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1 Regional Medical Center (The MED) Plastic Surgery PGY-3 By the end of the Plastic Surgery at the MED, the PGY-3 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) Patient Care Formulate 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, refine skills to diagnose, evaluate and treat patients with the following conditions that require plastic surgery, including but not limited to: Upper extremity infections Minor benign and malignant conditions of the head and neck Lower extremity trauma and ulceration of a variety of etiologic origins Wound problems such as dehisc, delayed healing, multiple traumatic wounds and evaluate patients with scar problems and revise scars to achieve maximum functional and aesthetic benefit With assistance from faculty, refine skills to perform the following plastic surgery procedures including but not limited to: Minor skin grafting of soft tissue defects of the upper extremity Specific grafting techniques including the operation of various types of dermatomes, Formative Evaluation Method(s) Frequency of Evaluation

2 management of graft donor sites, and care of graft recipient sites Knowledge of techniques to alter scar (such as Z-plasty, W-plasty) Knowledge to debride and close wounds, acute and chronic of the upper extremity Discuss treatment options for patients who have complications of flaps and grafts including skin graft loss, flap necrosis, wound dehisc and wound infection. Develop a non-operative and operative plan depending on the patient s diagnosis, age and condition. Undertake perioperative management and surgical treatment of patients with major acute and chronic injuries of the lower extremities requiring reconstruction and resurfacing. Develop the basic microsurgery techniques including micro-neural repair and microsurgical anastomosis. Formulate a care plan for patients with both malignant and infectious chest wall pathology

3 Medical Knowledge Apply knowledge of various factors, in addition to body surface area, which affect prognosis of a patient with a thermal injury. Treat patients with injuries and sequelae associated with electrical injuries. Demonstrate an understanding of principles pertinent to burn rehabilitation and reconstruction including aesthetic units of the face, tissue expansion, hair transplantation and hand splinting. Demonstrate a familiarity with the spectrum of congenital abnormalities of the upper extremity. Demonstrate the knowledge of the clinical techniques for physical examination of the hand.

4 Develop the knowledge of 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. Demonstrate an 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. Demonstrate knowledge of the local wound factors which influ bone graft survival and recognizes the biologic differs between vascularized and non-vascularized bone grafts. Demonstrate an understanding of the concept of fasciocutaneous flaps and can design them on the distal lower extremity. Develop knowledge of the cutaneous margins and vascular anatomy of foot flaps including medical plantar, lateral plantar, V-Y plantar, and dorsalis pedis-based flaps. Demonstrate an understanding of the physiology of arterial insufficiency, venous hypertension, and

5 diabetes as they pertain to the lower extremity. Demonstrate an understanding of the indications for and timing of closure of soft tissue traumatic defects of the lower extremity. Develop a 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. Demonstrate an understanding of the management of infectious processes (including osteomyelitis) related to traumatic injuries of the lower extremity. Demonstrate an understanding of the etiology of gynecomastia and is familiar with the various surgical options for treatment. Demonstrate knowledge of the principles and the techniques for administration of local anesthesia and understand the pharmacology and safe utilization of agents in "conscious sedation."

6 Practice Based Learning and Improvement Interpersonal and Communication Skills Analyze progress towards meeting and improvement goals Assimilate evid from plastic surgery literature that pertains to their patient s health problems to develop management plans Demonstrate improvement in clinical management Incorporate formative evaluation feedback into daily practice Takes the time to explain the treatment or procedure

7 Professionalism Accurately present a case to attending physician, fellows, residents, and other health care professionals Educate and counsel patients and families Demonstrate empathy when communicating endof-life information Demonstrate exemplary professional behavior including respect, compassion, integrity, punctuality, reliability, and honesty with patients and colleagues Demonstrates accountability to patients, society and the profession Demonstrate sensitivity to issues of culture, age,

8 Systems-Based Practice gender, ethnicity, and disability in patient care Describe the business aspects of medical practice including coding, billing and insurance in patient care Utilize available resources within the hospital system to provide optimal care Implement potential system improvement plans

9 St Jude Children s Hospital Plastic Surgery Pediatric PGY-3 By the end of the St. Jude rotation, PGY-3 residents are expected to expand and cultivate skills and knowledge learned during previous training and to achieve the following objectives based on the six general competencies. The resident should exhibit an increasing level of responsibility and independency as he or she progresses throughout the year. Competency Required Skill(s) Teaching Method(s) Formative Evaluation Method(s) Patient Care Provide preoperative, postoperative and follow up care for patients. Diagnose, evaluate and treat patients with common conditions that require surgery including, but not rs/c limited to: onfers Flap salvage, lower extremity Chest wall/breast reconstruction Skin graft/flap closure carcinoma defects Medical Knowledge Demonstrate an understanding of flaps, skin grafts in the pediatric patient. Demonstrate knowledge of the methods for diagnosis and treatment of chest wall/breast reconstruction in the pediatric patient. Develop a detailed knowledge of the anatomy of the lower extremity of a pediatric patient. Demonstrate familiarity with the spectrum of secondary radiation effects in the pediatric patient. rs/c onfers rs/c onfers rs/c onfers Frequency of Evaluation

10 Practice Based Learning and Improvement Interpersonal and Communication Skills Demonstrate knowledge of skin grafts/flap closure of cutaneous carcinoma defects and understand their basic principles and treatment. Develop and improvement goals based on analysis of own knowledge and expertise Synthesize evid from plastic surgery literature that pertains to their patient s health problems to develop management plans Demonstrate improvement in clinical management Incorporate formative evaluation feedback into daily practice Analyze benefits/risks of a treatment or procedure rs/c onfers rs/c onfers rs/c onfers rs/c onfers rs/c onfers rs/c onfers rs/c onfers

11 Professionalism Demonstrate respectful and considerate attitudes, effectively communicate with patients families and other health care personnel Accurately present a case to attending physician, fellows, residents, and other health care professionals Provide timely and legible medical record documentation including histories and physical exams, admission notes, progress notes, procedure notes and discharge summaries Educate and counsel patients and families Interact with colleagues in a team-focused manner Demonstrate exemplary professional behavior including respect, compassion, integrity, punctuality, reliability, and honesty with patients and colleagues rs/c onfers rs/c onfers rs/c onfers rs/c onfers rs/c onfers rs/c onfers Demonstrate behaviors conducive to patient wellness

12 Systems-Based Practice Demonstrate accountability to patients, society and the profession Appraise issues of culture, age, gender, ethnicity, and disability as it relates to each patient Develop the skills to work within St. Jude s unique system where inability to pay does not impact patient care Utilize available resources within the hospital system to provide optimal care Analyze the impact of St. Jude s mission on your own patient care practices rs/c onfers rs/c onfers rs/c onfers rs/c onfers rs/c onfers rs/c onfers

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