Guidelines for each level of training by service

Gastrointestinal Surgery (PGY-1, 2, 3, 4 and 5)

The basic goals of resident training in gastrointestinal surgery proceed according to the criteria established by the ACGME and the RRC, which provide an education in the basic biological phenomena constituting the foundations of surgical practice. In addition, that education includes an increasing degree of responsibility for and experience in the application of these principles in the management of clinical problems. Residents receive, under constant supervision, the opportunity for direct patient management and experience to attain detailed knowledge of generative, neoplastic, infectious and other surgical diseases of the gastrointestinal tract.

Gastrointestinal Endoscopy

The basic goal of endoscopic training is to provide experience in gastroscopy, flexible sigmoidoscopy, colonoscopy and choledochoscopy to such a degree that the resident would be eligible for membership in the two national endoscopic organizations (SAGES and ASGE). The service should provide all of the endoscopic procedures performed in the context of the diagnosis and, when appropriate, the treatment of various surgical diseases. Junior residents should be instructed in flexible sigmoidoscopy, which provides an appropriate and convenient step to the use of more advanced endoscopic techniques.

Surgical Oncology (PGY-1, 2, 3 and 5)

  1. Take an adequate history form and perform a physical examination on the patient with cancer.
  2. Evaluate the extent of disease and properly stage the disease.
  3. Select the best form of treatment (surgical or otherwise) for each individual patient.
  4. Learn the roles of chemotherapy and radiation therapy in various malignant diseases.
  5. Perform operations as appropriate for year level for malignant diseases.
  6. Understand the role of palliation and pain control in those patients who are non-curable.

Vascular and Transplantation Surgery (PGY-1, 2, 3 and 5)

  1. The overall goal of the multi-year exposure of the residents on the Vascular Surgery Service is the production of an accomplished general surgeon skilled in the diagnosis, management and operative therapy of general and vascular surgical problems.
  2. The objectives are listed below by level, with the presumption that each level of advancement also includes the objectives from the previous level. All of these levels include inpatient and outpatient contacts.
  3. Appreciation of the underlying pathophysiologic abnormalities occurring in chronic renal failure.
  4. Understanding of the various alternative treatments for endstage renal disease, including hemodialysis, peritoneal dialysis and renal transplantation.
  5. Knowledge of the appropriate medical therapy for metabolic derangements seen in chronic renal failure, including secondary hyperparathyroidism and hyperkalemia.
  6. Introductory exposure to concepts of transplantation immunology, including immunosuppressive therapy, with particular attention to the influence of immunosuppression on surgical therapy.

PGY-1 Level

1. Diagnosis and management - pre- and post-op care of vascular surgical and other general surgical patients.
2. Knowledge of vascular disease, diagnosis (including non-invasive diagnosis) and indications for surgery.
3. Exposure to operative technique of amputation, hernia, vascular access, etc.
4. Exposure to critical care management.
5. Teaching responsibilities for medical students.

PGY-2 Level

  1. Further knowledge of vascular disease, critical care and vascular access
  2. Increased responsibility for patient management.
  3. Teaching responsibilities for medical students.

PGY-3 Level

  1. Further increased knowledge of vascular disease and treatment.
  2. Initial evaluation of vascular and general surgical consults and emergencies.
  3. Increased judgment and operative skill and patient care responsibility.
  4. Increased critical care responsibility.
  5. At this level, the resident will perform some general surgical procedures in addition to some vascular access, and usually some renal transplants.
  6. Teaching responsibilities for junior level residents and medical students.

PGY-5 Level (Chief resident)

  1. Increased knowledge of vascular disease and its management.
  2. Full responsibility for management of vascular and other general surgical problems.
  3. Full responsibility for consultant on vascular and other general surgical problems.
  4. Knowledge of indications and techniques for various vascular and general surgical operative procedures, including operations for cerebral vascular disease, abdominal aortic aneurysm, aortic and peripheral arterial occlusive disease, and renal transplantation.

PGY-2 Level

  1. Reemphasis of the points covered above.
  2. Intensive exposure to techniques of dialysis access.
  3. Primary responsibility for the surgical care of patients with renal disease.

PGY-3 Level

  1. Initial operative involvement in renal transplantation, initially as first assistant and subsequently as resident surgeon.

PGY-5 Level

  1. Perform as resident surgeon during renal transplantation and renal and multiple organ procurement.
  2. Full responsibility for the care of the renal transplant recipient in conjunction with the transplant attending surgeons and physicians and physician assistants.

Trauma (PGY-1, 2 and 4)

PGY-1 Level

  1. Learn initial trauma management methodology:

 Primary surgery, resuscitation, secondary survey, definitive care;

 Assessment skills;

Management techniques and procedures, i.e. chest tubes, diagnostic peritoneal lavage, EID insertion, CVP insertion, arterial line insertion, wound repair techniques, etc.

  1. Learn trauma biomechanics.
  2. Learn trauma pre-hospital care.
  3. Learn post-accident hospital observation, indications, and methods.
  4. Learn post-injury routine hospital management methodology.
  5. Learn routine trauma surgery post-op care.
  6. Learn post-trauma outpatient follow up management.
  7. Observe operative techniques in trauma surgery.
  8. Learn methods of physician interaction with patients and families used during routine hospital care.
  9. Learn proper record-keeping skills and their medicolegal importance.
  10. Learn trauma care quality assurance methods.

PGY-2 Level

  1. Learn initial trauma management methodology:

 Primary survey, resuscitation, secondary survey, definitive care;

 Assessment skills;

 Management techniques and procedures, i.e. chest tubes, diagnostic peritoneal lavage, EID insertion, CVP insertion, arterial line insertion, wound repair techniques, etc.

  1. Learn trauma biomechanics.
  2. Learn post-trauma outpatient follow up management.
  3. Observe operative techniques in trauma surgery.
  4. Learn methods of physician interaction with patients and families used during routine hospital care.
  5. Learn proper record keeping skills and their medicolegal importance.
  6. Learn trauma pre-hospital care.
  7. Learn basic surgical intensive care unit management skills and techniques.

PGY-4 Level

  1. Learn to direct and coordinate the various aspects of initial trauma victim management.

 Assessment judgment.

 Treatment judgment.

 Priority judgment.

  1. Acquire operative technique and judgment capabilities regarding trauma surgery.
  2. Learn to direct surgical ICU management integrating support of all systems: central nervous, cardiovascular, pulmonary, renal, gastrointestinal, musculoskeletal, integumentary and hematologic systems and metabolic changes and nutritional support in the surgical patient.
  3. Learn basic disability assessments.
  4. Learn proper interaction with patients and families concerning:

 Initial emergency department assessment and management status;

 Intensive care unit status;

 Patient death;

 Organ donation;

 Disability status.

  1. Learn personnel management skills:

 A. Lower level house staff;

 B. Ancillary health care providers.

  1. Learn how to develop, organize, prepare and present medical conferences.

Pediatric Surgery (PGY-1 and PGY-4)

  1. Diagnosis and initial evaluation of surgically correctable congenital anomalies in children.
  2. Pre- and post-operative management of the same.
  3. Initial evaluation, resuscitation of pediatric trauma patient (including burns).
  4. Diagnosis, evaluation and operative management of common pediatric surgical problems, e.g. inguinal hernia, appendicitis, pyloric stenosis.
  5. Pre-op evaluation, operative technique and pos-op management of vascular access procedures in children, e.g., broviac catheter, port-a-cath, radial artery cutdown, saphenous vein cutdown.
  6. Diagnosis, pre- and post-op care of pediatric tumor patients, e.g., Wilm's tumor, neuroblastoma.
  7. Pre- and post-op care pf infant on extra-corporeal membrane oxygenation.
  8. Indications, techniques and operative consequence of 24-hour pH monitoring in children with suspected gastroesophageal reflux.

Night Float

PG-1
PG-2
PG-3
PG-4

VAMC General Surgery

VAMC Vascular Surgery

Colorectal Surgery

Community Surgery (South Georgia Surgical Associates, Thomasville)

PG-3
PG-4

Surgical Intensive Care

PG-2

Urology

PG-1

Plastic Surgery

PG-2