DScPS_GS Curriculum.pdf

General Surgery Fellowship

Residency Guidelines for the Army Doctor of Science in Physician Assistant Studies with a

Major in General Surgery (DScPA-GS) Degree

1. Introduction

2. Mission and Vision Statements: Rationale for DScPA-GS Degree

3. Overview of DScPA-GS Program

a. Purpose Statement and Description

b. Phases of the DSc-GS Program.

c. Overview and Organization

d. DScPA-GS Requirements

4. Research

a. Purpose and Overview

b. Completed General Surgery Physician Assistant Projects

5. Curriculum

a. Curriculum Overview

b. Complete Curriculum

c. Curriculum Syllabus

d. Performance Outcome Measures

6. Description of Titles and Responsibility

7. Making It Work

8. Appendices

a. Due Process MEMOs

b. Surgical Clinical Practice guidelines for General Surgery Students.

The Army DScPA residency is an 18-month curriculum of 16 didactic sections and 15 clinical rotations. This includes 5440 clinical training hours and 814 hours of classroom instruction.

The didactic portion is divided into 16 blocks of General Surgery topics with reading assignments and monthly exams.

The clinical rotations consist of four General department rotations (1280 clinical hours), one vascular surgery rotation (320 clinical hours), one night float rotation (320 clinical hours), two trauma rotations (640 clinical hours), two surgical intensive care rotations (640 clinical hours), one elective rotations (320 clinical hours), one Interventional Radiology rotation (320 clinical hours), two burn critical care rotation (640 clinical hours), one neurosurgery rotation (320 clinical hours), one plastic surgery rotation (320 clinical hours), and one emergency medicine refresher course (320 clinical hours).

The final written and oral boards are based on the standards set by the American Board of Surgery. The emphasis on individual research and evidence-based practice, combined with the excellent clinical curriculum, make the residency unique and desirable.

The research concentration of the program is based on the U.S. Army-Baylor University Doctoral Physical Therapy Research model. The Research portion is divided into four phases.

During phase I research protocol development occurs during a dedicated one week research course. Phase II has the residents being introduced to their actual projects. During the third (III) phase of the research portion data collection is conducted and analyzed. The project culminates during phase four (IV) with completion of the abstract, completion of the final paper and presentation to a panel composed of at least one general surgeon, one general surgery PA, and one University of Baylor staff member.

OVERVIEW OF RESIDENCY

Purpose Statement and Application Requirements

1. Purpose Statement:

a. The purpose of the Army DScPA-GS degree/residency is to provide Army Physician Assistants an opportunity to develop advanced competencies in the care of the Surgical Patient while they participate in evidence based clinical management of a wide variety of surgical illnesses and injuries at a military treatment facility (MTF) and local hospitals. Residents learn to stabilize critically injured patients while a member of the trauma team which utilizes the same skills and goals as stabilizing injured Soldiers on the battlefield. This knowledge and experience is what makes the residency invaluable to any military Physician Assistant. More importantly, this same knowledge and experience distinguishes the General Surgery trained Physician Assistant as invaluable to commanders and their Soldiers.

b. The Army DScPA-GS degree/residency is modeled after the initial three years of the

General Surgery Residency. The program offers the best experience in the Army with unmatched volume, variety and complexity of cases. Residents are intimately involved in patient care from presentation to discharge and follow-up. The General Surgery teaching staff includes surgeons with trauma, critical care, burn, colorectal, minimally invasive, bariatric surgery, and surgical oncology subspecialty training as well as senior surgeons with extensive clinical war-time experience. These assets make this a one of a kind and invaluable training opportunity.

c. The proposed Army DScPA-GS degree/residency develops strong research skills by initiating and completing individual research projects or by assisting with ongoing GS Resident and staff research projects.

d. The Residency curriculum includes several structured learning opportunities such as participation in didactic class work, research, lectures, in-services, teaching conferences, clinical rotations, morbidity and mortality conference, tumor board, breast conference, vascular conference, grand rounds, journal club and/or case presentations. The curriculum is designed to provide a broad base of knowledge in general surgery.

2. Requirements for Application to the General Surgery-PA Program:

a. At least four years’ experience as a general practices Physician Assistant.

b. Master’s degree in Physician Assistant studies or equivalent with successful completion of a research oriented original Master’s thesis.

c. Take a GRE with a combined score of 1000 or greater.

d. Have a minimum of 3.0 overall GPA for all college level courses taken.

Phases of the Residency

The Program manager for SAMMC (and proposed sites) will discuss the overall Residency goals/objectives with the residents as part of the orientation process. Additionally, the Program manager or member of the faculty discusses the goals/objectives of each new rotation as it begins. The purpose of these goals/objectives is to provide the resident with the residency expectations throughout the year. **Note** - These goals provide the residents with a framework from which to work. Occasionally, due to unforeseen circumstances, the director may modify the schedules.

1. Orientation Month: (First Month)

a. Introduction: Upon arrival at the training site, residents will begin in-processing and be provided adequate time to settle themselves and families into the area. During the first four weeks after arrival, residents will meet many staff and health professionals and tour different clinics and facilities. Specific orientation will occur with the General Surgery Physician Assistant and Physician Staff, as well as the Chief Residents as scheduled during the orientation rotation.

b. Goals/Objectives of Orientation:

1) Become oriented to the military treatment facility and surrounding area

2) Become oriented to the clinics and various staff

3) Become oriented (overall review) to the General Surgery-Physician Assistant

Residency Program

4) Attend ultrasound course

5) Participate in a two week (80 hour) didactic and interactive class on the basics of research

c. During this time the Resident will also receive instruction on initiation and style guidelines of a research project at the DSc level.

d. The Resident will be given time to choose a project or familiarize themselves with an existing project and commence research.

e. If the Resident feels strongly about pursuing a project of their original design, they are encouraged to communicate this to Program Director prior to arrival at the program. This will allow formulation of an IRB proposal and submission in a timely fashion during the orientation month.

f. Residents may pursue existing research projects to complete their requirements

g. Emergency Medicine refresher

2. Clinical and Didactic Months: (Months 2-17)

a. Introduction: Residents spend this time in learning didactic and practical material while working in various services throughout the surgery department. Residents will be involved in direct patient care working with the staff and chief residents on the assigned rotations within the department of surgery during patient evaluations, treatments and procedures. Residents will also have time to dedicate to their research projects with three days dedicated at the end of each month for research. Though research is an integral part of this curriculum, it is not the primary focus of the program. This is not a research oriented course, but research is considered a critical part of the clinical curricula and is weighted heavily in the overall grade. During these months, Residents experience the widest range of learning opportunities. By attending lectures from surgical specialties the Residents are further provided well-rounded educational experiences.

The curriculum, practical exercises and data collection for research projects further challenge the residents during these few short months.

b. Goals/Objectives:

1) Become proficient in all clinical procedures

2) Demonstrate or choose a research project (phase I) which will focus on one of the following: deployment medicine, trauma/critical care medicine, perioperative medicine, burn and surgery medicine, clinical based improvement, and educational improvement based issues and provide an update or addition to the literature reviewed that answers an individual research question.

3) Begin curriculum on research design and statistics (phase II)

4) Begin Residency didactic curriculum

5) Attend Grand Rounds lectures and be prepared to present a lecture if requested

6) Finalize research project choice and begin data collection (phase III)

7) Continue to update literature review on research project

8) Read required reading for each rotation and prepare for the end of rotation examination

10) Report findings of research project if concluded by submission of abstract to a scientific meeting, manuscript for publication or presentation of a platform or poster at a scientific meeting

3. Commencement: (Month 18)

a. Introduction: Residents graduate, out-process and prepare for their next duty assignment

b. Goals/Objectives:

1) Complete final evaluation of the program

2) Out-process and prepare for next duty station

3) Graduate

1. Overview and Organization: The Residency curriculum is divided into the following sections: Physician Assistant Residency Clinical Rotations, Clinical Didactic Subjects and Reading Assignments, Public Speaking and Research. Each Clinical rotation is scheduled for a specific time and overlaps with Clinical Didactic and Reading Assignments. Though there is a carefully planned schedule, if situation dictates adjustments may be made. Prior to commencement to any new rotation, the Program manager or faculty member will clearly delineate the goals and objectives of the particular rotation. Finally, as with any educational program, constant discussion, feedback, and analysis are expected during each rotation to promote continued growth and improvement of the Residency.

2. Physician Assistant Residency Clinical Rotations: An essential component of the Physician Assistant Residency is clinical competency. Complete comprehension of methodologies and personal initiative are critical in successful clinical practice and the advancement of the field of surgery. Residents follow a comprehensive curriculum to establish a firm base of the care of the surgical patient. This will also strengthen competency and stimulate future ideas that will continue into future practice and research. Direct patient care, discussions, and hands-on learning are examples of tools utilized to increase knowledge during this phase of the Residency.

During each rotation, the Residents interact with and work in conjunction with physicians in various areas of surgical specialties to promote critical learning and skill sets.

3. Physician Assistant Residency Clinical Didactic Subjects and Reading Assignments: During each rotation, Residents are required to attend and participate in Grand Rounds, tumor board, morning report, vascular conference, breast conference, and morbidity and mortality conference with the General Surgery Residents. The Grand Rounds lecture topics are based on the model of surgical education as outlined by the American College of Surgeons and the American Board of Surgery. Physician Assistants are continually challenged with questions, facilitating the development of effective and efficient clinical management of patients. During each rotation, Residents are assigned required reading from the 19th edition of Sabiston Textbook of Surgery:

The Biological Basis of Modern Surgical Practice and other references as listed. The reference text and all related assignments and tests are updated whenever a new edition is released.

Attempts are made to correlate reading assignments with clinical rotations to enhance both the reading and rotational learning objectives, but this is not always possible. Residents take several examinations during the curriculum, which serve to assess learning and reinforce the material covered.

4. Public Speaking: Each resident is required to present two graded lectures to the physician assistant students. Residents are expected to act as the subject matter expert and produce a 1-hour lecture/ presentation on a subject given them by the General Surgery IPAP instructor and present it to a General Surgery IPAP class. This lecture serves to prepare the resident for public speaking opportunities and to develop their skills as a speaker and potential as an educator. This course provides a general surgery knowledge base to entry-level Physician Assistants.

5. Research

a. The Physician Assistant Residents are actively involved in research projects during their eighteen-month curriculum. Each Resident will initiate or complete one research project which will focus on one of the following areas deployment medicine, trauma/critical care medicine, perioperative medicine, burn and surgery medicine, clinical based improvement, and educational improvement based issues that provide an update or an addition to the literature reviewed that answers an individual research question related to General Surgery during the program. When a research project is completed the report findings will be shared with the medical and scientific community by submission of an abstract to a scientific meeting, and/or submission of the manuscript for publication or presentation of the platform or poster at a scientific meeting. In addition, Residents are expected to familiarize and support ongoing research within the General Surgery Physician Assistant Residency and the concurrent General Surgery Physician residency.

b. Students can choose from a research that has already been through the IRB and needs to be started or is ongoing, if available, but they are also encouraged to develop a project of their own prior to arrival and communicate this with the Program Director to expedite IRB approval. If this cannot be done prior to arrival, staff will support the resident in development of the protocol and presentation to the IRB.

c. The project builds as it progresses through the four phases of research protocol development. The process of identifying the research topic, reviewing the literature, formulation of a hypothesis, designing a study protocol and obtaining IRB approval will be accomplished during Phase I of the research portion of the program. This phase includes an extensive classroom instruction over two weeks. During the second phase of the program the residents will work closely with faculty in expanding the literature review and the study overview. In Phase III the study procedures are refined, a manual of operations and procedures is developed, subject recruitment occurs, data collection begins and findings are analyzed and interpreted. The research project culminates in the fourth phase called dissemination. It is during this phase that a completed project will be presented either by submission of an abstract to a scientific meeting, submission of a manuscript for publication or presentation of a poster or the platform at a scientific meeting. It is required of every student to meet with his or her research mentor monthly without exception.

DScPA-GS Requirements

1. DScPA-GS Requirements and Opportunities:

a. Education:

1) Attend and participate in clinics as scheduled during each rotation with physician staff.

2) Experience one-on-one clinical education with the General Surgery Physicians and PA Staff

3) Experience one-on-one clinical rotations with General Surgeons, Radiologist, Interventional Radiologist, Critical Care Physicians, Burn Care Specialist, Vascular Surgeons, Pediatric Surgeons, Trauma Surgeons, and Neurosurgeons.

4) Attend weekly blocks of instruction in the study of the care of the General Surgery patient and related topics. General Surgery staff and Residents will cover the didactic material in the form of lectures and group discussions. Other educational resources include a medical reference library, audiovisual aids, computer-assisted data management systems, and reference software.

5) Attend Morning Report. Morning Report entails case presentations in oral board format

6) Participate in opportunities such as research presentation at physician assistant professional conferences when the opportunity arises and funding is available

7) Assist in routine and emergency operative cases

b. Presentations:

1) Defend research proposal to a committee as previously described

2) Prepare and present Grand Rounds Lecture when required

3) Present patients at morning report as required by the chief resident of your service

c. Research:

1) Each Resident will initiate or join an ongoing research proposal (must be completed prior to graduation date) that answers an individual research question

2) The research project will be considered initiated when it is accepted by the IRB and data collection has begun. The research project will be considered complete when the research manuscript is submitted to the review committee at their defense

3) All publications and related research associated with the Residency will be maintained by the Research Coordinator or the Director of the General Surgery Physician Assistant Residency Program and will list the residents’ names and appropriate staff’s names

4) No presentation of research material will be made to any conference or local medical education groups without prior approval by the Director of the General Surgery Physician Assistant Residency Program

d. Professional:

1) Maintain a current valid National Commission on Certification of Physician Assistants (NCCPA) license

2) Keep credential file current (kept in the Credential Services Office at MTF)

3) Provide appropriate and timely medical record documentation on all patients

4) Maintain current CPR and ACLS certifications, Acquire ABLS certification during the program

2. Requirements for Successful Completion of the DScPA-GS degree/residency:

a. Obtain a minimum of 80% on all written examinations

b. Obtain a minimum of 80% on all rotational evaluations

c. Obtain a minimum of 80% on the final written cumulative multiple choice examination

d. Successfully pass the final oral board examination. During oral boards, Residents will investigate a patient encounter from initial presentation until final disposition and verbally describe the process to General Surgery Physicians and GS PA staff, evaluated as Go/No Go.

e. Complete a research project

f. Complete 2 lecture presentations to the physician assistant students to the satisfaction of surgery instructor

3. Supervision: The Program manager is the direct supervisor for each resident. The manager will ensure that each Resident has successfully met all curriculum requirements leading to graduation. The manager will also serve as the rater on the Resident’s Academic Evaluation Report (AER).

4. Length of Residency: eighteen months (from mid-June to mid-December)

5. Curriculum: See attached documents

RESEARCH REQUIREMENT

1. Purpose

a. Research is the foundation and progressive lifeline of any medical profession. Both the American Board of Surgery and American College of Surgeons recognize the importance of training residents in research methodology and critical literature review. The focus of this degree is primarily a clinical degree, not a research-centric degree. However the ability to analyze and critically assess the medical literature becomes even more important after completing formal residency training and certification, as medical journals and other periodicals becomes the cornerstone of most physicians continuing medical education (CME).

b. In an era of dwindling resources and budget constraints, military health care providers are continuously compelled to provide efficient and effective care. To meet these demands the PA graduate programs have been shifting from the long standing “expert based” to “evidenced based” practice. The advent of the Evidence-Based Medicine (EBM) movement has furthered these endeavors, and provides a logical model for further investigation and intellectual growth within our chosen specialty.

c. Clinicians must continue to question the validity of traditional practices and procedures, particularly those that have not met scientific scrutiny. In addition to the importance of self-education, research methodology is taught in the Army PA graduate residency programs in the hope of fostering continued interest in scientific inquiry among General Surgery practitioners.

Such inquiry has served both to establish the unique body of knowledge that comprises “expertise” in the fields of General Surgery, orthopedics and has simultaneously pushed-back the “walls of dogma” that have historically surrounded so much of the treatment of acutely ill and injured individuals.

d. Another purpose of research is to investigate common practices and share the results with colleagues and other health care providers. To accomplish this each resident will initiate or complete an approved research study and submit the findings to an indexed, peer-reviewed journal. The research project requirement will positively contribute to the body of knowledge shared by providers throughout the field of General Surgery, and the Physician Assistant profession in particular.

2. Overview

a. The resident will be required to develop a research proposal and answer a specific research question. This can be accomplished as an individual project or part of an existing study as long as the resident prepares a separate final manuscript.

b. Residents will select or be assigned a prepared and IRB approved protocol due to the time constraints of the program and the time required to obtain IRB approval for new protocols.

Residents will then develop and submit a new research proposal that is acceptable to their research preceptor prior to completion of the sixteenth month of the program. The faculty will submit the best proposals for IRB approval and make them available for future Residents to use for their research.

3. Goals/Objectives: GS PA Residency Program Research Curriculum is based soundly upon the goals and objectives outlined by ABS/ACS that are within the PA scope of practice.

a. Goals

1) Describe the fundamental techniques of critically analyzing biomedical research, and demonstrate the ability to do so in a public forum.

2) Describe the basic methods of hypothesis development and testing.

3) Describe various types of study design and methodology.

4) Be aware of the various methods of obtaining consent for biomedical research.

5) Describe basic statistical methods and their respective applications.

6) Demonstrate and reinforce a strong ethical grounding for the conduct of clinical research.

7) Describe the skills to develop a manuscript that is acceptable for publication in a peer-reviewed journal.

8) Describe the need for grants and funding of research, and develop a rudimentary understanding of how to pursue research funding both effectively and ethically.

9) Foster an understanding and potential interest in academic General Surgery as a career.

b. Objectives

1) Participate in the didactic research course, successfully completing the outlined assignments and the post-test.

2) Attend and participate actively in Journal Club as schedule permits.

3) Complete the assignments for the Evidence Based Medicine Reading Module.

4) Complete other required research reading as outlined in the reading guide.

5) In conjunction with the program director, develop and successfully execute a plan for completion of the “Resident Scholarly Activity Requirement.” This requirement has been crafted in a manner that allows tailoring and selection of activities based upon personal preference, interests and career goals, and integrates both individual projects as well as didactic components of the research curriculum. In order to track progress and scholarly output, we have adopted a quantitative “point system” comprised of the various didactic programs and acceptable forms of scholarly activity. Points will be adjudicated and awarded by the program director.

The point system will be based on the current General Surgery format for grading. Residents will be required to accumulate a total of 15 points in order to meet graduate requirements, from the following menu:

a) 12 – successful design, execution and completion of program director pre-approved case-control, prospective observational, clinical trial or systematic review project (the traditional “soup-to-nuts” research project) (Must Complete).

b) 6 - successful completion of program director pre-approved “Evidence Based General Surgery Review” topic in ANNALS of GENERAL SURGERY format, and submission to a peer-reviewed MEDLINE-indexed medical journal.

c) 4 – successful development, completion, submission and selection for presentation of program director pre-approved “Innovations in General Surgery Education”

d) 3 – successful completion program director pre-approved case report / case series with detailed review of the literature, and submission to a peer-reviewed MEDLINE-indexed medical journal.

e) 3 – successful preparation and execution of a program director pre-approved and GSPA selected Clinical Pathology Case (CPC) presentation.

f) 2 – successful preparation, selection, presentation and peer-reviewed, MEDLINE-indexed journal publication of a program director pre-approved scholarly abstract (presented at a national medical meeting).

h) 1 to 3 – successful preparation, selection, and peer-reviewed, MEDLINE-indexed journal publication of a program director pre-approved scholarly project manuscript.

i) 1 – successful preparation and execution of a General Surgery presentation to Interservice Physician Assistant Program Phase I students pre-approved lecture (total points eligible 2)

j) 1 – one year credit for Journal club participation (metric = 20 literature review sheets).

k) 1– Presenting at morning report

6) In all cases, scholarly projects must include the following elements:

a) Problem identification and/or hypothesis formulation.

b) A formal phase of information gathering or data collection.

c) Critical analysis of the data or information obtained.

d) A formal statement or report of interpretation of results and conclusion.

e) Submit to the program a publishable-quality research report summarizing the project. The report must conform to research policy to include on-time submission.

7) In addition to these required objectives, residents are strongly encouraged to consider the following optional objective: Submit a paper to a peer-reviewed journal.

8) Residents must select a faculty advisor for their research project. The faculty advisor may be the resident’s faculty mentor, program manager, program director or another faculty member. With permission of the program director, a faculty member outside of General Surgery may be selected.

4. Research Requirement Milestones

a. Specific milestones will be established and residents will be expected to meet them as they progress towards their final project. These milestones are minimums; residents should strive to beat these suspense dates well in advance. These milestones are as followed:

1) Upon selection to GSPA Program the student must register and complete the online training for biomedical research at www.citiprogram.org.

2) Research question prepared by the student and approved by Residency Manager prior to the students report date.

3) Rough draft of research proposal turned into Residency Manager by end of July of the

1st training year. Revision will be turned in by mid-August, and final draft turned into the IRB 30 days prior to the October IRB meeting. Upon request by the IRB for revision of the research proposal, the student will ensure the final draft will be turned in 30 days prior to the January IRB meeting.

4) Progress of the research will be evaluated by Residency Manger quarterly at a minimum.

5) All data collection will be completed by end of month August of final training year.

6) Rough draft must be turned in to Program Manager by mid-September, and revisions turned in by October 1st. Final draft must be completed by end of month October.

7) The final research paper will be turned into IRB for review and approval for publication by end of month October (first year).

http://www.citiprogram.org/

8) The Student will defend his research project by 1st week of December. The defense board will be made up of the Medical Director, Residency Manager, and two additional members, which can be individual site hospital staff or GSPA staff from other sites.

b. Residents not meeting these milestones will not comply with program requirements.

c. With the input of the research directors, it is crucial that each resident construct a feasible “road map” early in the course of their training, which they will use to fulfill their graduation requirements. Close coordination with their faculty research advisor and the program director is important. All expectations of participation should be worked out in advance.

d. Identify the roles of all participants. In general, only one resident can claim to be the principal investigator on a study. Large studies with multiple components may be able to support multiple residents, but this must be approved in advance.

e. Identify authorship for future papers submitted to journals. The general rules of journal authorship dictate that the first author is the individual most responsible for producing the manuscript (as opposed to the principal investigator, who takes lead in running the study). Often these are the same individual. The preceding discussion applies to articles submitted for publication. Take note that the resident is wholly responsible for writing up his or her results of the research project to meet graduation requirements.

f. The Program Director is responsible for tracking the progress of all resident research and providing regular updates to the program leadership.

g. The Program Manager, Assistant Program Manager, and Medical Director will convene an informal board, quarterly, in conjunction with individual counseling, to review all ongoing projects. The faculty members will give recommendations for the resident’s research requirement.

h. Graduating residents will be required to submit their final report to the IRB prior to receiving credit for the project and being cleared for graduation. It is the principle investigator’s (resident) responsibility to properly close the protocol with the IRB when departing the institution.

i. All academic and related papers, abstracts, publications, and academic presentations made outside the program will be submitted to the Research Director for review and approval, and if necessary, to the chain of command for review and approval.

j. All academic and related papers, abstracts, publications and academic presentations made outside the program will be submitted for PAO and OPSEC review.

CURRICULUM

Curriculum Overview

1. Introduction: The core academic curriculum is primarily conducted on the general surgery service. Academic conferences are held on a weekly basis. They include bedside teaching rounds, case presentations, discussions, and didactic lectures. Weekly reading assignments will be based on the didactic lecture. A structured curriculum with learning and performance goals and objectives is designed yearly by the staff with resident input.

This residency focuses on clinical assignments in surgery, with documented experience in emergency care and surgical critical care in order to enable residents to manage patients with severe and complex illnesses and with major injuries within the essential content areas of surgery. The essential content areas are: the abdomen and its contents; the alimentary tract; skin, soft tissues, and breast; endocrine surgery; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and non-operative trauma (burn experience that includes patient management may be counted toward non-operative trauma); and the vascular system.

2. Goals and Objectives:

1) Didactic: Provide post-graduate instruction on:

1) General Surgical (Colorectal/Bariatric),Trauma/Critical Care Surgery, Oncology

Surgery, Burn Surgery, Pediatric Surgery, Plastic Surgery, Vascular Surgery, and Neurosurgery to people of all age groups.

2) Public speaking forums

3) Research design and statistical analysis

4) Evidence-based practice

a) Increase “current” knowledge of professional literature through review of pertinent research.

b) Attend weekly Grand Rounds, breast conference, morning report, tumor board, vascular conference, and scheduled lectures covering all aspects of General Surgery practice.

b. Practical:

1) Demonstrate evaluation and management techniques for all patients presenting to the General Surgery Department, surgical ward, surgical intensive care unit or trauma service with focus on fundamentals of general surgery practice, resuscitation and perioperative care.

2) Provide an overall competency in the essential content areas of surgery.

c. Miscellaneous: Assist with the administration of the Physician Assistant Residency

Program, specifically with the management of scheduling, continuous quality improvement of program rotations, and other residency program related activities as required.

3. Plan:

a. Didactic:

1) The General Surgery-Physician Assistant Residency includes a comprehensive curriculum with classes conducted on a variety of topics. The classes are designed to inspire critical thinking, and where applicable, to incite discussion of current practice and theory with scientific evidence.

2) Daily morning report in oral board format covers focused topics in General Surgery with top professionals using small group settings.

3) Weekly schedule is as follows (unless changed by the Surgery Department):

Monday:

0700 Morning Report 0730 Morbidity and Mortality Conference 0830 Didactic Lecture 0930 Simulation/Interesting case conference (as applicable) 2nd Monday – Trauma lecture and M&M 3rd Monday – Grand Rounds 4th Monday – Journal Club 1430 Multi-disciplinary Breast Conference

ALL residents are required to attend the academic conferences on Monday from 0700 until complete.

-Simulation training will be incorporated into the formal didactic curriculum

Tuesday: 0700 Morning Report 1430 Multidisciplinary Trauma Conference (one Tuesday each month)

Wednesday: 0700 Morning Report 0730 Vascular conference (4th Wednesday of month)

Thursday: 0700 Conference:

1st and 3rd Thurs – Tumor Board 2nd Thurs - GI Conference 4th Thurs – Acute Care Surgery Theatre Teleconference – at least one Thursday per month

Friday: 0700 Morning Report

b. Practical:

1) The Residents work side by side with staff surgeons and surgery residents in different surgical specialties. Patient evaluation, differential diagnosis, analysis through application of a variety of testing methods, interpretation of test results and treatment options are discussed

3) Residents work with the GS PA faculty and General Surgery physicians practicing life-saving procedures during trauma rotations and intraoperatively.

4) For details in research administration, see Research section.

4. Evaluation of Performance:

a. Didactic: The Resident achieves the goals and objectives of the didactic portion by:

1) Completing the reading and other assignments for each specific rotation in the curriculum and actively participating in classroom discussions.

2) Attending weekly conferences, journal clubs, lecture series seminars, research meetings, in-services and related activities.

3) Achieving a minimum of 80% on tests based on reading assignments and clinical rotations, passing their oral board and achieving a minimum score of 80% on the final test.

b. Practical Portion: The Resident achieves the goals and objectives of the practical portion by:

1) Completion of each clinical rotation in accordance with the expectations of their supervising physician.

a) For Program grading criteria, see Performance Outcome Measures.

b) For evaluation of research projects, see Performance Outcome Measures.

Complete Curriculum for DSc Surgery Program

Didactic Portion

MGS6210 Surgical Basic Principles.

MGS6211 Perioperative Management MGS6212 The Abdomen MGS6213 Surgery of the Esophagus and Stomach MGS6214 Surgery of the Small Intestine, Large intestine, rectum, and anus MGS6215 Surgery of the Liver and Biliary tract MGS6216 Surgery of the Pancreas and Spleen MGS6217 Endocrine Surgery MGS6218 Breast Surgery MGS6319 Neurosurgery, Pediatric Surgery MGS6320 Burn Surgery MGS6321 Trauma Surgery MGS6322 Surgical Critical Care MGS6323 Surgery on the Lung, Chest Wall, and Mediastinum MGS6324 Surgical Oncology MGS6325 Vascular Surgery

Practical Clinical Rotations

MGS6130 Orientation to General Surgery MGS6331 Clinical research MGS6332 General Surgery Team A (Colorectal) MGS6333 General Surgery Team B (Minimally Invasive Surgery) MGS6334 General Surgery Team C (General Surgery) MGS6335 General Surgery Team D (Surgical Oncology) MGS6336 Neurosurgery MGS6237 Interventional Radiology MGS6238 Plastic Surgery MGS6339 Night float MGS6440 Trauma Surgery MGS6441 Burn Surgery and critical care MGS6442 Vascular Surgery MGS6443 Surgical Intensive Care Unit (SICU) MGS6344 Elective Concentration MGS6245 Emergency Medicine Refresher

MGS6210 Surgical Basic Principles

Instructors: SAMMC General Surgery Staff and Chief Residents

1. DESCRIPTION: This section forms the basis of all of the knowledge and skills the GS PA Resident will develop throughout the course. This didactic section emphasizes cellular and molecular principles, fluid resuscitation, shock, the inflammatory response and wound healing.

2. GOALS

a. Describe the human genome

b. Describe the principles of cell signaling

c. Describe the cell division cycle.

d. Describe cell death

e. Describe the anti-inflammatory response

f. Describe the physiology of shock

g. Describe resuscitation and perioperative fluid management

h. Describe electrolyte abnormalities and treatment

i. Describe metabolism of the surgical patient

j. Describe the wound healing phases

k. Describe abnormal wound healing

l. Describe wound dressings and other therapies

3. OBJECTIVES

a. Discuss the structure of genes and DNA

b. Describe DNA replication and repair

c. Discuss protein synthesis

d. Discuss control of gene expression

e. Discuss the different cell receptors

f. Describe apoptosis and autophagy

g. Discuss the danger hypothesis

h. Describe cell signaling during the inflammatory response

i. Describe the neuroendocrine control of the inflammatory response

j. Describe the causes and manifestations of hyponatremia, hypernatremia, hypokalemia, and hyperkalemia

k. Describe the Surgery treatment for Describe the signs & symptoms of hypocalcemia, hypercalcemia and hypomagnesmia

l. Describe the treatment for hyponatremia, hypernatremia, hypokalemia, hyperkalemia

m. hypocalcemia, hypercalcemia and hypomagnesmia

n. Discuss the different types of shock

o. Discuss the pathophysiology, clinical features, diagnosis, and treatment of a patient presenting in all forms of shock

p. Demonstrate understanding of the pathophysiology, clinical features, management, and complications of fluid resuscitation and transfusion of blood

q. Describe the lethal triad

r. Discuss damage control resuscitation

s. Describe the composition of crystalloids

t. Describe the nutritional and caloric requirements of the surgical patient

u. Discuss the components of each phase of wound healing

v. Describe the characteristics of an ideal dressing

w. Discuss negative pressure wound dressings

4. IMPLEMENTATION

a. Reading assignments – Sabiston Textbook of Surgery Nineteenth ed., Surgical Basic

Principles, pages 24 – 151. Selected journal articles.

b. Lectures – Grand Rounds lectures, morning report, morning rounds will deal daily with resuscitation and wound healing.

c. Clinical – The GS PA Resident will be required to work in the area of his or her clinical rotation. Evaluation will include all acuity levels of patients presenting to the Surgery department and patients on the surgical wards and in the surgical intensive care unit. PA residents will also be able to perform wound vac changes and other wound care procedures at the bedside on their own by graduation

5. RESOURCES AND FACILITIES: Each GS PA Resident will be required to acquire all texts required to complete the goals and objectives as outlined in the curriculum. Grand Round lectures will be held in the GS Conference room or other locations as necessary. The Medical library at each MTF is available twenty-four hours daily for research or study requirements.

6. DUTIES AND RESPONSIBILITIES OF THE GSPA RESIDENT: The preceptor in the

General Surgery Department will coordinate the duty hours during MGS 6210 didactic section. Duty uniform will be either Class B or ACU’s, and hospital scrubs during clinical shifts or appropriate civilian attire in local civilian hospitals (as directed by GSPA staff).

Attendance at Grand Round lectures, Student lectures, Morning Report, and other conferences are mandatory.

7. GS PA SUPERVISION, EVALUATION, AND FEEDBACK: The GSPA Resident will be under direct supervision by the staff physician or staff GSPA for the clinical rotation you are

on. All patients evaluated by the GSPA Resident will be discussed and evaluated by the staff physician or staff GSPA prior to admission, orders being written or the patient being discharged. There will be a written examination at the end of the section covering the objectives listed.

8. GRADING SCALE: Residents must achieve a score of 80 percent or higher on all didactic exams.

9. SCHEDULING: This is an independent didactic study section.

Week 1 introduction, goals and objectives, reading assignment, morning report, grand rounds, clinical conferences Week 2 reading assignment, grand rounds, clinical conferences Week 3 reading assignment, grand rounds, clinical conferences Week 4 complete reading assignment, grand rounds written exam

MGS6211 Perioperative Management

Instructors: SAMMC General Surgery Staff and Chief Residents

1. DESCRIPTION: The MGS6211 section instructs the resident on the preoperative and postoperative care of the surgical patient.

2. GOALS

a. Assimilate concepts of general medicine, history taking and physical examination skills to develop a systemic evaluation and differential diagnosis for patients presenting to the surgery department

b. Describe the indications for admission and the criteria for discharge for a wide variety of medical conditions

c. Discuss the preoperative preparation of the patient

d. Describe the systems approach to the preoperative workup

e. Discuss the causes of intraoperative instability

f. Describe some basic tenets of intraoperative care

g. Discuss the different risk factors for infection

h. Describe the infection control techniques

i. Discuss different surgery associated infections

j. Discuss antibiotic therapy for surgery associated infections

k. Discuss complications associated with antibiotic therapy

l. Describe different postoperative surgical complications

m. Discuss anesthesiology principles of general anesthesia, pain management, and conscious sedation

n. Describe the indications, contraindications, methodology, and complications associated with procedures common to general surgery

o. Demonstrate the knowledge and skills necessary to interpret and effectively utilize laboratory and radiographic data used to assess patient pathology

a. Demonstrate the ability to perform correctly a history and physical examination in the surgical patient

b. Describe the American Society of Anesthesiologist classification system for general risk

c. Discuss the preoperative management of patients by system including cardiovascular, pulmonary, hepatobiliary, endocrine, immune, and hematologic

d. Discuss other preoperative considerations including nutritional status, obesity, and antibiotic prophylaxis

e. Describe the appropriate interventions for intraoperative myocardial infarction, pulmonary embolism, pneumothorax, malignant hyperthermia

f. Discuss the importance of maintaining normothermia, skin preparation, hemostasis

g. Describe different wound closure techniques

h. Describe different surgical devises and energy sources

i. Describe the common etiology and pathophysiology associated with surgical wound infections

i. Discuss the fundamentals of surgical site infection treatment

j. Define hospital acquired pneumonia, health care associated pneumonia, and ventilator associated pneumonia

k. Discuss Clostridium difficile colitis and its appropriate treatment

l. Discuss surgical wound complications

m. Discuss postoperative respiratory, cardiac, renal, urinary tract, gastrointestinal, hepatobiliary, and neurologic complications associated with surgery

n. Describe the pharmacological principles of inhalation agents and intravenous agents used for operative and procedural anesthesia

o. Discuss patient monitoring while anaesthetized

p. Describe the principles of contrast radiographic studies and their use in diagnosing surgical patients.

q. Describe the principles and application of Computed Tomography (CT) in the surgical evaluation of a patient.

r. Describe the principles and application of Magnetic Resonance Imaging (MRI) in the surgical evaluation of a patient.

s. Describe the application and interpretation of plain film radiographs

t. Describe the principles and application of Magnetic Resonance Angiogram/intraoperative and diagnostic angiography

u. Demonstrate competency in various procedures related to the care of Surgery patients skills including abscess I&D, nasogastric tube insertion, wound vac changes, thoracostomy, central line placement, arterial line placement, wound debridement, use of bedside ultrasound, venous cut downs, local wound exploration, vessel ligation, repair of simple and complex lacerations, , cricothyroidotomy, resuscitative thoracotomy, pericardiotomy, aortic cross-clamping, and anoscopy

Principles, pages 211-417. Selected journal articles.

b. Lectures – Grand Rounds lectures, morning report, morning rounds will deal daily with resuscitation and wound healing.

c. Clinical – The GS PA Resident will be required to work in the area of his or her clinical rotation. Evaluation will include all acuity levels of patients presenting to the Surgery department and patients on the surgical wards and in the surgical intensive care unit. PA residents will be able to perform all facets of perioperative care by graduation from preoperative work up to postoperative inpatient and outpatient care.

5. RESOURCES AND FACILITIES: Each GS PA Resident will be required to acquire all texts required to complete the goals and objectives as outlined in the curriculum. Grand Round lectures will be held in the GS Conference room or other locations as necessary. The Medical library at each MTF is available twenty-four hours daily for research or study requirements.

General Surgery Department will coordinate duty hours. Duty uniform will be either Class B or ACU’s, and hospital scrubs during clinical shifts or appropriate civilian attire in local civilian hospitals (as directed by GSPA staff). Attendance at Grand Round lectures, Student lectures, Morning Report, and other conferences are mandatory.

on. All patients evaluated by the GSPA Resident will be discussed and evaluated by the staff physician or staff GSPA prior to admission, orders being written or the patient being

9. SCHEDULING: This is an independent didactic study section.

Week 1 introduction, goals and objectives, reading assignment, morning report, grand rounds, clinical conferences Week 2 reading assignment, grand rounds, clinical conferences

MGS6212 The Abdomen

Instructors: SAMMC General Surgery Staff and Chief Residents

1. DESCRIPTION: This rotation emphasizes the didactics of surgical disease and treatment of the abdominal wall, umbilicus, peritoneum, mesenteries, omentum, and retroperitoneum

2. GOALS:

a. Master the anatomy of the abdominal wall

b. Master abnormalities of the abdominal wall

c. Master the anatomy and physiology of the peritoneum and peritoneal cavity

d. Master the anatomy and physiology of the mesentery, omentum, and retroperitoneum

e. Master the hernia including intra-abdominal hernias, inguinal hernias, umbilical hernias, ventral hernias, Richter’s hernia, spigelian hernias, femoral hernias, sliding hernia, recurrent hernias, incisional hernias, obturator hernias, lumbar hernias, and complicated hernias

3. OBJECTIVES:

a. Discuss the subcutaneous tissues, muscle and investing fasciae, preperitoneal space and peritoneum of the abdominal wall

b. Define the vascular supply and innervation of the abdominal wall

c. Discuss the pathophysiology, clinical features, diagnostic studies, and treatment of congenital abnormalities of the abdominal wall including omphalocele, umbilical hernias, gastroschisis

d. Discuss the pathophysiology, clinical features, diagnostic studies, and treatment of acquired abnormalities of the abdominal wall including diastasis recti, anterior abdominal wall hernias

e. Discuss the pathophysiology, clinical features, diagnostic studies, and treatment of malignancies of the abdominal wall

f. Discuss the pathophysiology, clinical features, diagnostic studies, and treatment of peritoneal disorders

g. Discuss the pathophysiology, clinical features, diagnostic studies, and treatment of omental cysts, omental torsion and infarction, omental neoplasms, mesenteric cysts, mesenteric lymphadenitis, sclerosing mesenteritis, malignancies of the mesentery

h. Master the pathophysiology, clinical features, diagnostic studies, and…