Surgery

Overview

The surgery rotation is a preceptorial rotation. Residents are required to complete one block of general surgery rotations. The rotation occurs at Memorial Hospital, in the surgeon’s office, and in other locations included in the surgeon’s usual practice. The teaching of surgery in the program includes this rotation as well as the surgical subspecialties rotation, experiences in the Family Medicine Center, the noon conference series and on other rotations (see other curricula).

Goals

1. At the completion of this rotation, the resident will have an understanding of the practice of surgery in a community setting, which will facilitate appropriate referral practices in the future.
2. At the completion of this rotation, the resident will have knowledge and skills in the areas of surgery pertinent to the practice of family medicine.

Objectives:

At the completion of this rotation, the resident will have demonstrated to the satisfaction of the surgery preceptor:

• medical knowledge in surgery pertinent to the practice of family medicine, including the appropriate evaluation and treatment of (MK): peripheral vascular disease, breast masses, acute and chronic abdominal pain, gallbladder disease, appendicitis, diverticulitis, ischemic bowel, small bowel and colonic obstruction, abdominal masses, anorectal disorders, hernia and perforation of the gastrointestinal tract. In addition, the resident will learn about the general principles of pre-operative risk assessment, post-operative care and aseptic technique.
• the ability to perform an appropriate history and physical examination on the surgery patient and to present these findings to another physician in an appropriate manner (PC).
• communication and interpersonal skills which facilitate positive and therapeutic relationships (ICS).
• the ability to work cooperatively with other health professionals as part of a healthcare team (PC).
• compassion, respect and integrity; responsiveness to the needs of patients and society that supersedes self-interest; accountability to patients, society and the profession; a commitment to excellence and on-going professional development (P).
• a commitment to ethical principles pertaining to the provision or withholding of clinical care, confidentiality of patient information, informed consent and business practices (P).
• sensitivity and responsiveness to a patient’s culture, age, gender and disabilities (P).
• the ability to interpret appropriate data related to the surgery patient and arrive at reasonable diagnostic and management decisions, weighing alternatives, benefits and risks of diagnostic and therapeutic options, and co-managing patients appropriately with other specialists (PC).
• the ability to make appropriate decisions to assure high-quality care in a cost-effective manner ( SBP ).
• the ability to advise patients as to the risks and benefits of various surgical intervention for common problems seen in family medicine (ICS).
• the ability to recognize the need for emergent, urgent, and elective procedures for presenting surgical problems (PC).

There are no specific procedural requirements for this rotation. However, there is a separate Procedures Curriculum, and residents may gain experience meeting these requirements during this rotation. Procedures typically performed by residents on this rotation include: first-assisting skills including sterile technique, proper exposure, homeostasis, and wound closure; central line placement; pleural tube placement; and excision of skin lesions.

Implementation

This is a preceptorial rotation, so the resident is assigned to a particular general surgeon or general surgery group. The resident will accompany the surgeon during his/her professional activities at Memorial Hospital, including the emergency department, in the surgeon’s office and in other locations involved in the preceptor’s usual practice. In the course of seeing patients, the surgeon will provide experiential learning, role-modeling and one-on-one teaching to the resident. At the discretion of the preceptor, the resident may be assigned to research specific topics in surgery.

The resident is responsible for contacting the surgeon prior to the start of the rotation to arrange a schedule for the rotation. The resident must continue to meet usual residency obligations to his/her Family Medicine Center population, including attending scheduled clinics, caring for continuity patients admitted to Memorial Hospital, and rounding in the nursing home. The resident is expected to attend noon conferences and abide by duty hour restrictions in keeping with usual program policies. Upon completion of the rotation, the resident must complete and return the evaluation form provided by the program.

Evaluation

The surgery preceptor will complete an evaluation form at the end of the rotation. Residents will specifically be evaluated on the following ACGME Milestones:

• PC-1: Cares for acutely ill or injured patients in urgent/emergent situations and in all settings.
• PC-5: Performs specialty-appropriate procedures to meet the health care needs of individual patients, families and communities, and is knowledgeable about procedures performed by other specialists to guide their patients’ care.
• MK-1: Demonstrates medical knowledge of sufficient breadth and depth to practice family medicine.
• MK-2: Applies critical thinking skills in patient care.
• PROF-2: Demonstrates professional conduct and accountability.
• SBP-2: Emphasizes patient safety.
• PBLI-2: Demonstrates self-directed learning.
• C-3: Develops relationships and effectively communicates with physicians, other health professionals and healthcare teams.