Residency Level:
Surgical Rotation:
Length of Rotation:
PGY 1
SICU
1 Weeks - (One 4-Week Rotations)
Goals and Objectives
Patient care:
 Evaluation and preparation of the pre-operative general surgical patient
 Management skills required to independently evaluate the surgical patient, develop your own plan for the
patient and communication of the plan to the appropriate level of supervision
 Take ownership in care of the patient
 Post-operative care of the surgical patient
 Mechanisms and criteria for minimally invasive surgery of the abdomen
 Fluid and electrolyte management including indications for parenteral and enteral nutrition
 Understanding and utilization of diagnostic techniques including routine films, contrast studies, ultrasound,
CT scan, MRI and endoscopic procedures
 Clear and timely documentation of daily progress notes
 Develop a strong work ethic
 Develop appropriate safe hand offs
 Develop the ability to care for surgical emergencies in the role as the surgical resident on call
Technical skill:
 Become proficient in correct basic surgical technique such that incision, suturing, knot-tying and dissection
 Evaluation of the acute abdomen
 Assist at major abdominal and minimally invasive surgical procedures
 After a period of learning and appropriate supervision, perform procedures for venous access, chest tube
placement, etc.
 After a period of learning and appropriate supervision, learn to perform minor surgical procedures (i.e.
excisional biopsies, lipoma removal), hernia repair, appendectomy, cholecystectomy and bowel resections
Medical knowledge:
 Demonstrate evidence of continued increase in general surgery core knowledge from basic surgical texts,
additional readings and the SCORE curriculum as noted below
 Obtain a broad knowledge base of general surgery and other surgical specialties
 Study and prepare for the ABSITE
 Anatomy and physiology of the GI tract, liver, biliary tract and pancreas
 Fluid and electrolyte management including management of parenteral and enteral nutrition
Practice-based learning and improvement:
 Participate actively in M and M conferences, daily chief conferences and journal clubs
 Understand and when possible participate in SCOAP projects
 Learn to critically read the literature
 Master the IT resources available to you to develop a commitment to lifelong learning and education
 You are encouraged to pursue a clinical research project in an area that interests you
Interpersonal and communication skills:
 Develop the appropriate skills to provide efficient, concise, patient presentations
 Master text paging, emailing, etc.
 Develop strong doctor patient relationships using counseling and education of patients and their families
 Learn to master EPIC to provide proper documentation in the electronic medical record
 Learn to properly consult other specialty services in a professional manner
Professionalism:
 Respect every patient regardless of social or other circumstances
 Log cases appropriately
 Log your duty hours using My Evaluations appropriately and in a timely fashion
 Complete all required clinical and residency documents in a timely fashion
 Demonstrate sensitivity to age, gender and culture of patients and other members of the health care delivery
team
 Learn to be punctual
 Always exemplify professional attire, appropriate grooming and hygiene
 Demonstrate honesty, integrity and leadership skills
Systems-based practice:
 Demonstrate effective communication with referring physicians throughout the Swedish health care system
 Keep patients’ safety foremost while discharging patients in a timely fashion
 Demonstrate time management and organizational skills while adhering to work hour regulations
 Gain an understanding of the importance of discharge planning and the writing of timely discharge orders
to the overall throughput of patients in our system
CATEGORY 1: ABDOMEN − GENERAL
Diseases/Conditions
BROAD
• Acute abdominal pain
• Intra-abdominal abscess
• Rectus sheath hematoma
FOCUSED
• Chronic abdominal pain
• Carcinomatosis
• Pseudomyxoma peritoneii
• Spontaneous bacterial peritonitis
• Desmoid tumors
• Chylous ascites
• Retroperitoneal fibrosis
Operations/Procedures
ESSENTIAL − COMMON
• Insertion peritoneal dialysis catheter
• Laparoscopic exploratory laparotomy
• Open exploratory laparotomy
ESSENTIAL − UNCOMMON
• Open drainage abdominal abscess
SCORE CURRICULUM - CATEGORY 2: ABDOMEN − HERNIA
Diseases/Conditions
Operations/Procedures
BROAD
ESSENTIAL − COMMON
• Inguinal hernia
• Open repair of inguinal and femoral hernia
• Femoral hernia
• Laparoscopic repair of inguinal and femoral hernia
•Ventral hernia
• Open repair of ventral hernia
• Miscellaneous hernias
• Laparoscopic repair of ventral hernia
ESSENTIAL − UNCOMMON
• Repair miscellaneous hernias
SCORE CURRICULUM - CATEGORY 3: ABDOMEN − BILIARY
Diseases/Conditions
Operations/Procedures
BROAD
ESSENTIAL − COMMON
• Jaundice
• Open cholecystectomy with or without cholangiography
• Cholangitis
• Laparoscopic cholecystectomy with or with
• Acute cholecystitis
out cholangiography
• Chronic cholecystitis
• Choledocholithiasis
ESSENTIAL − UNCOMMON
• Biliary pancreatitis
• Acalculous cholecystitis and biliary dyskinesia
FOCUSED
• Gallbladder cancer
• Cancer of the bile ducts
• Choledochal cyst
• Cholecystostomy
SCORE CURRICULUM - CATEGORY 4: ABDOMEN − LIVER
Diseases/Conditions
Operations/Procedures
BROAD
ESSENTIAL − COMMON
• Liver mass − evaluation
• Open liver biopsy
• Hepatic abscess
• Laparoscopic liver biopsy
FOCUSED
• Hepatic adenoma
• Focal nodular hyperplasia
• Hemangioma
• Hepatocellular carcinoma
• Cholangiocarcinoma
• Metastatic tumors
• Miscellaneous hepatic neoplasms
ESSENTIAL − UNCOMMON
• Drainage liver abscess
SCORE CURRICULUM - CATEGORY 5: ABDOMEN − PANCREAS
Diseases/Conditions
BROAD
• Pancreatic abscess and infected necrosis
• Pancreatic pseudocyst
FOCUSED
• Autoimmune pancreatitis
• Chronic pancreatitis, including hereditary
pancreatitis
• Pancreatic insufficiency
• Ductal adenocarcinoma
• Acinar cell carcinoma
• Cystic neoplasms
• Intraductal papillary mucinous neoplasms
SCORE CURRICULUM - CATEGORY 6: ABDOMEN − SPLEEN
Diseases/Conditions
BROAD
• Postsplenectomy sepsis
FOCUSED
• Hemolytic anemias
• Idiopathic thrombocytopenic purpura
• Secondary hypersplenism and splenomegaly
• Neoplasms of spleen
• Splenic cysts
SCORE CURRICULUM - CATEGORY 7: ALIMENTARY TRACT −ESOPHAGUS
Diseases/Conditions
Operations/Procedures
BROAD
ESSENTIAL − COMMON
• Gastroesophageal reflux and Barrett’s esophagus
• Laparoscopic antireflux procedure
• Hiatal hernia
• Dysphagia
FOCUSED
• Achalasia
• Zenker’s diverticulum
• Epiphrenic diverticulum
• Foreign bodies
SCORE CURRICULUM - CATEGORY 8: ALIMENTARY TRACT − STOMACH
Diseases/Conditions
Operations/Procedures
BROAD
ESSENTIAL − COMMON
• Upper gastrointestinal bleeding
• Percutaneous endoscopic gastrostomy
• Gastric carcinoma
• Open gastrostomy
• Duodenal ulcer
• Gastric ulcer
• Peptic ulcer disease with bleeding
• Peptic ulcer disease with perforation
• Peptic ulcer disease with obstruction
SCORE CURRICULUM - CATEGORY 9: ALIMENTARY TRACT − SMALL INTESTINE
Diseases/Conditions
Operations/Procedures
BROAD
ESSENTIAL − COMMON
• Small bowel obstruction and ileus
• Open small bowel resection
• Emergent management of Crohn’s disease of
• Open adhesiolysis
small intestine
• Laparoscopic adhesiolysis
• Acute mesenteric ischemia: arterial, venous,
• Ileostomy
and nonocclusive
• Ileostomy closure
• Meckel’s diverticulum
• Open feeding jejunostomy
• Radiation enteritis
• Laparoscopic feeding jejunostomy
SCORE CURRICULUM - CATEGORY 10: ALIMENTARY TRACT − LARGE INTESTINE
Diseases/Conditions
Operations/Procedures
BROAD
ESSENTIAL − COMMON
• Lower gastrointestinal bleeding
• Open appendectomy
• Large bowel obstruction
• Laparoscopic appendectomy
• Acute appendicitis
• Open partial colectomy
• Diverticulitis
• Laparoscopic partial colectomy
• Diverticular bleeding
• Colostomy
• Diverticular fistulae
• Colostomy closure
• Colonic polyps
• Colonic cancer
•Volvulus
• Ischemic colitis
• Antibiotic-induced colitis
SCORE CURRICULUM - CATEGORY 11: ALIMENTARY TRACT − ANORECTAL
Diseases/Conditions
Operations/Procedures
BROAD
ESSENTIAL − COMMON
• Hemorrhoids
• Banding for internal hemorrhoids
• Anal fissure
• Hemorrhoidectomy
• Anorectal abscess and fistulae
• Subcutaneous lateral internal sphincterotomy
• Rectal cancer
• Drainage anorectal abscess
• Anal cancer
• Anal fistulotomy/seton placement
FOCUSED
• Pelvic floor dysfunction
• Rectal prolapse
SCORE CURRICULUM - CATEGORY 15: SKIN AND SOFT TISSUE
Diseases/Conditions
Operations/Procedures
BROAD
ESSENTIAL − COMMON
• Pilonidal cyst and sinus
• Excisional and incisional biopsy of skin/soft
• Nevi
tissue lesions
• Melanoma
• Incision, drainage, debridement for soft tissue infections
• Squamous cell carcinoma
• Pilonidal cystectomy
• Basal cell carcinoma
• Evaluation of soft tissue masses
ESSENTIAL − UNCOMMON
• Epidermal cyst
•Wide local excision melanoma
• Apocrine tumor
• Sentinel lymph node biopsy for melanoma
• Eccrine tumor
• Sebaceous tumor
• Merkel cell tumor
• Dermatofibrosarcoma
• Hidradenitis
• Cellulitis
• Necrotizing fasciitis
• Paronychia
• Felon
•Wound infection
FOCUSED
• Decubitus ulcer