Upon completion of the general surgery rotation, the neurosurgery resident shall be able to:
- Demonstrate a working diagnostic approach to a patient with an acute abdomen, including: history, physical examination, ordering and interpretation of laboratory and radiological investigations.
- List the differential diagnosis for a patient with an acute abdomen.
- Outline the symptoms and signs of a patient with a small/large bowel obstruction, and initiate management of these patients.
- Discuss the diagnosis and initial treatment of common fluid balance disorders, including hypovolemia and hypervolemia.
- Discuss the diagnosis and treatment of common electrolyte balance disturbances, including: hypo/hypernatremia, hypo/hyperkalemia, hypo/hypermagnesemia, hypo/hypercalcemia, and hypo/hyperglycemia.
- Describe the approach to and primary management of the multiply injured person.
- Outline the mechanism of normal hemostasis and describe the mechanisms of common abnormalities.
- Outline the pre-operative management of a patient with a warfarin-induced coagulopathy.
- Outline the diagnostic criteria and management of DIC.
- Describe the indications for blood transfusions.
- Outline the symptoms and signs, and initiate management of minor/major transfusion reactions, including: anaphylaxis, hemolytic transfusion reactions, and non-hemolytic transfusion reactions.
- Perform the following skills:
- Insert a nasogastric tube
- Insert a Foley catheter
- Sharp and blunt dissection
- Basic suturing techniques
- Open and close a small laparotomy incision
During the rotation, all residents should fulfill the Royal College’s CanMEDS Competencies.
- Develop rapport, trust, and ethical therapeutic relationships with patients and families , be able to review/update day to day care with patients.
- Conduct, document and present pertinent surgical history and physical exam.
- With appropriate supervision discuss relevant information with patients and family, especially for general surgery procedures that are commonly required in neurosurgical patients – G-tube/peg/tracheostomy, be able to obtain consent for these procedures.
- Share and present pertinent information to other surgeons, specialists and other health care providers
- Accurately elicit and synthesize relevant information and perspectives of patients and families, colleagues, and other professionals
- Work/collaborate effectively in an interdisciplinary team, including pharmacy/physiotherapists/occupational therapists.
- Consult other services such as gastroenterology/other specialists appropriately
- Be involved in all educational activities and teaching offered by the service.
- Be able to share workload and duties appropriately with other house staff.
- Describe the surgeon’s roles and responsibilities to other professionals; Describe the elements of a good consultation
- Recognize one’s own limitations and when help is needed from others
- Work with other health professionals effectively to prevent, negotiate, and resolve conflict
- Effectively utilize and allocate finite resources, prioritize tests and OR emergency cases.
- While on a busy surgical service manage own time, education and personal life for a balanced lifestyle.
- Learn to work effectively and efficiently.
- Triage patients being able to identify urgent cases in emergency that require prompt and immediate management such as trauma and acute abdomen.
- Demonstrate an understanding of the influences that affect the workings of the health care system at various levels,
- Participate in discharge planning of a complex surgical patient.
- To be able to lead the interdisciplinary team managing a surgical patient
- Recognize and council patients on determinants of health in patients, especially with respect to surgical risks such as smoking, DM and bmi.
- Promote lifestyle which improves surgical risks, especially preoperatively in clinic setting.
- Contribute to overall patient well-being and outcome, though appropriate pre and post operative care.
- Facilitate return of patient to community/alternate care and help put care/support in place to reduce return to hospital for surgical care.
- Ensure consults and tests are done in an appropriate timely manner.
- To be involved in rounds and educational activities provide by the surgical service.
- Identify and seek out personal learning needs, especially with respects to surgical problems common to neurosurgical patients such as electrolyte abnormalities and coagulation.
- Apply principles of critical appraisal to medical information, be involved in journal clubs
- Participate in patient, student and peer learning
- Contribute to development of new knowledge and be involved in appropriate research projects as available.
- Demonstrate a commitment to their patients, profession, and society through ethical practice
- Exhibit appropriate professional behaviors in practice, including honesty, integrity, commitment, compassion, respect and altruism
- Maintain appropriate relations with patients and other health care providers.
- Show appropriate respect for opinions of other health care providers.
- Be able to appraise and identify own limits with respect to knowledge and patient care, and when to ask for assistance and consult effectively