Acute Care Surgery / Trauma Rotation
PGY-2
Acute Care Surgery / Trauma: PGY-2
Introduction
The Acute Care Surgery (ACS) service provides comprehensive nighttime surgical coverage for all
surgical services. This includes: responsibility for the care of all surgical inpatients including SICU
patients, evaluation and management of all new trauma patients, new surgery patients, and all surgical
consults, and performance of all emergency surgeries and procedures.
Organization of the Service
There are primarily four attending surgeons who provide most of the nighttime coverage on the ACS
service: Drs. Kopelman, O’Neill, Pieri, and Vail. Additional attending surgeons, Drs. Caruso, Foster,
Matthews, Dixon, and Miller also take Trauma call, but less frequently. The attending/teaching
surgeons take in-house call and are available from 1700 until 0900 the next morning. Weekend call
(Saturday, Sunday, and holidays) is from 0800 to 0800 (24-hour shifts). The remaining general
surgeons (Drs. Thomas, Anwar, and Goldberg, along with Dr. Dixon) take back-up Trauma / ACS call
from home.
The service is composed of five residents: a PGY-4 or PGY-5 resident who serves as the Chief
Resident, a PGY-2 resident who covers the SICU (see SICU Rotation: PGY-1 / PGY-2 for details), a
second PGY-2 resident who covers emergency general surgery, trauma, and surgical consults, a PGY1 who is responsible for taking inpatient calls (the house officer or HO), and a second PGY-1 resident
who covers emergency general surgery and trauma. No vacations are allowed on the ACS rotation, so
this structure should not change throughout the year.
There are no mid-level providers on the service. Occasionally, medical students will spend one to
several nights with the ACS team, but they are typically not part of the service.
A simple organization chart is shown below:
ACS
Attending
PGY IV/V
Chief
PGY-2
ACS/Trauma
PGY-1
House officer
PGY-2
SICU
PGY-1
ACS/Trauma
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Acute Care Surgery / Trauma: PGY-2
Schedule
The ACS team is on from 1700 until 0600 the following morning Sunday through Thursday. There are
check out rounds at 1700 and 0600. The team has no daytime responsibilities, except for attending
Wednesday morning conferences from 0600 until 0800. The team is off from Friday 0600 until
Sunday 1700.
Expectations
Division of Labor: There are two PGY-2 residents on the ACS service. One has SICU duty, and one
has ACS / Trauma duty. These positions are rotation specific: one PGY-2 resident is on SICU for the
entire 5-week rotation and the other is on ACS / Trauma for the entire rotation. They then switch to the
other position for the second ACS rotation later in the year. The ACS rotations are temporally
separated.
Specific duties of the SICU resident includes (but are not limited to):
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Be present and available in the SICU (the SICU is your only clinical responsibility) during
work hours (with the exception of lunch and restroom breaks)
Gather information and discuss patient issues with the SICU team
Patients with significant past medical histories will require extra effort to find outside
medical records and medication lists
Perform a COMPLETE examination on each assigned patient prior to rounds including,
but not limited to:
o Standard physical exam including all wounds and back/buttocks skin
o Assessing the stability of the patients airway
 If intubated, determine the position and security of the tube / trach
o Assess the position and security of all enteral tubes (NG, OG, DHT, etc.)
o Examination of all invasive catheters to assess for signs of infection
o Check extremities for signs/symptoms of phlebitis or septic thrombophlebitis
o Reviewing any new radiographs and obtaining the official interpretation
o Review and confirm any and all culture results including speciation and antibiotic
susceptibilities and log such results in the SICU Culture Book
o Review all currently prescribed medications and discontinue those that are no
longer needed to keep the Medication Reconciliation accurate and safe
Present at morning rounds to the Attending (and Fellow)
Write comprehensive patient notes with the above data
Perform bedside procedures under the guidance of the Attending (or Fellow) and write
procedure notes immediately following the procedure.
Update patients and their families as appropriate (at least daily)
Be an active participant in check out rounds each evening to the PGY-2 SICU resident
The specific duties of the ACS / Trauma PGY-2 position are outlined below:
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Update patients and their families appropriately
Provide surgical consultation services to all Departments
Diagnose, make operative plans, and perform selected operations on surgical patients
Participate actively in check out rounds
Respond to and care for all Yellow and Red Trauma activations
Provide assistance in the Burn Emergency Department for consultations and admissions
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Acute Care Surgery / Trauma: PGY-2
Operating Experience: The PGY-2 SICU resident is not expected to participate in any surgeries
unless there is a critical need for his/her presence and as long as his/her primary
responsibilities have been fulfilled. The ACS / Trauma PGY-2 is expected to workup, operate
on, and manage postoperatively any surgical patient on which they are consulted.
Clinic: There is no clinic for the ACS rotation
Conferences: Mandatory conferences include Basic Science, M&M, and Grand Rounds on
Wednesday morning, as well as Junior Clinical Review conference on Wednesday. The SICU-specific
conferences are the Multidisciplinary Conference on Thursday mornings and the SICU Fellow
Conference on Thursday afternoons (when a Fellow is rotating in the SICU). Rotators on the ACS
service are excused from all conferences except Basic Science, M&M, and Grand Rounds.
Procedures: Maricopa residents have competency requirements that must be met prior to performing
procedures (such as central venous access, arterial lines, tube thoracostomy, etc.) 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.
The attending surgeon must be notified prior to performance of bedside procedures. A word of
advice: Read and understand the technical aspects and potential complications of a procedure
BEFORE attempting it. Beginning a procedure without adequate preparation will result in
FORFEITURE of the procedure.
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: The textbook for the ACS rotation is our general surgery textbook, Sabiston, Textbook of
Surgery by Townsend, et al. The trauma surgery text is Trauma by Mattox, et al. The critical care text
is The ICU Book by Marino. There is a posted reading list that if followed will allow the resident to
complete the book in time for the end-of-rotation SICU examination.
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: The ACS service rotators are on for the hours listed above. There is no call, per se.
Evaluation: The evaluation criteria that will be used by the Chief Surgical Resident, the mid-levels,
and the Attending/Teaching surgeons to evaluate you are listed in the Goals and Objectives.
Additionally, each evaluator is asked to submit a subjective narrative of overall impression, areas of
strength and improvement, and overall performance. You will also be asked to evaluate the ACS
rotation, your Attending surgeons, and your Chief Residents.
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Acute Care Surgery / Trauma: PGY-2
Goals and Objectives:
Patient Care
Goals
The resident will provide care that is compassionate, appropriate, and effective for the treatment
of health problems and the promotion of health. The resident will develop and execute patient
care plans appropriate for their level of training.
Objectives
 Communicates effectively and demonstrates caring and respectful behaviors when
interacting with patients and their families
 Gathers essential and accurate information about his/her patients
 Makes informed decisions about diagnostic and therapeutic interventions based on patient
information and preferences, up-to-date scientific evidence, and clinical judgment
Develops and carry out patient management plans
Counsels and educates patients and their families
Uses information technology to support patient care decisions and patient education
Provides health care services aimed at preventing health problems or maintaining health
Works with health care professionals, including those from other disciplines, to provide
patient-focused care
 Manages infectious complications including: ventilator-associated pneumonia, catheter
infection, urinary tract infection, skin and soft tissue infection, and intra-abdominal infection
 Understands the pathophysiology and manage the open abdomen in patients with damage
control laparotomy, abdominal compartment syndrome, and abdominal infections
 Treats endocrine problems of the critically ill including: adrenal insufficiency, diabetes
insipidus, syndrome of inappropriate ADH secretion, and serotonin syndrome
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Medical Knowledge
Goals
The resident will achieve and demonstrate detailed knowledge of established and evolving
biomedical, clinical, epidemiological and social-behavioral sciences, as well as the application
of this knowledge to patient care. The resident will learn to critically evaluate and demonstrate
knowledge of pertinent scientific information.
Objectives
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Demonstrates an investigatory and analytic thinking approach to clinical situations
Knows and applies the basic and clinically supportive sciences which are appropriate to
his/her discipline
Interprets arterial blood gas measurements correctly
Recognizes the need for nutritional support and formulate caloric, protein, and other
nutritional regimens
Understands the principles and use of continuous renal replacement therapy (CRT) in the
critically ill patient
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Acute Care Surgery / Trauma: PGY-2
Practice-Based Learning and Improvement
Goals
The resident will demonstrate the ability to investigate and evaluate his/her care of patients, to
appraise and assimilate scientific evidence, and to continuously improve patient care based on
constant self-evaluation and life-long learning.
Objectives
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Analyzes practice experience and perform practice-based improvement activities using a
systematic methodology
Locates, appraises, and assimilates evidence from scientific studies related to his/her
patients’ health problems
Obtains and uses information about his/her own population of patients and the larger
population from which his/her patients are drawn
Applies knowledge of study designs and statistical methods to the appraisal of clinical
studies and other information on diagnostic and therapeutic effectiveness
Uses information technology to manage information, access on-line medical information,
and support his/her own education
Facilitates the learning of students, residents, and other health care professionals
Constructs strategies to avoid development of antibiotic resistance in the SICU
Interprets literature in an evidence-based medicine methodology
Interpersonal and Communication Skills
Goals
The resident will demonstrate interpersonal and communication skills that result in the effective
exchange of information and collaboration with patients, their families, and health professionals.
Objectives
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Creates and sustains a therapeutic and ethically sound relationship with patients
Uses effective listening skills, and elicits and provides information using effective
nonverbal, explanatory, questioning, and writing skills
Works effectively with others as a member or leader of a health care team or other
professional group
Communicates end of life issues effectively
Functions as an effective team member
Professionalism
Goals
The resident will demonstrate a commitment to carrying out professional responsibilities,
adherence to organizational and ethical principles, and demonstrate compassion, integrity, and
respect for others.
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Acute Care Surgery / Trauma: PGY-2
Objectives
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Demonstrates respect, compassion, and integrity; a responsiveness to the needs of patients
and society that supersedes self-interest; accountability to patients, society, and the
profession; and a commitment to excellence and on-going professional development
Demonstrates a commitment to ethical principles pertaining to provision or withholding of
clinical care, confidentiality of patient information, informed consent, and business practices
Demonstrates sensitivity and responsiveness to patients’ culture, age, gender, and
disabilities
Involves patients and their families in care management plan and medical decision making
Treats patients and families with respect, compassion, and empathy
Dictates operative notes and discharge summaries effectively in a timely fashion
Systems-Based Practice
Goals
The resident will demonstrate an awareness of and responsiveness to the larger context and
system of health care, as well as the ability to call effectively on other resources in the system to
provide optimal health care.
Objectives
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Understands how his/her patient care and other professional practices affect other health
care professionals, the health care organization, and the larger society and how these
elements of the system affect his/her own practice
Knows how types of medical practice and delivery systems differ from one another,
including methods of controlling health care costs and allocating resources
Practices cost-effective health care and resource allocation that does not compromise quality
of care
Advocates for quality patient care and assist patients in dealing with system complexities
Knows how to partner with health care managers and health care providers to assess,
coordinate, and improve health care and know how these activities can affect system
performance
Appreciates the ethical issues involved with end or life, withdrawal of support, “do not
resuscitate” orders, brain death, and organ harvest and transplantation
Procedural Mastery
Goals
The resident will demonstrate manual dexterity appropriate for his/her level of training. The
resident will safely and effectively perform operative procedures appropriate for his/her level of
training.
Objectives
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Performs central venous line catheter placement
Performs arterial line catheter placement
Performs diagnostic and therapeutic bronchoscopy; interprets BAL results
Places pulmonary artery catheter and makes appropriate clinical interventions based on
catheter parameters
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