Vascular Surgery Rotation

Upon completion of the Vascular Surgery rotation, the neurosurgery resident shall be able to:

  1. Outline the risk factors for atherosclerosis.
  2. Describe the pathogenesis of atherosclerosis.
  3. Discuss the patient with cerebrovascular ischemia, including: history, physical examination, investigations and treatment (anterior/posterior circulation)
  4. Discuss the results of clinical trials evaluating efficacy of carotid endarterectomy (e.g. NASCET, ACAS) as well as surgical indications for symptomatic and asymptomatic carotid stenosis.
  5. Describe the pathophysiology of intermittent claudication, and differentiate if from neurogenic claudication.
  6. List the risk factors for developing deep vein thrombosis, and methods to help prevent deep vein thrombosis.
  7. Outline the diagnosis and treatment of deep venous thrombosis, including indications for Greenfield filters.
  8. Describe the surgical steps involved in performing a carotid endarterectomy.
  9. Outline brachocephalic ischemic syndromes.
  10. Describe vascular compartment syndromes, their investigation, natural history and management.

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 history and physical exam in context of Vascular diseases/surgery; with particular attention to diseases seen also in neurosurgery – ie. carotid disease.
  3. With appropriate supervision discuss relevant information with patients and family in a compassionate way and be able to obtain consent for common procedures.
  4. Share and present information with other health care providers, with attention to communicating information to when organizing diagnostic tests and procedures.

COLLABORATOR:

  1. Work/collaborate effectively in an interdisciplinary team, including interventional radiology to coordinate patient care.
  2. Consult other services when appropriate in context of a complicated vascular patient with multiple medical comorbidities – nephrolology/internal medicine/endocrinology/geriatrics.
  3. Take part in all educational activities and teaching afforded by the service during the rotation.
  4. Be able to share workload and duties appropriately with other residents and medical students
  5. Be able to teach medical students, other residents and patients.
  6. Describe the surgeon’s roles and responsibilities to other professionals; Describe the elements of a good consultation
  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. Work effectively and efficiently
  4. Triage patients being able to identify vascular surgery emergencies that require prompt and immediate management such as ruptured abdominal aneurysm, and ischemic limb
  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

HEALTH ADVOCATE:

  1. Recognize and council patients on determinants of health in patients, especially with respect to vascular risks such as smoking, DM and bmi.
  2. Contribute to overall patient well-being and outcome, though appropriate pre and post-operative care.
  3. Promote lifestyle which improves surgical risks, especially preoperatively in clinic setting.
  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. Participate in rounds and educational activities provided by the vascular surgery service.
  2. Identify and seek out personal learning needs, especially with conditions relevant to neurosurgical patients such as stroke, carotid disease, coagulation and vascular access.
  3. Apply principles of critical appraisal to medical information.
  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