COMMUNITY LEARNING OBJECTIVES

Preamble

The Community General Surgery rotation offers the General Surgery resident the opportunity to experience general surgical practice in a community setting. This rotation has both urban and rural sites available. The resident should contact the Surgical Education Office sufficiently in advance in order to secure his/her desired site.

General Objectives

Upon completion of the Community General Surgery rotation, the General Surgery resident is expected to:  Demonstrate knowledge, clinical and technical skills, decision-making capabilities and attitudes essential to the roles of specialist in General Surgery practiced in the community  Appreciate the features of General Surgery practiced in the community that make it distinct from tertiary General Surgery

Specific Objectives

At the completion of the Community General Surgery rotation, the General Surgery resident will have acquired the following competencies and will function effectively as:

Medical Expert

General Surgeons possess a defined body of knowledge and procedural skills which are used to collect and interpret data, make appropriate clinical decisions and carry out diagnostic and therapeutic procedures within the boundaries of their discipline and expertise. Their care is characterized by up-to-date and (whenever possible) evidence-based, ethical and cost-effective clinical practice and effective communication in partnership with patients, other health care providers and the community. The role of the medical expert is central to the function of the general surgeon and draws on the competencies included in the role of communicator, manager, health advocate, collaborator, scholar and professional.

At the completion of training, the General Surgery resident will be able to:

 Function effectively as a consultant, integrating all of the CanMEDS roles to provide optimal, ethical and patient- centered general surgical care . Effectively perform a consultation, including the presentation of well-documented assessments and recommendations in written and/or verbal form in response to a request from another health care professional . Identify and appropriately respond to relevant ethical issues arising in patient care . Effectively and appropriately prioritize professional duties when faced with multiple patients and problems . Demonstrate compassionate and patient-centered care . Recognize and respond to the ethical dimensions in medical decision-making . Demonstrate medical expertise in situations other than patient care (e.g. presentations, medico-legal cases, etc.)  Establish and maintain clinical knowledge, skills and attitudes appropriate to the practice of General Surgery . Apply knowledge of the clinical, socio-behavioral and fundamental biomedical sciences relevant to General Surgery . Apply lifelong learning skills to implement a personal program to keep up-to-date and enhance areas of professional competence . Contribute to the enhancement of quality care and patient safety, integrating the available best evidence and best practices

The resident in General Surgery is required to attain sufficient knowledge as follows:

Basic/General Areas

Surgical Anatomy and Embryology Surgical Physiology Surgical Pathology Clinical Pharmacology  Analgesics; sedatives; anesthetic agents  Respiratory and cardiovascular  Gastrointestinal  Antibiotics  Antineoplastic agents  Antiemetic agents Medical Problems in the Surgical Patient  Preoperative assessment  Preparation for specific operative interventions  Antimicrobial prophylaxis  Anticoagulation and thromboembolic prophylaxis  Corticosteroid management  Diabetes management Conduct of a Surgical Procedure  General principles  Specific operative interventions Postoperative Care  Prevention and treatment of postoperative infections  Management of cardiac/hypertensive complications  Management of postoperative thromboembolic complications  Management of postoperative pulmonary complications  Management of endocrine/metabolic problems (e.g. diabetes)  Management of fluid and electrolyte/renal problems Wound Management and Healing Sepsis and Surgical Infections Hemostasis and Use of Blood Products Epidemiology and Biostatistics Trauma and Thermal Injuries  Metabolic response to critical illness/trauma  Multi-organ dysfunction  Trauma assessment and resuscitation (ATLS principles)  Triage and transport  Airway management in trauma  Shock in trauma  Injuries to the central nervous system  Injuries to the face and jaw  Injuries to the neck  Injuries to the chest/diaphragm/great vessels  Abdominal trauma (including major vascular injuries)  Injuries to the urogenital tract  Musculoskeletal injuries  Injuries to the extremities (vascular; bone; soft tissues)  Burns and other thermal injuries Fluid Management and Acid-Base Problems Metabolic and Nutritional Care Hemodynamics/Oxygen Transport/Shock Transplantatation and Implantation  Immunology and transplantation biology  Specifics of transplantation techniques Cancer  Principles of neoplasia  Diagnosis and staging  Therapeutic options: surgery; chemotherapy; radiation; other  Principles of chemotherapy  Principles of radiation oncology Legal and Ethical Issues in General Surgery Radiology for the General Surgeon  Plain x-rays  Mammography/stereotactic breast biopsy  Contrast studies and interventional radiology  Computerized tomography  Ultrasound  Magnetic resonance imaging  Nuclear medicine studies  Positron emission tomography (PET) Laboratory Medicine for the General Surgeon  Hematology  Biochemistry  Microbiology  GI laboratory studies: esophageal manometry and pH;  Vascular laboratory studies

Specific Disease Entities

Skin and Soft Tissue  Pressure sores  Hidradenitis suppurativa  Pilonidal sinus disease  Cysts  Neoplasms, including melanoma and Kaposi’s sarcoma Breast  Fibrocystic condition/simple cyst/complex cyst  Fibroadenoma and other benign neoplasms/phylloides tumour  Abscess/mastitis  Nipple discharge  Gynecomastia  Mastodynia  Evaluation of dominant mass/thickening  Atypical epithelial hyperplasia  LCIS/DCIS  Inherited breast cancer  Paget’s disease  Invasive breast cancer  Male breast cancer  Breast reconstruction Head and Neck  Lip lesions  Oral cavity lesions  Salivary gland lesions: inflammatory; infectious; neoplastic  Thyroid disorders: goiter; neoplastic; inflammatory  Parathyroid disorders: metabolic; neoplastic Veins and Lymphatics  Thromboembolic disorders  Venous insufficiency  Varicose veins  Lymphatic disorders and Diaphragm  Motility disorders  Gastroesophageal reflux disease  Barrett’s esophagus  Perforation/Mallory-Weiss tear  Diverticulum  Esophageal cancer  Caustic injury  Varices  Diaphragmatic  Diaphragmatic injury/rupture and Duodenum  Gastritis/gastropathy  Peptic ulcer/H. pylori  Volvulus  Diverticula  Menetrier’s Disease  Bezoars  Postgastrectomy syndromes  Neoplasms: benign; malignant  Arteriovenous malformations; GAVE; watermelon stomach  Dieulafoy’s lesion  Varices  Gastroparesis  Duodenal diverticulum  Crohn’s disease  SMA syndrome  Crohn’s disease  Celiac disease  Enteritis/enteropathy  Neoplasms: benign; polyps; malignant  Small intestinal fistulas  Diverticulum; Meckel’s  Blind loop syndrome  Pneumatosis  Short bowel syndrome/intestinal failure  Intestinal obstruction  Motility disorders/ileus  Mesenteric ischemia Colon and  Mechanical obstruction  Paralytic ileus/pseudo-obstruction  Inflammatory bowel disease: Crohn’s; ulcerative colitis  Ischemic colitis  Infectious colitis  Pseudomembranous colitis  Radiation enterocolitis  Diverticular disease  Megacolon  Volvulus: sigmoid; cecal  Polyps and polyposis syndromes  Neoplasms: benign; malignant; HNPCC  Solitary rectal ulcer  Rectal prolapse  Constipation/motility disorders/functional disorders  Pneumatosis  Angiodysplasia/vascular malformations  Colorectal bleeding  Foreign bodies of the rectum  Rectal trauma Anus  Neoplasms: benign; malignant  Anal infections/sexually-transmitted disease  Condyloma/AIN  Hemorrhoids  Fistula  Fissure  Pruritis ani  Incontinence  Levator ani syndrome Appendix  Appendicitis  Neoplasms: benign; malignant  Crohn’s disease and Portal System  Abscess  Cyst  Neoplasms: benign; malignant  and its manifestations Biliary Tract/  Gallstone disease and its manifestations  Choledochal cyst  Sclerosing cholangitis  Cholangiohepatitis  Neoplasms: benign; malignant  Hemobilia  Pancreatitis: acute; chronic  Cyst  Periampullary neoplasms: benign; malignant  Endocrine disorders of the pancreas Spleen  Operative indications for splenectomy  Hypersplenism  Neoplasms: benign; malignant  Metabolic disorders  Erythrocyte disorders  Autoimmune disorders  Vascular disorders  Cyst  Infections/abscess  Splenosis  Hematologic effects of splenectomy  Postsplenectomy sepsis and Retroperitoneum  Peritonitis  Abscess  Ascites  Adhesions  Retroperitoneal fibrosis  Retroperitoneal hematoma  Neoplasms/pseudomyxoma  Internal hernia Omentum and Mesentery  Omental torsion  Omental cyst  Mesenteric vascular disease  Neoplasms: benign; malignant Abdominal Wall/Hernia  Rectus sheath hematoma  Neoplasms: benign; malignant  Inguinal hernia   Umbilical hernia  Ventral hernia  Spigelian hernia  Lumbar hernia  Obturator hernia  Richter’s hernia  Parastomal hernia Adrenal  Cushing’s syndrome  Adrenogenital syndrome  Primary aldosteronism  Addison’s disease  Estrogen-secreting neoplasms  Pheochromocytoma  Neuroblastoma  Ganglioneuroma  Cyst  Metastatic disease Other Clinical Problems  Gastrointestinal bleeding  Intestinal obstruction  The acute abdomen  Morbid obesity/  Perform a complete and appropriate assessment of a patient . Elicit a history that is relevant, concise and accurate . Perform a focused physical examination that is relevant and accurate . Select medically appropriate investigations in a resource-effective and ethical manner . Demonstrate effective clinical problem solving and judgment to address patient problems, including interpreting available data and integrating information to generate differential diagnoses and management plans  Use preventive and therapeutic interventions effectively . Implement an effective management plan in collaboration with a patient and his/her family . Demonstrate effective, appropriate and timely application of preventive and therapeutic interventions relevant to the practice of General Surgery . Ensure appropriate informed consent is obtained for therapies . Ensure patients receive appropriate end-of-life care

The PGY-1 resident will be able to:  Perform many of the above clinical skills  Correctly diagnose the common general surgical problems  Formulate management strategies; will often require corroboration or modification by more senior individual The junior resident will be able to:  Perform the above clinical skills  Complete the data gathering process  Correctly diagnose most general surgical problems  Formulate management strategies; will require corroboration or modification by more senior individual The senior/chief resident will be able to:  Perform the above clinical skills  Complete the data gathering process efficiently  Correctly diagnose all general surgical problems  Formulate management strategies completely, even for complex or difficult problems  Demonstrate proficient and appropriate use of procedural skills . Demonstrate effective, appropriate and timely performance of diagnostic procedures relevant to the practice of General Surgery . Demonstrate effective, appropriate and timely performance of therapeutic procedures relevant to the practice of General Surgery . Ensure appropriate informed consent is obtained for procedures . Appropriately document and disseminate information related to procedures performed and their outcomes . Ensure adequate follow-up is arranged for procedures performed . Compile and maintain an accurate and complete electronic data base (T-Res log) of all operative procedures performed as a General Surgery resident Residents at all levels of training will be able to:  Apply knowledge and expertise to performance of technical skills relevant to the practice of General Surgery  Assist in the operating room  Master the techniques of gentle tissue handling The PGY-1 resident will be able to:  Initiate the process of technical skills development by assisting in simple procedures, under supervision  Develop familiarity with surgical instruments and suture materials  Position and drape patients for general surgical procedures  Demonstrate the principles of gentle tissue handling The junior resident will be able to:  Perform the above technical skills  Perform some common general surgical procedures, under supervision The senior/chief resident will be able to:  Perform the above technical skills  Competently and independently perform most general surgical procedures  Lead a team in the safe ,effective and efficient operative management of patients  Deal with operative circumstances that may be unusual or unexpected  Supervise and teach more junior residents in performing operative procedures Having completed the rotation in General Surgery, the resident will be able to demonstrate technical competence for the following procedures: (Designation is listed as to expectation of Surgeon (S) or Assistant (A) for each procedure and for each level of training) Operative Procedures PGY-1 Junior Senior/Chief

General Diagnostic and Therapeutic Procedures

Arterial puncture S S S Venipuncture/venous cutdown S S S Central venous catheter insertion S S S Insertion/removal of venous access reservoir (Portacath) S S S Endotracheal intubation S S S Insertion/removal of catheter S S S Injection of varicose veins S S S Urinary catheter insertion S S S Nasogastric tube insertion S S S Tracheostomy A S S Cricothyrotomy A S S Needle/tube thoracostomy S S S Pericardiocentesis for trauma A S S Pericardiotomy for trauma A S S /diagnostic peritoneal lavage S S S

Integumentary System Incision/drainage of subcutaneous abscess S S S Foreign body removal S S S Excision of benign skin lesions S S S Wide excision of melanoma A S S Excision of subcutaneous lesions S S S Excision of pilonidal sinus disease S S S Excision of hidradenitis suppurativa A S S Suture of laceration S S S Creation of skin flaps A S S Split thickness skin grafts A S S Full thickness skin grafts A S S

Breast Aspiration of breast mass/lesion S S S Core biopsy (True-cut) of breast mass S S S Incision/drainage of breast abscess S S S Excision of benign breast neoplasm S S S Partial mastectomy/lumpectomy A S S Total (simple) mastectomy A S S Modified radical mastectomy A A S Axillary dissection A A S Sentinel lymph node biopsy A A S Excision of mammary ducts (Adair) A S S Subcutaneous mastectomy A A S

Head and Neck Excision of thyroglossal duct cyst (Sistrunk) A A S Excision of cystic hygroma A A S Excision of branchial cleft cyst/sinus A A S

Excisional biopsy of cervical lymph node A S S Radical/modified radical neck dissection A A A/S Excision of parotid gland A A S Excision of submandibular gland A A S Thyroid lobectomy A A S Total thyroidectomy A A S V-excision of lip cancer A S S Vermilionectomy A S S Biopsy of premalignant/malignant oral cavity lesion A S S Hematologic/Lymphatic

Biopsy of enlarged lymph nodes (cervical; axillary; inguinal; scalene) A S S Staging for Hodgkin’s disease A A S Ileoinguinal lymph node dissection A A S Open splenectomy A A/S S Laparoscopic splenectomy A A A/S

Endoscopic Procedures Esophagogastroduodenoscopy NA S S NA S S Flexible NA S S Rigid sigmoidoscopy S S S Endoscopic biopsy techniques NA S S Endoscopic injection therapy NA S S Endoscopic variceal banding NA S S Hemorrhoid banding S S S Endoscopic polypectomy NA S S Endoscopic thermal techniques NA S S Endoscopic detorsion of sigmoid volvulus NA S S Percutaneous endoscopic A A S Endoscopic dilation techniques NA S S Diagnostic A S S Choledochoscopy A A/S S

Esophageal Procedures Laparoscopic esophagomyotomy () A A A/S Open transabdominal hiatus /fundoplication A A A/S Laparoscopic transabdominal hiatus hernia repair/fundoplication A A A/S Repair of perforated esophagus A A S Repair of Mallory-Weiss tear A A S Esophagogastrectomy A A A/S

Gastroduodenal Procedures

Open wedge excision of gastric GIST/other lesions A A S Laparoscopic excision of gastric GIST/other lesions A A A/S Open partial gastric resection with /Billroth II/Roux-en-y A A/S S reconstruction Laparoscopic partial gastric resection with Billroth I/Billroth II/Roux-en-y A A A/S reconstruction Open total A A S Open gastroenterotomy A S S Laparoscopic gastroenterotomy A A A/S Open surgical gastrostomy techniques (Stamm/Janeway) A A/S S Laparoscopic surgical gastrostomy techniques A A A/S Open pyloroplasty A A/S S Laparoscopic pyloroplasty A A A/S Open A A/S S Laparoscopic pyloromyotomy A A/S A/S Open gastrostomy and oversewing of bleeding gastric ulcer A A/S S Oversewing of bleeding duodenal ulcer A A/S S techniques A A A/S Open omental patch of perforated peptic ulcer A S S Laparoscopic omental patch of perforated peptic ulcer A A S Laparoscopic gastric bypass with Roux-en-y gastrojejunostomy for morbid A A A obesity

Small Intestinal Procedures Open enterostomy (end/loop/feeding) A S S Laparoscopic enterostomy A A S Closure of enterostomy A A S Laparotomy and enterolysis for intestinal obstruction A A/S S Open small intestinal resection/anastomosis A S S Laparoscopic small intestinal resection/anastomosis A A A/S Open resection of Meckel’s diverticulum A S S Laparoscopic resection of Meckel’s diverticulum A A S Open enteroanastomosis A S S Laparoscopic enteroanastomosis A A A/S Stricturoplasty for Crohn’s disease A A/S S

Colon and Rectal Procedures Open A/S S S Laparoscopic appendectomy A S S Open (end/loop) A A/S S Laparoscopic colostomy A A A/S Colostomy closure A A/S S Open colonic resection/anastomosis (segmental/subtotal) A A/S S Sigmoid resection with Hartmann for perforated diverticulitis A A/S S Laparoscopic colonic resection (segmental/subtotal) A A/S S Open anterior resection with total mesorectal excision (TME) A A/S S Laparoscopic anterior resection with total mesorctal excision (TME) A A S Open abdominoperineal resection with total mesorectal excision A A/S S (including perineal portion of the procedure) Laparoscopic-assisted abdominoperineal resection with total mesorectal A A A/S excision (including perineal portion of the procedure) Total proctocolectomy with Brooke for colitis A A S Pelvic pouch procedure with stapled j-pouch for ulcerative colitis A A A/S Pelvic pouch procedure with total /rectal mucosectomy and A A A/S stapled j-pouch/handsewn ileoanal anastomosis for FAP/dysplasia Open takedown of Hartmann A A/S S Laparoscopic takedown of Hartmann A A A/S Transanal excision of rectal polyp A S S Laparoscopic repair of rectal prolapse A A A/S Perineal rectosigmoidectomy for rectal prolapse A A/S S

Anorectal Procedures Excision of thrombosed hemorrhoid S S S Hemorrhoidectomy A A/S S Hemorrhoid banding S S S Hemorrhoid injection S S S A A A/S Lateral internal sphincterotomy for anal fissure A A/S S Excision of anal fissure A A/S S Incision/drainage of perianal abscess S S S Incision/drainage of ischiorectal abscess S S S Anal fistulotomy techniques, including: A A/S S  Probing of fistula tract  Seton placement  Mucosal advancement flap  Fistula plug placement Anoplasty with v-y mucosal advancement flap A A/S S Anal dilatation S S S Anal sphincter repair A A A/S Excision/fulguration of condylomata acuminata A A/S S Excision and mapping for AIN/Bowen’s disease A A/S S Repair of rectovaginal fistula with mucosal advancement flap A A S Incision/drainage of pilonidal abscess S S S Excision of pilonidal sinus disease A S S

Liver Procedures Open A S S Laparoscopic liver biopsy A A/S S Wedge excision of liver lesion A A/S S Left lateral segmentectomy A A/S S Left hepatic lobectomy A A A/S Right hepatic lobectomy A A A/S Left trisegmentectomy A A A/S Right hepatic lobectomy A A A/S Right trisegmentectomy A A A/S Open radiofrequency ablation of liver lesion A A A/S Open decompression/management of liver abscess/cyst A A/S S Laparoscopic decompression/management of liver abscess/cyst A A A/S

Gallbladder and Biliary Tract Procedures Laparoscopic and A S S Open cholecystectomy and cholangiography A S S Open A S S Laparoscopic cholecystostomy A S S Open common exploration A A S Laparoscopic common bile duct exploration A A A/S Biliary-intestinal anastomosis A A/S S Operative management of choledochal cyst or neoplasm A A/S S

Pancreatic Procedures Drainage of pancreatic abscess A S A/S Pancreatic necrosectomy A A/S S Open drainage of pancreatic pseudocyst by anastomosis to stomach or A A/S S intestine Laparoscopic drainage of pancreatic pseudocyst by anatomosis to A A A/S stomach or intestine Puestow procedure A A A/S Local excision of pancreatic lesion A A/S S Distal A A/S A/S (Whipple procedure) A A A/S

Hernia and Abdominal Wall Procedures Elective open repair of inguinal hernia using tension-free mesh technique A S S Elective laparoscopic repair of inguinal hernia A A/S S Emergency repair of incarcerated/strangulated inguinal hernia using A A/S S Cooper’s ligament (McVay) technique Elective open repair of femoral hernia using tension-free mesh technique A S S Elective laparoscopic repair of femoral hernia A A/S S Emergency repair of incarcerated/strangulated femoral hernia using A A/S S Cooper’s ligament (McVay) technique Open repair of ventral (incisional) hernia A S S Laparoscopic repair of ventral (incisional) hernia A A/S A/S Repair of parastomal hernia A A/S S Repair of lumbar hernia A A/S S Open repair of Spigelian hernia A A/S S Laparoscopic repair of Spigelian hernia A A S Emergency repair of obturator hernia A A/S S Emergency repair of fascial dehiscence/evisceration A S S Repair of hydrocele A S S Incision/drainage of abdominal wall abscess S S S

Adrenal Procedures Laparoscopic adrenalectomy A A A/S

Procedures for Trauma Diagnostic peritoneal lavage (DPL) S S S Focused Assessment with Sonography for Trauma (FAST) examination A A A/S Cricothyroidotomy A A/S S Pericardiocentesis for tamponade A A/S S Emergency room thoracotomy for penetrating cardiac injury and cardiac A A S arrest Needle decompression for tension pneumothorax S S S Chest tube insertion for chest trauma S S S Emergency neck exploration for penetrating trauma A A A/S Laparotomy for trauma (including damage control techniques) A A/S S Repair of liver injuries A A S Repair of diaphragmatic injury A A S Repair of injuries A A/S S Pyloric exclusion for duodenal/pancreatic injury A A S Pancreatic resection for trauma A A A/S Repair of bile duct injuries using t-tube A A S Biliary-intestinal anastomosis for bile duct injuries A A S Splenectomy for trauma A A/S S Splenic repair for trauma A A/S S

 Seek appropriate consultation from other health professionals . Demonstrate insight into his/her own limitations of expertise by self-assessment . Demonstrate effective, appropriate and timely consultation of another health professional as needed for optimal patient care . Arrange appropriate follow-up care services for a patient and his/her family Educational Strategies The General Surgery resident will achieve the above objectives by means of the following:  Self-directed learning  Role modeling in the learning environment  Exposure/experience on the teaching units and in the operating room  Problem-based learning at rounds and at academic sessions  Workshops and skills labs covering relevant topics Evaluation Strategies The General Surgery resident will be assessed with respect to the above objectives by means of the following:  In-training evaluation of observed behaviors/performance (360 degree assessment)  Objective written examinations (CAGS examination)  Structured oral examinations

Communicator

Communication is an essential component of virtually all aspects of general surgical practice and forms the cornerstone of the physician-patient relationship. Good communication skills are necessary for eliciting information from patients and their families about their medical conditions, their beliefs, expectations and associated concerns and for providing appropriate explanations and guidance. Communication with colleagues and other health professionals is also integral to the role of the General Surgeon.

At the completion of training, the General Surgery resident will be able to:  Develop rapport, trust and ethical therapeutic relationships with patients and families . Establish positive therapeutic relationships with patients and their families that are characterized by understanding, trust, respect, honesty and empathy . Respect patient confidentiality, privacy and autonomy . Listen effectively  Accurately elicit and synthesize relevant information and perspectives of patients and families, colleagues and other professionals . Gather information about a disease, but also about a patient’s beliefs, concerns, expectations and illness experience . Seek out and synthesize relevant information from other sources, such as a patient’s family, caregivers and other professionals  Accurately convey relevant information and explanations to patients and families, colleagues and other professionals . Deliver information to a patient and family, colleagues and other professionals in a humane manner and in a way that it is understandable, encourages discussion and participation in decision-making  Develop a common understanding on issues, problems and plans with patients, families and other professionals . Respect diversity and difference, including the impact of gender, religion and cultural beliefs on decision-making . Engage patients, families and relevant health professionals in shared decision-making . Effectively address issues such as obtaining informed consent, delivering bad news and dealing with anger, confusion and misunderstanding  Convey effective oral and written information . Maintain clear, accurate, appropriate and timely records (e.g. written or electronic) of clinical encounters and operative procedures . Maintain an accurate, complete and up-to-date electronic database (log) of operative procedures performed during the General Surgery residency . Effectively present verbal reports of clinical encounters and medical information Educational Strategies The General Surgery resident will achieve the above objectives by means of the following:  A learning environment that encourages respect, empathy and good communication  Role modeling  Communications skills discussions at academic sessions  Communications skills workshops Evaluation Strategies The General Surgery resident will be assessed with respect to the above objectives by means of the following:  In-training evaluation of observed behaviors (360 degree assessment)

Collaborator

General Surgeons work in partnership with others who are appropriately involved in the care of individuals or specific groups of patients. It is essential that General Surgeons collaborate with patients, families and an interprofessional team of health professionals for the provision of optimal care, education and scholarship.

At the completion of training, the General Surgery resident will be able to:  Participate effectively and appropriately in an interprofessional healthcare team . Recognize and respect the diversity of roles, responsibilities and competences of other professionals . Work with others to assess, plan, provide and integrate care for patients . Work with others to assess, plan, provide and review tasks such as research and educational assignments . Participate effectively in interprofessional team meetings (e.g. surgical service rounds; multidisciplinary teaching rounds) . Respect team ethics, including confidentiality, resource allocation and professionalism . Demonstrate leadership in a healthcare team (e.g. surgical teaching unit senior resident; chief resident in General Surgery; Trauma (Gold Surgery) senior resident team leader)  Effectively work with other health professionals to prevent, negotiate, and resolve interprofessional conflict . Demonstrate a respectful attitude towards other colleagues and members of an interprofessional team . Work with other professionals to prevent conflicts . Employ collaborative negotiation to resolve conflicts . Respect differences, misunderstandings and limitations in other professionals . Recognize one’s own differences, misunderstandings and limitations that may contribute to interprofessional tension Educational Strategies The General Surgery resident will achieve the above objectives by means of the following:  Role modeling within the learning environment (e.g. nutrition support team; trauma team; the operating room team)  Interdisciplinary sessions (e.g. service rounds) Evaluation Strategies The General Surgery resident will be assessed with respect to the above objectives by means of the following:  In-training evaluation of observed behaviours (360 degree assessment)

Manager

General Surgeons function as managers in a variety of settings within the health care system. They must be able to manage their own clinical practices and their personal lives. They may play a supervisory role within the health care environment. Furthermore, part of their role as managers involves the establishment of priorities and the participation in decision-making that affects the allocation of finite health care resources.

At the completion of training, the General Surgery resident will be able to:  Participate in activities that contribute to the effectiveness of the health care system . Work collaboratively with others (e.g. surgical units; operating room; emergency room) . Participate in systemic quality process evaluation and improvement (e.g. new technologies; patient “time-out” in the operating room and other patient safety initiatives)  Manage his/her professional and personal activities effectively . Set priorities and manage time to balance professional responsibilities, outside activities and personal life . Demonstrate an understanding of practice management, including finances and human resources . Employ information technology effectively (e.g. electronic surgical procedure database)  Demonstrate an understanding of cost-effectiveness in patient management . Recognize the importance of just allocation of healthcare resources

 Serve in leadership roles, as appropriate . Participate effectively in meetings (e.g. teaching rounds; surgical service rounds) . Lead a team effectively and efficiently (e.g. Senior resident trauma team leader) . Plan relevant elements of health care delivery (e.g. coordinating on-call schedules) Educational Strategies The General Surgery resident will achieve the above objectives by means of the following:  Role modeling  Practice management workshops (e.g. MD Management workshop) Evaluation Strategies The General Surgery resident will be assessed with respect to the above objectives by means of the following:  In-training evaluation of observed behaviors

Health Advocate

General Surgeons recognize their duty and ability to improve the overall health of their patients and the society they serve.

At the completion of training, the General Surgery resident will be able to:  Respond to individual health needs and issues as part of patient care . Identify the health needs of an individual patient (e.g. patient work-up, management and discharge planning and instructions) . Identify opportunities for advocacy, health promotion and disease prevention with individuals to whom he/she provides care (e.g. Home Care Services referral; Social Services referral; arrangements for colorectal and other cancer screening and surveillance examinations)  Promote the health of individual patients, communities and populations . Identify points of influence in the healthcare system and its structure (e.g. regional health authority) . Describe the role of the medical profession (e.g. Canadian Association of General Surgeons) in advocating collectively for health and patient safety (e.g. helmet and seatbelt legislation; snowmobile safety) Educational Strategies The General Surgery resident will achieve the above objectives by means of the following:  Role modeling  Educational workshops Evaluation Strategies The General Surgery resident will be assessed with respect to the above objectives by means of the following:  In-training evaluation of observed behaviours (360 degree evaluation)  Objective written examinations (CAGS exam)

Scholar

General Surgeons engage in a lifelong pursuit of mastering their domain of expertise. As learners, they recognize the need to be continually learning this for others. Through their scholarly activities, they contribute to the creation, dissemination, application and translation of knowledge. As teachers, they facilitate the education of students, patients, colleagues and others.

At the completion of training, the General Surgery resident will be able to:  Maintain and enhance professional activities through ongoing learning . Understand the principles of maintenance of competence . Understand the principles and strategies for implementing a personal knowledge management system . Conduct a personal practice audit . Pose an appropriate learning question . Access and interpret the relevant evidence . Integrate new learning into practice . Evaluate the outcomes of any changes in practice  Critically evaluate medical information and its sources and apply this appropriately to clinical decisions . Understand the principles of critical appraisal . Critically appraise retrieved evidence in order to address a clinical question . Integrate critical appraisal conclusions into clinical care  Facilitate the learning of patients, families, students, colleagues and others, as appropriate

. Understand the principles of learning relevant to medical education . Collaboratively identify the learning needs and desired learning outcomes of others . Select effective teaching strategies and content to facilitate learning . Provide effective feedback  Contribute to the development, dissemination and translation of new knowledge and practice . Understand the principles of research and scholarly inquiry . Understand the principles of research ethics . Pose a scholarly question . Conduct a systematic search for evidence . Select and apply appropriate methods to address the question . Appropriately disseminate the findings of a study Educational Strategies The General Surgery resident will achieve the above objectives by means of the following:  A learning environment that encourages self-directed and lifelong learning and evidence-based practice of General Surgery  Academic sessions/seminars/lectures  General Surgery Journal Club (CAGS Evidence-Based Surgery Reviews)  Attendance/presentation at local, national and international surgical/medical meetings (e.g. Canadian Surgery Forum)  Involvement in research projects/Master of Science in Surgery  TIPS workshop

Evaluation Strategies The General Surgery resident will be assessed with respect to the above objectives by means of the following:  Direct observation of the resident’s teaching skills in seminars, lectures and case presentations  Written evaluations from students  Assessment of resident research projects and publications

Professional

General Surgeons have a unique role in society as professionals. They have mastered a complex body of knowledge and skills. They are guided by a code of ethics and a commitment to clinical competence, the embracing of appropriate attitudes and behaviors, integrity, altruism, personal well-being and to the promotion of the public good within their domain.

At the completion of training, the General Surgery resident will be able to:  Demonstrate a commitment to his/her patients, profession and society through ethical practice . Exhibit appropriate professional behaviors, including honesty, integrity, commitment, compassion, respect and altruism . Demonstrate a commitment to delivering the highest quality care and maintenance of competence . Recognize and appropriately respond to ethical issues encountered in practice . Appropriately manage conflicts of interest . Recognize the principles and limits of patient confidentiality as defined by professional practice standards and the law . Maintain appropriate relations with patients  Demonstrate a commitment to his/her patients, profession and society through participation in profession-led regulation . Appreciate the professional, legal and ethical codes of practice . Demonstrate accountability to professional regulatory bodies . Recognize and respond to others’ unprofessional behaviors in practice . Participate in peer review (e.g. morbidity and mortality reviews; review of patients at surgical service rounds; death reviews)  Demonstrate a commitment to his/her professional and personal health . Balance personal and professional priorities . Strive to heighten personal and professional awareness and insight . Recognize other professionals in need and respond appropriately

Educational Strategies

The General Surgery resident will achieve the above objectives by means of the following:

 A learning environment where the professional/ethical principles are observed  Role modeling of professional attitudes and behaviors  Discussion of ethical issues at rounds and seminars  Bioethics Education Project sponsored by the Royal College of Physicians and Surgeons of Canada (RCPSC)  Medico-legal topics discussed at rounds and academic sessions (e.g. Canadian Medical Protective Association seminars)

Evaluation Strategies The General Surgery resident will be assessed with respect to the above objectives by means of the following:  In-training evaluation of observed behaviors (360 degree evaluation)

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