Expectations
Operating Experience: We expect you to scrub on OR cases as frequently as possible, especially on Mondays and
Thursdays. Occasionally there may be too many rotators on the service to have everyone scrub. Under these
conditions, the chief resident will determine who gets to scrub. Likewise on clinic days some residents will go to clinic
and some residents will go to the OR. Again, this designation is the responsibility of the chief resident. If you feel as
though your OR experience is lacking, please let the chief resident and the attending surgeon know. Your role in the
OR is primarily as assistant, but we will try to allow you to operate as surgeon as much as possible. Note: every patient
going to the OR requires a pre-operative note, an operative note, and a post-operative note. Operative notes are to be
dictated IMMEDIATELY following the procedure.
Clinic: It is expected that you will spend at least one full day in clinic. With three days available each week, this should
not be a problem. In general, every resident is expected to attend clinic on Tuesdays unless excused by the chief
resident. Your role in clinic is to evaluate patients and then see the same patient with Dr. Holloway.
Burn Emergency Room: The admission room in the Burn Center functions as an emergency room. All patients
presenting to the adult or pediatric ED with a burn diagnosis will be transferred to the Burn Center for evaluation.
About 50% of these patients will be admitted and about 50% will be treated as outpatients. If the nurses ask you to
evaluate an ED patient, please do so. The paperwork is very similar to that for inpatients. Once you have evaluated an
ED patient, please discuss the patient with the chief resident or one of the mid-level providers.
Conferences: Mandatory conferences include Multidisciplinary Rounds on Tuesday morning, Basic Science, M&M,
and Grand Rounds on Wednesday morning, and the noon conferences on Wednesday, Thursday, and Friday. You will
be expected to give a brief presentation (about 1 minute) on the patients you are following for Multidisciplinary Rounds.
You may also be asked to give a 20-minute didactic presentation for Burn Conference on Thursday at noon. The topics
are pre-assigned and, in general, there will be several resources available to you to prepare this brief lecture, including
PowerPoint(s) of previous talks on the same topic. The rest of the conferences generally require your attendance only.
Ward Conduct: In general, the chief resident, Ms Wall, and the PGY-2 residents will care for the ICU patients. PGY-1
residents will likely care for one or more ICU patients in addition to caring for less critical “floor” patients.
Assignments will be made by the chief resident. It is expected that you will see each of your patients in the morning
and as needed during the day including during dressing changes to evaluate the burn wounds. It is expected that you
will write a daily progress note on each patient including documentation of wound status and degree of pain control.
Any significant change in patient status or significant clinical intervention requires additional documentation in the
chart. Any significant change in patient care must be cleared with the chief resident or mid-level prior to
implementation. If you are not sure, ask.
Procedures: Maricopa residents have competency requirements that must be met prior to performing procedures (such
as central venous access, arterial lines, tube thoracostomy) independently. All rotating residents must demonstrate
proficiency at procedures to the satisfaction of the chief resident, mid-level, or attending prior to performing procedures
independently. All procedures must be accompanied by a written procedure note placed in the chart immediately
following the procedure. Bronchoscopy procedures performed by residents must be done so in the presence of the
attending burn surgeon.
Research: We have numerous clinical and basic science research trials ongoing at any point in time. Residents will be
made aware of these trials for educational purposes. Resident participation in research is strongly encouraged and
vigorously supported.
Textbook: There is really only one definitive textbook on burn care. This is Total Burn Care by Herndon. This text is
available in the Burn Center, in the Surgery library, and in the MMC library. This text is very detailed. Most general
surgical texts address the basics in burn care fairly adequately, if somewhat more superficially.
Literature: We have included copies of what we consider to be pivotal studies and publications in the field of burn care
with this packet.
Call: Junior residents are not expected to take call on the burn service.
Evaluation: The evaluation criteria that will be used by the chief surgical resident, the mid-levels, and the attending
burn surgeons to evaluate you are listed below. Additionally, each evaluator is asked to submit a subjective narrative of
overall impression, areas of strength and improvement, and overall performance. The 10 objectives specific for this
rotation-which are all part of the evaluation criteria-are listed separately below. You will also be asked to evaluate the
burn rotation, your attending surgeon, and your chief resident.
GENERAL
Exhibits initiative and self-motivation
Demonstrates dependability and reliability
Takes responsibility for own actions
Performance and actions appropriate for level of training
PATIENT CARE
Caring and respectful to patients and their families
Gathers essential and accurate diagnostic information
Formulates appropriate management plan
Performs bedsides procedures safely and competently
Performs evaluation and management of minor outpatient burns including the use
of topical antimicrobial dressings, control of pain and itching, and the use of
pressure garments to control hypertrophic scarring
Manages acute burn patients including airway control, fluid resuscitation, line
placement, and monitoring
Conducts evaluation and management of inpatient burn wounds including
recognition of superficial, partial thickness, and full thickness burns, daily
debridements and dressing changes, and evaluation for surgery
Performs tangential and fascial excision, and split-thickness skin grafting of burn
wounds, and understands the use of allograft, xenograft, and skin substitutes
Diagnoses and manages compartment syndrome and rhabdomyolysis; performs of
escarotomies and fasciotomies
PRACTICE-BASED LEARNING & IMPROVEMENT
Translates information from scientific studies to patient care
Demonstrates continuous quality improvement activity in clinical care
Uses information technology to manage information and support own education
Facilitates teaching and learning of other health care professionals
Participates effectively in burn multidisciplinary conference
INTERPERSONAL & COMMUNICATION SKILLS
Participates effectively in the informed consent process
Communicates clinical information appropriately to patients and their families
Maintains therapeutically and ethically sound relationships with patients and their
families
Demonstrates collegial attitude when interacting with other staff members
Works effectively as a team member or leader
Responds appropriately to delegation
Acts positively on constructive criticism
PROFESSIONALISM
Demonstrates respect, compassion, and integrity when interacting with patients and
their families
Demonstrates accountability to patients, society, and profession
Maintains confidentiality of private health information
Demonstrates sensitivity to patients’ culture, age, gender, and disability
Dictates thorough, concise, and timely discharge summaries
Dictates accurate and timely operative reports
Attends and participates in conferences
SYSTEMS-BASED PRACTICE
Practices cost-effective health care and resource allocation that does not
compromise quality of care
Demonstrates advocacy for patient care and assists in dealing with system
complexities
Coordinates health care professionals to improve system performance
Participates in patient discharge disposition and follow up
MEDICAL KNOWLEDGE
Understands the pathophysiology of burn pain and the evaluation, management,
and documentation of pain, and the use of sedation and alternative pain control
methods in burn patients
Develops a basic knowledge of ICU care: treatment of inhalation injury and
ventilator management, hemodynamic monitoring including pulmonary artery
catheter use, continuous renal replacement therapy (CRT), treatment of infections,
and the use of fluid and ionotropes/pressors for cardiovascular support
Understands the evaluation of the nutritional status of burn patients and
administration of enteral nutrition and nutritional supplementation
Recognizes of the special needs of pediatric and elderly burn patients
Appreciates the pathophysiology, diagnosis, and treatment of other skin diseases
including Stevens-Johnson Syndrome, Toxic Epidermal Necrolysis, necrotizing
soft tissue infections, and purpura fulminans
Objectives
The 10 objectives specific for this rotation and this level of training are listed below.
1.
Performs evaluation and management of minor outpatient burns including the use of topical antimicrobial
dressings, control of pain and itching, and the use of pressure garments to control hypertrophic scarring.
2.
Manages acute burn patients including airway control, fluid resuscitation, line placement, and monitoring.
3.
Conducts evaluation and management of inpatient burn wounds including recognition of superficial, partial
thickness, and full thickness burns, daily debridements and dressing changes, and evaluation for surgery.
4.
Performs tangential and fascial excision, and split-thickness skin grafting of burn wounds, and understands the use
of allograft, xenograft, and skin substitutes.
5.
Understands the pathophysiology of burn pain and the evaluation, management, and documentation of pain, and the
use of sedation and alternative pain control methods in burn patients.
6.
Diagnoses and manages compartment syndrome and rhabdomyolysis; performs of escarotomies and fasciotomies.
7.
Develops a basic knowledge of ICU care: treatment of inhalation injury and ventilator management, hemodynamic
monitoring including pulmonary artery catheter use, continuous renal replacement therapy (CRT), treatment of
infections, and the use of fluid and ionotropes/pressors for cardiovascular support.
8.
Understands the evaluation of the nutritional status of burn patients and administration of enteral nutrition and
nutritional supplementation.
9.
Recognizes of the special needs of pediatric and elderly burn patients.
10. Appreciates the pathophysiology, diagnosis, and treatment of other skin diseases including Stevens-Johnson
Syndrome, Toxic Epidermal Necrolysis, necrotizing soft tissue infections, and purpura fulminans.