PGY Component KSA 1 2 3 4-5 A detailed understanding of the The diagnosis and treatment of The utilization of , radiation anatomy, the head and neck with disorders of the pharynx and larynx. and chemotherapy in the treatment particular attention to the cranial Morphologic anomalies, , of of the head and neck. nerves. An understanding of the trauma and tumors of the external ear, Knowledge lymphatic drainage of the head and nose, paranasal sinuses and mouth. neck and their surgical significance.

Perform a thorough exam of the head Airway management, bag valve mask Rigid and fiberoptic of Parotidectomy. Neck dissection. and neck, including thyroid, nose, ventilation, direct laryngoscopy and the upper and lower airway. Benign Head and Neck Skills mouth, pharynx, larynx and cervical endotracheal intubation, tracheotomy. tumors of the salivary glands. lymphatics.

Diagnostic workup of benign and Manage emergencies including Management of neck . malignant conditions of the head and hemorrhage, airway obstruction, neck. Recognize and manage airway major trauma and brims of the upper Abilities obstruction, trauma to head, neck and airway. airway.

Define the anatomy and the hormonal Differential diagnosis of breast Options for treatment of breast Diagnosis and management of regulation of the breast. Genetic masses including fibroadenoma, cancer. Less common lesions of the advanced breast cancer, including markers and epidemiology of breast cysts, abscess, fibrocystic breast including inflammatory chemotherapy. cancer and risk factors involved and the and cancer. Indications, usage and carcinoma, Paget’s disease, overall incidence of breast cancer limitations of mammography including Mondor’s disease and male breast Knowledge marking mammograms. Breast cancer cancer. Breast reconstruction staging and micropathology. Sentinel options. lymph node interpretation and its significance.

Detailed breast and nodal examination. Office-based breast procedures: fine Surgical diagnostic Surgical removal of breast cancer: Breast needle aspiration, cyst aspiration. procedures:ultrasound, marking lumpectomy, quadrantectomy, Skills mammography, breast biopsy, mastectomy, axillary dissection. sentinel node biopsy Diagnostic workup of breast mass, Diagnostic workup of patients with Management of patients with breast management of benign breast breast cancer. Ultrasound, cancer based on stage, conditions and . mammographic, and radiological micropathology, biochemical and interpretation. genetic markers. Coordinates care Abilities with oncology and radiation therapy. Informed discussions with patient.

Normal . Wound and Melanoma , basal and Soft tissue sarcoma. Diagnosis and Adjuvant chemotherapy and radiation surgical infections (abscess, necrotizing squamous cell carcinomas. treatment of necrotizing soft tissue therapy for advanced skin and soft infections). Suture material and Differential diagnosis of skin lesions. infections. tissue malignancy. needles. Processes that impede Diagnostic workup of patient with healing: nutrition, metabolic stage, melanoma. Techniques for covering hematologic status, immune response soft tissue defects. Basic plastic Knowledge and infection. Antibiotic use. Wound surgical techniques: local rotation and classification and site infection risk. advancement flaps. Surgical site infection prophylaxis. Multiply-resistant organisms, tetanus, rabies, . Skin and Soft Wound closure. Examination of Skin biopsy. Skin graft. Debridement. Wide local excision for cancer. Advanced plastic surgical techniques: Tissue postoperative . Examination of Vacuum-assisted systems. Sentinel node biopsy in context of free flap, microsurgery, etc. traumatic wounds. Timing of suture Complicated dressing management. melanoma and skin cancer. Basic Skills removal. Incision and drainage of soft Complicated facial lacerations in plastic surgical techniques: local tissue abscess. Routine dressing emergency department. rotation and advancement flaps. management.

Manages postoperative incisions. Manages complicated wounds (VAC Diagnosis and management of Management of advanced stage Recognizes and manages surgical site drains, large defects, wounds patients with skin cancer and melanoma and soft tissue sarcoma infections. Diagnosis and management requiring debridement, compromised melanoma. Recongizes and based on stage and micropathology. Abilities of soft tissue abscess. Timely and patients). Diagnotic management of manages necrotizing soft tissue appropriate use of perioperative patients with benign skin and soft infections. antibiotics. tissue lesions. PGY Component KSA 1 2 3 4-5 Anatomy of the alimentary tract from Pathology and pathophysiology of Gastric and colorectal cancer: Esophageal and anal cancer: staging, the cervical to the anus with benign GI , including peptic staging, micropathology; diagnostic micropathology; diagnostic workup emphasis on systemic blood supply, ulcer disease, GERD, obesity, workup and surgical management. and surgical management. Adjuvant portal venous drainage, innervation and malabsorption, inflammatory bowel Anatomy of cancer operations of the and neoadjuvant protocols for lymphatic drainage. Deglutition, disease, enterocutaneous fistula. GI tract, with margins and nodal advanced GI cancers, all sites. esophageal and intestinal motility, and Symptomatology and presentations of anatomy. Surgical operations for Unusual GI malignancies; e.g. defecation. Physiology of GI secretion, GI disease. Indications and benign GI disease (anti-reflux, carcinoid, GIST, APUD, sarcoma and absorption, and hormonal regulation. appropriate application of diagnostic gastric resection, short bowel lymphoma. Approaches to advanced Mucosal acid-base and enzyme tests: laboratory, radiological, syndrome, bariatric, GI diseases: unresectable GI secretion. GI hormones and their endoscopic. Basic principles and enterocutaneous fisulta, etc) and malignancy, intractable actions. Pathology, diagnosis and complications of intestinal their physiological effects. enterocutaneous fistula, short bowel Knowledge principles of management of GI tract anastomosis, suture and stapled. Anastomotic complications (leak, syndrome. emergencies: hemorrhage, perforation, fistula, intraabdominal abscess). obstruction. Appendicitis and differential diagnosis of the acute abdomen. Appropriate antibiotic management for GI disease and operations. Alimentary Tract

Detailed examination of the anterior Open small . Open Upper and lower GI endoscopy. Resections for GI malignancy, all abdominal wall and gastrointestinal . Anal procedures for Open colon resection for cancer. sites. Laparoscopic intestinal tract. Placement of gastric and rectal benign disease (hemorrhoid, fistula, Enterostomy and resection. Laparoscopic antireflux Skills tubes for decompression. abscess, etc). and construction and closure. procedures. Esophageal and distal feeding enterostomy. Laparoscopic appendectomy. Lysis anorectal surgery. Gastric operations of adhesions to free bowel for peptic ulcer disease. obstruction. Recognizes patients with peritonitis Recognition and stabilization of Recognition of GI pathology by Management of advanced GI through the physical examination. patients with acute GI disease: endoscopy. Diagnosis and disease, esophageal and distal Institution of appropriate antibiotic hemorrhage, obstruction, perforation. management of benign and anorectal neoplasms, unusual GI therapy. Diagnostic workup of suspected GI malignant GI disease involving the neoplasms, short bowel syndrome, Abilities disease, benign and malignant. , , colon and complicated fistulas, and peptic ulcer Interpretation of laboratory and rectosigmoid. Enterocutaneous disease. Complicated anorectal radiological tests. fistula management. disease (e.g. Crohn's, incontinence)

Anatomy of the abdomen and its Pathology and pathophysiology of disease, liver failure, cirrhosis Pancreatic, hepatic, biliary cancer contents, specifically the liver (lobes, benign biliary disease: gallstone and portal . Splenic staging, diagnosis, and management. segments, vascular anatomy and formation, chronic and acute pathology. Diagnostic workup using anomalies), biliary tract (triangle of cholecystitis, common duct stones, clinical history and exam, aboratory Calot, ductal anomalies), and cholangitis. Acute and chronic and radiological tests. Morbidity of (ducts and ductal anomalies), spleen, pancreatitis and complications. patients with chronic liver failure. portal vascular system, abdominal wall Diagnostic workup using clinical Ductal anatomy of the pancreas and (esp ref. ), peritoneal cavity history and exam, aboratory and anomalies. (greater and lesser sac, sulcuses, and radiological tests. Pathology of foramina), and omentum. Vascular formation, underlying conditions, anatomy, lymphatic drainage, and predisposition to recurrence, innervation of various components. management of recurrent hernia. Physiology of secretion of bile and Intra-abdominal abscess and sepsis. Knowledge pancreatic juice. Hormonal and incisions and closure digestive system control of gall bladder techniques. Use of electrocautery. and pancreatic function (both exocrine Basic laparoscopic principles and and endocrine). Hematological and techniques: equipment, instruments, immunological functions of the spleen. supplies, set up. Mechanism of Bacteriology of the biliary tract and , complications immunological consequences of associated with PD. Prosthetic splenectomy, with antibiotic and material used in . vaccination protocols.Accessory spleens.

Abdomen Drain management. Open inguinal and Laparotomy and closure. Open liver Continued straight-forward Advanced laparoscopic cases umbilical hernia repair. biopsy. Open hernia repair. Basic laparoscopic cases (gall bladder, (splenectomy, adrenalectomy). laparoscopic cases: straight-forward appendectomy), begin advanced Pancreatic, liver resections. Skills chronic cholecystitis. Intra-abdominal laparoscopic cases (hernia, ventral Recurrent-reoperative laparoscopic abscess management. Placement of hernia). Open splenectomy. cases. peritoneal dialysis catheters. Recurrent hernia.

Diagnoses patients with inguinal hernia, Diagnosis and management of Diagnosis and management of Diagnosis and management of starts appropriate workup, and patients with acute cholecystitis and patients with patients with pancreatic, biliary, and prepares for operation. Diagnosis and pancreatitis. Diagnosis and and complications of acute hepatic cancer. Unusual hepatic, management of patients with benign management of intra-abdominal cholangitis and pancreatitis. pancreatic, and biliary conditions. biliary disease (chronic cholecystitis). abscess. Placement, management, Manages diseases and conditions Begins diagnostic management of and management of complications of requiring splenectomy (e.g., ITP). patients with acute abdomen (see peritoneal dialysis. above), considering non GI tract Abilities causes. Begins appropriate resuscitation and antibiotic management of patients with suspected acute hepatic, biliary and pancreatic disease. Recongizes esophageal variceal bleeding as a cause of GI hemorrhage. PGY Component KSA 1 2 3 4-5 Anatomy of the peripheral arterial Diagnostic workup of patients with Endovascular techniques: grafts, Diagnosis and management of vascular system, including collateral suspected arterial occlusive and introduction systems, catheters and endovascular complications. pathways. of arterial aneurysmal disease. Application and balloons. Interpretation of Management of graft infection. occlusive, aneurysmal, and embolic interpretation of noninvasive vascular arteriography and venous studies. Surgical anatomy of visceral and disease. Pathogenesis of laboratory tests. Acute vascular Techniques for embolectomy. renal branches of the aorta. cerebrovascular disease and emergencies. Management of Diagnosis and management of Pathogenesis of visceral aneurysms thromboembolic mechanisms of stroke. complications of vascular surgery vascular traumatic injuries. Surgical and unusual arterial disease (eg Symptomatology and clinical (e.g., thrombosis, restenosis, graft anatomy of major peripheral arteries Takayasu, fibromuscular , manifestations of lower and upper infection, wound infection). and veins. Diagnosis and neurofibromatosis, mycotic extremity, cerebral, and visceral Management of venous management of acute and chronic aneurysm). , and renovascular thromboembolism and pulmonary visceral insufficiency. Diagnosis and hypertension. Venous anatomy embolism. Management of chronic management of acute venous especially with regard to central venous venous insufficiency. Recognition of ischemia (phlegmasia cerulia access. Pathogenesis of patients with complications of dolens). Knowledge thromboembolism, chronic and acute anticoagulation and hypercoagulable venous insufficiency. Pathophysiology states. Techniques for placement of of pulmonary embolism. Pharmacology temporary hemodialysis access. of anticoagulation, thrombolysis, and Techniques for vascular anastomosis. antiplatelet therapy. Deep venous Radiation safety. thrombosis (DVT) prophylaxis. Antibiotic prophylaxis in vascular surgery. of arteriovenous fistulas. Lymphatic anatomy and disease. Compartment syndrome. Fascial compartment anatomy.

Physical examination of arteries, veins Familiarity with Seldinger technique. Vascular anastomosis of major Selection of endovascular and lymphatics, with gradation of pulse Placement of IVC filters. Application arteries to grafts. OR setup for prostheses. Surgical exposure of exam. Recognition and diagnostic and interpretation of noninvasive endovascular surgery. Exposure of abdominal aorta and its branches. Vascular measures for pulmonary embolism. vascular laboratory testing. Use of femoral, popliteal, and distal Surgical exposure of extracranial Placement of central venous access thrombolytic therapy. Placement of trifurcation branches. Preparation of branches of the carotid. Surgical using subclavian, internal jugular, and temporary dialysis access. Vascular saphenous vein for harvest or in situ exposre of thoracic outlet. Open femoral approaches. Use of anastomosis with construction of grafting. Selection, use, and surgical vascular surgery techniques: anticoagulation and anti-platelet arteriovenous fistulas. Use of techniques using vascular instruments and techniques to control Skills therapies, use of laboratory tests to embolectomy catheters. prostheses for AV fistulas. major blood vessels and perform monitor responses. Compartment pressure arterial reconstructions (anastomosis, measurements. Fasciotomy. endarterectomy).

Recognizes patients with acute and Stablizes patients with acute vascular Manages patients undergoing distal Diagnosis and management of chronic arterial and venous emergencies (eg AAA, acute bypass procedures. Manages patients with acute and chronic insufficiency. Institutes appropriate ischemia, pulmonary embolism). patients with acute vascular vascular insufficiency and aneurysmal interventions to preserve skin integrity Manages patients with postoperative emergencies. Management of disease. Ruptured AAA. in at-risk patients. Management of complications of vascular surgery and patients with "last chance" venous Endovascular and open procedures. central venous access, including pharmcological therapies access. Diagnoses and manages Management of patients with graft complications of placement. Institution (anticoagulation, anti-platelet, traumatic vascular injuries. Wound infection and graft failure (eg and adjustments of anticoagulation and thrombolytic). Placement, management in patients with endoleak, graft collapse). Abilities anti-platelet therapies, including routine management and care of IVC filters. potential limb-loss situations. DVT prophylaxis. Institutes appropriate Placement, management, and Management of patients with life- antibiotic prophylaxis. management of complications of threatening pulmonary embolism. hemodialysis access and renal failure patients. Observes standard radiation safety practices. Manages wound infections in vascular patients.

Anatomy, histology, pathology and Provocative and functional tests of Preoperative preparation, intra- and Surgical approaches to adrenal pathophysiology of the pancreas, hyper- and hypofunction (eg ACTH postoperative care of patients with disease, endocrine disorders of the adrenals, thyroid and parathyroid, stimulation tests). Specialized imaging hyperfunctioning states (eg pancreas, and hyperparathyroidism including neural and biochemical techniques (eg Sestamibi scans) and hyperthyroidism, (adenoma, , multiple mechanisms of feedback and control. localizing tests (eg selective venous hyperparathyroidism, Cushing's, glands, ectopic glands). Management Clinical and laboratory manifestations sampling). Complications of pheochromocytoma, of gastrinoma. Management of MEN of disease conditions. Differential thyroidecomy and parathyroidectomy. hyperaldosteronism, gastrinoma). with multiple glandular hyperfunction. diagnosis and workup of thyroid nodule Multiple endocrine neoplastic Management of acute endocrine Knowledge and hypercalcemia. Radiiological syndromes. Carcinoid and unusual emergencies (thyroid storm, imaging. Perioperative glucose GI hormone states. Surgical malignant hypercalcemia, management, diabetic patient and anatomy of the thyroid and hypertensive crises, Addisonian insulin management, and hyperglyemic parathyroid. Thyroid cancer staging, crises). complications. Perioperative micropathology, and treatment. management of steroid-dependent Endocrine patients.

History and physical examination of Drains postoperative neck hematoma. Thyroidectomy Parathyroidecomy, (incl intraoperative patients with a thyroid nodule. localization techniques), Skills adrenalectomy,

Postoperative management of Preoperative evaluation of patients Management of patients with thyroid Management of patients with thyroidectomy and parathyroidectomy with thyroid nodule, hyperthyroidism, cancer, hyperthyroidism, recurrent hyperparathyroidism, patients. Management of postoperative and hyperparathyroidism. hyperparathyroidism, carcinoid. adrenal adenoma, Abilities hypocalcemia. Perioperative Management of hypercalcemic crisis, pheochromocytoma, gastrinoma. management of diabetic and steroid- hyperglycemia, Addisonian crisis, Management of patients with unusual dependent patients. hypertensive crisis GI hormone pathology. PGY Component KSA 1 2 3 4-5 Anatomy and pathophysiology of acute Evaluation and management of Evaluation and management of Coordination of multi-victim trauma responses to injury, shock, and head specific injuries to torso, pelvis and trauma in special populations: care: triage, disaster situations, injury. Physiology of resusciation, use of contents, and extremities. Evaluation pediatric, pregnant patient, elderly. transfer of patients to specialized crystalloid solutions and blood and management of injuries to head, Coordination of trauma care by a units (eg burn units). Techniques to products. ATLS protocols. Use of neck and neuraxis. Care of team. Techniques to repair hollow repair major injuries to the major tetanus prophylaxis and antibiotics. complicated wounds: vacuum- viscus injury, non-exsanguining blood vessels, liver, pancreas, Clinical manifestations of life- assisted devices, role of plastic bleeding to solid organs. Techniques kidneys, retroperioneum and pelvis. Knowledge threatening and serious injuries. surgical techniques. Non-operative that address the initial and definitive Techniques that address chest, heart. Laboratory and radiological evaluations approaches to injury, including CT management of major extremity of the injured patient. Basic pre-hospital interpretation. FAST exam. injuries (degloving, amputation). care. Simple laceration care and Management of compound fractures closure. Care of open wounds. Basic and those complicated by orthopedic fracture management. neurovascular compromise.

Clinical evaluation of injured patient. Detection of injuries through clinical Leads trauma resuscitations for Leads trauma resuscitations for Trauma and Peripheral intravenous placement. examination, laboratory and unstable patients and those from multiple victim situations. Operative Placement of central venous catheter radiological tests including CT. special populations. Laparotomy in management in unstable patients Emergency by subclavian, internal jugular, or Conducts FAST exam. Applies VAC stable patients, open splenectomy, involving both thoracotomy and femoral routes. Clean and dressings. Laparotomy in stable control of hepatic lacerations in laparotomy. Complicated exposure of Medicine Skills contaminated wound management and patients with hollow viscus injury. stable patients. vessels and structures of the base of closure. Spllint and cast management. Acute airway management, including neck and thoracic inlet, endotracheal intubation and surgical thoracoabdominal area, and airway (tracheotomy). retroperitoneum.

Productive and reliable member of Productive and reliable member of Leads trauma team in care of Leads service in multi-victim trauma team. Initiates intravenous trauma team. Takes primary care of unstable patients requiring critical situations. Decides when surgery is resuscitation and blood transfusions. patients with acute injury through ER care and operation. Performs required and conducts operative Places chest tubes. Manages stable to discharge. Manages patients laparotomy, organ removal and management. patients not requiring cirtical care. undergoing non-operative approaches repair with senior assistance. Abilities Manages clean fresh lacerations and to torso injuries. Manages closed simple closed fractures. Manages head injuries and postoperative head closed head injuries GCS 13-15. injured patients with GCS <=12. Manages complicated wounds, open fractures.

Physiology and pathophysiology of Airway anatomy and management of respiratory, cardiovascular, renal, acute airway obstruction. Respiratory metabolic, endocrine, and neurological physiology, pathophysiology and systems in the context of critical care. pharmacology. Ventilatory support Diagnosis and management of patients equipment, instruments, monitoring with chronic respiratory failure who devices, and safety systems. require surgery. Heart failure and Cardiovascular physiology, ischemic heart disease. Acute and pathophysiology and support. dhronic renal insufficiency. ; Pharmacological and mechanical management of enteral and parenteral cardiac support. Monitoring Knowledge nutrition support. Endocrinopathy (see equipment, devices, and safety Endocrine above). Infectious systems. Pathophysiology and complications of critical care management of ARDS and SIRS. (nosocomial infections, VAP, multiply Nutritional support. Renal function, resistant organisms). Fluid, electrolyte, pathophysiology, acute renal failure and metabolic and and renal dialysis. Metabolic and toxic Surgical Critical derangements. Coagulopathy and DIC. derangements and their management. Care

Central line placement. Chest tube Bronchoscopy. Endotracheal placement. Laboratory and blood gas intubation. Tracheotomy. Gastrostomy. interpretation. Feeding . Ventilator Skills management. Pharmacological cardiovascular support.

Recognizes acutely ill patients who Manages acutely ill patients who require intensive care. Institutes require intensive care, with ventilatory appropriate respiratory support and and cardiac support. Manages life- chest physiotherapy on ward patients. threatening derangements of Abilities Manages noncritical metabolic, fluid, metabolism, flluid and electrolytes, electrolyte and infectious conditions. infecious conditions, and coagulopathies and DIC.

Anatomy and pathophysiology of Pathology, anatomy and lympatic surgical cardiac diseases, including drainage of lung cancer, including atherosclerotic coronary vascular staging and micropathology. Workup and valvular disease. Management and management of pulmonary Knowledge of lung abscess and thoracic nodule and lung cancer. Esophageal empyema. cancer and motility pathology (see Alimentary Tract above).

Clinical evaluation of patient with Lung biopsy, lobar resection, ischemic heart disease and heart pneumonectomy. Esophageal Cardiothoracic failure. Mediastinoscopy, median resection, esophageal myotomy (see Skills sternotomy. Alimentary Tract avove). Video- assisted thoracoscopic surgery.

Management of surgical patients Diagnosis and management of with associated ischemic heart patients with pulmonary nodule, lung Abilities disease and heart failure. cancer, esophageal pathology. PGY Component KSA 1 2 3 4-5 Anatomy and physiology of newborn Surgical diseases and conditions infants and children with reference to unique to newborns, infants and perioperative management and children. Perioperative care of trauma care. Injuries and responses to newborn infants. Childhood cancer. injuries unique to pediatric age groups. Dosing and interval changes of commonly used medications, Knowledge including narcotics and antibiotics. Differential diagnosis of the acute abdomen in children. Malrotation. Intussusception. Acute scrotal pain. Inguinal hernia. Umbilical hernia. Undescended testis.

Pediatric Incision and drainage of soft tissue . Infant laparotomy. abscess in children. History and Placement and removal of central Surgery physical examination of the injured venous catheters. child and children with acute Skills abdomen. Inguinal hernia and umbilical hernia repairs. Appendectomy. Gastrostomy and enterostomy care. Diagnosis and management of injured Diagnosis and management of children. Soft tissue infections and pyloric stenosis. Perioperative abscess. Acute appendicitis. Inguinal management of surgical infants. hernia, umbilical hernia. Work-up of Abilities infants with vomiting, abdominal pain, gastrointestinal hemorrhage. Postoperative pain management.

Local anesthetics and conscious Basic plastic surgical techniques: split Myocutaneous and free flap sedation techniques. Skin incisions and thickness skin grafts, local rotation anatomy. Techniques used in (see Skin and Soft and advancement flaps (see Skin and immediate breast reconstruction. Tissues above). Dressings and splints. Soft Tissues above). Minor burn care Management of facial trauma and Treatment and prevention of pressure (partial thickness, <5% full thickness). fractures, major injurires involving sores and decubitus ulcer. Airway management in patients with degloving and tissue loss. Knowledge Pathophysiology of burns, carbon thermal burns of the airway and Tangential excision and grafting of monoxide poisoning and inhalational inhalation injury. burns. injury. Resuscitation goals and indices for patients with major burns. Antibiotic Plastic Surgery management in burn patients. and Burns See Skin and Soft Tissues above. Skin graft. Basic plastic surgical Participates in advanced plastic Advanced plastic surgical techniques: Wound closure. Routine dressing techniques: local rotation and surgical techniques: free flaps, free flap, microsurgery, management. advancement flaps. microsurgery, etc. Diagnostic reimplantation, etc. Skills evaluation of trauma. Care of major burns (escharotomy, excision, grafting) See Skin and Soft Tissues above. Management of complicated wounds, Diagnosis and management of Participates in major plastic surgery Management of clean traumatic minor burns. Critical care of patients patients with facial trauma and reconstructions (breast, deformities, Abilities lacerations. with major burns. injuries involving degloving and major tissue coverage, major tissue loss. Major burns. reimplantation). Protocols that involve brain death and Clinical evaluation of organ donors organ donation. MCCG procedures and and recipients. Surgical immunology. personnel to support organ donation. Immunosuppression and Legal and ethic issues that surround pharmacological agents. Organ organ donation. preservation. Histocompatibility and cross matching. Organ procurement. Transplant anatomy of the liver, Knowledge kidney, and pancreas. Postoperative management including rejection. General surgical complications and conditions that arise in transplant patients.

Transplantation Approach to potential organ donors. Surgical techniques, pre- and Skills postoperative management.

Obtains permission from organ donors. Evaluation of potential organ donors. Participation in perioperative management and tranplant operations. Management of postoperative care. Management of Abilities general surgical conditions that arise in transplant patients. PGY Component KSA 1 2 3 4-5 Indications and diagnostic and Equipment, instrument use and therapeutic roles for upper and lower maintenance. Required supplies for Knowledge gastrointestinal endoscopy. Screening endoscopy. . Bronchoscopy.

Conscious sedation and monitoring. Endoscopic proceures: Biopsy, Colonoscopy, EGD, bronchoscopy. polypectomy, measures to control Endoscopy Skills Troubleshooting equipment, bleeding. ERCP. instruments, and supplies.

Management of patients requiring See Alimentary Tract above. screening endoscopy. Pulmonary Diagnosis and endoscopic Abilities toilet using bronchoscopy. management of patients with tumors and hemorrhagic lesions of the GI tract. See Alimentary Tract and Abdomen Equipment, instrument use and Specialized supplies for Issues in application of new products above. Principles of laparoscopic and maintenance. Required supplies for : endoscopic stapling and instruments. minimal access surgery. laparoscopy: graspers, dissectors, and clipping devices, retractors, etc. electrocautery, scissors, etc. Areas of Positioning required for laparoscopic attention in laparoscopic surgery: port and thoracoscopic procedures, placement injury, thermal injury, etc. including intraoperative adjustments Knowledge Potential complications specific to to facilitate exposure. Required laparoscopic equipment and supplies for thoracoscopy. instrumentation and their management (e.g., hypoventilation, hypotension, pneumothorax, gas embolism). Minimal Access Equipment and instrument set-up. Equipment and instrument trouble- Use of specialized equipment, Surgery Initial port placement. Camera shooting. Advanced tissue instruments and devices, e.g., handling and control. Video-assisted dissection. Use of endoscopic , Lap Band, balloon Skills instrument handling and control: suturing techniques and devices. dissection, hand-assist ports, dissection, tissue manipulation, Mechanical clipping and stapling morcellators, etc. hemostasis. devices. Set-up, port placement, and conduct Set-up, port placement, and conduct Conduct of complex minimal access for routine procedures for advanced procedures (Nissen, procedures (colon resections for (, appendectomy). enterectomy and anastomosis, cancer, pancreatectomy, ventral hernia, etc.). Trouble shoots adrenalectomy, common duct Abilities problems with equipment and exploration). Manages intraopeative instruments that occur during case. complications (unintentional organ injury, hemorrhage).

Anatomy of kidney, ureters, and lower urinary tract, including associated vessels and nerves. Diagnosis and management of urological trauma. Renal stones. Hematuria. Urinary infections and antibiotics. Prostatic Knowledge and carcinoma. Undescended testis. Radiological imaging of urological conditions. Role of endoscopic procedures. Management and care of urethral and vesicostomy catheters. Urology Skills Urethral catheterization. Vesicostomy. Obtains appropriate urological consultations. Diagnosis and initial management of urological trauma. Management of urinary drainage Abilities systems. Diagnosis and management of urinary tract infections. Recognition of urological disease as a cause of acute abdominal pain.

Anatomy of the ovaries, uterus, vagina, and lower genital tract, including vascular anatomy and relationships to pelvic and urological anatomy. Diagnosis and management of gynecological trauma. Trauma in pregnancy. Pelvic inflammatory disease Knowledge and infections and antibiotic management. Understanding of ovarian, uterine, cervical malignancies. Physiology and endocrinology of the hypophyseal-pituitary-ovarian axis. Indications and surgical anatomy for Gynecology hysterectomy and ovarectomy.

History and pelvic exam, including speculum examination and obtaining Skills microbiological specimens. Understanding of basic obstetrical monitoring. Obtains appropriate gynecological and obstetrical consultations. Recognition of Abilities pelvic infections and pathology as potential causes of acute abdominal pain. PGY Component KSA 1 2 3 4-5 Anatomy of the cranial vault and Pathophysiology of increased vetebral column. Brain, brain stem, intracranial pressure, intracranial spinal cord, cranial nerves and brachial hemorrhage, and measures to control plexus. Pathophysiology of brain and ICP. Pharmacological strategies to spinal cord trauma. Clinical examination minimize cord damage. Brain death of the CNS, including Glasgow Coma criteria. Score, radiological evaluation. Mechanisms of spinal and cord injuries, Knowledge methods of spine stabilization. Scalp anatomy. Anatomy of radicular pain syndromes, pharmacological, non- Neurological operative, and surgical strategies in the management of chronic neck, back, Surgery and sciatic pain.

Closure of scalp wounds. Skills Immobilization of the spine. Assessment of neurotrauma, including Management of paitients with closed head injury, decreased GCS, increased intracranial pressure, partial Abilities spine injury. Evaluation of patients with and complete spinal cord injuries. radicular, neck and back pain. Recognition of brain death.

Diagnosis of fractures and sprains. Diagnosis and management of major Diagnosis and management of Diagnosis and management of open Basic management, including splinting fractures causing blood loss (femur, mangled extremity and fracures with pelvic fractures involving disruptions and casting. Recognition of pelvis) and neurovascular major tissue loss. and injuries to pelvic organs. compartment syndrome within casts, compromise (eg supracondylar Knowledge forearm and leg fractures. Diagnosis fracture of humerus, dislocations of and initial management of open knee). fractures, including antibiotics.

Spint application. Bivalve and removal Noninvasive vascular imaging and Vascular anastomosis using Control of major pelvic hemorrhage. Orthopaedic of casts. Doppler evaluation. autologous and synthetic grafts. Repair and management of Skills Techniques of nerve repair. associated colorectal, urological, and Surgery gynecological injuries.

Examination and recognition of Resuscitation of patients with multiple Diagnosis and management of Diagnosis and management of open fractures and sprains. Immobilization of orthopedic and pelvic fractures. mangled extremity and fracures with pelvic fractures involving disruptions injured extremities. Initial management Initiation of vascular imaging major tissue loss. and injuries to pelvic organs. Abilities of open fractures. Spine immobilization procedures. Neurological evaluation of (see Neurological Surgery above). injured extremities.

Airway anatomy as referable to bag Stablilization of injured patients valve mask ventilation and requiring surgery. endotracheal intubation. Pharmacology of anesthetic induction, paralytic agents, local anesthetics. Side effects and hazards of general anesthesia and local anesthetics. Spinal anatomy referable to epidural and intraspinal anesthesia. Malignant hyperthermia. Anesthetic monitors, eg pulse oximetry, Knowledge ECG, end-tidal CO2, arterial and central lines. Preoperative evaluation of patients with cardiac, respiratory, hepatic and renal insufficiency and Anesthesia failure. Preoperative routines that prevent complications, incl n.p.o., antibiotics, DVT prophylaxis. Blood ordering.

Bag valve mask ventilation. Application Endotracheal intubation. Skills of monitoring devices. Recognition of patients at increased Preoperative stabilization of injured risk for anesthesia and surgery. patients. Direct laryngoscopy and Abilities Appropriate use of local anesthetics. endotracheal intubation. Bag valve mask ventilation.

Anatomy and pathological anatomy Ultrasonography referable to trauma Vascular anatomy referable to Imaging studies referable to referable to the chest and abdominal (FAST examination). Computed aneurysmal and occlusive arterial oncological disease and workup for plain films. Computed tomography of tomography for benign disease and disease (see Vascular Surgery primary and metastatic tumors, the chest and abdomen. injuries of the head, spine, chest, above). including mammography, CT and MRI Ultrasonography of the biliary tract and abdomen, and pelvis. Extremity (see Skin and Soft Tissue, Breast, Knowledge abdomen. Pharmacology and side imaging for trauma, esp fractures with Alimentary Tract, and Abdomen effects of radiological contrast agents. significant risk (see Orthopedic above). Surgery above). Application and use of interventional radiological techniques.

Radiology MCCG procedures to obtain routine MCCG procedures to obtain specialty Vascular ultrasonography. Stereotactic breast biopsy and breast and emergency studies, eg n.p.o. radiological images. ultrasonography. Intraoperative Skills routines, renal function studies, etc. ultrasound.

Makes preliminary interpretations of Performes FAST exams. Interprets Recongizes vascular disease on Diagnoses and participates in radiological findings and obtains trauma CT images and obtains basis of exam and radiological management of oncological patients confirmation from staff radiologists. confirmation from staff radiologists. images and obtains confirmation on basis of clinical exam and Abilities Obtains appropriate interventional from staff vascular surgeons. radiological studies. radiological consultation for intraabdominal abscess, etc. PGY Component KSA 1 2 3 4-5 Basic science: cell biology and physiology. Cell culture. Clinical research: retrospective reviews, prospective studies. Institutional Knowledge Review Board and informed consent. Statistical tests for significance. Reporting of data. Preparation of Research manuscripts. Skills Data collection. Formation of hypothesis and research question. Data analysis and Abilities presentation. Preparation of manuscripts. Surgical anatomy of the hand and upper extremity. Physical diagnosis of the hand and upper extremity. Injuries. Knowledge Immobilization and splinting techniques. Rehabilitation principles.

Hand Surgery Examination of the hand and upper Skills extremity. Splinting.

Diagnosis and management of hand Abilities and upper extremity injuries.

Melanoma and skin cancer pathology Tumor cell biology. Pathological Advanced, recurrent and metastatic and tumor cell biology (see Skin and features of common neoplasms. cancer. Familial and genetic Soft Tissue above). TNM staging systems for major neoplastic syndromes (eg MEN, epithelial neoplasms. Basic cancer familial polyposis, BRCA-associated operations, resection margins and cancers). Unusual neoplasms (eg soft regional lymphadenectomy. tissue sarcoma, GIST, etc.). Biological markers and clinically significant genetic mutations. Multimodal therapies for common cancers; i.e., common Knowledge radiotherapeutic and chemotherapeutic regimens for locally advanced and metastatic disease. Management of precancerous lesions (eg, Surgical adenomatous polyps, Barrrett's esophagus, ulcerative colitis). Oncology (see Selection of different therapies specific regions based upon patient preferences above) Melanoma excision, sentinel node Basic cancer operations: breast Major cancer operations involving the procedures, lymph node dissections resections, colon resections, esophagus, stomach, pancreas, for melanoma and skin cancer. sentinel node procedures, axillary anorectum and extremity sarcomas. and inguinal lymph node dissections Major resections, eg abdominal Skills for breast cancer. Endoscopic perineal resection, Whipple operation, procedures (EGD and colonoscopy) pelvic exenteration. with biopsy.

Diagnosis and management of Diagnosis and management of Diagnosis and management of melanoma and skin cancer. breast and colon cancers. Informed esophageal, gastric, pancreatic, Abilities consent of patients undergoing anorectal cancers and extremity breast cancer surgery. sarcomas. Contributes to tumor board discussions.

Scope of practice of surgeons in rural practices (endoscopy, trauma, emergencies). Resources in critical access hospitals. Relationships with providers in rural regions. Referral Knowledge criteria to tertiary hospitals. Professional and social relationships of surgeons in rural areas.

See specific regions above. Upper and lower endoscopy, basic laparoscopic (cholecystecomy, Rural Surgery appendectomy) and open operations Skills (bowel resection, trauma). Evaluations of basic emergency conditions and trauma patients.

See core competencies. Management of patients in critical access hospitals. Consultation for referring physicians Abilities practicing in rural areas. Followup of patients in rural/sparsely populated areas.