VASCULAR SURGERY Educational objectives:
Competency-based Educational Objectives
The vascular surgery residency program at the University of Arkansas for Medical Sciences requires its residents to obtain competence in the six areas listed below to the level expected of a new practitioner. The following specific knowledge, skills, behaviors, and attitudes have been identified by the faculty and residents to be essential to the effective practice of vascular surgery.
1. In general, the Vascular Surgery Resident should be able to provide Patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.
a. Specifically, the vascular surgery resident should be able to demonstrate manual dexterity appropriate for the training level.
Teaching method – manual dexterity and surgical skills will be taught primarily during the performance of operative procedures under the supervision of the vascular surgery faculty. Additional training may be acquired through the use of surgical simulators and computer-based virtual reality programs.
Assessment method – manual dexterity is assessed by the surgical faculty on an ongoing basis and formal written evaluation is provided to the vascular resident on a semiannual basis.
b. Specifically, the vascular surgery resident should be able to develop and execute patient care plans appropriate for the resident’s level
Teaching method: The vascular resident is expected to participate in all aspects of care of the vascular surgery patient. This involves initial assessment including performance of comprehensive history and physical, understanding the appropriate use of the non-invasive vascular laboratory, understand the variety of treatment options and followup.
Assessment Method: Faculty evaluation evaluation
360 evaluation
2. In general, the Vascular Surgery Resident should be able todemonstrate Medical Knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social behavioral) sciences, as well as the application of this knowledge to patience care.
a. Specifically, the vascular surgery resident should be able to critically evaluate and demonstrate knowledge of pertinent scientific information.
Teaching method Clinical science lecture series
Assessment method Board review test
Faculty evaluation
SAVS MOCK ORALS
Teaching method Basic Science lecture series
Assessment method Board review test
Faculty evaluation
Teaching Method AM Teaching rounds
Assessment Method Faculty evaluation
3. In general, the Vascular Surgery Resident should be able to demonstrate Practice-based learning and improvement that involves the investigation and evaluation of care for their patients, the appraisal and assimilation of scientific evidence, and improvements in patient care.
a. Specifically, the vascular surgery resident should be able to critique personal practice outcomes.
Teaching method Practice based learning conf
Assessment method Faculty evaluation
360 evalution
b. Specifically, the vascular surgery resident should be able to demonstrate a recognition of the importance of lifelong learning in surgical practice.
Teaching method Journal Club
Assessment method Faculty evaluation
360 evaluation
4. In general, the Vascular Surgery Resident should be able to demonstrate Interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and other health professionals.
a. Specifically, the vascular surgery resident should be able to communicate effectively with other health care professionals.
Teaching method Faculty mentoring
Visiting professor
Assessment Faculty evaluation
360 evaluation
- Specifically, the vascular surgery resident should be able to counsel and educate patients and families.
Teaching Method Faculty mentoring
Assessment method Faculty evaluation
360 evalution
- Specifically, the vascular surgery resident should be able to effectively document practice activities.
Teaching Method Faculty mentoring
Assessment method Faculty evaluation
Hospital record review
5. In general, the Vascular Surgery Resident should be able to demonstrate Professionalism, as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to patients of diverse backgrounds.
a. Specifically, the vascular surgery resident should be able to maintain high standards of ethical behavior.
Teaching Method Mentoring
Assessment Faculty evaluation
360 evaluation
b. Specifically, the vascular surgery resident should be able to demonstrate a commitment to continuity of patient care.
Teaching Method Mentoring
Assessment Faculty evaluation
360 evaluation
c. Specifically, the vascular surgery resident should be able to demonstrate sensitivity to age, gender and culture of patients and other health care professionals.
Teaching Method Mentoring
Assessment Faculty evaluation
360 evaluation
6. In general, the Vascular Surgery Resident should be able to demonstrate an understanding of Systems-based practice, as manifested by actions that 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.
a. Specifically, the vascular surgery resident should be able to practice high quality, cost effective patient care.
Teaching method General surgery grand rounds
Assessment method Faculty evaluation
360 evaluation
b. Specifically, the vascular surgery resident should be able to demonstrate a knowledge of risk-benefit analysis.
Teaching method General surgery grand rounds
Assessment method Faculty evaluation
360 evaluation
- Specifically, the vascular surgery resident should be able to demonstrate an understanding of the role of different specialists and other health care professionals in overall patient management.
Teaching method General surgery grand rounds
Assessment method Faculty evaluation
360 evaluation
In addition to the specific competencies listed above, the Vascular Surgery Resident is expected to utilize three documents prepared by the Association of Program Directors in Vascular Surgery to further refine their educational experience.
The Clinical Science Goals and Objectives
The Basic Science Goals and Objectives
The Goals and Objectives for Vascular Laboratory Training.
These documents have been used by the faculty and residents to define the following specific objectives:
- Demonstrate sufficient mastery of the educational objectives distributed by the Association of Program Directors in Vascular Surgery to obtain passing score on Vascular Surgery Qualifying/ Certifying Examination of the American Board of Surgery. (medical knowledge)
- Faculty evaluation
- Board review exam performance
- ABS examination pass/fail rates
- Demonstrate a comprehensive understanding of Basic Science of vascular disease as distributed by the APDVS.
- Faculty evaluation
- Evaluation of Basic Science presentation
- Demonstrate competence in interpretation and performance of vascular lab diagnostic tests in accordance with the core Curriculum for Resident Training in the Vascular Diagnostic Laboratory distributed by the APDVS. (medical knowledge)
In particular, the Vascular Resident is expected to maintain a portfolio of noninvasive vascular cases to be reviewed with the technical director of the vascular lab and with the Program Director.
Cerebrovascular interpretation – 50 cases
Lower extremity venous interpretation – 50 cases
Lower extremity arterial interpretation – 50 cases
Upper extremity venous interpretation – 50 cases
Assessment method
- Portfolio review by technical director of vascular lab
- Portfolio review by program director.
For all of these objectives, the teaching methods will include didactic conferences, journal club, board review conference, practice-based learning conference, grand rounds, teaching rounds, intraoperative supervision and one-on-one tutoring.
The evaluation methods will include Faculty evaluation, 360 evaluation, board review scores, PBLI conference scores and selected additional measures of success.
1. Interventional Vascular Techniques and Vascular laboratory: pgy 6 AND 7
General OBJECTIVES:
Demonstrate knowledge regarding the indications, contraindications, and possible adverse effects of diagnostic and interventional vascular procedures.
Demonstrate knowledge about the risks and appropriate safety practices concerning the use of ionizing radiation.
Demonstrate skill in the performance of diagnostic and therapeutic vascular interventions.
Demonstrate knowledge regarding the indications for and interpretation of noninvasive vascular laboratory techniques, and skill in the performance of these procedures.
Speicific PATIENT CARE Objectives:
Rotation I
Months 1-6
- To understand radiation safety issues for the patient and operator.
- To understand arterial and venous radiographic anatomy.
- To develop proficiency with percutaneous arterial and venous cannulation of the upper and lower extremity.
- To become familiar with and be able to name all basic guidewires, catheters and other devices used for diagnostic and therapeutic interventional procedures.
- To perform under supervision diagnostic arteriography and venography of the abdomen and lower extremities.
- To learn the indications for, the performance of, and the interpretation of arterial physiologic testing and venous duplex scanning for DVT.
- To demonstrate expertise with percutaneous puncture and with diagnostic arteriography of the abdomen and lower extremity.
- To perform under supervision diagnostic arteriography of the renal and brachiocephalic arteries.
- To perform under supervision balloon angioplasty and stenting of the iliac and lower extremity arteries.
- To perform under supervision vena cava filter placement.
- To use percutaneous closure techniques after arterial catheterization.
- To learn the indications for, the performance of, and the interpretation of peripheral arterial duplex scanning and duplex scanning for venous valvular incompetence.
Rotation II
Months 7-12
- To perform under supervision catheter directed thrombolysis procedures.
- To perform under supervision of balloon angioplasty and stenting of renal and mesenteric arteries.
- To perform under supervision thrombin injection of femoral pseudoaneurysms.
- To use embolic protection devices during renal and mesenteric stenting.
- To learn the indications for, the performance of, and the interpretation of carotid artery duplex, abdominal arterial duplex, and upper extremity venous duplex scanning.
Rotation III
Months13-18
- To demonstrate expertise with the techniques learned during the previous year.
- To perform under supervision carotid artery stenting.
- To perform under supervision selective catheterization of branch arteries for coil embolization.
- To perform under supervision percutaneous atherectomy of leg arteries.
- To use mechanical thrombolytic devices.
- To read noninvasive vascular laboratory studies and perform interpretations under faculty supervision.
Rotation IV
Months 19-24
- To demonstrate expertise with the techniques learned during the previous rotations.
- To demonstrate expertise with all basic and advanced interventional procedures.
- To instruct a junior residents in basic diagnostic interventional procedures.
- To independently manage complex interventional procedures with minimal faculty supervision.
- To demonstrate appropriate rescue techniques for complications of interventional procedures.
- To read sufficient noninvasive vascular laboratory studies and perform interpretations under faculty supervision to qualify for the (RPVI) Registered Physicians Vascular Interpretation Exam.
- INPATIENT, OUTPATIENT AND OPEN VASCULAR SURGERY
General Objectives:
To understand the appropriate diagnostic and management options for vascular disease as outlined in the detailed list of topics under knowledge objectives.
To demonstrate the ability to manage the preoperative, operative, and postoperative care of patients with arterial, venous, and lymphatic disease using both open surgical, interventional, and medical treatment.
Specific PATIENT CARE Objectives:
Rotation I
Months 1-6
- To demonstrate effective patient evaluation techniques, including history, physical examination and noninvasive testing.
- To clearly present patient information on rounds and in conferences.
- To demonstrate appropriate initial evaluation of outpatients with the vascular disease including plans for initial diagnostic evaluation.
- To demonstrate expertise with the procedures learned during the general surgery residency.
- To demonstrate responsibility for the care of the vascular patients in the intensive care units.
- To acquire detailed knowledge concerning arterial occlusive and aneurysmal disease and venous thrombosis and insufficiency.
- To perform under supervision basic vascular operations including carotid endarterectomy, abdominal aneurysm repair and leg bypass
- To demonstrate appropriate OUTPATIENT evaluation of patients with vascular disease, including plans for diagnostic evaluation and initial therapeutic planning.
- To demonstrate proficiency in placing percutaneous arterial and venous monitoring catheters.
Rotation II
Months 7-12
- To demonstrate expertise with procedures learned during the previous rotation.
- To acquire basic knowledge concerning less common arterial, venous and lymphatic disease processes, including diagnosis and treatment options.
- To perform under supervision inpatient consultations for other services.
- To perform under supervision operations including lower extremity bypass, carotid endarterectomy, exposure of the abdominal aorta through trans-and retroperitoneal exposure, and endovascular aortic and iliac aneurysm repair.
- To demonstrate thorough evaluation of outpatients with vascular disease, including diagnostic and therapeutic planning.
Rotation III
Months 13-18
- To demonstrate expertise with procedures learned during the previous year.
- To acquire detailed knowledge concerning less common arterial, venous and lymphatic disease processes, including diagnosis and treatment options.
- To take primary responsibility for supervising junior residents in the management of all patients on the inpatient vascular service.
- To perform under supervision operations including open abdominal aortic aneurysm repair, upper extremity bypass, direct cervical brachiocephalic reconstruction, extra anatomic bypass, endovascular repair of thoracic aortic pathology, and exposure for thoracic and thoracoabdominal aneurysm.
- To demonstrate complete evaluation of outpatients with vascular disease, including diagnostic and therapeutic planning with minimal faculty supervision.
Rotation IV
Months 19-24
- To demonstrate expertise with procedures learned during the previous rotations.
- To demonstrate detailed knowledge concerning all arterial, venous and lymphatic disease processes, including diagnosis and treatment options,using interventional, open and medical management techniques.
- To assume responsibilities for supervision of the entire vascular service.
- To instruct junior residents in basic open operations.
- To perform under supervision complex vascular operations, including thoracoabdominal aneurysm repair, excision and replacement of infected bypass grafts, redo carotid endarterectomy, carotid body tumor excision, renal and mesenteric artery bypass, and redo abdominal aortic surgery.
- To independently manage complex vascular patients minimal faculty supervision in both the outpatient and inpatient setting.
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