HARBOR-UCLA MEDICAL CENTER Department Of Surgery /
HARBOR-UCLA MEDICAL CENTERDepartment of Surgery / General Surgery Residency ProgramGoals andObjectives2014-2015
HARBOR-UCLA MEDICAL CENTERGENERAL SURGERY RESIDENCY PROGRAMGOALS & OBJECTIVESCOUNTY OF LOS ANGELES HARBOR -UCLA MED ICAL CENTERGeneral Surgery Residency ProgramChristian de Virgilio, MD, Program DirectorDepartment of SurgeryResidency Program Office:1000 W. Carson Street, Box 461, Bldg. F-7Torrance, CA 90509Phone 310.222.2700 Fax 310.533.1841Revised June 2014Page 2 of 59
HARBOR-UCLA MEDICAL CENTERGENERAL SURGERY RESIDENCY PROGRAMProgram GoalsGOALS & OBJECTIVESTable of ContentsObjectivesProgram Design444Overall GoalsBasic ObjectivesRotation Learning Objectives555R1 OverviewR2 OverviewCardiothoracicColon & Rectal SurgeryEndovascular SurgeryGI/Surgical OncologyHead & Neck SurgeryNeurosurgeryPlastic & Reconstructive SurgeryTrauma Acute Care Surgery & Critical CareUrologyVascular SurgeryOverall GoalsRotation Learning ObjectivesR3 OverviewBurn Management – USCCardiothoracic SurgeryGI/Surgery OncologyLiver Transplantation – UCLAPediatric/BreastPediatric Surgery - Children’s HospitalTrauma & Critical CareVascular SurgeryOverall GoalsRotation Learning ObjectivesR4 OverviewBreastColon & Rectal SurgeryGeneral Surgery – KaiserTrauma Acute Care Surgery & Critical CareOverall GoalsRotation Learning ObjectivesR5 53537384242Cardiothoracic SurgeryEndocrineGeneral Surgery-KaiserTrauma & Critical CareKaiser Vascular Surgery4243464748Overall GoalsRotation Learning ObjectivesColon & Rectal SurgeryGI/Surgical OncologyTrauma Acute Care Surgery & Critical CareVascular SurgeryPage 3 of 59515151535557
HARBOR-UCLA MEDICAL CENTERGENERAL SURGERY RESIDENCY PROGRAMGOALS & OBJECTIVESProgram GoalsThe overall goal of the Harbor-UCLA General Surgery Residency Program is to develop ethical,competent, and fully qualified general surgeons who, upon completion of training, will dedicatethemselves to a high standard of surgical practice and contribute to the ongoing provision of qualitypatient care.OBJECTIVES1. Provide a surgical training program that permits maximum opportunity for post-graduateeducation.2. Ensure that all residents in training will acquire detailed knowledge, experience, and technicalskills in relation to preoperative, operative, postoperative care of patients of all dimensionsand complexities in the following areas:§ Alimentary Tract§ Abdomen§ Breast§ Skin and Soft Tissue§ Vascular System§ Comprehensive Management of Trauma, Burns, and Emergency Surgery§ Surgical Critical Care§ Abdomen§ Head and Neck, and;§ Endocrine SystemPROGRAM DESIGNThe Residency Program is divided into a junior, senior, and chief resident experience.Rotation schedules for all levels of training are designed to accommodate a "level appropriate"experience with specific learning expectations and responsibilities corresponding to that particularlevel. Residents expecting to complete residency training are provided ample opportunity toparticipate in operative cases which will satisfy ABS application prerequisites as well as maintainProgram compliance with ACGME-RRC Defined Categories in General Surgery target minimums.Scholarly activity is strongly encouraged and a major highlight of Program design. To guarantee anenvironment of maximum opportunity for post-graduate education, Program curriculum advocatesone day per week (normally, Wednesday) during which service related work is minimized andvarious teaching conferences are presented.Page 4 of 59
HARBOR-UCLA MEDICAL CENTERGENERAL SURGERY RESIDENCY PROGRAMGOALS & OBJECTIVESR-1 OverviewThe first year resident rotates on all General Surgical Services (GI/Oncology; Vascular Surgery;Colorectal Surgery; and Trauma, and Endovascular). In addition, the R-1 will rotate through theSurgical Subspecialties of Urology, Neurosurgery, Plastic and Reconstructive Surgery, and Head andNeck Surgery. The junior resident is responsible for the day-to-day care of surgical patients on theservice to which they are assigned. Senior residents and faculty supervise the R-1. A major goal offirst year training is to teach the novice surgeon to understand the principles of pre- andpostoperative care. The R-1 will gain valuable experience both as an assistant and an operatingsurgeon working under close senior supervision. These rotations promote surgical competence andconfidence by providing a well-balanced experience.R-1 OVERALL GOALSTo encourage the development of:1. Clinical judgment2. Clinical skills3. Humanistic qualities4. Professional attitudesR-1 BASIC OBJECTIVESUpon conclusion of the first year of basic surgery training, the R-1 resident will be able to:1. Obtain complete medical histories2. Perform complete medical examinations3. Define patient problems4. Develop rational plans for diagnosis5. Implement treatments based on etiology, pathogenesis and clinical manifestations of variousdiseases6. Monitor responses to treatment, including side effects from drugs7. Evaluate patients preoperatively8. Participate in operations9. Follow and participate in postoperative careR-1 ROTATION LEARNING OBJECTIVESCardiothoracic SurgeryThe goal of this rotation is to expose the second year resident to clinical management of the patienton the Cardiothoracic Surgery Service including patients with coronary artery disease, congenitaldefects, cardiomyopathy, and penetrating cardiothoracic trauma. Additionally management of thepatient with thoracic neuroplasms will play an important role.Objectives1. Perform appropriate cardiovascular history and examination of the patient2. Manage the cardiothoracic patient pre and post-operatively in the coronary care unit3. Liaison with the cardiology team and understand the indications for the use of variouscardiac imaging and assessment tests4. Assist during cardiothoracic surgery procedures with particular emphasis on saphenous veinidentification and harvest, and manage lower extremity wounds5. Perform limited cardiothoracic procedures including pericardiocentesis; manage of pacingwires, thoracostomy tubes, endotracheal tubes, and tracheostomiesPage 5 of 59
HARBOR-UCLA MEDICAL CENTERGENERAL SURGERY RESIDENCY PROGRAMGOALS & OBJECTIVES6. Assist in thoracic surgery cases including evacuation of hemothoraces, clotted hemothoraces,and resection of thoracic tumors7. Formulate appropriate postoperative care including both critical care and ward management8. Understand need for cardiac rehab and act as the liaison between the primary medical teamand family and care givers to formulate a discharge plan and prepare for adequatepostoperative carePatient CareThe intern will provide patient care that is compassionate, appropriate and effective for thetreatment of the cardiothoracic surgery patient Develop expertise in the various bedside and surgery assist techniques involved in cardiothoracicsurgery cases and patients Ability to perform a good pre and post op examination of cardiothoracic surgery patients Ability to monitor and maintain optimal patient care management skills in the cardiothoracicintensive care unitMedical KnowledgeThe intern will achieve detailed knowledge of the evaluation and management of the cardiothoracicsurgery patient. Understand the fundamental principles of anatomy, histology, and function of the thorax, heart,and lungs Understand the epidemiology and natural history of cardiovascular disease and thoracic diseaseand traumaInterpersonal and Communication SkillsThe intern will demonstrate interpersonal and communication skills that result in effectiveinformation exchange and teaming with patients, their families, and professional associates. Display a friendly disposition that is conducive to successful interaction with team members andpatients Communicate treatment plans with support staff and be able to listen and respond to patients andsupport staff questions in a positive manner Interact effectively with patients and family members from a diverse background Learn to gather essential information from patients, and accurately document patient encounters Interact with nurses, residents, attending surgeons and ancillary staff to achieve the health-relatedgoals of the patientProfessionalismThe intern will demonstrate a commitment to carrying out professional responsibilities adherence toorganizational and ethical principles, and demonstrate sensitivity to a diverse patient population. Relate as a team member with other residents and fellows from other departments Relate with all patients and support staff politely and with respect Respond to pages and consults in a timely manner Respond to criticism and correction with calm and attentive demeanor Demonstrate appropriate dress and decorum while on duty Handle all patient information confidentially and not discuss it in hallways or other public places Use and know the chain of command on the resident service Demonstrate kindness, empathy and maturity in the interrelationship with patients with routinesurgical problemsPage 6 of 59
HARBOR-UCLA MEDICAL CENTERGENERAL SURGERY RESIDENCY PROGRAMGOALS & OBJECTIVESPractice-based LearningThe intern will investigate and evaluate his or her own patient care practices appraise and assimilatescientific evidence and improve patient care practices. Remain current on medical literature as it relates to common coronary artery disease, congenitaldefects, cardiomyopathy, and penetrating cardiothoracic trauma Be familiar with online medical databases Teach, guide and be a role model for medical students Acquire skills in resource management Participate in didactic sessions/presentationsSystems-based PracticeThe intern will demonstrate an awareness of and responsiveness to the larger context and system ofhealthcare and be able to call on system resources to provide care that is of optimal value. Integrate closely with the total team of medical students, residents, and attending, caring forpatients with cardiovascular or thoracic diseases Utilize the expertise of other services and support personnel Demonstrate good patient advocacy skills Recognize and understand how different health insurance companies affect the treatment plan forpatients and how limited indigent care resources can be efficiently utilizedColon and Rectal SurgeryThe goal of this rotation is to provide R-1 exposure to the etiology and clinical management ofcolon and rectal diseases.Objectives1. Demonstrate skill in basic surgical techniques, including:a. Suturing and knot tyingb. Exposure and retractionc. Knowledge of instrumentationd. Incisionse. Closure of incisions2. Evaluate emergency department or clinic patients who present with problems referable tocolon and rectal disorders3. Serve as assistant to the primary surgeon during operations of the small intestine, colon, andanorectum4. Perform less complicated surgical procedures such as:a. Meckel's diverticulectomyb. Appendectomyc. Hemorrhoidectomy and hemorrhoid bandingd. Anal fissurectomy and fistulotomye. Incision and drainage of perirectal abscesses5. Accept responsibility (under the guidance of the chief resident and attending surgeon) forthe postoperative management of:a. Nasogastric tubesb. Intestinal tubesc. Intra-abdominal drainsd. Intestinal fistulase. Abdominal incisions (simple and complicated)6. Evaluate and manage nutritional needs (enteral and parenteral) of surgical patients untilnormal GI function returnsPage 7 of 59
HARBOR-UCLA MEDICAL CENTERGENERAL SURGERY RESIDENCY PROGRAMGOALS & OBJECTIVES7. Provide follow-up care to the surgical patient in the outpatient clinicPatient CareThe intern will provide patient care that is compassionate, appropriate and effective for thetreatment of the colorectal surgery patient Develop expertise in the various techniques including draining simple and horseshoe perianalabscesses and other minimally invasive procedures common to the service’s patient population Ability to learn the indications in performing good small bowel follow throughs, barium enemas,CT scan, and other related diagnostic radiologic testing Ability to perform a good colon, rectal, and anus exam Ability to perform a work-up for lower GI bleedingMedical KnowledgeThe intern will achieve detailed knowledge of the evaluation and management of the colorectalpatient. Understand the fundamental principles of anatomy, histology, and function of the anal canal,colon and rectum Understand the epidemiology and natural history of lower GI bleeding, carcinoma of the analcanal, colon, and rectum Understand the disease processes related to Crohn’s disease and Ulcerative Colitis and the diseasedifferencesInterpersonal and Communication SkillsThe intern will demonstrate interpersonal and communication skills that result in effectiveinformation exchange and teaming with patients, their families, and professional associates. Display a friendly disposition that is conducive to successful interaction with team members andpatients Communicate treatment plans with support staff and be able to listen and respond to patients andsupport staff questions in a positive manner Interact effectively with patients and family members from a diverse background Learn to gather essential information from patients, and accurately document patient encounters Interact with nurses, residents, attending surgeons and ancillary staff to achieve the health-relatedgoals of the patientProfessionalismThe intern will demonstrate a commitment to carrying out professional responsibilities adherence toorganizational and ethical principles, and demonstrate sensitivity to a diverse patient population. Relate as a team member with other residents and fellows from other departments Relate with all patients and support staff politely and with respect Respond to pages and consults in a timely manner Respond to criticism and correction with calm and attentive demeanor Demonstrate appropriate dress and decorum while on duty Handle all patient information confidentially and not discuss it in hallways or other public places Use and know the chain of command on the resident service Demonstrate kindness, empathy and maturity in the interrelationship with patients with routinesurgical problemsPractice-based LearningThe intern will investigate and evaluate his or her own patient care practices appraise and assimilatescientific evidence and improve patient care practices. Remain current on medical literature as it relates to common colon and rectal diseasesPage 8 of 59
HARBOR-UCLA MEDICAL CENTERGENERAL SURGERY RESIDENCY PROGRAMGOALS & OBJECTIVES Be familiar with online medical databases Teach, guide and be a role model for medical students Acquire skills in resource management Participate in didactic sessions/presentationsSystems-based PracticeThe intern will demonstrate an awareness of and responsiveness to the larger context and system ofhealthcare and be able to call on system resources to provide care that is of optimal value. Integrate closely with the total team of medical students, residents, and attending, caring forpatients with colorectal diseases Utilize the expertise of other services and support personnel Demonstrate good patient advocacy skills Recognize and understand how different health insurance companies affect the treatment plan forpatients and how limited indigent care resources can be efficiently utilizedEndovascular SurgeryThe goal of the Endovascular Surgery rotation is to enhance the R-1’s understanding of and skillsrelating to the management of patients with endovascular disease and surgical techniques.Objectives1. Demonstrate skill in basic endovascular surgical techniques2. Screen and evaluate patients for endovascular vascular disease3. Perform the preoperative assessment and postoperative care of patients undergoing majorendovascular surgical procedures4. Participate in surgery for endovascular procedures, including:a. Aortic aneurysmb. Iliac stenosisc. Carotid stentingPatient CareThe intern will provide patient care that is compassionate, appropriate and effective for thetreatment of the endovascular patient Develop expertise in performing preoperative assessment and postoperative care of patientsundergoing endovascular surgical procedures Learn and understand the indications in which vascular diseases best benefit from endovascularintervention Ability to perform a good endovascular examMedical KnowledgeThe intern will achieve detailed knowledge of the evaluation and management of the endovascularpatient. Understand the fundamental principles vascular and arterial disease and minimally invasivetechniques which offer an immediate advantage over more traditional, yet highly invasive surgeries Understand the epidemiology and natural history of lower GI bleeding, carcinoma of the analcanal, colon, and rectum Understand the disease processes related to cerebrovascular disease, upper and lower extremityocclusive diseases, aneurysms, vascular trauma, angio access, and venous diseasePage 9 of 59
HARBOR-UCLA MEDICAL CENTERGENERAL SURGERY RESIDENCY PROGRAMGOALS & OBJECTIVESInterpersonal and Communication SkillsThe intern will demonstrate interpersonal and communication skills that result in effectiveinformation exchange and teaming with patients, their families, and professional associates. Display a friendly disposition that is conducive to successful interaction with team members andpatients Communicate treatment plans with support staff and be able to listen and respond to patients andsupport staff questions in a positive manner Interact effectively with patients and family members from a diverse background Learn to gather essential information from patients, and accurately document patient encounters Interact with nurses, residents, attending surgeons and ancillary staff to achieve the health-relatedgoals of the patientProfessionalismThe intern will demonstrate a commitment to carrying out professional responsibilities adherence toorganizational and ethical principles, and demonstrate sensitivity to a diverse patient population. Relate as a team member with other residents and fellows from other departments Relate with all patients and support staff politely and with respect Respond to pages and consults in a timely manner Respond to criticism and correction with calm and attentive demeanor Demonstrate appropriate dress and decorum while on duty Handle all patient information confidentially and not discuss it in hallways or other public places Use and know the chain of command on the resident service Demonstrate kindness, empathy and maturity in the interrelationship with patients with routinesurgical problemsPractice-based LearningThe intern will investigate and evaluate his or her own patient care practices appraise and assimilatescientific evidence and improve patient care practices. Remain current on medical literature as it relates to common endovascular diseases Be familiar with online medical databases Teach, guide and be a role model for medical students Acquire skills in resource management Participate in didactic sessions/presentationsSystems-based PracticeThe intern will demonstrate an awareness of and responsiveness to the larger context and system ofhealthcare and be able to call on system resources to provide care that is of optimal value. Integrate closely with the total team of medical students, residents, and attending, caring forpatients with endovascular diseases Utilize the expertise of other services and support personnel Demonstrate good patient advocacy skills Recognize and understand how different health insurance companies affect the treatment plan forpatients and how limited indigent care resources can be efficiently utilizedGI/Surgical OncologyThe goal of the GI/Surgical Oncology rotation is to provide R-1 level experience pertaining to theclinical management of gastrointestinal disorders encountered in the practice of Gener
Vascular Surgery 33 R3 Overview Overall Goals 35 Rotation Learning Objectives 35 Breast 35 Colon & Rectal Surgery 35 General Surgery – Kaiser 37 Trauma Acute Care Surgery & Critical Care 38 R4 Overview Overall Goals 42 Rotation Learning Objectives 42 Cardiothoracic Surgery 42 Endocrine 4
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