UCSF General Surgery Common Goals & Objectives

The following Goals & Objectives are common to all clinical assignments and to all levels of residents in training.  While these activities are common to all residents we expect each resident’s level of performance to advance in competence and sophistication as the resident progresses through the training program, focusing on performance at a more basic level for PGY-1s and at a more complex level for PGY-5s. The expected level of performance and graduated level of responsibility will be directed by the level-specific goals and objectives for each clinical assignment.

The Responsibilities & Expectations are also common to all rotations, but only rarely will there be any difference between the expected level of compliance according to the level of training of the resident (i.e. technical skills). 

PATIENT CARE

GOALS & OBJECTIVES

1. Obtain an accurate and appropriately complete clinical history.
2. Perform an appropriately thorough physical examination.
3. Select appropriate diagnostic tests (laboratory, imaging, non-invasive, invasive).
4. Integrate the results of the clinical assessment (clinical history & physical examination, diagnostic studies) in order to develop appropriate and effective patient management plans:
5. preoperatively
6. postoperatively
7. Identify, analyze and balance risks and benefits of treatment approaches for surgical diseases and conditions.
8. Execute appropriate and effective treatment plans, with a focus on anticipating the next step in the patient’s clinical course.
9. Anticipate, diagnose and manage complications of surgical diseases, conditions and treatments.

RESPONSIBILITIES & EXPECTATIONS

1. Actively participate in all daily rounds (except when off duty).
2. Attend all departmental, divisional, and rotation conferences relevant to each clinical assignment.
3. Provide accurate, complete and reliable patient information during rounds and at all hand-offs.
4. Assume primary responsibility for the preoperative and postoperative evaluation, care and management of patients, as determined by each clinical assignment.
5. Implement the clinical decisions made by the team (on rounds, during the day) in a timely manner:
   1. Arrange consultations
   2. Schedule diagnostic tests
   3. Schedule therapeutic procedures
   4. Notify the senior resident/fellow/attending if unable to implement the clinical decisions.
   5. Communicate the results of consultations, diagnostic tests and therapeutic procedures to the team in a timely manner.

MEDICAL KNOWLEDGE

GOALS & OBJECTIVES

Describe (PGY1), Analyze (PGY2-3) and Implement and Teach (PGY4-5) the:

1. Basic science of surgical diseases and conditions
2. Clinical course of surgical diseases and conditions
3. Risks and benefits of treatment approaches
4. Complications of surgical diseases, conditions and treatments and the management of those complications
5. Approaches to reduce complication risk

RESPONSIBILITIES & EXPECTATIONS

1. Attend all basic science conferences.
2. Attend all journal club sessions.
3. Attend all departmental, divisional, and rotation conferences relevant to each clinical assignment.
4. Complete all on-line educational assignments on time.
5. Read and study daily.
6. Meet the Departmental requirements for proficiency on the yearly ABSITE.
7. Successfully complete the clinical proficiency module prior to PGY2 (PGY 1 only).

TECHNICAL SKILLS

GOALS & OBJECTIVES

1. Demonstrate manual dexterity.
2. Perform procedures and operations, progressing from individual skills, to essential-common operative procedures, essential-uncommon operative procedures and finally complex operative procedures.
3. Manage and conduct complete operative procedures.
4. Properly position, prepare and drape patients prior to operation.
5. Assist appropriately in the operating room:
   1. Anticipate the course and conduct of the procedure
   2. Facilitate exposure and retraction
   3. Control lighting
   4. Pay attention to the operative field and general intra-operative condition of the patient
   5. Avoid technical complications.
   6. Correct technical complications.

RESPONSIBILITIES & EXPECTATIONS

1. Attend and complete all skills laboratory assignments.
2. Attend all advanced surgical technique sessions (PGY 4-5 only).
3. Practice/rehearse techniques and procedures, as directed by skills laboratory sessions, advanced surgical technique sessions and other focused procedural instructional sessions.
4. Read and prepare for each operative procedure in which you participate.
5. Successfully complete the technical proficiency module prior to PGY2 (PGY1 only).
6. Complete the basic and advanced laparoscopic courses.
7. Pass the Fundamentals of Laparoscopic Surgery test before the start of the PG 4 year.
8. Exceed the RRC-Surgery operative case requirements, as well as specific operation and/or procedure requirements expected on specific clinical assignments.

PRACTICE-BASED LEARNING AND IMPROVEMENT

GOALS & OBJECTIVES

1. Use an evidence-based approach to patient care.
2. Read and critically assess the literature, in an ongoing manner.
3. Analyze clinical outcomes to improve patient care.
4. Identify deficiencies and limits in knowledge, practice and technical skills and develop an educational plan to correct these.
5. Educate patients, families, other physicians, health care professionals, junior residents and medical students appropriately.
6. Develop mentoring and role-modeling skills for the medical students, more junior residents and other health care professionals. 

RESPONSIBILITIES & EXPECTATIONS

1. Attend all morbidity & mortality conferences.
2. Meet with the faculty education representative at least three times during the rotation (beginning, midpoint, exit) to review goals & objectives.
3. Review personal performance evaluations quarterly.
4. Meet with mentor/advisor twice yearly and review summary performance assessment.
5. At the relevant PG level:
   1. Coordinate journal club
   2. Teach, organize & facilitate sessions in the following educational series
      1. Intern survival skills conference
      2. Clinical science series
      3. Advanced technical conduct sessions

INTERPERSONAL AND COMMUNICATION SKILLS

GOALS & OBJECTIVES

1. Communicate effectively (correct information, presented in a timely and sensitive manner) with patients, families and the public in a way that appropriately considers age, gender, socioeconomic and cultural backgrounds.
2. Communicate effectively (correct information, presented in a timely and sensitive manner) with other physicians and health care professionals involved in the care of the patient, including consultants, nurses, nurse practitioners, social workers, therapists.
3. Recognize circumstances when the method and timing of communication with patients and families needs to be modified or deferred to more senior physicians.
4. Recognize the weight and impact of your actions, behavior and words on others, particularly subordinates.
5. At all levels of training, work effectively as a member of the health care team.
6. At appropriate levels of training, demonstrate the skills needed to lead a surgical team, including effective organization and supervision of more junior members of the team.
7. Complete comprehensive, timely and coherent medical records, accurately and clearly documenting clinical activities.
8. Develop mentoring and role-modeling skills for the medical students, more junior residents and other health care professionals.

RESPONSIBILITIES & EXPECTATIONS

1. Complete all medical record entries in compliance with the rules and regulations of the institutions in which you train:
   1. Operative note dictation
   2. Discharge summary dictation
   3. Verbal order attestation (sign and date)
   4. Communicate all changes in patient status to the responsible attending physician in a time appropriate manner and in compliance with:
      1. The rules of the specific institution
      2. The residency training program list of clinical circumstances mandating direct attending notification
      3. Communicate all changes in patient status to the other members of the team in a manner appropriate to the type of status change and the role of the team member.
      4. Respect the chain of command and hierarchy of the team.
      5. Support the team in meeting responsibilities during unanticipated staffing shortages or unusual clinical demands.
      6. Obtain informed consent for surgical procedures.
      7. Attend all sessions of the Teaching and Leadership module (per level).

PROFESSIONALISM

GOALS & OBJECTIVES

1. Demonstrate commitment to the care of the patient that supersedes self-interest (patient-centered focus).
2. Demonstrate high standards of:
   1. Ethical behavior, incorporating the four basic principles of autonomy, beneficence, non-maleficence and justice
   2. Compassion
   3. Integrity
   4. Respect
   5. Sensitivity
   6. Reliability
   7. Maturity
   8. Demonstrate respect for patient privacy and autonomy.
   9. Demonstrate accountability (accepting responsibility) to:
      1. Patients and families
      2. The treating team
      3. Others involved in the care of the patient
      4. The profession
      5. Society
      6. Recognize personal limitations.
      7. Recognize boundaries.
      8. Accept constructive criticism with insight that allows for personal growth & development.
      9. Develop mentoring and role-modeling skills for the medical students, more junior residents and other health care professionals.

RESPONSIBILITIES & EXPECTATIONS

1. Complete all assigned administrative tasks in a timely, accurate and high-quality manner:
   1. Accurate daily entry of duty hours (by 9 am)
   2. Regular entry of cases in the acgme case log system (at least monthly)
   3. Completion of rotation, peer, faculty and site evaluations (monthly)
   4. Submit application for california state license at the start of the pg-2 year
   5. Submit application for board examination at the appropriate time
   6. BE PUNCTUAL for all rounds, assignments, conferences and other activities of the training program.
   7. Present yourself in a manner that engenders confidence in the patients.
   8. Self-monitor your duty hours and communicate problems or issues to the team, the service education attending and/or the program administration (office staff, associate program directors, program director).
   9. Chief & senior residents must monitor duty hours of more junior team members and facilitate compliance.

SYSTEMS-BASED PRACTICE

GOALS & OBJECTIVES

1. Gain experience caring for patients in a variety of health care delivery systems:
   1. Academic medical center
   2. Veterans affairs medical center
   3. Health maintenance organization
   4. Private practice facility
   5. Public facility
   6. Assess the role of different specialists and other health care professionals in patient management.
   7. Incorporate cost awareness into patient care:
      1. Charges vs costs
      2. Degrees of coverage
      3. Use of resources
      4. Implications for continuity of care
      5. Participate in identifying systems errors and developing solutions to improve patient safety and quality of care.

RESPONSIBILITIES & EXPECTATIONS

1. Comply with hospital specific policies and procedures including but not limited to:
1. Universal precaution and infection control policies
2. HIPPA regulations and policies regarding patient confidentiality and privacy
3. Human research protocols
4. Sexual harassment