Stanford Multiorgan Transplant Surgery: PGY-3 Tuesday, February 02, 2016

Stanford University General Surgery Residency Program Abdominal Transplant Surgery Goals and Objectives for Residents: PGY-3 Rotation Director: Carlos Esquivel, M.D., Ph.D.

Description The Abdominal Transplant Surgery rotation at Stanford University Medical Center offers a broad experience in the evaluation and treatment of patients with end-stage abdominal organ failure. The R3 multiorgan transplant rotation specifically focuses on the critically ill post-transplant patients.

Goals The goal of the Transplant Surgery rotation is to help the residents: • Develop knowledge and experience in the evaluation and management of patients with end-stage kidney and liver disease. • The R3 should learn the pathophysiology of acute and chronic diseases leading to liver failure and fulminant hepatitis, drug- induced liver failure, alcoholic cirrhosis, post-necrotic cirrhosis, and others. • Learn the indications and contraindication for liver and kidney transplantation. • The R3 should learn the anatomy and physiology of the liver and kidney. • Learn the fundamentals of post-transplant immunosuppression. Residents will further develop their critical care skills. • Refine operative skills assisting on liver and kidney transplants and assisting on multiorgan procurements. • Become acquainted with the day-to-day function of a complex surgical service.

Objectives The Abdominal Transplant R-3 rotation has the following objectives: • The residents have primary responsibility for the management of all patients admitted to or evaluated by the team in conjunction with the attending surgeon. • The R-3 residents are responsible for daily evaluation, physical examination, assessment and plan for the post-transplant patients in the intensive care unit. This includes coordinating care with other services and physician extenders • The residents gain knowledge of the surgical care of transplant patients through discussion on rounds with the attending physician, attending the weekly Transplant Journal Club, and also by independent reading. The R-3 should present at least once at journal club.

1 Stanford Multiorgan Transplant Surgery: PGY-3 Tuesday, February 02, 2016

• The resident gains operative skills through pre-operative reading and by direct intra-operative teaching from the Transplant Surgery Attendings, and by going on at least three organ procurements.

Residents can expect frequent teaching from members of the team, both at the bedside and during formal and informal sessions. Because the residents are paired with an attending for an entire week, feedback and teaching is individualized to the needs of the residents.

Residents are evaluated in the 6 core competencies (Medical knowledge, Patient care, Interpersonal communication skills, Professionalism, Practiced based learning and Systems based practice) using specific web-based evaluation forms. An outline of core competencies with rotation objectives, instructional activities, and evaluations is below.

Specific goals and objectives for residents

2 Stanford Multiorgan Transplant Surgery: PGY-3 Tuesday, February 02, 2016

GOALS R-3OBJECTIVES INSTRUCTIONAL EVALUATION Core Competencies ACTIVITIES Knowledge: • Know and apply the basic and • Teaching by • Weekly feedback by attending To acquire and apply clinical sciences appropriate to the attending faculty. and Rotation evaluation by each knowledge of practice of Surgical Care such as Transplant Surgery attending established and physiology, pathophysiology, • Transplant Journal • (https://stanford.medhub.com) evolving basic and pharmacology, and disease Club (weekly) applied clinical processes. Demonstrates an sciences that relate to investigatory and analytic approach • Independent the practice of adult to patients with end-stage organ reading and pediatric failure, recent organ transplants, transplant patients. and post-operative complications. • Attend the Patient • Prioritizes patient’s disease related Selection meetings states, issues and designs a care (Liver/Kidney) plan accordingly, anticipates potential complications and • Attend the Liver prevention. Transplant • Develops a basic understanding of Pathology the commonly used conference immunosuppressant medications. • Attend the Liver Transplant Radiology conference

3 Stanford Multiorgan Transplant Surgery: PGY-3 Tuesday, February 02, 2016

Patient Care: Adequate assessment of peri-operative and • Daily rounds with • Weekly feedback by attending To provide post-transplant surgical patients including: the Transplant and Rotation evaluation by each compassionate, • Physical exam and history Surgery Team Transplant Surgery attending appropriate, and • Evaluation of appropriate • Pre-operative and • (https://stanford.medhub.com) effective pre- laboratory data and imaging intra-operative operative, operative, results teaching and post-operative • Development of comprehensive • Presentation of care for transplant treatment plan clinical patients. patients. • Recognition and management of complications including infection, rejection, immunosuppression toxicity, and delayed graft function.

Effective • Provide family members an update • Daily rounds with Weekly feedback by attending and Interpersonal and of patient’s condition. the Transplant Rotation evaluation by each Transplant Communication • Discusses appropriate perioperative Surgery Team Surgery attending skills: concerns with team & consultants. (https://stanford.medhub.com) Residents must • Works effectively with team communicate in a members (attending, interns and way that leads to physician extenders) to effective information communicate care plan. exchange of a critical • Coordinate care plans with other care plan to patients, specialties such as nephrology, their families, and hepatology, radiology, infectious professional diseases and others. associates.

4 Stanford Multiorgan Transplant Surgery: PGY-3 Tuesday, February 02, 2016

Practice based • Identify impact of complications on • Daily rounds with Weekly feedback by attending and learning and recovery of patients the Transplant Rotation evaluation by each Transplant improvement: • Use information technology to Surgery Team Surgery attending In order to improve assimilate current medical literature • Weekly Transplant (https://stanford.medhub.com) patient care as it relates to patient care Journal Conference practices, residents • Learn attention to detail in surgical must be able to patients critically evaluate their own performance as well as appraise and incorporate clinical scientific evidence. Professionalism: • Displays appropriate demeanor, • Daily rounds with Weekly feedback by attending and Residents must show even in adverse or stressful the Transplant Rotation evaluation by each Transplant a commitment to situations Surgery team Surgery attending professional • Acts with sensitivity and (https://stanford.medhub.com) responsibilities, responsiveness to patient’s culture, adherence to ethical age, gender, and disabilities principles, and • Maintains accountability to sensitivity to patients, medical profession, and diversity. society. • Obtains proper consent and confirm advanced directives, if present. • Becomes life long learner

5 Stanford Multiorgan Transplant Surgery: PGY-3 Tuesday, February 02, 2016

Systems-based • Act as an organizational problem • Daily rounds with Weekly feedback by attending and Practice: solver for patients the Transplant Rotation evaluation by each Transplant A resident must be • Understands how care for patients Surgery Team Surgery attending able to demonstrate and enables the hospital to deliver a • Participation in the (https://stanford.medhub.com) an awareness of and wide range of patient care. candidate selection responsiveness to the • Understands how care practice committees for liver system of health care affects staffing and health care costs and kidney and the ability to • Develops an understanding of the transplant. effectively call on organ allocation system for liver system resources to and kidney grafts. provide optimal care.

6