General Surgery Rotation

Upon completion of the general surgery rotation, the neurosurgery resident shall be able to:

  1. Demonstrate a working diagnostic approach to a patient with an acute abdomen, including: history, physical examination, ordering and interpretation of laboratory and radiological investigations.
  2. List the differential diagnosis for a patient with an acute abdomen.
  3. Outline the symptoms and signs of a patient with a small/large bowel obstruction, and initiate management of these patients.
  4. Discuss the diagnosis and initial treatment of common fluid balance disorders, including hypovolemia and hypervolemia.
  5. Discuss the diagnosis and treatment of common electrolyte balance disturbances, including: hypo/hypernatremia, hypo/hyperkalemia, hypo/hypermagnesemia, hypo/hypercalcemia, and hypo/hyperglycemia.
  6. Describe the approach to and primary management of the multiply injured person.
  7. Outline the mechanism of normal hemostasis and describe the mechanisms of common abnormalities.
  8. Outline the pre-operative management of a patient with a warfarin-induced coagulopathy.
  9. Outline the diagnostic criteria and management of DIC.
  10. Describe the indications for blood transfusions.
  11. Outline the symptoms and signs, and initiate management of minor/major transfusion reactions, including: anaphylaxis, hemolytic transfusion reactions, and non-hemolytic transfusion reactions.
  12. 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.

COMMUNICATOR:

  1. Develop rapport, trust, and ethical therapeutic relationships with patients and families , be able to review/update day to day care with patients.
  2. Conduct, document and present pertinent surgical history and physical exam.
  3. 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.
  4. Share and present pertinent information to other surgeons, specialists and other health care providers
  5. Accurately elicit and synthesize relevant information and perspectives of patients and families, colleagues, and other professionals

COLLABORATOR:

  1. Work/collaborate effectively in an interdisciplinary team, including pharmacy/physiotherapists/occupational therapists.
  2. Consult other services such as gastroenterology/other specialists appropriately
  3. Be involved in all educational activities and teaching offered by the service.
  4. Be able to share workload and duties appropriately with other house staff.
  5. Describe the surgeon’s roles and responsibilities to other professionals; Describe the elements of a good consultation
  6. Recognize one’s own limitations and when help is needed from others
  7. Work with other health professionals effectively to prevent, negotiate, and resolve conflict

MANAGER:

  1. Effectively utilize and allocate finite resources, prioritize tests and OR emergency cases.
  2. While on a busy surgical service manage own time, education and personal life for a balanced lifestyle.
  3. Learn to work effectively and efficiently.
  4. Triage patients being able to identify urgent cases in emergency that require prompt and immediate management such as trauma and acute abdomen.
  5. Demonstrate an understanding of the influences that affect the workings of the health care system at various levels,
  6. Participate in discharge planning of a complex surgical patient.
  7. To be able to lead the interdisciplinary team managing a surgical patient

HEALTH ADVOCATE:

  1. Recognize and council patients on determinants of health in patients, especially with respect to surgical risks such as smoking, DM and bmi.
  2. Promote lifestyle which improves surgical risks, especially preoperatively in clinic setting.
  3. Contribute to overall patient well-being and outcome, though appropriate pre and post operative care.
  4. Facilitate return of patient to community/alternate care and help put care/support in place to reduce return to hospital for surgical care.
  5. Ensure consults and tests are done in an appropriate timely manner.

SCHOLAR:

  1. To be involved in rounds and educational activities provide by the surgical service.
  2. Identify and seek out personal learning needs, especially with respects to surgical problems common to neurosurgical patients such as electrolyte abnormalities and coagulation.
  3. Apply principles of critical appraisal to medical information, be involved in journal clubs
  4. Participate in patient, student and peer learning
  5. Contribute to development of new knowledge and be involved in appropriate research projects as available.

PROFESSIONAL:

  1. Demonstrate a commitment to their patients, profession, and society through ethical practice
  2. Exhibit appropriate professional behaviors in practice, including honesty, integrity, commitment, compassion, respect and altruism
  3. Maintain appropriate relations with patients and other health care providers.
  4. Show appropriate respect for opinions of other health care providers.
  5. Be able to appraise and identify own limits with respect to knowledge and patient care, and when to ask for assistance and consult effectively