airway and
providing bag/mask ventilation (simulated)providing bag/mask ventilation (simulated)►Performing orotracheal intubation (simulated)Performing orotracheal intubation (simulated)
Describe the actions, risks, and optimum use of local Describe the actions, risks, and optimum use of local and general anesthetic agentsand general anesthetic agents
Essentials for Surgical Residents Entering PGY-Essentials for Surgical Residents Entering PGY-11
Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Management of Fluid/Electrolytes Management of Fluid/Electrolytes and Acid/Base Balanceand Acid/Base Balance
Calculate routine maintenance fluid requirements Calculate routine maintenance fluid requirements appropriate for age and clinical problem, and write appropriate for age and clinical problem, and write orders for themorders for them
Write orders for appropriate monitoring, and Write orders for appropriate monitoring, and calculate intake and output calculate intake and output
Essentials for Surgical Residents Entering PGY-Essentials for Surgical Residents Entering PGY-11
Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Make changes in maintenance fluid and electrolyte Make changes in maintenance fluid and electrolyte orders based on biochemical and clinical orders based on biochemical and clinical assessmentassessment
Calculate and interpret acid/base balanceCalculate and interpret acid/base balance►Anion gapAnion gap►Arterial blood gasesArterial blood gases
Essentials for Surgical Residents Entering PGY-Essentials for Surgical Residents Entering PGY-11
Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Fever and Surgical InfectionsFever and Surgical Infections
Describe the pathophysiology and common causes Describe the pathophysiology and common causes of fever in the surgical patientof fever in the surgical patient
Identify the common postoperative infectionsIdentify the common postoperative infections
Describe the evaluation of a patient with Describe the evaluation of a patient with postoperative fever, including appropriate use of postoperative fever, including appropriate use of physical examination, cultures, and other physical examination, cultures, and other diagnostic testsdiagnostic tests
Essentials for Surgical Residents Entering PGY-Essentials for Surgical Residents Entering PGY-11
Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Describe the systemic inflammatory response Describe the systemic inflammatory response syndrome and associated findingssyndrome and associated findings
Discuss common pathogens in surgical woundsDiscuss common pathogens in surgical wounds
Describe the principles of surgical treatment of Describe the principles of surgical treatment of infectioninfection
Essentials for Surgical Residents Entering PGY-Essentials for Surgical Residents Entering PGY-11
Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Wound ManagementWound Management
List wound classificationsList wound classifications
Describe the phases of normal wound healing, Describe the phases of normal wound healing, including the major cell types involved (platelets, including the major cell types involved (platelets, polymorphonuclear leukocytes [PMNs], polymorphonuclear leukocytes [PMNs], macrophages, and fibroblasts) and the timing of macrophages, and fibroblasts) and the timing of each phase and the maximum strength of the each phase and the maximum strength of the woundwound
Essentials for Surgical Residents Entering PGY-Essentials for Surgical Residents Entering PGY-11
Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Describe the principles of tetanus prophylaxisDescribe the principles of tetanus prophylaxis
Perform simple wound debridement under Perform simple wound debridement under supervisionsupervision
Perform dressing changes for sterile and Perform dressing changes for sterile and contaminated woundscontaminated wounds
Essentials for Surgical Residents Entering PGY-Essentials for Surgical Residents Entering PGY-11
Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Shock and Critical CareShock and Critical Care
List the types of shockList the types of shock►Describe clinical findings of eachDescribe clinical findings of each►Outline principles of management of eachOutline principles of management of each
List the indications for and risks of a red cell List the indications for and risks of a red cell transfusiontransfusion
Identify the physical findings of abnormal Identify the physical findings of abnormal intravascular volumeintravascular volume
Essentials for Surgical Residents Entering PGY-Essentials for Surgical Residents Entering PGY-11
Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Trauma and Surgical EmergenciesTrauma and Surgical Emergencies
Discuss the primary survey of the trauma patient, Discuss the primary survey of the trauma patient, including the ABCsincluding the ABCs
Control bleeding from external woundsControl bleeding from external wounds
Correctly identify clinical and radiologic findings in Correctly identify clinical and radiologic findings in common fracturescommon fractures
Essentials for Surgical Residents Entering PGY-Essentials for Surgical Residents Entering PGY-11
Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Describe the findings and appropriate treatment of:Describe the findings and appropriate treatment of:►Airway compromiseAirway compromise►Pericardial tamponadePericardial tamponade►Tension pneumothoraxTension pneumothorax
Describe the estimation of total body surface area Describe the estimation of total body surface area burn in thermal injuryburn in thermal injury
Describe initial fluid resuscitation in thermal injuryDescribe initial fluid resuscitation in thermal injury
Essentials for Surgical Residents Entering PGY-Essentials for Surgical Residents Entering PGY-11
Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Stroke and Transient Ischemic Stroke and Transient Ischemic AttackAttack
Describe the clinical manifestations of:Describe the clinical manifestations of:►Hemorrhagic strokeHemorrhagic stroke► Ischemic strokeIschemic stroke►Transient ischemic attack (TIA) Transient ischemic attack (TIA)
Essentials for Surgical Residents Entering PGY-Essentials for Surgical Residents Entering PGY-11
Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Coagulation and AnticoagulationCoagulation and Anticoagulation
Discuss the coagulation cascadeDiscuss the coagulation cascade
List a differential diagnosis of coagulopathies List a differential diagnosis of coagulopathies according to history and laboratory testsaccording to history and laboratory tests
Discuss prevention of deep vein thrombosis (DVT) Discuss prevention of deep vein thrombosis (DVT) and pulmonary embolismand pulmonary embolism
Essentials for Surgical Residents Entering PGY-Essentials for Surgical Residents Entering PGY-11
Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Describe signs of acute DVTDescribe signs of acute DVT
List drug regimens for therapeutic anticoagulationList drug regimens for therapeutic anticoagulation
List indications and contraindications of List indications and contraindications of anticoagulationanticoagulation
Recognize chronic venous insufficiency and its Recognize chronic venous insufficiency and its implicationsimplications
Essentials for Surgical Residents Entering PGY-Essentials for Surgical Residents Entering PGY-11
Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Pharmacology and PharmacokineticsPharmacology and Pharmacokinetics
Discuss basic pharmacology of common drugs:Discuss basic pharmacology of common drugs:►AnalgesicsAnalgesics►AntibioticsAntibiotics►AnticoagulantsAnticoagulants►AntiemeticsAntiemetics►AntihypertensivesAntihypertensives►Antiplatelet agentsAntiplatelet agents►CorticosteroidsCorticosteroids►DiureticsDiuretics
Essentials for Surgical Residents Entering PGY-Essentials for Surgical Residents Entering PGY-11
Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Common Drugs continued:Common Drugs continued:►Gastric acid-reducing drugsGastric acid-reducing drugs►LaxativesLaxatives►Nonsteroidal antiinflammatory drugs (NSAIDS)Nonsteroidal antiinflammatory drugs (NSAIDS)►Oral hypoglycemic agentsOral hypoglycemic agents►SedativesSedatives
Discuss age- and metabolic-specific implications of Discuss age- and metabolic-specific implications of drug dosingdrug dosing
Essentials for Surgical Residents Entering PGY-Essentials for Surgical Residents Entering PGY-11
Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Complications and Conditions in Complications and Conditions in Surgical PatientsSurgical Patients
Identify and outline age-appropriate initial Identify and outline age-appropriate initial evaluation of the following:evaluation of the following:
►Abdominal distentionAbdominal distention►Acute abdomenAcute abdomen►Acute alcohol intoxicationAcute alcohol intoxication►Alcohol or drug withdrawalAlcohol or drug withdrawal►Altered mental statusAltered mental status►Arterial bleedingArterial bleeding
Essentials for Surgical Residents Entering PGY-Essentials for Surgical Residents Entering PGY-11
Medical Knowledge and Patient CareMedical Knowledge and Patient Care
►AspirationAspiration►Aspiration pneumoniaAspiration pneumonia►AtelectasisAtelectasis►Bleeding and coagulopathyBleeding and coagulopathy►Bowel obstructionBowel obstruction►Chest painChest pain►Congestive heart failureCongestive heart failure►ConstipationConstipation►CyanosisCyanosis►Deep vein thrombosisDeep vein thrombosis►Diabetic ketoacidosisDiabetic ketoacidosis►DyspneaDyspnea
Essentials for Surgical Residents Entering PGY-Essentials for Surgical Residents Entering PGY-11
Medical Knowledge and Patient CareMedical Knowledge and Patient Care
►Dysrhythmias (as covered in Advanced Cardiovascular Dysrhythmias (as covered in Advanced Cardiovascular Life Support)Life Support)
►Fecal impactionFecal impaction►FeverFever►Gastrointestinal bleeding (upper, lower)Gastrointestinal bleeding (upper, lower)►HemothoraxHemothorax►Hyperosmolar comaHyperosmolar coma►HypertensionHypertension►HyperventilationHyperventilation►HypotensionHypotension►HypoventilationHypoventilation►HypovolemiaHypovolemia
Essentials for Surgical Residents Entering PGY-Essentials for Surgical Residents Entering PGY-11
Medical Knowledge and Patient CareMedical Knowledge and Patient Care
►HypoxiaHypoxia► JaundiceJaundice►Malignancies (common; eg, breast, colon, lung)Malignancies (common; eg, breast, colon, lung)►NauseaNausea►OliguriaOliguria►Peripheral ischemia (acute, chronic)Peripheral ischemia (acute, chronic)►Perionitis (generalized, localized)Perionitis (generalized, localized)►Phlebitis, superficialPhlebitis, superficial►Pleural effusionPleural effusion►PneumoniaPneumonia►PneumothoraxPneumothorax►Postoperative painPostoperative pain
Essentials for Surgical Residents Entering PGY-Essentials for Surgical Residents Entering PGY-11
Medical Knowledge and Patient CareMedical Knowledge and Patient Care
►Pulmonary edemaPulmonary edema►Pulmonary embolusPulmonary embolus►SeizuresSeizures►Substance abuseSubstance abuse►Transfusion reactionTransfusion reaction►Urinary retentionUrinary retention►VomitingVomiting►Wound hematoma or seromaWound hematoma or seroma
Essentials for Surgical Residents Entering PGY-Essentials for Surgical Residents Entering PGY-11
Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Surgical and Technical SkillsSurgical and Technical Skills
Practice universal precautions routinely Practice universal precautions routinely
Administer a local anestheticAdminister a local anesthetic
Insert and maintain nasogastric tubesInsert and maintain nasogastric tubes
Insert and maintain urinary cathetersInsert and maintain urinary catheters
Essentials for Surgical Residents Entering PGY-Essentials for Surgical Residents Entering PGY-11
Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Assess the presence of peripheral blood flow using Assess the presence of peripheral blood flow using handheld Doppler instrumentshandheld Doppler instruments
Perform venipuncture and insert peripheral Perform venipuncture and insert peripheral intravenous cathetersintravenous catheters
Perform an arterial stick and obtain an arterial Perform an arterial stick and obtain an arterial samplesample
Scrub, gown, and glove properlyScrub, gown, and glove properly
Essentials for Surgical Residents Entering PGY-Essentials for Surgical Residents Entering PGY-11
Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Maintain appropriate sterile technique in the:Maintain appropriate sterile technique in the:►ClinicClinic►Emergency departmentEmergency department► Intensive care unitIntensive care unit►Operating roomOperating room►Patient’s roomPatient’s room
Use proper techniques for skin preparation and Use proper techniques for skin preparation and draping of the incision sitedraping of the incision site
Remove sutures and staplesRemove sutures and staples
Essentials for Surgical Residents Entering PGY-Essentials for Surgical Residents Entering PGY-11
Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Perform minor surgical procedures under Perform minor surgical procedures under supervision; e.g.,supervision; e.g.,
► Incision and drainage of superficial abcessesIncision and drainage of superficial abcesses►Minor excisionsMinor excisions►Skin suture using simple, subcutaneous, and mattress Skin suture using simple, subcutaneous, and mattress
sutures as well as staplessutures as well as staples
Understand potential complications of the above Understand potential complications of the above procedures as they relate to patient safetyprocedures as they relate to patient safety
Essentials for Surgical Residents Entering PGY-Essentials for Surgical Residents Entering PGY-11
Medical Knowledge and Patient CareMedical Knowledge and Patient Care
ProfessionalismProfessionalism
Essentials for Surgical Residents Entering PGY-Essentials for Surgical Residents Entering PGY-11
Adhere to the local institutional code of conduct, Adhere to the local institutional code of conduct, demeanor, behavior, and attiredemeanor, behavior, and attire
Demonstrate altruism in patient careDemonstrate altruism in patient care
Respect all individualsRespect all individuals
Use discretion in private and public communicationsUse discretion in private and public communications
Maintain an inquisitive mind and lifelong learning Maintain an inquisitive mind and lifelong learning habitshabits
Essentials for Surgical Residents Entering PGY-Essentials for Surgical Residents Entering PGY-11
ProfessionalismProfessionalism
Essentials for Surgical Residents Entering PGY-Essentials for Surgical Residents Entering PGY-11
ProfessionalismProfessionalism
Demonstrate an awareness of one’s own limitationsDemonstrate an awareness of one’s own limitations
Accept feedback appropriately and use it effectively Accept feedback appropriately and use it effectively for self-learning and improvementfor self-learning and improvement
Demonstrate self-directed learning skillsDemonstrate self-directed learning skills
Know when and where to obtain help for Know when and where to obtain help for professional and personal issuesprofessional and personal issues
Essentials for Surgical Residents Entering PGY-Essentials for Surgical Residents Entering PGY-11
ProfessionalismProfessionalism
Describe the principles of informed consentDescribe the principles of informed consent
Describe the basic principles of medical ethics:Describe the basic principles of medical ethics:►BeneficenceBeneficence►Patient autonomyPatient autonomy
Be illegal/illicit substance freeBe illegal/illicit substance free
Use time management skills appropriately in order Use time management skills appropriately in order to balance one’s personal and professional to balance one’s personal and professional responsibilities responsibilities
Essentials for Surgical Residents Entering PGY-Essentials for Surgical Residents Entering PGY-11
ProfessionalismProfessionalism
Demonstrate a strong work ethic, and consistently Demonstrate a strong work ethic, and consistently and dependably carry out one’s duties with and dependably carry out one’s duties with honesty, personal integrity, self-motivation, and honesty, personal integrity, self-motivation, and self-disciplineself-discipline
Work collaboratively with other members of the Work collaboratively with other members of the health care teamhealth care team
Accept responsibility for one’s actionsAccept responsibility for one’s actions
Essentials for Surgical Residents Entering PGY-Essentials for Surgical Residents Entering PGY-11
ProfessionalismProfessionalism
Be punctualBe punctual
Attend required Attend required conferencesconferences
Essentials for Surgical Residents Entering PGY-Essentials for Surgical Residents Entering PGY-11
Interpersonal and Interpersonal and Communication SkillsCommunication Skills
Essentials for Surgical Residents Entering PGY-Essentials for Surgical Residents Entering PGY-11
Interpersonal and Communication SkillsInterpersonal and Communication Skills
Listen actively with cultural, ethnic, gender, racial, Listen actively with cultural, ethnic, gender, racial, and religious sensitivityand religious sensitivity
Communicate effectively with patients, families, Communicate effectively with patients, families, and professional associatesand professional associates
Begin patient encounters, educate and advise Begin patient encounters, educate and advise patients, and end encounters, conveying sensitivity, patients, and end encounters, conveying sensitivity, compassion, and concerncompassion, and concern
Essentials for Surgical Residents Entering PGY-Essentials for Surgical Residents Entering PGY-11
Interpersonal and Communication SkillsInterpersonal and Communication Skills
Discuss medical errors or professional mistakes Discuss medical errors or professional mistakes honestly and openly in ways that promote learninghonestly and openly in ways that promote learning
Convey key information accurately to the transition Convey key information accurately to the transition team assuming careteam assuming care
Appreciate and be able to discuss sensitive issues Appreciate and be able to discuss sensitive issues with patients, including:with patients, including:
►Death and dyingDeath and dying►Health maintenance and disease preventionHealth maintenance and disease prevention►Substance abuse Substance abuse
Essentials for Surgical Residents Entering PGY-Essentials for Surgical Residents Entering PGY-11
Interpersonal and Communication SkillsInterpersonal and Communication Skills
Give accurate, clear, and concise oral presentationsGive accurate, clear, and concise oral presentations
Essentials for Surgical Residents Entering PGY-Essentials for Surgical Residents Entering PGY-11
Practice-Based Learning and Practice-Based Learning and ImprovementImprovement
Essentials for Surgical Residents Entering PGY-Essentials for Surgical Residents Entering PGY-11
Practice-Based Learning and ImprovementPractice-Based Learning and Improvement
Demonstrate self-directed and lifelong learning Demonstrate self-directed and lifelong learning skillsskills
Demonstrate the ability to access, analyze, and use Demonstrate the ability to access, analyze, and use the scientific literaturethe scientific literature
Describe the principles of evidence-based practiceDescribe the principles of evidence-based practice
Essentials for Surgical Residents Entering PGY-Essentials for Surgical Residents Entering PGY-11
Practice-Based Learning and ImprovementPractice-Based Learning and Improvement
Be proficient with computer applications; e.g., Be proficient with computer applications; e.g., word-processing programs, spreadsheets, simple word-processing programs, spreadsheets, simple databases, and electronic presentationsdatabases, and electronic presentations
Use electronically available medical information in Use electronically available medical information in patient carepatient care
Essentials for Surgical Residents Entering PGY-Essentials for Surgical Residents Entering PGY-11
Systems-Based PracticeSystems-Based Practice
Essentials for Surgical Residents Entering PGY-Essentials for Surgical Residents Entering PGY-11
Systems-Based PracticeSystems-Based Practice
Identify barriers to access to health careIdentify barriers to access to health care
Use the medical record appropriatelyUse the medical record appropriately
Comply with Health Insurance Portability and Comply with Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations Accountability Act of 1996 (HIPAA) regulations regarding patient privacy and confidentialityregarding patient privacy and confidentiality
Essentials for Surgical Residents Entering PGY-Essentials for Surgical Residents Entering PGY-11
Systems-Based PracticeSystems-Based Practice
Describe the principles of patient safety and patient Describe the principles of patient safety and patient safety practices, such as Joint Commission on safety practices, such as Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Accreditation of Healthcare Organizations (JCAHO) patient safety standards; e.g.,patient safety standards; e.g.,
► Improving the accuracy of patient identificationImproving the accuracy of patient identification► Improving the effectiveness of communication among Improving the effectiveness of communication among
caregiverscaregivers► Improving the safety of using high-alert medicationsImproving the safety of using high-alert medications►Eliminating wrong-site, wrong-patient, wrong-procedure Eliminating wrong-site, wrong-patient, wrong-procedure
surgery (using a time-out in operative procedures)surgery (using a time-out in operative procedures)► Improving the effectiveness of clinical alarm systemsImproving the effectiveness of clinical alarm systems
Essentials for Surgical Residents Entering PGY-Essentials for Surgical Residents Entering PGY-11
Systems-Based PracticeSystems-Based Practice
……continuedcontinued►Reducing the risk of health care- acquired infectionsReducing the risk of health care- acquired infections►Describing the roles of various health professionals in Describing the roles of various health professionals in
the patient care teamthe patient care team
Understand the concept of risk management and Understand the concept of risk management and the need for appropriate documentation in the the need for appropriate documentation in the medical recordmedical record
Use electronically available medical information Use electronically available medical information effectivelyeffectively
Essentials for Surgical Residents Entering PGY-Essentials for Surgical Residents Entering PGY-11
Systems-Based PracticeSystems-Based Practice
Demonstrate collegiality in working with all of those Demonstrate collegiality in working with all of those associated with the care of patientsassociated with the care of patients
Apply information technology effectively to enhance Apply information technology effectively to enhance patient carepatient care
Essentials for Surgical Essentials for Surgical Residents Completing PGY-1Residents Completing PGY-1
Upon completing the first postgraduate year,Upon completing the first postgraduate year,
surgical residents should have acquired thesurgical residents should have acquired the
knowledge and skills listed here in order to provideknowledge and skills listed here in order to provide
optimum patient care and ensure patient safety. The optimum patient care and ensure patient safety. The knowledge and skills should serve as the foundation knowledge and skills should serve as the foundation for further education and training in the various for further education and training in the various surgical specialties. The areas of knowledge and surgical specialties. The areas of knowledge and skills are listed in the context of the core skills are listed in the context of the core competencies: Medical Knowledge and Patient Care, competencies: Medical Knowledge and Patient Care, Professionalism, Interpersonal and Communication Professionalism, Interpersonal and Communication Skills, Practice-based Learning and Improvement, Skills, Practice-based Learning and Improvement, and Systems-Based Practiceand Systems-Based Practice
Essentials for Surgical Residents Completing Essentials for Surgical Residents Completing PGY-1PGY-1
Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Clinical Assessment and Clinical Assessment and Perioperative KnowledgePerioperative Knowledge
Obtain a detailed surgical history that is appropriate Obtain a detailed surgical history that is appropriate for age, sex, and clinical problemfor age, sex, and clinical problem
Obtain and review relevant medical records and Obtain and review relevant medical records and reportsreports
Perform a detailed physical examinationPerform a detailed physical examination
Essentials for Surgical Residents Completing Essentials for Surgical Residents Completing PGY-1PGY-1
Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Assess, document, and manage perioperative risk Assess, document, and manage perioperative risk factors:factors: ConditionsConditions
►Extremes of ageExtremes of age► Immune suppressionImmune suppression►Metabolic disordersMetabolic disorders►PregnancyPregnancy►Substance abuseSubstance abuse
Write a succinct and thorough history and physicalWrite a succinct and thorough history and physical
Obtain a written informed consentObtain a written informed consent
Essentials for Surgical Residents Completing Essentials for Surgical Residents Completing PGY-1PGY-1
Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Develop a focused differential diagnosisDevelop a focused differential diagnosis
Assess, document, and manage perioperative risk Assess, document, and manage perioperative risk factors:factors: Diseases:Diseases:
►CardiacCardiac►EndocrineEndocrine►HepaticHepatic► InfectiousInfectious►PsychiatricPsychiatric►PulmonaryPulmonary►RenalRenal
Essentials for Surgical Residents Completing Essentials for Surgical Residents Completing PGY-1PGY-1
Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Document the treatment plan in the medical Document the treatment plan in the medical record, including the indications for treatmentrecord, including the indications for treatment
Dictate an appropriate operative note and Dictate an appropriate operative note and discharge summarydischarge summary
Write comprehensive admission, preoperative, and Write comprehensive admission, preoperative, and postoperative orders including:postoperative orders including:
►Activity levelActivity level►Management of medicationsManagement of medications►Pain management Pain management
Essentials for Surgical Residents Completing Essentials for Surgical Residents Completing PGY-1PGY-1
Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Obtain relevant medical information from:Obtain relevant medical information from:►Previous hospitalizations in the same institutionPrevious hospitalizations in the same institution►Previous hospitalizations in other institutionsPrevious hospitalizations in other institutions►The patient’s other physiciansThe patient’s other physicians
Make appropriate patient discharge arrangements Make appropriate patient discharge arrangements including:including:
►Follow-up appointmentsFollow-up appointments►Urgent contact information for the doctor to reach the Urgent contact information for the doctor to reach the
patientpatient►Urgent contact information for the patient to reach the Urgent contact information for the patient to reach the
doctordoctor
Essentials for Surgical Residents Completing Essentials for Surgical Residents Completing PGY-1PGY-1
Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Obtain consultation appropriately from other Obtain consultation appropriately from other specialists as neededspecialists as needed
Read and use the multidisciplinary medical record Read and use the multidisciplinary medical record and patient dataand patient data
Essentials for Surgical Residents Completing Essentials for Surgical Residents Completing PGY-1PGY-1
Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Assessment of Basic Diagnostic Assessment of Basic Diagnostic Tests and RadiographsTests and Radiographs
Order and interpret appropriate laboratory and Order and interpret appropriate laboratory and imaging studies in a cost-effective mannerimaging studies in a cost-effective manner
Manage abnormalities identified by basic laboratory Manage abnormalities identified by basic laboratory teststests
Essentials for Surgical Residents Completing Essentials for Surgical Residents Completing PGY-1PGY-1
Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Recognize the following abnormalities based in Recognize the following abnormalities based in imaging studies:imaging studies:
►Abdominal massAbdominal mass►Aortic aneurysmAortic aneurysm►Aortic dissection/ruptureAortic dissection/rupture►AppendicitisAppendicitis►AtelectasisAtelectasis►Bowel gas patternsBowel gas patterns►Diaphragm abnormalitiesDiaphragm abnormalities►Fractures, long bonesFractures, long bones►Free air in abdomenFree air in abdomen►HemothoraxHemothorax► Intracranial hematomaIntracranial hematoma
Essentials for Surgical Residents Completing Essentials for Surgical Residents Completing PGY-1PGY-1
Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Abnormalities continued:Abnormalities continued:►Lung massLung mass►Paraesophageal herniaParaesophageal hernia►Pleural effusionPleural effusion►PneumoniaPneumonia►PneumothoraxPneumothorax►Pulmonary embolismPulmonary embolism►Pulmonary infiltratePulmonary infiltrate►Retroperitoneal abnormalities and injuriesRetroperitoneal abnormalities and injuries►Spinal column fracturesSpinal column fractures►Visceral abnormalities and injuriesVisceral abnormalities and injuries
Essentials for Surgical Residents Completing Essentials for Surgical Residents Completing PGY-1PGY-1
Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Verify radiographically and appropriate placement Verify radiographically and appropriate placement of:of:
►Central venous lineCentral venous line►Chest tubeChest tube►Endotracheal tubeEndotracheal tube►Feeding tubeFeeding tube►Nasogastric tubeNasogastric tube►TracheostomyTracheostomy
Recognize and initiate treatment of cardiac Recognize and initiate treatment of cardiac ischemia and arrhythmia in the surgical patient ischemia and arrhythmia in the surgical patient
Essentials for Surgical Residents Completing Essentials for Surgical Residents Completing PGY-1PGY-1
Medical Knowledge and Patient CareMedical Knowledge and Patient Care
NutritionNutrition
Perform a metabolic assessment of the surgical Perform a metabolic assessment of the surgical patientpatient
Describe the metabolic implications of trauma and Describe the metabolic implications of trauma and surgical stresssurgical stress
Calculate nutritional requirements on health and Calculate nutritional requirements on health and diseasedisease
Essentials for Surgical Residents Completing Essentials for Surgical Residents Completing PGY-1PGY-1
Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Recognize the indications, options, and timing for Recognize the indications, options, and timing for nutritional support of the surgical patientnutritional support of the surgical patient
Initiate enteral and parenteral nutritional supportInitiate enteral and parenteral nutritional support
Manage and monitor nutritional supportManage and monitor nutritional support
Describe complications of enteral and parenteral Describe complications of enteral and parenteral nutritionnutrition
Essentials for Surgical Residents Completing Essentials for Surgical Residents Completing PGY-1PGY-1
Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Manage:Manage:►Central venous linesCentral venous lines►GastrostomiesGastrostomies► Jejunostomy feeding tubesJejunostomy feeding tubes
Assess appropriate timing of resumption of oral Assess appropriate timing of resumption of oral intake after an operationintake after an operation
Essentials for Surgical Residents Completing Essentials for Surgical Residents Completing PGY-1PGY-1
Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Airway Management and AnesthesiaAirway Management and Anesthesia
Diagnose and manage common causes of airway Diagnose and manage common causes of airway obstruction in the surgical patientobstruction in the surgical patient
Describe indications for and how to perform surgical Describe indications for and how to perform surgical airways:airways:
►CricothyroidotomyCricothyroidotomy►Open tracheostomyOpen tracheostomy►Percutaneous tracheostomyPercutaneous tracheostomy
Essentials for Surgical Residents Completing Essentials for Surgical Residents Completing PGY-1PGY-1
Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Describe indications for and be able to perform Describe indications for and be able to perform orotracheal intubationorotracheal intubation
Position the patient properly for operative Position the patient properly for operative exposure, temperature control, and protection from exposure, temperature control, and protection from pressure/tractionpressure/traction
Describe the appropriate level of intraoperative Describe the appropriate level of intraoperative monitoring for a given patientmonitoring for a given patient
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Describe the complications of and be able to order Describe the complications of and be able to order appropriately:appropriately:
►BarbituratesBarbiturates►Local anestheticsLocal anesthetics►Neuromuscular blockade reversal agentsNeuromuscular blockade reversal agents►Neuromuscular blockersNeuromuscular blockers►SedativesSedatives
Describe the role and indications for use of Describe the role and indications for use of epinephrine in local anesthesiaepinephrine in local anesthesia
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Management of Fluid/Electrolytes Management of Fluid/Electrolytes and Acid/Base Balanceand Acid/Base Balance
Appropriately manage preoperative and Appropriately manage preoperative and postoperative fluid requirements, as guided by:postoperative fluid requirements, as guided by:
►Vital signsVital signs►Physical examinationPhysical examination►Urine outputUrine output►Central venous pressureCentral venous pressure►Pulmonary capillary wedge pressurePulmonary capillary wedge pressure
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Recognize acid-base disorders and manage them Recognize acid-base disorders and manage them correctlycorrectly
Make adjustments in fluid administration for Make adjustments in fluid administration for comorbid conditions:comorbid conditions:
►Cardiac insufficiencyCardiac insufficiency►DiabetesDiabetes►Extremes of ageExtremes of age► Intestinal fistulaIntestinal fistula►PregnancyPregnancy►Renal insufficiencyRenal insufficiency
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Recognize and treat abnormalities in the levels of Recognize and treat abnormalities in the levels of the following electrolytes:the following electrolytes:
►CalciumCalcium►MagnesiumMagnesium►PhosphatePhosphate►PotassiumPotassium►SodiumSodium
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Fever and Surgical InfectionsFever and Surgical Infections
Initiate appropriate evaluation of fever and provide Initiate appropriate evaluation of fever and provide supportive treatmentsupportive treatment
Initiate definitive treatment of fever with source Initiate definitive treatment of fever with source control and appropriate antibioticscontrol and appropriate antibiotics
Describe how to monitor antibiotic levels Describe how to monitor antibiotic levels appropriatelyappropriately
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Describe antibiotic-related complications, and Describe antibiotic-related complications, and discuss methods of preventiondiscuss methods of prevention
Discuss the normal flora of various organ systemsDiscuss the normal flora of various organ systems
Describe the common bacteria involved in site-Describe the common bacteria involved in site-specific infectionsspecific infections
Discuss the principles of prevention of nosocomial Discuss the principles of prevention of nosocomial infections, sterile technique, and universal infections, sterile technique, and universal precautionsprecautions
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Order and interpret appropriate imaging studies for Order and interpret appropriate imaging studies for localization of infectionlocalization of infection
Discuss the principles of abscess drainageDiscuss the principles of abscess drainage
Discuss the indications for and appropriate Discuss the indications for and appropriate administration of prophylactic antibioticsadministration of prophylactic antibiotics
Discuss the causes and mediators of the systemic Discuss the causes and mediators of the systemic inflammatory response syndrome and its inflammatory response syndrome and its pathophysiology pathophysiology
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Recognize the systemic inflammatory response Recognize the systemic inflammatory response syndrome, and initiate appropriate supportive syndrome, and initiate appropriate supportive treatmenttreatment
Discuss the development of bacterial resistance Discuss the development of bacterial resistance and the basic characteristics of epidemicsand the basic characteristics of epidemics
Discuss the common opportunistic infections Discuss the common opportunistic infections associated with immunocompromised patientsassociated with immunocompromised patients
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Wound ManagementWound Management
Describe the differences in primary, secondary, and Describe the differences in primary, secondary, and delayed primary healingdelayed primary healing
Describe the management of traumatic wounds, Describe the management of traumatic wounds, including tetanus prophylaxisincluding tetanus prophylaxis
Describe the signs of necrotizing soft tissue Describe the signs of necrotizing soft tissue infectioninfection
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Describe wound management based on the Describe wound management based on the classification of wounds (clean, clean-contaminated, classification of wounds (clean, clean-contaminated, contaminated, infected)contaminated, infected)
Identify, differentiate, and treat wound Identify, differentiate, and treat wound complications of infection, hematoma, and seromacomplications of infection, hematoma, and seroma
Perform extensive wound debridement under Perform extensive wound debridement under supervisionsupervision
Debride and pack wounds and apply dressingsDebride and pack wounds and apply dressings
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Identify wound dehiscence and evisceration, and Identify wound dehiscence and evisceration, and initiate careinitiate care
Discuss specific recommendations for management Discuss specific recommendations for management and prevention of complications in animal and and prevention of complications in animal and insect bitesinsect bites
Obtain a proper wound specimen for Gram stain Obtain a proper wound specimen for Gram stain and culturesand cultures
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Critical Care and Management of Critical Care and Management of ShockShock
Differentiate types of shock, and initiate Differentiate types of shock, and initiate appropriate therapy:appropriate therapy:
►AnaphylacticAnaphylactic►CardiogenicCardiogenic►HemorrhagicHemorrhagic►NeurogenicNeurogenic►SepticSeptic
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Maintain pulmonary artery and arterial catheters, Maintain pulmonary artery and arterial catheters, interpret data, and direct therapyinterpret data, and direct therapy
Discuss principles of mechanical ventilation, Discuss principles of mechanical ventilation, including volume and pressure-controlled modesincluding volume and pressure-controlled modes
Outline the indications for blood component Outline the indications for blood component therapy, and direct treatmenttherapy, and direct treatment
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Identify major and minor transfusion reactions, and Identify major and minor transfusion reactions, and initiate managementinitiate management
Institute measures to prevent complications in Institute measures to prevent complications in critacally ill patients:critacally ill patients:
►AspirationAspiration►Deep vein thrombosisDeep vein thrombosis►Line sepsisLine sepsis►Pressure ulcersPressure ulcers►Upper gastrointestinal bleedingUpper gastrointestinal bleeding
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Trauma and Surgical EmergenciesTrauma and Surgical Emergencies
Obtain Advanced Trauma Life SupportObtain Advanced Trauma Life Support® ® certification certification if caring for multisystem traumaif caring for multisystem trauma
Under supervision:Under supervision:►Resuscitate patients from shockResuscitate patients from shock► Interpret data from primary and secondary surveysInterpret data from primary and secondary surveys► Initiate further evaluationInitiate further evaluation► Initiate definitive managementInitiate definitive management
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Under supervision:Under supervision:► Insert:Insert:
Chest tubesChest tubes Nasogastric tubesNasogastric tubes Nasotracheal tubesNasotracheal tubes Orotracheal tubesOrotracheal tubes Peripheral and central linesPeripheral and central lines Trauma linesTrauma lines Urinary cathetersUrinary catheters
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Discuss options for rapid assessment of Discuss options for rapid assessment of intraabdominal bleedingintraabdominal bleeding
Order and interpret screening radiographs and Order and interpret screening radiographs and computed tomographic scanscomputed tomographic scans
Identify and initiate treatment of neurologic injuries:Identify and initiate treatment of neurologic injuries:► Intracranial hemorrhageIntracranial hemorrhage►Spinal fracturesSpinal fractures
List injuries most commonly missed on primary and List injuries most commonly missed on primary and secondary surveyssecondary surveys
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Discuss basic principles of fracture managementDiscuss basic principles of fracture management
Describe the symptoms, signs, diagnosis, and Describe the symptoms, signs, diagnosis, and management of inhalation injuriesmanagement of inhalation injuries
Describe the symptoms, signs, diagnosis, and Describe the symptoms, signs, diagnosis, and management of the acute abdomenmanagement of the acute abdomen
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Stroke and Transient Ischemic Stroke and Transient Ischemic AttackAttack
Differentiate between focal and nonfocal neurologic Differentiate between focal and nonfocal neurologic signssigns
Order appropriate imaging studies to investigate Order appropriate imaging studies to investigate cerebrovascular eventscerebrovascular events
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Coagulation and AnticoagulationCoagulation and Anticoagulation
Develop a differential diagnosis and institute Develop a differential diagnosis and institute appropriate management of basic hyper- and appropriate management of basic hyper- and hypocoagulable states (eg, deep vein thrombosis hypocoagulable states (eg, deep vein thrombosis [DVT] and pulmonary embolism [PE], disseminated [DVT] and pulmonary embolism [PE], disseminated intravascular coagulation [DIC])intravascular coagulation [DIC])
Perform risk assessment for DVT and PEPerform risk assessment for DVT and PE
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Describe appropriate DVT/PE prophylaxis based on Describe appropriate DVT/PE prophylaxis based on risk assessmentrisk assessment
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Pharmacology and Pharmacology and PharmacokineticsPharmacokinetics
Interpret drug levels and use pharmacokinetics for Interpret drug levels and use pharmacokinetics for drug administrationdrug administration
Describe indications and complications of common Describe indications and complications of common drugs used in surgical patients:drugs used in surgical patients:
►AnalgesicsAnalgesics►AntibioticsAntibiotics
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Common drugs continued:Common drugs continued:►Anticoagulants Anticoagulants ►AntiemeticsAntiemetics►AntihypertensivesAntihypertensives►Antiplatelet agentsAntiplatelet agents►Chemotherapeutic agentsChemotherapeutic agents►CorticosteroidsCorticosteroids►DiureticsDiuretics►Gastric acid-reducing drugsGastric acid-reducing drugs►LaxativesLaxatives►Nonsteroidal antiinflammatory drugs (NSAIDS) Nonsteroidal antiinflammatory drugs (NSAIDS)
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Common drugs continued:Common drugs continued:►Oral hypoglycemic agentsOral hypoglycemic agents►SedativesSedatives
Discuss the implications of hepatic or renal Discuss the implications of hepatic or renal insufficiency and extremes of age on the use of insufficiency and extremes of age on the use of various drugsvarious drugs
Identify common drug interactionsIdentify common drug interactions
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Complications and Conditions in Complications and Conditions in Surgical PatientsSurgical Patients
Evaluate and outline age-appropriate initial Evaluate and outline age-appropriate initial management of the following:management of the following:
►Abdominal distentionAbdominal distention►Acute abdomenAcute abdomen►Acute alcohol intoxicationAcute alcohol intoxication►Alcohol or drug withdrawalAlcohol or drug withdrawal►Altered mental statusAltered mental status
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Medical Knowledge and Patient CareMedical Knowledge and Patient Care
►Arterial bleedingArterial bleeding►AspirationAspiration►Aspiration pneumoniaAspiration pneumonia►AtelectasisAtelectasis►Bleeding and coagulopathyBleeding and coagulopathy►Bowel obstructionBowel obstruction►Chest painChest pain►Congestive heart failureCongestive heart failure►ConstipationConstipation►Contrast allergyContrast allergy►Contrast-induced nephropathy Contrast-induced nephropathy
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Medical Knowledge and Patient CareMedical Knowledge and Patient Care
►CyanosisCyanosis►Deep vein thrombosisDeep vein thrombosis►Diabetic ketoacidosisDiabetic ketoacidosis►DyspneaDyspnea►Dysrhythmias (as covered in Advanced Cardiovascular Dysrhythmias (as covered in Advanced Cardiovascular
Life Support)Life Support)►Fecal impactionFecal impaction►FeverFever►Gastrointestinal bleeding (lower, upper)Gastrointestinal bleeding (lower, upper)►HemothoraxHemothorax►Hyperosmolar comaHyperosmolar coma►HypertensionHypertension
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Medical Knowledge and Patient CareMedical Knowledge and Patient Care
►HyperventilationHyperventilation►HypotensionHypotension►HypoventilationHypoventilation►HypovolemiaHypovolemia►HypoxiaHypoxia► Intestinal ischemiaIntestinal ischemia► JaundiceJaundice►Malignancies (common; e.g. breast, colon, lung)Malignancies (common; e.g. breast, colon, lung)►NauseaNausea►OliguriaOliguria►Peripheral ischemia (acute, chronic)Peripheral ischemia (acute, chronic)►Peritonitis (generalized, localized)Peritonitis (generalized, localized)
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Medical Knowledge and Patient CareMedical Knowledge and Patient Care
►Phlebitis, superficialPhlebitis, superficial►Pleural effusionPleural effusion►PneumoniaPneumonia►PneumothoraxPneumothorax►Postoperative painPostoperative pain►Pulmonary edemaPulmonary edema►Pulmonary embolusPulmonary embolus►Retroperitoneal hematomaRetroperitoneal hematoma►SeizuresSeizures►Substance abuseSubstance abuse►Transfusion reactionTransfusion reaction►Urinary retention Urinary retention
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Medical Knowledge and Patient CareMedical Knowledge and Patient Care
►VomitingVomiting►Wound hematoma or seromaWound hematoma or seroma
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Surgical and Technical SkillsSurgical and Technical Skills
Describe concepts of atraumatic tissue handling Describe concepts of atraumatic tissue handling
Perform as first assistantPerform as first assistant
Obtain hemostasis of small vessels in the operative Obtain hemostasis of small vessels in the operative fieldfield
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Identify common surgical instruments and suture Identify common surgical instruments and suture materials and their proper usesmaterials and their proper uses
Perform basic surgical maneuvers (suture of skin, Perform basic surgical maneuvers (suture of skin, soft tissues, and fascia; knot tying)soft tissues, and fascia; knot tying)
Demonstrate appropriate techniques of dissection, Demonstrate appropriate techniques of dissection, handling of tissues, and wound closurehandling of tissues, and wound closure
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Under supervision, perform basic surgical procedures Under supervision, perform basic surgical procedures such as the following:such as the following:
►Anorectal procedures (simple)Anorectal procedures (simple)►AnoscopyAnoscopy►AppendectomyAppendectomy►Breast biopsyBreast biopsy►Burr holeBurr hole►Digital amputationDigital amputation►Doppler examination (handheld) to evaluate arterial Doppler examination (handheld) to evaluate arterial
circulationcirculation►Examination under anesthesiaExamination under anesthesia►Excision of benign lesions of skin and subcutaneous tissuesExcision of benign lesions of skin and subcutaneous tissues► Implanted venous accessImplanted venous access
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Medical Knowledge and Patient CareMedical Knowledge and Patient Care
► Incision and drainage of an abscessIncision and drainage of an abscess► Insertion of central venous cathetersInsertion of central venous catheters► Insertion of gastrostomy tubesInsertion of gastrostomy tubes► Insertion of pulmonary artery cathetersInsertion of pulmonary artery catheters►Lymph node biopsyLymph node biopsy►ParacentesisParacentesis►Removal of superficial foreign bodiesRemoval of superficial foreign bodies►Repair of simple lacerationsRepair of simple lacerations►Repair of umbilical and inguinal herniasRepair of umbilical and inguinal hernias►Skin graftsSkin grafts►ThoracentesisThoracentesis
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Manage central venous lines and gastrostomy and Manage central venous lines and gastrostomy and jejunostomy feeding tubesjejunostomy feeding tubes
Insert, maintain, and remove drains and chest Insert, maintain, and remove drains and chest tubestubes
Insert and manage tubes and drains placed Insert and manage tubes and drains placed operatively or percutaneouslyoperatively or percutaneously
Perform orotracheal intubationPerform orotracheal intubation
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Perform surgical airways (cricothyroidotomy, open Perform surgical airways (cricothyroidotomy, open and percutaneous tracheostomy)and percutaneous tracheostomy)
Immobilize extremitiesImmobilize extremities
Insert indwelling arterial and venous linesInsert indwelling arterial and venous lines
Demonstrate appropriate methods of routine and Demonstrate appropriate methods of routine and reverse isolation proceduresreverse isolation procedures
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Medical Knowledge and Patient CareMedical Knowledge and Patient Care
Maintain appropriate sterile technique in the Maintain appropriate sterile technique in the emergency department, intensive care unit, office, emergency department, intensive care unit, office, and at the patient’s bedsideand at the patient’s bedside
Describe potential complications of procedures and Describe potential complications of procedures and how they relate to patient safetyhow they relate to patient safety
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1
ProfessionalismProfessionalism
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1ProfessionalismProfessionalism
Adhere to the local institutional code of conduct, Adhere to the local institutional code of conduct, demeanor, behavior, and attiredemeanor, behavior, and attire
Respect all individualsRespect all individuals
Use discretion in private and public Use discretion in private and public communicationscommunications
Maintain an inquisitive mind and lifelong learning Maintain an inquisitive mind and lifelong learning habitshabits
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1ProfessionalismProfessionalism
Know when and where to obtain help for Know when and where to obtain help for professional and personal issuesprofessional and personal issues
Demonstrate self-directed learning skillsDemonstrate self-directed learning skills
Care for patients in a compassionate way, Care for patients in a compassionate way, consistently demonstrating respect for the privacy consistently demonstrating respect for the privacy and dignity of all patientsand dignity of all patients
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1ProfessionalismProfessionalism
Accept feedback appropriately, and use it Accept feedback appropriately, and use it effectively for self-learning and improvementeffectively for self-learning and improvement
Work collaboratively with other members of the Work collaboratively with other members of the patient care teampatient care team
Use the resources available when ethical of Use the resources available when ethical of professional behavior problems arise (department, professional behavior problems arise (department, institution, American College of Surgeons, etc.)institution, American College of Surgeons, etc.)
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1ProfessionalismProfessionalism
Demonstrate a strong work ethic, and consistently Demonstrate a strong work ethic, and consistently and dependably carry out one’s duties with honesty, and dependably carry out one’s duties with honesty, personal integrity, self-motivation, and self-discipline personal integrity, self-motivation, and self-discipline
Demonstrate mentoring and positive role-modeling Demonstrate mentoring and positive role-modeling skillsskills
Develop teaching skills, and facilitate medical Develop teaching skills, and facilitate medical student learningstudent learning
Know one’s limitations and when to ask for help Know one’s limitations and when to ask for help
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1ProfessionalismProfessionalism
Be well organized and efficient; demonstrate good Be well organized and efficient; demonstrate good time management to balance personal and time management to balance personal and professional responsibilitiesprofessional responsibilities
Discuss issues of ethics:Discuss issues of ethics:►Advanced directivesAdvanced directives►SurrogacySurrogacy
Complete medical records in a timely fashionComplete medical records in a timely fashion
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1ProfessionalismProfessionalism
Fulfill administrative responsibilities in a timely Fulfill administrative responsibilities in a timely fashionfashion
Accept responsibility for one’s actionsAccept responsibility for one’s actions
Be illegal/illicit substance freeBe illegal/illicit substance free
Attend required conferencesAttend required conferences
Be punctualBe punctual
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1ProfessionalismProfessionalism
Develop and maintain evidence of good Develop and maintain evidence of good professional standing:professional standing:
►State licensureState licensure►Membership in professional organizationsMembership in professional organizations
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1
Interpersonal and Interpersonal and Communication SkillsCommunication Skills
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Interpersonal and Communication SkillsInterpersonal and Communication Skills
Actively listen with cultural, ethnic, gender, racial, Actively listen with cultural, ethnic, gender, racial, and religious sensitivityand religious sensitivity
Communicate effectively with patients, families, Communicate effectively with patients, families, and professional associatesand professional associates
Give an accurate, clear, and concise oral Give an accurate, clear, and concise oral presentationpresentation
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Interpersonal and Communication SkillsInterpersonal and Communication Skills
Discuss effectively with patients such sensitive Discuss effectively with patients such sensitive issues as:issues as:
►Advanced directives Advanced directives ►Brain deathBrain death►End-of-life careEnd-of-life care►Permission for postmortem examinationPermission for postmortem examination
Communicate information to coworkers accurately Communicate information to coworkers accurately and effectively to ensure continuity of careand effectively to ensure continuity of care
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Interpersonal and Communication SkillsInterpersonal and Communication Skills
Share information regarding adverse events and Share information regarding adverse events and changes in conditions of patients with other members changes in conditions of patients with other members of the health care team in a timely and effective of the health care team in a timely and effective fashionfashion
Discuss medical errors of professional mistakes Discuss medical errors of professional mistakes honestly and openly within the context of quality honestly and openly within the context of quality improvement to promote patient safety, trust, and improvement to promote patient safety, trust, and self-learningself-learning
Discuss strategies to share information regarding Discuss strategies to share information regarding adverse outcomes with patients and familiesadverse outcomes with patients and families
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Interpersonal and Communication SkillsInterpersonal and Communication Skills
Obtain informed consentObtain informed consent
Demonstrate appropriate interactions when Demonstrate appropriate interactions when performing and obtaining professional consultationsperforming and obtaining professional consultations
Present medical information completely and Present medical information completely and appropriately, both written and oralappropriately, both written and oral
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1
Practice-Based Learning and Practice-Based Learning and ImprovementImprovement
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Practice-Based Learning and ImprovementPractice-Based Learning and Improvement
Maintain a personal patient logMaintain a personal patient log
Describe methods of outcomes assessment, Describe methods of outcomes assessment, including measures of health status and patient including measures of health status and patient satisfactionsatisfaction
Discuss the principles of continuous quality Discuss the principles of continuous quality improvement and their role in improving patient improvement and their role in improving patient care and the learning environmentcare and the learning environment
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Practice-Based Learning and ImprovementPractice-Based Learning and Improvement
Use independent self-study and assessment Use independent self-study and assessment programs, such as Surgical Education and Self-programs, such as Surgical Education and Self-Assessment Program (SESAP)Assessment Program (SESAP)
Critically analyze available literature and its Critically analyze available literature and its application to patient careapplication to patient care
Discuss the common sources of medical errors, and Discuss the common sources of medical errors, and outline steps to avoid or minimize themoutline steps to avoid or minimize them
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Practice-Based Learning and ImprovementPractice-Based Learning and Improvement
Use discussions about adverse events and near Use discussions about adverse events and near misses as a means of self-reflection, enhancing misses as a means of self-reflection, enhancing patient safety and improving patient carepatient safety and improving patient care
Participate in root cause analyses of adverse Participate in root cause analyses of adverse events, including implementation of corrective events, including implementation of corrective measuresmeasures
Be proficient with computer applications; e.g. word-Be proficient with computer applications; e.g. word-processing programs, spreadsheets, simple processing programs, spreadsheets, simple databases, and electronic presentationsdatabases, and electronic presentations
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Practice-Based Learning and ImprovementPractice-Based Learning and Improvement
Use electronically available medical information in Use electronically available medical information in patient carepatient care
Demonstrate critical literature review skillsDemonstrate critical literature review skills
Understand basic statistical techniques, and Understand basic statistical techniques, and interpret statistics related to clinical datainterpret statistics related to clinical data
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1
Systems-Based PracticeSystems-Based Practice
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Systems-Based PracticeSystems-Based Practice
Identify barriers to access to health careIdentify barriers to access to health care
Use the medical record appropriatelyUse the medical record appropriately
Use institutional resources, such as social services, Use institutional resources, such as social services, hone health care, outpatient services, etc. for hone health care, outpatient services, etc. for effective discharge planning; be able to begin this effective discharge planning; be able to begin this process well in advance for efficient and patient-process well in advance for efficient and patient-oriented discharge oriented discharge
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Systems-Based PracticeSystems-Based Practice
Discuss the need for cost-benefit analysis of workup Discuss the need for cost-benefit analysis of workup and treatment options, and participate in the and treatment options, and participate in the development of a cost-effective patient development of a cost-effective patient management planmanagement plan
Apply the appropriate documentation needed for Apply the appropriate documentation needed for coding and billingcoding and billing
Describe and apply the principles of clinical Describe and apply the principles of clinical researchresearch
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Systems-Based PracticeSystems-Based Practice
Have specific information about accessing Have specific information about accessing rehabilitation services, indications for referral, and rehabilitation services, indications for referral, and the potential benefits to be anticipatedthe potential benefits to be anticipated
Describe how types of medical practice and Describe how types of medical practice and delivery systems differ from one another, including delivery systems differ from one another, including methods of controlling costs and allocating methods of controlling costs and allocating resourcesresources
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Systems-Based PracticeSystems-Based Practice
Describe and participate in implementation of Describe and participate in implementation of patient safety practices, such as Joint Commission patient safety practices, such as Joint Commission on Accreditation of Healthcare Organizations on Accreditation of Healthcare Organizations (JCAHO) patient safety standards e.g.:(JCAHO) patient safety standards e.g.:
► Improving the accuracy of patient identificationImproving the accuracy of patient identification► Improving the effectiveness of communication among Improving the effectiveness of communication among
caregiverscaregivers► Improving the safety of using high-alert medicationsImproving the safety of using high-alert medications►Eliminating wrong-site, wrong-patient, wrong-procedure Eliminating wrong-site, wrong-patient, wrong-procedure
surgery (Using a time-out in operative procedures)surgery (Using a time-out in operative procedures)► Improving the effectiveness of clinical alarm systemsImproving the effectiveness of clinical alarm systems►Reducing the risk of health care-acquired infectionsReducing the risk of health care-acquired infections
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Systems-Based PracticeSystems-Based Practice
Comply with Health Insurance Portability and Comply with Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations Accountability Act of 1996 (HIPAA) regulations regarding patient privacy and confidentialityregarding patient privacy and confidentiality
Demonstrate collegiality in working with all of those Demonstrate collegiality in working with all of those associated with the care of patientsassociated with the care of patients
Use electronically available medical information Use electronically available medical information effectivelyeffectively
Describe the process and benefits of root cause Describe the process and benefits of root cause analysisanalysis
Essentials for Surgical Residents Completing PGY-1Essentials for Surgical Residents Completing PGY-1Systems-Based PracticeSystems-Based Practice
Apply information technology effectively to enhance Apply information technology effectively to enhance patient carepatient care
Understand the concept of risk management and Understand the concept of risk management and the need for appropriate documentation in the the need for appropriate documentation in the medical recordmedical record
Practice cost-effective medical carePractice cost-effective medical care
Practice patient safetyPractice patient safety