Residency Level:PGY 4

Surgical Rotation:Thoracic/Foregut Surgery

Length of Rotation:Two Months

Goals and Objectives

Patient care:

  • Evaluation and preparation of the pre-operative thoracic surgical patient in the outpatient setting
  • Comprehensive care of the thoracic surgical patient, including pre-operative evaluation and post-operative management, including intensive care unit management.
  • Management skills required to independently evaluate the thoracic surgical patient, develop your own plan for the patient and communication of the plan to the appropriate level of supervision
  • Take ownership in care of the patient
  • Post-operative care of the thoracic surgical patient
  • Mechanisms and criteria for minimally invasive surgery of the thorax and foregut
  • Fluid and electrolyte management including indications for parenteral and enteral nutrition
  • Understanding and utilization of diagnostic techniques including routine films, contrast studies, ultrasound, CT scan, MRI and endoscopic procedures
  • Clear and timely documentation of daily progress notes
  • Develop a strong work ethic
  • Develop appropriate safe hand offs
  • Develop the ability to care for thoracic surgical emergencies in the role as the surgical resident on call

Technical skill:

  • With appropriate supervision, perform procedures for chest tube placement, etc.
  • With appropriate supervision, take a greater role as surgeon in complex/advanced thoracic surgical cases (including minimally invasive surgery) including pneumonectomy and chest wall reconstruction

Medical knowledge:

  • Advanced knowledge of the anatomy, physiology and pathophysiology of the thorax and foregut.
  • Demonstrate evidence of continued increase in thoracic surgery core knowledge from basic surgical texts, additional readings and the SCORE curriculum as noted below
  • Obtain a broad knowledge base of thoracic surgery
  • Study and prepare for the ABSITE
  • Anatomy and physiology of the GI tract, as it applies to the esophagus, stomach and gastroesophageal reflux disease
  • Fluid and electrolyte management including management of parenteral and enteral nutrition

Practice-based learning and improvement:

  • Participate actively in M and M conferences, daily chief conferences and journal clubs
  • Learn to critically read the literature
  • Master the IT resources available to you to develop a commitment to lifelong learning and education

Interpersonal and communication skills:

  • Develop the appropriate skills to provide efficient, concise, patient presentations
  • Master text paging, emailing, etc.
  • Develop strong doctor patient relationships using counseling and education of patients and their families
  • Learn to master EPIC to provide proper documentation in the electronic medical record
  • Learn to properly consult other specialty services in a professional manner

Professionalism:

  • Respect every patient regardless of social or other circumstances
  • Log cases appropriately
  • Log your duty hours using My Evaluations appropriately and in a timely fashion
  • Complete all required clinical and residency documents in a timely fashion
  • Demonstrate sensitivity to age, gender and culture of patients and other members of the health care delivery team
  • Learn to be punctual
  • Always exemplify professional attire, appropriate grooming and hygiene
  • Demonstrate honesty, integrity and leadership skills

Systems-based practice:

  • Demonstrate the effective communication with referring physicians throughout the Swedish health care system
  • Keep patients’ safety foremost while discharging patients in a timely fashion
  • Demonstrate time management and organizational skills while adhering to work hour regulations
  • Gain an understanding of the importance of discharge planning and the writing of timely discharge orders to the overall throughput of patients in our system

SCORE CURRICULUM CATEGORY 7: ALIMENTARY TRACT −ESOPHAGUS
Diseases/Conditions
BROAD
• Gastroesophageal reflux and Barrett’s esophagus
• Hiatal hernia
• Dysphagia
• Spontaneous esophageal perforation
• Iatrogenic esophageal perforation
• Mallory-Weiss syndrome
FOCUSED
• Achalasia
• Zenker’s diverticulum
• Epiphrenic diverticulum
• Foreign bodies
• Schatzki’s ring
• Chemical burns
• Benign neoplasms
• Adenocarcinoma
• Squamous cell carcinoma
• Diffuse esophageal spasm
• Nutcracker esophagus
• Presbyesophagus
• Scleroderma connective tissue disorders / Operations/Procedures
ESSENTIAL − COMMON
• Laparoscopic antireflux procedure
ESSENTIAL − UNCOMMON
• Open antireflux procedure
• Open repair of paraesophageal hernia
• Laparoscopic repair of paraesophageal hernia
• Repair/resection of perforated esophagus
COMPLEX
• Total esophagectomy
• Esophagogastrectomy
• Cricopharyngeal myotomy with excision
Zenker’s diverticulum
• Open Heller myotomy
• Laparoscopic Heller myotomy
• Collis gastroplasty
SCORE CURRICULUM CATEGORY 22: THORACIC SURGERY
Diseases/Conditions
BROAD
• Pneumothorax
• Hemothorax
• Pleural effusion/empyema
FOCUSED
• Mediastinitis
• Chylothorax
• Adenocarcinoma of the lung
• Undifferentiated lung carcinoma
• Small-cell carcinoma of the lung
• Large-cell carcinoma of the lung
• Soft tissue sarcomas of chest wall
• Thymoma
• Teratoma of the medisastinum
• Neurogenic tumor of the mediastinum
• Enteric cyst of the mediastinum
• Pericardial cyst
• Bronchgenic cyst
• Superior vena cava syndrome
• Tracheoinnominate fistula
• Tracheoesophageal fistula
•Valvular heart disease
• Congestive heart failure
• Endocarditis
• Coronary artery disease
•Ventricular aneurysms
• Cardiomyopathy
• Pericarditis / Operations/Procedures
ESSENTIAL − COMMON
• Chest tube placement
ESSENTIAL − UNCOMMON
• Exploratory thoracotomy
• Pericardial window for drainage
• Thoracoscopy with or without biopsy
• Thoracoscopic pleurodesis
• Thoracoscopic Heller myotomy
• Excision mediastinal tumor
• Transthoracic repair diaphragmatic hernia
• Open drainage of empyema
• Pneumonectomy
• Pericardiectomy
SCORE CURRICULUM CATEGORY 12: ENDOSCOPY
Operations/Procedures
ESSENTIAL − COMMON
• Esophagogastroduodenoscopy
• Bronchoscopy
• Laryngoscopy
COMPLEX
• Mediastinoscopy