Description of Rotation or Educational Experience

This is a one month required rotation for the acute care surgical resident. Exposure to hepatobiliary patients and their diseases will occur at University Medical Center. While on this rotation, residents will acquire a broad understanding of the evaluation and management of patients with diseases of the liver, pancreas, gallbladder and biliary system.

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

• Perform detailed evaluation of patients with hepatobiliary and pancreatic disease and plan appropriate management and operative approach.
• Obtain informed consent after a review with the patient of the procedure(s), risks, benefits and alternative therapeutic options/procedures.
• Recognize monitoring abnormalities and physical signs/symptoms that need immediate attention during a procedure.
• Demonstrate knowledge of appropriate post procedure recovery, patient management and follow-up for diseases of the complex hepatobiliary and pancreatic systems.
• Demonstrate knowledge of common diseases requiring liver transplantation as well as the workup, post-operative care and management of problems associated with liver transplantation (immunosuppression, rejection, hepatic artery thrombosis, etc).
• Perform, under supervision, increasingly complex hepatobiliary and pancreatic surgery.

Objectives

• Simple and complex cholecystectomy with cholangiography
• Common bile duct exploration with choledochoscopy – open and laparoscopic
• Hepatobiliary and pancreatic drainage procedures
• Simple liver resection – wedge or anatomic
• Pancreatic resection
• Pancreatic debridement, packing and drainage
• ERCP including imaging, biopsy and stenting procedures

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

• Demonstrate knowledge of basic anatomy, physiology, pharmacology and pathology as it relates to hepatobiliary and pancreatic surgery.
• Understand the indications and contraindications of the major hepatobiliary and pancreatic procedures.
• Understand the principles of specialized anesthesia in hepatobiliary and pancreatic surgery.
• Understand the differences in diagnosis and management of neoplastic disease of the hepatobiliary and pancreatic systems including “benign” hepatic tumors, malignant tumors (HCC, CDC, pancreatic cancer) and endocrine tumors of the pancreas
• Understand the medical management of hepatobiliary and pancreatic disease including indications for palliative surgery.
• Demonstrate knowledge of the scoring systems used to classify the severity of hepatobiliary disease (Child-Pugh and MELD scores) as well as the complexities in management of liver transplant patients including indications, patient selection, and post-operative complications including failure, infection and rejection

Objectives

• Create a power point presentation that overviews an approved, selected topic in hepatobiliary surgery
• Pass an oral evaluation given by the preceptor during the rotation.

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

• Locate, appraise and assimilate evidence from scientific studies related to their patients’ health problems.
• Use information technology to optimize learning.

Objectives

• Create at least one power point presentation of sufficient quality to be included in the resident lecture databank.

Or

• Complete a research project under the supervision of the rotation preceptor.

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
• Participate in identifying systems errors and in implementing potential systems solutions

Objectives

• While on service, act as primary consultant to referring physicians and other members of the health care team and definitively arrange appropriate procedures (under direct supervision of preceptor).
• Participation in weekly departmental quality assessment/quality improvement meetings

Professionalism

Goal

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

Competencies

• Responsiveness to patient needs that supersedes self-interest
• Accountability to patients, society, and the profession

Objectives

• Obtain satisfactory or above ratings on nursing- and physician-filed evaluations in the category of professionalism

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, colleagues, referring physicians and other members of the health care team concerning imaging appropriateness, informed consent, safety issues and results of imaging tests or procedures.
• Maintain comprehensive, timely and legible medical records.

Objectives

• Obtain satisfactory or above ratings on nursing- and physician-filed evaluations in the area of communication
• Production of accurate and appropriate diagnostic and procedural reports.

Teaching Methods

• Directed reading in selected topics in interventional radiology.
• Direct procedural training by interventional radiologist.

Assessment Method (residents)

• Global faculty evaluation
• 360 degree evaluations
• Evaluation of quality of reports
• Learning portfolio (including documentation of conferences attended, courses attended, self-assessment modules completed, etc.)

Assessment Method (Program Evaluation)

• Evaluation of faculty by fellowship director and clinical fellow.
• Evaluation of clinical fellow’s knowledge and performance by fellowship director.

Level of Supervision

• Direct supervision by interventional radiologist.
• Available on-call attending for consultation and assistance.

Educational Resources

• Access to department-recommended texts and journals
• On-site medical library
• Internet access for review and research