Description of Rotation or Educational Experience

To acquire a fundamental knowledge and appreciation of the basic principles of burn care surgery, along with the recognition and surgical treatment of disorders associated with extensive burns. The rotation will also include an introduction to the indications for and treatment of complicated wounds with hyperbaric therapy.

Patient Care

Goal

Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Residents are expected to:

Competencies

• Demonstrate knowledge of the metabolic, nutritional, and endocrine effects of a critical burn injury
• Demonstrate an understanding of the physiology of thermal, electrical, and radiation injuries
• Describe the initial care and management of burns and other related wounds
• Develop a strategy for effective wound closure, which would include both surgical and non-surgical approaches
• Describe the indications for the use of tissue substitutes
• Describe the physiology of inhalation injuries

Objectives

• Participate in daily burn care teaching rounds and burn care conferences
• Evaluate the appearance of the burn wound in relation to its depth, bacteriologic condition, healing potential, and requirement for intervention
• Accurately provide resuscitation and cardiopulmonary support for an acute burn patient
• Perform burn wound excision and preparation for skin grafting
• Perform split and full thickness skin grafts
• When caring for a burn wound, demonstrate knowledge of the indications for use of:
• skin substitutes
• biological dressing
• splinting /pressure garments to minimize scar formation/contractures
• escharotomies/fasciotomies
• Demonstrate knowledge of appropriate use of hyperbaric therapy for treatment of burn and other wound types
• Assist the Burn Care Nurses on hospital rounds for wound care
• Assist the Hyperbaric Nurses during treatment of wound clinic patients in the hyperbaric chamber

Medical Knowledge

Goal

Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care. Residents are expected to:

Competencies

• Utilize information technology to increase medical knowledge and guide care of the burn patient
• Demonstrate knowledge of categorization of burns in regards to degree and description of the three zones of a wound
• Demonstrate options for airway management in the critically ill burn patient, and when each option is most appropriate
• To effectively support the cardiovascular system of the burn patient, describe invasive and noninvasive monitoring techniques
• Describe the unique infectious disease issues associated with burn care units, including infection control methods
• Summarize options for management of pain and anxiety of the burn care patient
• Describe nutritional support of the burn patient, including additional supplements which are most beneficial
• Describe the positive physiologic effects of hyperbaric oxygen therapy on wound healing

Objectives

• Read Chapter 48 in Trauma, fifth edition, by Moore, Feliciano and Mattox
• Accurately document a description of the extent of burn, including percent and degree, for each initial patient evaluation performed
• Assist with the pulmonary and cardiovascular management of at least two critical burn care patients
• Demonstrate ability to characterize a burn wound infection, as well as perform a biopsy for quantitative culture (perform at least one)
• Place patients in isolation due to infectious complications when indicated
• Demonstrate ability to provide appropriate antibiotic treatment of a burn wound infection
• List appropriate options for management of pain and anxiety in the burn patient. Also, include possible side effects that can be detrimental to the patient
• Demonstrate knowledge of nutritional support in the burn ICU setting, by providing dietary recommendations to at least two burn care patients

Practice-Based Learning and Improvement

Goal

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life long learning. Residents are expected to develop skills and habits to be able to :

Competencies

• Systematically analyze practice, using quality improvement methods, and implement changes with the goal of practice improvement
• Use information technology to optimize learning
• Participate in the education of patients, families, students, residents and other health professionals, as documented by evaluations of a resident’s teaching abilities by faculty and/or learner

Objectives

• Use information technology to prepare for surgical cases, applying the knowledge of the most current modalities to patient care
• Maintain a log of the burn surgery case experience. Document the type of burn and associated injuries, and any complications that occur during the patient’s hospital stay
• Maintain a log of the hyperbaric wound care case experience. Document the type of wound, and any complications that occur during the patient’s therapy
• Provide a list of all informational resources utilized during the burn and hyperbaric medicine elective. The list will be inserted into a resident databank. Example resources include:
• authoritative texts
• journals
• evidence-based web sites
• peers/consultants
• other health care specialty providers
• Actively participate in the education of fellow residents, students, and other healthcare providers. The fellow will receive evaluations from the above peers, which will include feedback regarding areas for suggested improvement

Systems Based Practice

Goal

Residents must 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. Residents are expected to:

Competencies

• Coordinate patient care within the health care system relevant to their clinical specialty
• Advocate for quality patient care and optimal patient care systems
• Work in interprofessional teams to enhance patient safety and improve patient care quality
• Demonstrate an awareness of and utilize all available resources to improve patient care quality

Objectives

• Attend weekly morbidity/mortality conference
• List ancillary health care services and other resources utilized most frequently to optimize patient care and rehabilitation during the burn and hyperbaric medicine elective. Examples include:
• burn care nurse
• physical therapy
• occupational therapy
• dietician
• physical medicine and rehabilitation physician
• social worker
• case manager
• psychologist
• child life specialist
• other consultants
• When treating patients operatively, demonstrate knowledge of cost-effective burn care

Professionalism

Goal

Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to demonstrate:

Competencies

• Compassion, integrity, and respect for others
• Responsiveness to patient needs that supersedes self-interest
• Respect for patient privacy and autonomy
• Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation

Objectives

• Demonstrate administrative competencies, which include completion of tasks as requested, following directions, responding in a timely manner to staff needs, following up on patient care issues, and being punctual
• Interact in a compassionate and respectful manner with a diverse group of patients and health care professionals of the multidisciplinary burn care team
• Develop a sensitivity for the unique stresses placed on families caring for a loved one with a burn injury

Interpersonal and Communication Skills

Goal

Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates. Residents are expected to:

Competencies

• Communicate effectively with patients and families across a broad range of socioeconomic and cultural backgrounds
• Communicate effectively with physicians, other health professionals, and health related agencies
• Work effectively as a member or leader of a health care team or other professional group
• Act in a consultative role to other physicians and health professionals as indicated

Objectives

• Provide thorough oral presentations regarding patient condition, using appropriate medical terminology
• Following a procedural intervention, be able to accurately describe the procedure performed, and expected course to the patient, patient's family member, or other health care personnel
• Effectively educate patients and families on post-burn rehabilitative strategies
• Accurately cart and record information during daily patient rounds
• Work as a respectful team member, which includes interaction with students, fellow residents, attendings, consultants, and emergency medical staff

Teaching Methods

• direct supervision by burn care surgeons
• attendance of lectures, conferences
• review of appropriate reading materials
• self-guided study, pertinent to patient problem list

Assessment Method (residents)

Utilizing the e-value system of self-assessment and outside assessment

Assessment Method (Program Evaluation)

Utilizing the e-value system of self-assessment and outside assessment

Level of Supervision

Direct supervision by above mentioned mentors

Educational Resources

• Principles and Practice of Burn Surgery, Barret-Nerin et al., Informa Health Care, 2004
• Trauma, 5th edition, Moore et al., McGraw-Hill, 2004