`Le Bonheur Children’s Hospital Plastic Surgery Rotation PGY-4 · PDF file ·...

`Le Bonheur Children’s Hospital Plastic Surgery Rotation PGY-4 By the end of the Plastic Surgery Rotation at Le Bonheur Children’s Hospital, the PGY-4 residents are expected to expand and cultivate knowledge and skills developed during previous training and to achieve the following goals and objectives based on the six general competencies. Competency Required Skill(s) Teaching

Method(s) Formative Evaluation Method(s)

Frequency of Evaluation

Patient Care SPECIALTY SPECIFIC OBJECTIVES Under the guidance and supervision of faculty, perform the following procedures including but not limited to: • Surgical and nonsurgical procedures of

common congenital disorders of the head and neck

• Otoplasty • Primary and secondary surgery on patients

with common congenital disorders of the head and neck, chest, trunk and extremities

• Closed reductions, open reductions, internal fixations, and bone grafting

• Special grafting techniques including dermabrasion, xenografts, cadaver grafts, skin matrix and synthetic or chemically manipulated materials

• Operations incorporating the full spectrum of flaps and grafts including skin grafts, local flaps, fascial and musculocutaneous flaps, free tissue transfers, bone grafts, composite grafts

Clinical teaching/experience Lectures/seminars/conferences Self-directed learning

Direct Observation Case logs Skills evaluation Written evaluation Written Examination

Daily Weekly End of Rotation Annually

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• Specific grafting techniques including the operation of various types of dermatomes, management of graft donor sites, and care of graft recipient sites

• Carve autografts and alloplastic implants Diagnose, evaluate, and treat patients with the following conditions needing plastic surgery including but not limited to: • Pediatric problems of the ear • Common congenital disorders of the head and

neck including cleft lip and palate and Craniosynostosis as related to pediatric patients

• Minor and major soft tissue injuries of the face including injuries to the facial nerve, lacrimal apparatus and parotid gland as related to pediatric patients

• Closed and open fractures of the facial skeleton as related to pediatric patients

• Fractures of the facial skeleton as related to pediatric patients

• Maxillary, mandibular, orbital, nasoethmoidal, frontal, zygoma and zygomatic arch fractures; the potential complications of such treatment (including malposition, deformity, malocclusion, etc); the management of these complications as related to pediatric patients

• Complications of flaps and grafts including skin graft loss, flap necrosis, wound dehiscence and wound infection as related to pediatric patients




2

Appraise common skin malignancies and formulate plan to include staging, extirpation and reconstruction.




Develop surgical plan for patients with common congenital disorders of the head and neck including cleft lip and palate and craniosynostosis.




Manage patients postoperatively after surgical treatment of facial fractures.




Demonstrate knowledge the principles of management of patients undergoing tissue expansion; recognizes the complications of tissue expansion and is competent in their treatment.




Utilize the techniques of local anesthesia and carry out emergency management of pediatric burn and pediatric trauma patients.

Clinical teaching/experience

Direct Observation Case logs Skills evaluation

Daily Weekly End of

3

Lectures/seminars/conferences Self-directed learning

Written evaluation Written Examination

Rotation Annually

Manage all plastic surgical patients postoperatively.




Integrate the Rule of Nines, the use of more detailed body surface charts, and the difference in relative body surface area comparing children to adults.




Apply knowledge of the parameters, which define major, moderate and minor burns.




Specify an understanding of the various factors, in addition to body surface area, which affect prognosis of a patient with a thermal injury.

Clinical teaching/experience Lectures/seminars/conferences Self-directed



4

learning Apply the principles and techniques of fluid resuscitation.




Appraise injuries and sequelae associated with electrical injuries.




Apply principles pertinent to burn rehabilitation and reconstruction including pediatric units of the face, tissue expansion, hair transplantation and hand splinting.




Medical Knowledge

SPECIALTY SPECIFIC OBJECTIVES Demonstrate an understanding of the medical and legal perspectives of the contractural agreement between a physician and his/her patient.




5

Specify an understanding of the concepts of informed consent and implied guarantee and understands the role of the medical record as a legal document.




Apply understanding of the impact a physical deformity can have on patients and their families.




Obtain informed consent from all patients and effectively documents the consent agreement.




Treat patients with physical deformity and explores the psychological aspects of their care.




Apply knowledge of the coding of diagnoses by the ICD-9 system and the coding of procedures by the CPT system.



Daily Weekly End of

6



Rotation Annually

Practice an understanding of ethical principles as they relate to billing and coding.




Practice an understanding of how to take and catalogue standardized medical photographs.




Practice a thorough familiarity with the principles of risk management.




Apply knowledge of the anatomy of the facial bones, their ostia and bony relationships, and embryology.




7

learning Apply familiarity with the general principles of embryology of the head and neck, with special reference to the development of the facial structures including lip, palate and ear.




Utilize intimate knowledge of the common congenital disorders of the head and neck including cleft lip and palate, craniofacial syndromes, vascular malformations, auricular abnormalities.




Apply knowledge of the priorities involved in treating patients with multiple trauma, the timing of treatment of head and neck injuries, and the indications for endotracheal intubation and tracheostomy in such patients.




Apply a systematic approach to the physical examination of patients with facial trauma.




Utilize understanding of the indications for specific diagnostic studies including conventional

Clinical teaching/experi

Direct Observation Case logs

Daily Weekly

8

radiography, Panorex films, computer-assisted tomography, three-dimensional CT scan imaging, and magnetic resonance imaging.

ence Lectures/seminars/conferences Self-directed learning

Skills evaluation Written evaluation Written Examination

End of Rotation Annually

Distinguish the mechanical properties of the facial skeleton and patterns of injury associated with facial trauma including associated cervical and cranial trauma.




Apply understanding of the management of open facial injuries including: anesthesia, local wound care, principles of debridement, and biologic features, which distinguish facial injuries from those in other locations.




Specify understanding of the concepts of primary bone healing, malunion, nonunion and osteomyelitis.




Distinguish the indications for operative treatment of facial fractures.

Clinical teaching/experience Lectures/seminars/conferences



9

Self-directed learning

Specify through knowledge of the advantages and disadvantages of various techniques for treatment of facial fractures including nonoperative treatment, closed reduction, mandibulomaxillary fixation, open reduction with and without fixation, wire fixation, compressive and non-compressive fixation, intraoral splints, external fixation (including halo and biphasic techniques) and bone grafting.




Translate understanding of the physiology of flaps and grafts, is thoroughly familiar with surgery in all types of flaps and grafts, and can design and utilizes flaps effectively for reconstruction in the full spectrum of plastic surgical practice.




Apply understanding of the terminology of flap movement, composition and vascular supply.




Show the physiology of normal flaps, ischemic flaps, and the "delay" phenomenon.




10

learning Apply understanding of the specific physiology of split and full thickness skin grafts, dermal grafts, cartilage grafts, bone grafts, tendon grafts, nerve grafts, fascial grafts, and composite grafts.




Apply familiarity with the biology of the various implant materials including bone, cartilage, and alloplasts.




Utilize knowledge the local wound factors which influence bone graft survival and recognizes the biologic differences between vascularized and non-vascularized bone grafts.




Specify understanding of the influence of perichondrium and on the warping of cartilage grafts.




Apply understanding of the physiology of cavitation.

Clinical teaching/experi

Direct Observation Case logs

Daily Weekly

11

ence Lectures/seminars/conferences Self-directed learning

Skills evaluation Written evaluation Written Examination

End of Rotation Annually

Show knowledge of the physiologic principles of tissue expansion and understand the various techniques for expansion.




Demonstrate knowledge of common agents for local anesthesia (esters and amides), regional anesthesia and general anesthesia (intravenous agents, inhalation agents, muscle relaxants, antiemetics, etc).




Utilize knowledge of the principles and the techniques for administration of local anesthesia and understand the pharmacology and safe utilization of agents in "conscious sedation."




Apply understanding of normal skin anatomy, circulation and how it is impacted by injury.




12


Specify understanding of the physiologic changes, which occur with thermal or traumatic injury.




Demonstrate an understanding of the relationship between duration of exposure and temperature and the specific changes which occur in the zone of coagulation, stasis, and hyperemia.




Utilize understanding of the pathophysiology and treatment of inhalation injuries and carbon monoxide poisoning.




Apply understanding of the pathophysiologic changes unique to chemical burns.




Demonstrate an understanding of the Clinical Direct Observation Daily

13

pharmacology and utilization of topical antibacterial agents, analgesics and antibiotics in the treatment of burns.

teaching/experience Lectures/seminars/conferences Self-directed learning

Case logs Skills evaluation Written evaluation Written Examination

Weekly End of Rotation Annually

Practice Based Learning and Improvement

SPECIALTY SPECIFIC OBJECTIVES Analyze evidence from plastic surgery literature and examine alternate sources for relevant information that pertains to their patient’s health problems, using Up-to date, PubMed or Ovid to enhance patient care




Develop and integrate strategies to improve clinical performance




Assess the principles of research design and methodology




Develop a plan for life-long learning Clinical teaching/experience


Daily Weekly End of

14



Rotation Annually

Interpersonal and Communication Skills

SPECIALTY SPECIFIC OBJECTIVES Along with the attending, lead the plastic surgical team




Demonstrate empathy when communicating end-of-life information




Demonstrate skills in conflict resolution Clinical teaching/experience Lectures/seminars/conferences Self-directed learning



Refine skills to function effectively as a consultant for specialty and subspecialty care




15


Professionalism SPECIALTY SPECIFIC OBJECTIVES Interface with referring and consulting physicians and hospital staff in a professional and respectful manner, recognizing and instituting the core competencies




Acknowledge own and other’s limits as surgeons Clinical teaching/experience Lectures/seminars/conferences Self-directed learning



Demonstrate sensitivity to a diverse patient population




Systems-Based Practice

SPECIALTY SPECIFIC OBJECTIVES Serve as a patient advocate in the outpatient and inpatient setting




16

learning Use systematic approaches to reduce errors Clinical




Differentiate between the different types of medical practice and health care delivery systems and integrate this knowledge into patient care




Deliver high-quality medical care in pediatric patient care setting




17

Methodist University Hospital Plastic Surgery Rotation PGY-4 By the end of the Plastic Surgery Rotation at Methodist, the PGY-4 year residents are expected to expand and cultivate knowledge and skills developed during previous training and to achieve the following goals and objectives based on the six general competencies. Competency Required Skill(s) Teaching

Method(s) Formative Evaluation Method(s)

Frequency of Evaluation

Patient Care SPECIALTY SPECIFIC OBJECTIVES Recommend initial analysis of radiographs and other diagnostic images for evaluation of traumatic, congenital and degenerative problems of the hand and upper extremity.




With assistance from faculty, improve skills to diagnose, evaluate and treat patients with the following conditions that require plastic surgery, including but not limited to: • Intermediate nerve, tendon, fingertip and bony

injuries. • Intermediate benign and malignant conditions

of the head and neck • Intermediate pressure sores • Intermediate mammary hypertrophy




With assistance from faculty, improve skills to perform the following plastic surgery procedures including but not limited to: • Intermediate skin grafting of soft tissue defects

of the upper extremity • Intermediate techniques available for

appearance restoration and understand the specific reconstructive needs of special tissues such as oral mucosa, nasal lining, etc

• Intermediate reconstruction of specific head and neck structures such as eyelid, lips, nose,




oropharynx, ear, mandible, scalp and skull • Intermediate breast reconstruction with various

techniques, such as implants, tissue expanders and flaps

• Intermediate nipple and areolar reconstruction • Intermediate techniques to alter scar (such as

Z-plasty, W-plasty) • Intermediate knowledge to debride and close

wounds, acute and chronic of the upper extremity

Confer treatment options for patients who have complications of flaps and grafts including skin graft loss, flap necrosis, wound dehiscence and wound infection.




Specify a non-operative and operative plan depending on the patient’s diagnosis, age and condition.




Assume perioperative management and surgical treatment of patients with major acute and chronic injuries of the lower extremities requiring reconstruction and resurfacing.




Specify the basic microsurgery techniques including micro-neural repair and microsurgical anastomosis.




Propose a care plan for patients with both malignant and infectious chest wall pathology




Confer decision as to which technique of anesthesia should be used on his patients.




Under in-direct supervision of attending and senior fellow, participate in the management of all plastic surgical patients postoperatively.




Medical Knowledge

SPECIALTY SPECIFIC OBJECTIVES Apply familiarity with the spectrum of congenital abnormalities of the upper extremity.




Apply knowledge of the clinical techniques for physical examination of the hand.




Asses the techniques for operative and nonoperative management of traumatic injuries of the upper extremity, their indications and contraindications, and their potential complications and treatment thereof.




Apply understanding of the specific physiology of split and full thickness skin grafts, dermal grafts, cartilage grafts, bone grafts, tendon grafts, nerve grafts, fascial grafts, and composite grafts.




Apply knowledge of the local wound factors which influence bone graft survival and recognizes the biologic differences between vascularized and non-vascularized bone grafts.




Apply understanding of the concept of fasciocutaneous flaps and can design them on the distal lower extremity.




Specify knowledge of the cutaneous margins and vascular anatomy of foot flaps including medical plantar, lateral plantar, V-Y plantar, and dorsalis pedis-based flaps.




Apply understanding of the physiology of arterial insufficiency, venous hypertension, and diabetes as they pertain to the lower extremity.



Daily Weekly End of



Rotation Annually

Apply understanding of the indications for and timing of closure of soft tissue traumatic defects of the lower extremity.




Demonstrate thorough knowledge of coverage techniques (including skin grafts, local skin flaps, distant flaps, musculocutaneous flaps, and free flaps) for soft tissue and bony closure of the lower extremity.




Apply understanding of the etiology of gynecomastia and is familiar with the various surgical options for treatment.




Apply knowledge of the principles and the techniques for administration of local anesthesia and understand the pharmacology and safe utilization of agents in "conscious sedation."




Practice Based Learning and Improvement

SPECIALTY SPECIFIC OBJECTIVES Specify learning and improvement goals based on analysis of own knowledge and expertise





Analyze evidence from plastic surgery literature that pertains to their patient’s health problems to develop management plans




Develop and integrate strategies to improve clinical performance




Apply formative evaluation feedback into daily practice




Interpersonal and Communication Skills

SPECIALTY SPECIFIC OBJECTIVES Discuss the risk/benefit ratio of the treatment or procedure with the patient




Demonstrate skills in conflict resolution Clinical teaching/experience Lectures/seminars/conferences Self-directed learning



Develop skills to lead the healthcare team Clinical teaching/experience Lectures/seminars/conferences Self-directed learning



Professionalism SPECIALTY SPECIFIC OBJECTIVES Interface with referring and consulting physicians and hospital staff in a professional and respectful manner, recognizing and instituting the core competencies




Acknowledge own and other’s limits as surgeons Clinical teaching/experience Lectures/seminars/conferences Self-directed learning



Demonstrate sensitivity to a diverse patient population




Systems-Based Practice

SPECIALTY SPECIFIC OBJECTIVES Coordinates patient care within the health care system relevant to plastic surgery




Takes responsibility for lifelong learning Clinical Direct Observation Daily


Case logs Skills evaluation Written evaluation Written Examination

Weekly End of Rotation Annually

Identify system errors and implement potential system improvement plans




`Le Bonheur Children’s Hospital Plastic Surgery Rotation PGY-4 · PDF file ·...

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