Surgical Rotation: Thoracic/Foregut Surgery

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 Operations/Procedures BROAD ESSENTIAL − COMMON • Gastroesophageal reflux and Barrett’s esophagus • Laparoscopic antireflux procedure • Hiatal hernia • Dysphagia ESSENTIAL − UNCOMMON • Spontaneous esophageal perforation • Open antireflux procedure • Iatrogenic esophageal perforation • Open repair of paraesophageal hernia • Mallory-Weiss syndrome • Laparoscopic repair of paraesophageal hernia • Repair/resection of perforated esophagus FOCUSED • Achalasia COMPLEX • Zenker’s diverticulum • Total esophagectomy • Epiphrenic diverticulum • Esophagogastrectomy • Foreign bodies • Cricopharyngeal myotomy with excision • Schatzki’s ring Zenker’s diverticulum • Chemical burns • Open Heller myotomy • Benign neoplasms • Laparoscopic Heller myotomy • Adenocarcinoma • Collis gastroplasty • Squamous cell carcinoma • Diffuse esophageal spasm • Nutcracker esophagus • Presbyesophagus • Scleroderma connective tissue disorders

SCORE CURRICULUM CATEGORY 22: THORACIC SURGERY Diseases/Conditions Operations/Procedures BROAD ESSENTIAL − COMMON • Pneumothorax • Chest tube placement • Hemothorax • Pleural effusion/empyema ESSENTIAL − UNCOMMON • Exploratory thoracotomy FOCUSED • Pericardial window for drainage • Mediastinitis • Thoracoscopy with or without biopsy • Chylothorax • Thoracoscopic pleurodesis • Adenocarcinoma of the lung • Thoracoscopic Heller myotomy • Undifferentiated lung carcinoma • Excision mediastinal tumor • Small-cell carcinoma of the lung • Transthoracic repair diaphragmatic hernia • Large-cell carcinoma of the lung • Open drainage of empyema • Soft tissue sarcomas of chest wall • Pneumonectomy • Thymoma • Pericardiectomy • 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

SCORE CURRICULUM CATEGORY 12: ENDOSCOPY Operations/Procedures ESSENTIAL − COMMON • Esophagogastroduodenoscopy • Bronchoscopy • Laryngoscopy

COMPLEX • Mediastinoscopy