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Vascular Surgery Fellowship Overall Competency Goals & Objectives
Organizational Structure Clinical Spectrum Patient Care Medical Knowledge Practice-Based Learning and Improvement Interpersonal and Communication Skills Professionalism Systems-Based Practice Scheduled Conferences Scheduled Teaching Rounds Vascular Journals
Overall Competency Goals and Objectives for Vascular Surgery Vascular Surgery is the surgical specialty involving diseases of the arterial, venous, and lymphatic circulatory systems, exclusive of those circulatory vessels intrinsic to the heart and intracranial vessels. Specialists in this discipline must demonstrate not only the knowledge, skills, and understanding of the medical science relative to the vascular system, but also the acquisition of mature technical skills and surgical judgment.
Vascular Surgery is an integrated Division of the Department of Surgery and provides educational experience to both Surgery Residents and Vascular Surgery Fellows of the University of Tennessee College of Medicine Chattanooga. Graduate Medical Education within the Department is overseen in its entirety by the Chair of the Department of Surgery. Specific teaching structure and procedures regarding vascular surgery are implemented by the Vascular Surgery Program Director with the assistance of the department's Graduate Medical Education Committee. Essentially, the core vascular surgery faculty practice general and vascular surgery and the breadth of procedures that entails. Faculty and resident administrative support for vascular surgery teaching is provided via the Department of Surgery through the University of Tennessee College of Medicine Chattanooga and Erlanger Health System with a complement of support staff (Surgery Program Manager, administrative assistants, and secretarial staff).
The clinical spectrum of the vascular surgical training experience includes the medical and surgical care of patients with all forms of vascular disease. There are 7 vascular surgery residency faculty, all of whom actively participate in the care of patients with vascular surgical disease and are fully integrated into the training program. The training rotations take place at Erlanger Medical Center, the flagship hospital of the University of Tennessee College of Medicine Chattanooga, as well as at Memorial and Parkridge Hospitals in Chattanooga and the Surgical Subspecialties Building (SSB), an office-based practice operated by the surgical faculty of the UT College of Medicine Chattanooga that is located a few blocks away from the main hospital. Education in vascular surgery is graduated based upon resident capability, level, responsibility, and faculty supervision. Pre- and postoperative care is integral to the resident's activities in both inpatient and outpatient environment. Resident training is devoted to increasing cognitive skills and expanding technical expertise in a variety of operative procedures. The residents assume increasing responsibility for both perioperative decision making as well as operative procedures with the appropriate supervision by attending surgeons. Residents further expand their cognitive skills and technical expertise through their exposure to more complex general surgical procedures. The final year is organized to provide additional and enhanced independent decision making by the resident. An attending surgeon supervises each resident's activities; however, the relationship is consultative rather than authoritative.
General Competencies The six General Competency Areas developed by the ACGME have been incorporated into the overall curriculum of the Department of Surgery. The competencies are also part of the resident evaluations.
Patient Care treatment of health problems and the promotion of health. Residents:
(1) must demonstrate manual dexterity appropriate for their educational level;
(5) must have continuity of primary responsibility for patient care. This must be taught in a longitudinal way, and must include ambulatory care, inpatient care, referral and consultation, and utilization of community resources;
(6) must be provided with progressive senior surgical responsibilities in the total care of vascular surgery patients, including preoperative evaluation, therapeutic decision-making, operative experience, and postoperative management;
(7) must have the opportunity to provide consultation with faculty supervision. They should have clearly defined educational responsibilities for other residents, medical students, and professional personnel. These teaching experiences should correlate basic biomedical knowledge with the clinical aspects of vascular surgery;
(8) should act as teaching assistants, when operative experience justifies a teaching role, and should report such cases to the Review Committee during the final two years of their residency;
(9) must receive education in the special diagnostic techniques for the management of vascular disease. It is essential that residents understand the methods and techniques of angiography, CT scanning, MRI and MRA and other vascular imaging modalities. They should be competent in the assessment of the vascular portion of such images. Residents must also have experience in the application, assessment, and limitations of noninvasive vascular diagnostic techniques; and,
(10) must have experience with outpatient activities, as these constitute an essential component of adequate experience in continuity of patient care. One-half day per week, on average, should be devoted to these outpatient activities.
Competence in Patient Care (PC) will be evaluated by record review, standardized evaluations, the 360 evaluations and direct observation for faculty and resident peers. This competency will also be evaluated using oral interviews by supervising faculty with the Surgical Skills Lab Director.
Medical Knowledge
(1) must be able to critically evaluate and demonstrate knowledge of pertinent scientific information;
(2) should have education in the entire vascular system. Instruction in each area should be associated with relevant patient exposure. If this is not possible, instructional materials must be provided to ensure adequate education;
(3) must have instruction and become knowledgeable in the fundamental sciences, including anatomy, biology, embryology, microbiology, physiology, and pathology as they relate to the pathophysiology, diagnosis, and treatment of vascular lesions;
(4) must have instruction in critical thinking, design of experiments and evaluation of data, as well as in the technological advances that relate to vascular surgery and the care of patients with vascular diseases. The program must encourage the participation of residents in clinical and/or laboratory research, and make appropriate facilities available; and,
(5) will have educational conferences that are adequate in quality and quantity to provide a review of vascular surgery as well as recent advances. The conferences should be scheduled to permit the residents to attend on a regular basis. Participation by both residents and faculty must be documented. Active participation by vascular surgery residents in the planning and production of these conferences is essential. The following types of conferences must exist within a program:
(a) a review, held at least biweekly, of all current complications and deaths, including
(b) a course or a structured series of conferences to ensure coverage of the basic and clinical sciences fundamental to vascular surgery (a sole reliance on textbook review is inadequate);
(c) regular organized clinical teaching, such as ward rounds and clinical conferences; and,
(d) a regular review of recent literature, such as a journal club format.
Competence in Medical Knowledge (MK) will be evaluated by record review, standardized evaluations, direct observation, especially on patient rounds, scores on the yearly in-training exam and mock oral exams for the more senior residents.
Practice-Based Learning and Improvement
(1) identify strengths, deficiencies, and limits in one's knowledge and expertise;
(2) set learning and improvement goals;
(3) identify and perform appropriate learning activities;
(4) systematically analyze practice using quality improvement methods, and implement changes with the goal of practice improvement;
(5) incorporate formative evaluation feedback into daily practice;
(6) locate, appraise, and assimilate evidence from scientific studies related to their patients' health problems;
(7) use information technology to optimize learning; and,
(8) participate in the education of patients, families, students, residents and other health professionals.
(9) critique personal practice outcomes;
(10) demonstrate a recognition of the importance of lifelong learning in surgical practice.
Competence in Practice Based Learning and Improvement (PBLI) will be evaluated by record review, standardized evaluation forms, direct observation, especially on patient rounds, scores on the yearly in-training exam and mock oral exams for the more senior residents. This competency will also be evaluated by oral interviews with the research nurse(s) and the departmental statistician, Dr. Michael Biderman.
Interpersonal and Communication Skills
(1) communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds;
(2) communicate effectively with physicians, other health professionals, and health related agencies;
(3) work effectively as a member or leader of a health care team or other professional group;
(4) act in a consultative role to other physicians and health professionals; and,
(5) maintain comprehensive, timely, and legible medical records, if applicable.
(6) counsel and educate patients and families, and
(7) effectively document practice activities.
Competence in Interpersonal and Communication Skills (ICS) will be evaluated by record review, standardized evaluation forms and direct observation by faculty and resident peers. Residents will also be evaluated by oral interviews by supervising faculty with patients and hospital personnel.
Professionalism
(1) compassion, integrity, and respect for others;
(2) responsiveness to patient needs that supersedes self-interest;
(3) respect for patient privacy and autonomy;
(4) accountability to patients, society and the profession; and,
(5) sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation.
(6) high standards of ethical behavior;
(7) a commitment to continuity of patient care; and,
(8) sensitivity to age, gender and culture of other health care professionals.
Competence in Professionalism (P) will be evaluated by standardized evaluation forms and direct observation by faculty and resident peers. Residents will also be evaluated by oral interviews by supervising faculty with patients and hospital personnel.
Systems-Based Practice
(1) work effectively in various health care delivery settings and systems relevant to their clinical specialty;
(2) coordinate patient care within the health care system relevant to their clinical specialty;
(3) incorporate considerations of cost awareness and risk-benefit analysis in patient and/or population-based care as appropriate;
(4) advocate for quality patient care and optimal patient care systems;
(5) work in interprofessional teams to enhance patient safety and improve patient care quality; and,
(6) participate in identifying system errors and implementing potential systems solutions.
(7) practice high quality, cost effective patient care;
(8) demonstrate a knowledge of risk-benefit analysis; and,
(9) demonstrate an understanding of the role of different specialists and other health care professionals in overall patient management.
Competence in Systems Based Practice (SPB) will be evaluated by record review, standardized evaluation forms and direct observation by faculty and resident peers. Residents will also be evaluated by oral interviews by supervising faculty with patients and hospital personnel. Hospital resource management personnel will be involved in these evaluations.
The following conferences are fully integrated in the General Surgery Residency and will frequently involve vascular surgery, vascular medicine or endovascular topics. The Friday morning conference is made up completely of vascular topics. These include:
Vascular surgery teaching rounds are conducted by the Senior Vascular Resident every morning. This includes walking rounds, arteriogram presentations, and bedside teaching.
Vascular Journals Available to Residents The following is a list of journals available to the residents and medical students on a routine basis to assist with their didactic training in vascular surgery:
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