CMC Vascular

CMC Vascular Surgery Rotation Goals and Objectives PGY 1

Vascular Surgery Service – ACMC

Faculty Supervisor:  Gabriel Wallace, MD, FACS

Faculty:

Martin Ellenby, MD, FACS

Mohammad Sarhan, MD, FACS, RPVI

Gabriel Wallace, MD, FACS, RPVI

Ronak Patel, MD, RPVI

Faculty:Resident Ratio: 2:1

Patient Care 

Goal 

The PGY-1 Resident on the ACMC Vascular Surgery Service will provide patient care that is compassionate, sensitive, and value-based.  Residents are expected to master the initial evaluation and triage, and pre and post-operative care of patients with vascular disease. In the operating room the PGY-1 Residents will be introduced to the spectrum of open, endovascular, and hybrid operations and are expected to be proficient in basic vascular technical skills. The PGY-1 will be expected to interpret vascular imaging and incorporate this information into assessment and planning.

Competencies

The PGY-1 Resident is expected to master the following patient care competencies:

  • Provide care that is compassionate, appropriate, and effective perioperative care for vascular surgical patients. This care is to be based on the most current scientific information and to incorporate the knowledge of other health professionals as appropriate.

  • Indicate patients for surgery and provide an assessment of risks specific to the patient and the operation.

  • Identify common post-operative complications

  • Interpret vascular imaging

  • Basic technical skills and operating room set up

Objectives

Perform the preoperative assessment and postoperative care of patients undergoing vascular surgical procedures

  • Complete a thorough history and physical examination and consultation

  • Identify patient specific risk factors (cardiovascular and other)

  • Develop case presentation skills

  • Perform relevant reading regarding vascular disease processes

  • Assimilate data and organize and prioritize daily activity

  • Conduct bedside rounds

  • Identify, evaluate, and treat common complications of vascular disease

  • Communicate effectively with nursing staff and other ancillary personnel

  • Teaching and involvement of medical students on the vascular service

  • Post-operative checks

  • Perform accurate bedside Ankle-Brachial Index (ABI)

Interpret vascular imaging

  • Ankle-Brachial Index (ABI) and associated waveforms

  • CT angiogram and venogram

  • Duplex Ultrasound

  • Conventional Angiography

  • Intravascular Ultrasound

  • MRI

Technical Skills

  • Opening and closing incisions

  • Basic tissue handling

  • Knowledge and identification of vascular instrumentation

  • Open and endovascular

  • Handling of prolene suture with a castro-viejo needle holder.

  • Central venous catheter placement

  • Knot tying

  • Pulse and portable doppler examination

  • Neurologic examination

  • Dialysis access evaluation

  • Fasciotomy

  • Operating room positioning, prepping, and draping

Medical Knowledge 

Goal

The PGY-1 resident will have an introductory understanding of congenital and acquired diseases of the vascular system, including vascular anatomy, the pathophysiology of vascular disease, and the management of common vascular diseases and injuries.

Competencies

Understand pathophysiology of common vascular surgical diseases and disorders

Management of common vascular surgical diseases and disorders

Indications for vascular surgery

Identify standard arterial and venous anatomy

Understanding and differentiation of acute and chronic (critical) limb ischemia

Identify patient specific risk factors for perioperative complications

Objectives

Identify standard arterial and venous anatomy in the operating room and on vascular imaging

Describe operative technique for common vascular operations

  • Lower extremity diagnostic angiogram

  • Fistulagram

  • Endovascular AAA Repair (EVAR)

  • Carotid endarterectomy

  • Femoral-Popliteal bypass

  • Arteriovenous fistula and graft creation

  • Above and below knee amputation

Describe standard anatomic exposures

  • Carotid artery

  • Brachial artery

  • Common femoral artery

  • Popliteal artery

  • Lower extremity fasciotomy

Identify and differentiate acute and chronic (critical) limb ischemia

  • Describe open, endovascular, and hybrid approaches for treatment of same

Describe the Rutherford Classifications of limb ischemia

Management of common vascular surgical diseases and disorders

  • Acute limb ischemia

  • Critical limb ischemia (chronic)

  • Compartment syndrome

  • Venous thrombosis, pulmonary embolism, phlegmasia

  • Carotid stenosis

  • Abdominal aortic aneurysm

  • Dialysis access

Indications for surgery

  • Carotid stenosis

  • Peripheral arterial disease

  • Abdominal aortic aneurysm

Working understanding of anticoagulation and antiplatelet therapy

Practice Based Learning and Improvement

Goal

The PGY-1 residents are expected to demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to improve patient care based on constant self-evaluation and life-long learning.

Competencies

  • Identify and perform appropriate learning activities.

  • Use information technology to optimize learning.

Objectives

The PGY-1 Resident on the Vascular Surgery Service will demonstrate the ability to:

  • Evaluate published literature in critically acclaimed journals and tests

  • Apply clinical trials data to patient management

  • Participate in academic and clinical discussions

  • Teach medical students and physician assistant students

  • Attend conferences

  • Apply clinical calculators and scores when clinically applicable

Interpersonal and Communication Skills

Goal

Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teamwork with patients, their families, and professional associates.

The PGY-1 Resident on the Vascular Surgery Service will:

  • Demonstrate appropriate communication to all members of the healthcare team including residents and physicians from other services, APCs, nursing, and care management.

  • Effectively communicate the patient’s condition, interpretation of medical information and data, including laboratory and microbiology results, imaging, treatment plan, and expected outcome.

  • Communicate effectively and compassionately with patients and family members.

  • Communicate effectively and compassionately with OR staff.

  • Prompt return of perfect serve messages

  • Thorough sign out to other members of the team or covering physicians.

Professionalism

Goal

The PGY-1 resident is expected to act at all times in an ethical manner. The resident will demonstrate a commitment to excellence and treat all patients with respect, compassion, and a right to privacy.

The PGY-1 Resident on the Vascular Surgery Service should demonstrate:

  • Honesty at all times

  • Ability to receive and incorporate feedback on performance

  • Attention to ethical issues

  • Involvement in end-of-life discussions and decision

  • Sensitivity to gender, age, race, and cultural issues

  • Leadership

  • Prompt arrival to O.R.

  • Introduction to, examination of patients, and review of imaging prior to the O.R.

  • Maintenance of patient confidentiality

  • Attendance at conferences

Systems Based Practice

Goal

Residents must demonstrate an awareness of and responsiveness to the larger context and system of healthcare, as well as the ability to call effectively on other resources in the system to provide optimal healthcare.

The PGY-1 Resident on the Vascular Surgery Service will:

  • Be aware of cost-effective care issues

  • Be sensitive to medical-legal issues

  • Utilize information technology/computer resources available

Assessment Method (Residents)

  • MedHub assessment tool

  • Faculty

  • Peer to peer

  • Self-assessment

  • 360° (APC, nurses, and students)

  • At mid-rotation the supervisory faculty will review rotation goals and objectives with the resident to determine achievements and opportunities for improvement to date.

Assessment Method (Faculty and Program Evaluation)

  • MedHub rotation assessment at completion of rotation.

  • MedHub resident evaluation of faculty at completion of rotation.

Level of Supervision

Resident is always supervised by attending faculty during the rotation.

Educational Resources

  • Library text and journal material

  • Core curriculum conferences

  • Evidence Based Reviews in Surgery.

  • Journals and texts from surgical resident library.

  • Surgical simulation and training laboratory.

  • SCORE Curriculum e-learning

  • Anatomic Exposures in Vascular Surgery (Valentine)

  • Rutherford’s Vascular Surgery and Endovascular Therapy

  • Society for Vascular Surgery Practice Guidelines

  • Up-to-Date

Teaching Methods

  • Faculty supervision in clinic, operating room and rounds for inpatients.

  • Core curriculum conferences.

  • Morbidity and Mortality/patient safety conference.

  • Vascular Indications Conference

  • Vascular All-City Journal Club