Name of Resident AOA # Mailing Address

Transcription

1 AMERICAN OSTEOPATHIC ASSOCIATION RESIDENT S ANNUAL REPORT FOR GENERAL SURGERY and/or SPECIALTY TRACK INTERNSHIP American Osteopathic College of Otolaryngology-Head and Neck Surgery Name of Resident AOA # Mailing Address Daytime Phone ( ) Base Training Institution Address Name of Program Director(s) Year of Training: General Surgery Specialty Track Intern Report Period: From To: mo/day/yr mo/day/yr List hospital(s), length of each rotation, and identify rotation (as it applies to the specialty track intern): A. Name of Hospital Length of Rotation Rotation B. Name of Hospital Length of Rotation Rotation C. Name of Hospital Length of Rotation Rotation D. Name of Hospital Length of Rotation Rotation E. Name of Hospital Length of Rotation Rotation You are requested to use the above listing(s) as a way to identify the location of the facility in which each procedure was performed. Use the letter of the facility from above along with the number of procedures as you fill out each area of the segregated totals (i.e., b-3, c-5, etc.) Thus, one would be able to see how many procedures of each type are done in the base or an outside hospital. Total # of Major Procedures First Assistant Performed Under Supervision Total # of Minor Procedures First Assistant Performed Under Supervision Total Surgical Mortalities INSTRUCTIONS: This form is used by AOA-approved hospitals with residency programs in Otolaryngology and/or Facial Plastic Surgery and/or Head and Neck Surgery and by residents in the completion of their required annual reports. For your convenience, this form is compatible with the codes and nomenclature found in the International Classification of Diseases (ICD), 9 th Edition, which is used by medical record administrators. Please complete the entire form within thirty (30) days of the completion of EACH TRAINING YEAR and forward to the appropriate office as indicated below. One copy of this report with supporting documentation are to be mailed to the American Osteopathic Colleges of Ophthalmology and Otolaryngology-Head and Neck Surgery (AOCOO-HNS), 4764 Fishburg Road, Suite F, Huber Heights, OH within thirty (30) days of completion of each contract year. Failure to meet the deadline for submission may result in delayed evaluation by the specialty college. I certify that the information on this form is correct and accurate. (Signature of Resident) (Date) (Signature of Program Director) (Date)

2 Resident's Annual Segregated Total Report for General Surgery / Specialty Track Internship Number of Procedures I. Operations on Thyroid & Parathyroid Glands A. Unilateral thyroid lobectomy B. Other partial thyroidectomy C. Total thyroidectomy D. Excision of thyroglossal duct E. Parathyroidectomy F. Other operations thyroid &parathyroid region TOTAL PROCEDURES FOR SECTION I II. Operations on Other Endocrine Glands A. Adrenalectomy B. Thymectomy TOTAL PROCEDURES FOR SECTION II III. Operations on Liver A. Hepatotomy (Other than needle biopsy) B. Wedge resection C. Lobectomy D. Repair of liver TOTAL PROCEDURES FOR SECTION III IV. Operations on Gallbladder and Biliary Tract A. Cholecystostomy B. Laparoscopic Cholecystectomy C. Open Cholecystectomy Secondary procedures Common duct exploration Operative cholangiogram Without stones Choledochoscopy D. Gall bladder or bile duct anastomosis E. Common duct exploration F. Sphncteroplasty TOTAL PROCEDURES FOR SECTION IV V. Operations on Pancreas A. Pancreatotomy(other than needle biopsy) B. Local excision of pancreatic lesion C. Marsupialization of pancreatic cyst D. Internal drainage of pancreatic cyst E. Partial Pancreatectomy F. Total pancreatectomy G. Radical pancreaticoduodenectomy TOTAL PROCEDURES FOR SECTION V Page 2 - COPT/R-99

3 VI. Repair of Hernia A. Inguinal-unilateral B. Inguinal-bilateral C. Femoral Hernia D. Umbilical Hernia E. Incisional Hernia F. Other (list separately) 53.9 TOTAL PROCEDURES FOR SECTION VI VII. Other abdominal operations (only as Primary procedures) A. Exploratory laparotomy B. Lysis of adhesions (For relief of obstruction) C. Closure of disruption D. Peritoneovenous fistula TOTAL PROCEDURES FOR SECTION VII VIII. Operations on Kidney A. Nephrostomy Open Percutaneous B. Percutaneous Nephrolithotomy C. Extracorporeal Lithotripsy D. Open Biopsy E. Partial nephrectomy F. Total nephrectomy (including Radical) G. Pyeloplasty TOTAL PROCEDURES FOR SECTION VIII IX. Operations on Ureter A. Removal of obstruction-transurethral B. Ureteral meatotomy C. Ureterotomy D. Ileal conduit E. Other external diversion F. Other anastomosis G. Repair of ureter TOTAL PROCEDURES FOR SECTION IX Page 3 - COPT/R-99

4 X. Operations on Urinary Bladder A. Cystotomy (other than Percutaneous insertion) B. Cystostomy C. Excision or fulguration D. Partial cystectomy TUR Open E. Total cystectomy F. Repair of bladder rent TOTAL PROCEDURES FOR SECTION X XI. Other Operations on Urinary Bladder A. Plication of urethrovesical junction B. Urethral suspension MMK C. Other repair of stress incontinence TOTAL PROCEDURES FOR SECTION XI XII. Operations on Prostate and Seminal Vesicles A. Transurethral resection B. Prostatectomy Suprapubic Retropubic Perineal C. Radical prostatectomy D. Vasovasostomy or TOTAL PROCEDURES FOR SECTION XII XIII. Operations on Testes A. Incision of testis B. Unilateral orchiectomy C. Bilateral orchiectomy D. Orchiopexy TOTAL PROCEDURES FOR SECTION XIII XIV. Operations on Ovary ONLY AS PRIMARY PROCEDURE A. Wedge resection B. Unilateral oophorectomy C. Unilateral salpingo-oophorectomy D. Bilateral oophorectomy E. Bilateral salpingo-oophorectomy F. Repair of ovary TOTAL PROCEDURES FOR SECTION XIV Page 4 - COPT/R-99

5 XV. Operations on Fallopian Tubes ONLY AS PRIMARY PROCEDURE A. Bilateral endoscopic occlusion of tubes B. Other bilateral ligation and division C. Bilateral salpingectomy D. Salpingoplasty TOTAL PROCEDURES FOR SECTION XV XVI. Operations on Uterus A. Hysterotomy (including cesarean section) B. Total abdominal hysterectomy C. Vaginal hysterectomy D. Radical hysterectomy with node sampling or bilateral lymphadenectomy E. Pelvic Exenteration Anterior Posterior Total TOTAL PROCEDURES FOR SECTION XVI XVII. Operations of Vagina and cul-de-sac A. Obliteration or total excision of vagina B. Repair of cystocele and rectocele C. Repair of enterocele D. Vaginal reconstruction TOTAL PROCEDURES FOR SECTION XVII XVIII. Operations on Breast A. Reduction mammoplasty or subcutaneous mammectomy B. Mastectomy Quandrantectomy Unilateral simple Bilateral simple Unilateral modified radical Bilateral modified radical Unilateral standard radical Bilateral standard radical Unilateral extended radical Bilateral extended radical C. Augmentation mammoplasty D. Mastopexy E. Total reconstruction of breast TOTAL PROCEDURES FOR SECTION XVIII Page 5 - COPT/R-99

6 XIX. Neurological Surgery A. Burr hole exploration for ICP or Reservoir placement Ventriculostomy B. Craniotomy for Cerebral aneurysm or AVM Brain Tumor Cerebral revascularization Elevation depressed skull fracture Decompression for Tic Seizure ablation C. Incision of brain D. Rhizotomy E. Cordotomy Open Percutaneous F. Laminectomy Cervical Thoracic Lumbar G. Repair of peripheral nerve (other than carpal tunnel) H. Ventricular shunt I. Operations on cranial nerves J. Sympathectomy Cervical Thoracic Lumbar K. Carotid endarterectomy L. Anterior cervical disectomy M. Other (list separately, refer to page 10) TOTAL PROCEDURES FOR SECTION XIX XX. Thoracic Surgery: Lung and Bronchus A. Segmental resection lung B. Lobectomy (total or segmental) C. Pneumonectomy (simple or radical) D. Radical pneumonectomy with intra pericardial dissection E. Repair of bronchial tear F. Resection of mediastinal tumor G. Exploratory thoracotomy Biopsy Bleb resection Pleurodesis Drainage Trauma Page 6 - COPT/R-99

7 XX. Thoracic Surgery: Long and Bronchus (continued) H. Correction major thoracic deformity (trauma) I. Decortication of lung TOTAL PROCEDURES FOR SECTION XX XXI. Cardiovascular Surgery A. Replacement of heart valve B. Repair of septal defect C. Total repair congenital cardiac anomalies D. Coronary artery bypass IMA Vein With angioplasty E. Pericardiotomy with drainage F. Repair of trauma to heart & pericardium G. Permanent transvenous pacemaker H. Intra aortic balloon pump insertion I. Others (list separately, refer to page 10) TOTAL PROCEDURES FOR SECTION XXI XXII. Vascular Surgery A. Embolectomy or thrombectomy (limb) B. Endarterectomy Carotid Aortic Iliac or Femoral C. Ligation and stripping varicose veins D. Interruption of inf. Vana cava Transvenous Ligation or clip E. Intra-abdominal venous shunt F. Intra-thoracic vascular graft G. Aorto-iliac-femoral graft H. Peripheral vascular graft Hip to Knee Knee to foot Hip to foot I. Suture of artery J. Abdominal aortic resection with graft K. All other aneurysm resections L. Arteriovenous fistula for dialysis M. Arteriovenous shunt (dialysis) N. Percutaneous angioplasty (independent procedure) O. Sympathectomy (see Neurologic Surg.) Page 7 - COPT/R-99

8 XXII. Vascular Surgery (continued) P. Major amputation (see Orthopedic Surg.) (no digits) 84 Q. Other (list separately, refer to page 10) TOTAL PROCEDURES FOR SECTION XXII XXIII. Orthopedic Surgery A. Major amputations of limbs B. Arthroplasties of major joints C. Open reduction of major bones or joints D. Other (list separately, refer to page 10) TOTAL PROCEDURES FOR SECTION XXIII XXIV. Operations on the Digestive System A. Operations on esophagus 1. Esophagotomy Cervical esophagostomy Excision of diverticulum with or without myotomy Partial esophagectomy Total esophagectomy Esophagomyotomy Repair of Esophagus B. Operations on stomach 1. Temporary gastrostomy 43.1 Laparotomy PEG Permanent Gastrostomy Pyloromyotomy Partial gastrectomy with anastomosis to esophagus Partial gastrectomy-bilroth I Partial gastrectomy-bilroth II Total gastrectomy Vagotomy With pyloroplasty With gastrojejunostomy With pyloric antrectomy Transthoracic Highly selective Gastric bypass or stapling (any method) Suture of perforated ulcer (gastric or duodenal) Closure of gastrostomy Page 8 - COPT/R-99

9 XXIV. Operations on the Digestive System (continued) Operations on stomach (continued) 12. Creation of esophagogastric sphincteric competency Transabdominal Transthoracic Repair of diaphragmatic hernia (Traumatic) Other (list separately,refer page10) TOTAL PROCEDURES FOR SECTION XXIV XXV. Incision Excision and Anastomosis of Intestine A. Enterotomy B. Enterorrhaphy Large intestive Small intestine C. Enteroenterostomy D. Partial small bowel resection E. Resection of cecum and terminal ileum F. Right hemicolectomy G. Resection of transverse colon H. Left hemicolectomy I. Sigmoid resection J. Total abdominal colectomy (subtotal colectomy) K. Proctocolectomy L. Proctosigmoidectomy (low anterior resection) M. Abdominoperineal resection N. Colostomy (primary operation) O. Closure of stoma or fistula P. Appendectomy(primary proced.only) TOTAL PROCEDURES FOR SECTION XXV XXVI. Operations on Spleen A. Elective splenectomy B. Splenectomy for trauma C. Splenorrhaphy TOTAL PROCEDURES FOR SECTION XXVI Page 9 - COPT/R-99

10 OTHER MAJOR SURGERIES Number of Procedures TOTAL OTHER MAJOR PROCEDURES Page 10 - COPT/R-99

11 SUMMARY OF PROCEDURAL SECTIONS A. Total Procedures for Section I B. Total Procedures for Section II C. Total Procedures for Section III D. Total Procedures for Section IV E. Total Procedures for Section V F. Total Procedures for Section VI G. Total Procedures for Section VII H. Total Procedures for Section VIII I. Total Procedures for Section IX J. Total Procedures for Section X K. Total Procedures for Section XI L. Total Procedures for Section XII M. Total Procedures for Section XIII H. Total Procedures for Section XIV O. Total Procedures for Section XV P. Total Procedures for Section XVI Q. Total Procedures for Section XVII R. Total Procedures for Section XVIII S. Total Procedures for Section XIX T. Total Procedures for Section XX U. Total Procedures for Section XXI V. Total Procedures for Section XXII W. Total Procedures for Section XXIII X. Total Procedures for Section XXIV Y. Total Procedures for Section XXV Z. Total Procedures for Section XXVI Total Other Major Procedures OVERALL TOTAL OF PROCEDURES Number of Procedures Page 11 - COPT/R-99

12 NUTRITIONAL SUPPORT SERVICE A. Nutritional Support Cases 1. Enteral Support 2. Peripheral Support Central Support B. Nutritional Support Techniques 1. Central venous access a. Insertion into a vein Subclavian Internal Jugular b. Cutdown c. Broviac/Hickman Catheter insertion d. Mediport Infusoport e. Other Total of Nutritional Support Service ENDOSCOPY A. Esophagogastroduodenoscopy B. Rigid Sigmoidoscopy C. Flexible Sigmoidoscopy D. Fiber optic Colonoscopy E. Fiber optic Bronchoscopy With biopsy F. Cystoscopy G. Peritoneoscopy H. E.R.C.P. 1. Cannulation ob biliary tract Or pancreatic duct With sphincterotomy Choledochoscopy Total of Endoscopic Procedures Page 12 - COPT/R-99

13 MINOR SURGERIES Basic principles of wound care Opening of abdomen Closing of abdomen Excision of skin lesions Benign Malignant Excision of subcutaneous lesions Repair of laceration Simple Complicated Critical care monitoring Placement of arterial line Placement of central venous line Placement of Swan-Ganz catheter Enteral support Placement of nasojejunal feeding tube Percutaneous endoscopic gastrostomy Permanent gastrostomy Jejunostomy Needle Tube Placement of Infusaport Placement of Hickman/Broviak Groshong catheter Implantable venous access device Excision of lymph node (biopsy) Needle liver biopsy Needle aspiration of thyroid Anus Fissurectomy Fistulectomy Drainage of perianal abscess Pilonidal cystectomy Hemorrhoidectomy Injection therapy Rubber banding Infra-red coagulation Cryosurgery Laser Surgical Excision Breast Drainage of abscess Excision of recurring suppuration Aspiration/needle biopsy Excision of breast mass Page 13 - COPT/R-99

14 MINOR SURGERIES (continued) Vulva Local excision of lesion Drainage of Bartholin cyst Excision of Bartholin cyst Vagina Repair of laceration [OB 75.69] Excision of vaginal lesion Cervix Colposcopy Conization Repair of cerical laceration [OB 75.51] Uterus Fractional dilatation and curettage Endometrial biopsy Fallopian Tubes Sterilization procedure 1. Open Laparoscopic Trauma Thoracentesis Closed tube thoracostomy Pericardiocentesis Endotracheal intubation Ventilator support Abdominal paracentesis with lavage Tracheostomy Cardiopulmonary resuscitation Genitourinary Urethral dilatation Cystoscopy Hydrocelectomy Spermatocelectomy Circumcision Total of All Minor Surgeries Page 14 - COPT/R-99