Training Program Goals and Objectives
This policy applies to:
The General Surgery Training Program
Last Approval Date:
Name of Policy:
Overall Educational Goals for the Program
Written by: Marc L. Melcher, MD, PhD , Program Director
Reference Number to ACGME Common Program Requirements: [CPR IV.A.1]
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The goal of the Stanford General Surgery Program is to train high quality, professional, surgeons who make lasting impacts on the field of surgery through leadership positions in academia, research, healthcare, and education
To accomplish this we provide residents with level-specific training and guidance not only in the fundamentals of evidence-based clinical practice, the basic science principles that underlie the primary components of general surgery, and exposure to multiple healthcare delivery systems.
Technical skill is fundamental to the successful training of our residents and is taught in the operating room, in the surgical skills curriculum, and the Goodman Center for Surgical Simulation. Every resident in the General Surgery Training Program at Stanford is expected to receive the same level of technical training.
Our program’s clinical training includes the development of clinical and technical skills, experience in self-evaluation, systems based practice, the development of personal communication skills, teaching, and professionalism.
To further prepare our graduates for their careers they take time away from clinical duties for “Professional Development”. This period usually occurs after the second clinical year and will last two to three years. Residents may choose basic science research or applied surgical research. In addition, we have begun a Professional Development curriculum which allows residents to obtain advanced degrees in education, public health, law, business, international medicine and surgical simulation.
The following describes these goals in detail, how we accomplish them, and how we assess our success.
■ to train residents who perform appropriate and effective treatments of surgical diseases
■ to teach residents to communicate effectively, compassionately, and professionally with patients, families and colleagues
■ to teach residents to make evidence based decisions about diagnostic and therapeutic interventions, utilizing up-to-date scientific evidence and clinical judgment
■ to teach residents to use information technology to support patient care decisions and patient education and to train residents to work with health care professionals including those from other disciplines to provide multidisciplinary patient-focused care
The residents partake in the teaching activities developed by our program. Both level specifc and level independent teaching is provided. Early in the year new interns complete an “intern boot camp” to review potential on-call emergencies, learn how to navigate the electronic medical record, etc.
By taking on the clinical care of the patients with graduated responsibilities the residents develop their communication and surgical skills and apply their medical knowledge to the surgical diseases of their patients. Residents take on a graduated level of responsibility of patient care culminating in the Chief Residency year.
PGY 1: are expected to learn how to collect data, synthesize it, and accurately report it in a meaningful way to others on the surgical team. They are expected to learn how to identify sick patients that require additional intervention. They acquire basic surgical skills in the operating room.
PGY 2 & 3: are expected to perform the above tasks at a higher level, with more efficiency and accuracy. PGY2 residents begin to take consult call and learn how to diagnose surgical diseases in new patients and how to develop care plans that they review with their attendings and senior residents. In addition, these residents learn ICU care by working in the ICU. PGY 3 residents also begin to gain leadership experience running services.
PGY 4: consistently take on leadership positions on services where they are the most senior resident. For example, they are responsible for running the Trauma Service and the VA general surgery service.
Chief Residents receive the patient care data, validate it, discuss treatment options, and enact a treatment plan with the guidance of the attending.
Residents must develop the manual dexterity appropriate at each level. Therefore, residents are expected to perform a wide breath of procedures in sufficient numbers to achieve this. OR data are reviewed semi-annually to assure compliance. Technical skills are evaluated in the OR supplemented by simulation exercises in the Goodman Simulation Center.
Teaching activities include the following; Core Course, Morbidity and Mortality Conference, Daily Rounds, Attending Rounds, Pre-op Conferences, Clinical Care Conference, Mock Orals, Surgical Skills Course and Surgical Boot Camp.
Residents are evaluated and receive feedback in formal setting such as attending rounds and Morbidity and Mortality Conference. The faculty provides written assessments of their performance on each rotation using the “Medhub” global evaluation program. Residents receive face to face feedback after partaking in the mock orals.
Residents are expected to log all their surgical cases in the internet based ACGME Case Log Software. They are given immediate feedback by attendings during cases and documented feedback through Medhub at the end of each rotation.
2. Medical Knowledge
● to demonstrate knowledge of established and evolving biomedical and clinical science, as well as the application of this knowledge to patient care
● to demonstrate an understanding of the basic science that is the foundation for surgical practice and have a clinical knowledge necessary to treat the broad range of surgical diseases
■ every two years residents should review a complete surgical curriculum
■ residents need to go to and actively participate in the core course
■ junior and senior residents should present portions of the curriculum to their colleagues to facilitate their own deeper understanding of the materials
We have developed a core curriculum that is based on the curriculum put forth by the American College of Surgery and SCORE. This curriculum is completely presented every two years in Core Course. Core Course consists of 1.5 hours per week of lectures and Socratic method of teaching following a structured curriculum. Chapters from surgical textbooks covering the topic of the week are required reading.
The teaching activities consist of the following; Morbidity and Mortality Conference, weekly Grand Rounds, Daily Rounds, Attending Rounds, Pre-op Conferences, Clinical Care Conference and Surgical Skills Laboratory.
Evaluation by the Program Director, the service attendings (documented in MedHub), and chief residents (documented in MedHub).
■ three multiple choice practice ABSITE exams
■ mock orals for PGY-3 through 5. Residents get written feedback that is placed in their permanent record
■ ABSITE examination – Our goal is that all our residents score above the 50th percentile
3. Practice-Based Learning
Residents must demonstrate the ability to appraise and assimilate scientific evidence and to continually improve patient care based on constant self-evaluation and life-long learning. They are expected to develop skills and habits to meet the following goals:
● identify strengths, deficiencies, limits in one’s knowledge and expertise and set learning and improvement goals
● identify and perform appropriate learning activities, and analyze practice using quality improvement methods
● residents must be able to locate, appraise and assimilate evidence from scientific studies related to their patients’ health problems
● residents must be able to use information technology to optimize learning and to participate in the education of patients and families
■ use information technology to organize and review published scientific data and develop an understanding of factors such as demographics and insurance that influence their patients’ health problems
■ Self-assessment of surgical outcomes: Every six months residents review a series of their own cases and outcomes to try learn from their experience. This log is reviewed at the Biannual Program Director meeting.
■ take leadership roles in the teaching of students and more junior surgical residents
■ become involved in standardized simulations of surgical diseases to develop and assess their surgical skills
Goodman Simulation Center: Each resident is required to attend surgical skills at our new simulation center and they have protected time to attend their scheduled sessions. Our new simulation facility gives our residents first chance to experience surgery without the high stakes of a real operation. The Goodman Simulation Center will lead the way towards improved patient safety and quality of care by providing the best and most comprehensive learning for our residents.
It emphasizes on; Standardized Patients, Part-task & Procedural Simulation, and Patient Simulation for Individuals & Teams. These provide mannequin-based simulation drills to assess decision-making, team collaboration skills and to enhance training, teamwork and skills involving complex surgical cases, ICU patient care and trauma resuscitation
Morbidity and Mortality Conference: Senior residents are expected to present surgical complications to the department. Their presentation includes a critical assessment of the event, a review of the literature, and the development of a plan of action to reduce the chance of a recurrence.
Feedback is documented online in MedHub, and progress and feedback is reviewed with the resident at the biannual meetings with the program directors.
4. Interpersonal and Communication Skills
■ residents must demonstrate interpersonal and communication skills that exchange information and collaboration with patients and their families upon a broad-range of socioeconomic and cultural backgrounds
■ residents must communicate effectively with physicians, other health professionals and health related agencies and work effectively as a member or leader of a health care team
■ maintain comprehensive, timely, and legible medical records, if applicable.
■ residents should be able to present clinical cases to others in a clear, concise, and structured way to facilitate precise effective treatment of patients
■ residents should work well within a surgical team by facilitating communication between members of the team and be able to communicate and coordinate care with other medical specialties
■ senior residents should take an active role in the education of medical students and junior residents
Presentation of patients on Chief Resident Rounds; presentation of patients on Attending Rounds, Specific Core Course Lectures: 1) Lecture on Giving Bad News: Oncologist Beth Martin, MD and 2) Lectures by Cardiology, Radiology, etc to facilitate resident communication with consulting services.
Chief residents and Attendings give regular feedback through the Medhub online system and 360 Degrees of feedback from nurses on the wards.
Graduates of our program should be:
■ respectful of and responsive to the needs of diverse patient populations and be respectful of patient privacy and autonomy
■ accountable and compassionate to patients and society
■ cognizant of when patient needs supersede self-interest
■ accountable for their responsibilities and obligations as physicians as part of larger organizations.
● Residents treat every patient with respect.
● Residents treat co-workers with respect.
● Residents complete their documentation of medical care to facilitate optimal medical care.
Residents rotate through multiple styles of healthcare systems including a private hospital, a county hospital, the Veterans Administration Hospital, and a managed care hospital. Each gives exposure to overlapping diverse groups of patients with diverse backgrounds.
On daily rounds attendings and senior residents are expected to model professional behavior when interacting with patients.
Attendings and senior residents take on the responsibility of assessing the professionalism of the residents. Their assessments are documented in Medhub. Problems are addressed face-to-face with relevant attendings and/or the Program Director or Associate Program Director.
Hospital Medical records departments let our residents know whether they have not complted their documentation.
6. Systems-Based Practice
Residents must demonstrate an awareness of and a responsiveness to the larger system of healthcare and the resources to provide optimal healthcare.
● they must work effectively in a variety of healthcare delivery settings and coordinate patient care within that health system relevant to their clinical specialty
● they must incorporate considerations of cost and risk-benefit analysis in patient care and/or population-based care as appropriate
● residents must advocate for quality patient care, work in teams to enhance patient safety, and improve patient care
● identify system errors and implement potential systems solutions
● Residents will learn to function in a variety of healthcare systems including: private practice, county, university, and VA hospitals.
● Residents should actively look for opportunities to improve patients safety and surgical outcomes.
Teaching activities should include the following; Core Course, Morbidity and Mortality Conference, Daily Rounds, Attending Rounds, Pre-op Conferences, Clinical Care Conference. Residents are encouraged to participate in quality improvement projects.
Attendings and senior residents assess the efficiency of the residents’ ability to navigate through the multiple hospital systems.