Residency Training Programs
Advanced Intern Procedural Curriculum
PGY I - Post Graduate Year 1
1) Welcome to Surgery and Your Role as Teacher and Role Model
Interns receive guidance as to what is expected of them in their first year of residency. Among the most important is making the transition from learner to teacher and the constant adherence to professional standards.
2) Asepsis & Instrument Identification
Before beginning down the path of surgery the residents and the patients they will see must be protected from each other. This module instructs proper donning of surgical attire; correct prepping and draping of the surgical field, removal of the surgical attire, and identification of common instruments.
3) Basic Laparoscopy Skills/ Lap Opening and Closure
Laparoscopic camera features and navigation, eye-hand coordination, and basic laparoscopic tasks are taught using a validated proficiency-based training curriculum developed by MISTELS. The learners receive guidance on proper handling and manipulation of the instruments during the training exercise.
Following this, proper opening and closure of the abdominal wall is reviewed. The learners are guided through proper dissection technique and identification of structures as the opening ensues. Following opening, the learners perform interrupted and continuous suture closure of the surgical wound.
4) Surgical Exposures
Using methods developed at LAC+USC Keck School of Medicine residents are able to practice surgical exposures in the Fresh Tissue Simulation Laboratory using cadavers that have been pressurized to allow realistic surgical exposures that require the same careful technique used in living patients.
5) Airway Management
Airway management is taught and practiced on animate and cadaver models. Endotracheal and tracheotomy airways are covered in detail followed by insertion techniques, from blind insertion to the surgical airway with bronchoscopic assist.
6) Central and Arterial Line Placement
Arterial and Venous catheterization are also skills mandated by the Accreditation Council for Graduate Medical Education (AC-GME). Learners receive didactic instruction followed by hands-on practice of inserting these lines. Ultrasound guidance of the internal jugular vein and landmark tactile insertion into the subclavian vein are practiced. The complications of line placement and complications following line placement are described. Residents at Keck School of medicine are able to practice line placements on pressurized cadavers. The videos below show a resident with an inadvertent subclavian artery puncture followed by the correct subclavian vein access.
7) Ventilator Management
Critical Care physicians and respiratory therapists teach residents concepts and application of mechanical ventilation. This hands-on session allows the resident to evaluate how changes in lung compliance effect measured and set ventilator parameters in various ventilator modes. This session also reviews acid-base status and the methods used to correct derangements in patient blood gasses.
8) Chest Tube and Thoracentisis
Chest tube placement and thoracentisis are another two skills required by the AC-GME. This module prepares the learners for the signs and symptoms associated with a need for chest tube placement followed by guided practice of insertion. Complications of insertions and chest tube drainage systems are also covered during this module. The lessons learned in this module are not only essential skills for residents to perfect before practicing on patients but are required for advanced team training modules.
9) Trauma Assessment and the FAST Exam
10) Knot Tying, Sutures, and Suturing Techniques
This fundamental and essential skill is covered with faculty and learners during early medical school and early residency.
Knowledge of suture types and suturing techniques follow knot tying and represent another immensely important skill the residents must acquire through deliberate, frequent practice.
11) Tissue Handling, Dissection, Wound Closure and Biopsy
Atraumatic tissue handling includes identification of structures during deliberate dissection with scalpel, scissors, and forceps. Surgical wound closure follows the dissection; the learner is expected to close skin using the techniques practiced in the preceding modules. Faculty is on-hand to ensure proper techniques are followed during the course of the module and to aid in identification of structures.
12) Principles and Techniques of Surgical Biopsy; Incision and Drainage
Proper surgical biopsy techniques are essential to provide the pathologist with adequate specimens. The learner receives didactic and hands on training in a variety of surgical biopsy techniqeues including; fine needle aspiration, percutaneous core, ultrasound guided core, and cutaneous punch biopsy.
13) Team Training
Teams of residents will be put into simulated operating and intensive care rooms and confronted with issues that arise in these environments. Following exposure and resolution of the issues faculty and their peers will debrief the team.
At the end of the intern year the resident will be expected to meet milestones to reflect their gained experience. The transition from intern to PGYII.
Next: Post Graduate
Years II - IV Curricula