PGY-4 NEW

THE NEW YORK HOSPITAL MEDICAL CENTER OF QUEENS

SURGICAL TRAINING PROGRAM EDUCATIONAL GOALS AND OBJECTIVES

PGY-4 YEAR:

GOALS:

To assume primary responsibility for the daily care of patients.
To supervise and teach junior residents.
To serve as surgical consultant for patients on other clinical services (e.g. the Emergency Room, the Medical inpatient services).
To advance leadership skills.
To perform increasingly complex surgical procedures.
To manage complex trauma patients

The PGY-4 resident has similar goals as the PGY-3 resident with more responsibility and supervisory capacity.

I Demonstrate advanced patient care management ability.

Competency-Based Knowledge Objectives:
1a. Recognize typical presentations and clinical manifestations for different surgical diseases.
1b. Recognize atypical presentations and clinical manifestations for different surgical diseases.
1c. Explain indications and methods for nutritional support perioperatively.
1d. Discuss the management of critically ill patients in the Recovery Room, SICU and Emergency Room.
Competency-Based Performance Objectives:
1e. Perform advanced life saving procedures (e.g. emergency thoracotomy, pericardiocentesis).
1f. Obtain access for both enteral and parenteral nutrition.

1a. Assessment Measure - Attending Rounds.
1b. Assessment Measure - M&M presentations.
1c. Assessment Measure - Faculty evaluations.
1d. Assessment Measure - Resident evaluations.
1e. Assessment Measure - ABSITE exam.

II Demonstrate supervisory and teaching abilities.

              2a. Motivate and instruct junior house staff.
              2b. Effectively communicate and reassure patients and family.
              2c. Supervise and credential junior house officers in performing invasive procedures.
             2d. Arrange, prepare and delegate conference presentations.

2a. Assessment Measure - Resident evaluations.
2b. Assessment Measure - Credential Handbook.
2c. Assessment Measure - Medical Student evaluations.

III Consultant activity:

              3a. Perform prompt consultation in the Emergency Room.
              3b. Perform and delegate other medical consultations.
              3c. Present patient consults to attending surgical staff with recommendations for plan of management.

3a. Assessment Measure - Attending evaluations.
3b. Assessment Measure - Direct observation.

IV Leadership Skills:

             4a. Participate on hospital and departmental committees (e.g. GME Committee, Surgical CQI/QA Committee, Faculty Committee).
             4b. Demonstrate behavior that nurtures efficient and organized performance of junior house staff (e.g. daily rounds, ER, SICU, etc.).
             4c. Demonstrate understanding of and ability to utilize literature.
             4d. Critically evaluate the surgical literature.

4a.. Assessment Measure - Resident evaluations.
4b. Assessment Measure - Attending evaluations.
4c. Assessment Measure - Committee attendance.
4d. Assessment Measure - Journal Club presentations.

V Advanced Operative Skills.

Competency-Based Knowledge Skills:
5a. Understand and list relevant surgical anatomy.
5b. Recognize pathophysiology and management of complex surgical problems.
5c. Discuss indications and operative management of complex vascular problems.
5d. Understand indications for advanced laparoscopic procedures, open urologic operations, methods of wound management (plastic flaps, etc.).

5a. Assessment Measure - Faculty evaluations.
5b. Assessment Measure - ABSITE exam.

VI Trauma

Competency-Based Knowledge Objectives:
6a. Evaluate and manage trauma patients.
6b. Supervise trauma code.
Competency-Based Performance Objectives:
6c. Operate on all types of trauma victims.
6d. Operate with 2-handed technique on advanced laparoscopic cases.

6a. Assessment Measure - Rotation evaluations.
6b. Assessment Measure - Trauma Conference presentations.

VII General Surgery

Competency-Based Knowledge Objectives:
7a. Evaluate and prepare emergency room patients for OR.
7b. Prepare patients medically for cancer surgery including correction of nutritional and metabolic deficits.
7c. Describe the role of hormonal therapy in breast cancer.
7d. Discuss the secretion and control of thyroid hormones
7e. Define and differentiate MEN 1 and 2.
7f. Discuss the surgical approach to the parathyroid glands.
7g. Explain the indications for use and complications of peritoneal-venous shunts
7h. Discuss the indications for hiatal hernia repair.
7i. Assess the management of common bile duct stones.
7j. Discuss the evaluation and management of cystic neoplasms of the pancreas.
Competency-Based Performance Objectives:
7k. Perform an emergency exploratory laparotomy under supervision.
7l. Perform axillary lymph node dissection.
7m. Assess the need and institute appropriate monitoring both pre and post operatively.
7n. Perform radical neck dissections.
7o. Perform a thyroidectomy under supervision.
7p. Perform gastric resection under supervision.
7q. Perform operations on the common bile duct under supervision.
7r. Perform drainage procedures of the pancreas under supervision.

Assessment Measure: Attending evaluation
Assessment Measure: Direct Observation
Assessment Measure: ABSITE

VIII Neurosurgery

Competency-Based Knowledge Objectives:
8a. Recite the early findings with increased intracranial pressure.
8b. Discuss ethical and socioeconomic issues relating to neurosrugery (e.g. brain death, organ transplant).
Competency-Based Performance Objectives:
8c. Perform Burr holes
8d. Perform a laminectomy under supervision.
8e. Perform a lumbar puncture

Assessment Measure: Attending evaluations
Assessment Measure: Direct Observation
Assessment Measure: ABSITE

IX Head and Neck

Competency-Based Knowledge Objectives:
9a. Differentiate between neoplastic and non-neoplastic neck masses
9b. Discuss the anatomy of the facial nerve
Competency-Based Performance Objectives:
9c. Perform a mandibular resection under supervision
9d. Perform a radical parotidectomy under supervision