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Post Graduate Years II through IV Curricula for Surgical Residents

"Friday School" for the USC General Surgery Residents PGY 2-4 began in the Fall of 2002. Over the last several years we have developed a curriculum that spans 60 weeks of topics, outlined below.

 

PGY II - Post Graduate Year 2

1) Basic Laparoscopy Skills/ Lap Opening and Closure

At this stage PGYII residents are expected to be proficient with camera and instrument guidance through self directed practice. At this laboratory session Faculty instructors will offer assistance to allow the resident to further hone their laparoscopic skills.

 

2) Laparoscopic Appendectomy

With surgical faculty and veterinarian support, the residents will be expected to complete the removal of the porcine appendix while practicing good laparoscopic technique.

 

3) Inguinal Hernia

In this session faculty reviews the pathology of the inguinal hernia and proper surgical exposure for control. Inguinal anatomy is taught with the fresh tissue cadaveric model. The learners must identify external landmarks and proceed with dissection and exposure of the inguinal canal. The etiology of groin hernias is defined and visualization of potential weak areas of the inguinal and femoral region is explored. Following this, the residents perform the open inguinal hernia repair.

 

4) Advanced Tissue Handling: Breast Surgery, Skin Flaps and Grafts

A follow-up to the initial tissue-handling lab, this module prepares the learner for advanced wound closures.  Small student to faculty ratio at these sessions allow immediate feedback as to tissue handling and instrument skills.

 

5) Sentinal Lymph Node Biopsy and Axillary Lymph Node Dissection

Faculty from Surgical Oncology guide the residents through this session aimed at surgical methods used in early detection of breast cancer in the FTSL.

 

6) Vascular Anastomosis

Vascular anastomosis is taught by Vascular Surgeons in the SSSEC using synthetic materials as well as human saphenous vein. The resident will learn to properly spatulate the graft material and sew it in place to close a linear arteriotomy. The resident will learn how to properly suture the end to side and end-to-end vascular anastomosis.

 

7) Hand Sewn & Stapled Gastrointestinal Anastomosis

Colorectal surgeons teach the residents the intricacies of both the hand sewn and stapled GI anastomosis. Following didactic instruction including indications and principles of GI stapling, the learners practice functional end-to-end anastomosis and side-to-side bypass anastomosis using a variety of endoscopic staplers and hand sewn techniques on synthetic bowel.         

 

8) Laparoscopic and Open Cholecystectomy

Laparoscopic and open cholecystectomies are performed in the porcine model under direction of attending laparoscopic surgeons and faculty veterinarians. Access to real tissue for these procedures further prepares the surgeon in training for human operations.

 

9) Tracheostomy and Exposure of Neck Anatomy

Trauma surgeons teach the residents the surgical airway and review the anatomy of the neck in the fresh tissue simulation laboratory.

 

10) Arterial line, Central line, & Chest tube

Trauma surgeons in the fresh tissue simulation laboratory using the pressurized cadaver model teach these important skills enabling the same anatomy and findings the residents would feel in the clinical setting.  

 

11) Percutaneous Tracheostomy and Bronchoscopy

Trauma surgeons utilize the fresh tissue simulation laboratory to teach residents these skills to further refine the residents’ procedural expertise.

 

12) Cricothyrotomy, Airway Management, & Percutaneous Endoscopic Gastrostomy (PEG)

Trauma surgeons use the SSSEC to cover the procedural skills needed for Cricothyrotomy, airway management and PEG insertions. Manikins have the value of replaceable tissues and enable testing of procedural awareness.

 

13) Objective Structured Clinical Assessment (OSCA)

All PGY 2-4 residents participate in an OSCA. The purpose of the OSCA is to assess each resident’s interpersonal and communication skills and provide them with timely constructive feedback.

 

14 & 15) Team Training Exercises

The latest implementation of the curricula from the ACS and APDS is the Phase III Curriculum. This addresses team based skills and crisis management. These modules are primarily taught within the Hybrid Laparoscopic Suite with prebriefing and debriefing occurring in the Technical Skills Laboratory. These modules are combined where appropriate to maximize resources.

During the sessions the residents are put into simulated clinical areas such as the operating room or the ICU bedside and must problem solve and engage other participants to work as a team to deal with the issues that arise. Following the exercise expert faculty and their peers debrief the participants.

 

16) Residents as teachers

PGY 2-4 residents participate in an annual Residents-As-Teachers workshop. The purpose of the workshop is to provide residents with information that will help them in their role as a teacher and a leader. Topics of the workshops have included:

  • Microskills of teaching
  • Constructive Feedback
  • Dealing with difficult learners
  • How to effectively manage a team

 

Ethics Retreat

The retreat begins in a large group setting and residents are given a general overview of common ethical dilemmas in surgery. Topics have ranged from professional obligations, end-of-life issues, competition of interest, consents, confidentiality, and professionalism in the work place.

 

PGY III - Post Graduate Year 3

 

1) Upper Endoscopy

The learners review the anatomic landmarks from the oropharnyx to duodenum used for reference during an upper endoscopy. Following the didactic portion, the learners receive guided practice while using the endoscopes on virtual and partial task trainers.

 

2) Colonoscopy

The faculty instructor describes the basic features and handling of the colonoscope. Following the didactic portion the learner’s practice handling and guiding the colonoscope on virtual and partial task trainers.

 

3) Endocrine Surgery

4) Advanced Laparoscopic Skills

The progression from basic laparoscopic skills to advanced introduces the learners to; extracorporeal, interrupted intracorporeal, and continuous intracorporeal knot-tying techniques. The resident gains proficiency at these new skills through this session and continued self directed-deliberate practice.

5) Open Right Colon Resection and Sigmoid Resection

6) Vascular Exposures

7) Laparoscopic and Open Common Bile Duct Exploration

8) Laparoscopic Ventral Incision Hernia Repair

9) Use of Bio-surgical Agents

10) OSCA

11 &12) Team Training

The latest implementation of the curricula from the ACS and APDS is the Phase III Curriculum. This addresses team based skills and crisis management. These modules are primarily taught within the Hybrid Laparoscopic Suite with prebriefing and debriefing occurring in the Technical Skills Laboratory. These modules are combined where appropriate to maximize resources.

During the sessions the residents are put into simulated clinical areas such as the operating room or the ICU bedside and must problem solve and engage other participants to work as a team to deal with the issues that arise. Following the exercise expert faculty and their peers debrief the participants.

13) Residents as Teachers

 

 

PGY IV - Post Graduate Year 4

 

1) Vascular Exposures

2) Laparoscopic and Open Common Bile Duct Exploration

3) Laparoscopic Ventral Incision Hernia Repair

4) Laparoscopic Nissen Fundoplication

5) Gastric Resection and Peptic Ulcer Disease

6) Myorectomy

7) Open Left Colon Resection

8) Laparoscopic and Open Splenectomy

9) Laparoscopic Colon Resection

10) Laparoscopic Inguinal Hernia Repair

 

 

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Surgical Skills Simulation
and Education Center

USC Keck School of Medicine
Department of Surgery
2250 Alcazar Street, B-9
Los Angeles, CA 90033

Office: (323) 442-0349
Fax: (323) 442-0350